Prosthetic complications in fixed endosseous implant-borne reconstructions after an observations period of at least 40 months.

One hundred and seventy-two fixed reconstructions (317 prosthetic units), made on 283 ITI implants in 105 patients (age range 25-86 years) with a minimum follow-up period of 40 months, were taken into the study to analyse technical complication rate, complication type and costs for repair. The mean evaluation time was 62.5 +/- 25.3 months. Eighty were single crowns and 92 different types of fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases cemented with zinc phosphate cement or an acrylic-based cement. Complications occurred after a minimum period of 2 months and a maximum period of 100 months (mean: 35.9 +/- 21.4 months). Fifty-five prosthetic interventions were needed on 44 constructions (25%) of which 88% in the molar/premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest in 3-4 unit FPDs (35%) and in FPDs with an extension (44%). Of the necessary clinical repair, 36% was recementing and 38% tightening the screws. Of all interventions, 14% were classified as minor (no treatment or <10 min chair time), 70% as moderate (>10 min but <60 min chair time) and 14% as major interventions (>60 min and additional costs for replacement of parts and/or laboratory). For seven patients the additional costs ranged from euro 28 to euro 840. Bruxing seemed to play a significant role in the frequency of complications. Longer constructions seemed to be more prone to complications. The relatively high occurrence of technical complications should be discussed with the patient before the start of the treatment.

Comparison of clinical profiles and treatment outcomes of an elderly and a younger temporomandibular patient group.

STATEMENT OF PROBLEM: Older temporomandibular disorder patients with more general complications and health problems may have a different clinical profile and be likely to react less favorably to conservative treatment. PURPOSE: This retrospective study compared the clinical profiles of a young (20 to 30 years) and an older (50 to 70 years) group of patients with pain and dysfunction in the temporomandibular region and to analyze treatment outcomes. METHODS: Clinical profiles and treatment outcomes were studied with a standardized protocol and the Helkimo Pain and Dysfunction Index up to 1 year after initial examination. RESULTS: Younger and older patients with temporomandibular disorder differed only in pain intensity at initial examination, but the outcome of conservation treatment was equally successful. CONCLUSION: Conservative treatment resulted in a significant alleviation of pain and dysfunction in almost 85% of patients. Both the younger and the older patient groups benefitted from this treatment protocol and therefore can be treated in the same fashion.

Evaluation of syndromic patient management algorithm for urethral discharge.

OBJECTIVE: To determine feasibility, validity, and cost effectiveness of the syndromic approach to male patients with urethral discharge in Bandung, Indonesia. METHODS: The WHO algorithm on urethral discharge with no microscopy available was evaluated. Patients presented with a complaint of urethral discharge and if discharge was confirmed the algorithm was applied. Treatment covered gonococcal and chlamydial infection (ciprofloxacin 500 mg single oral dose plus doxycycline 100 mg, twice daily orally for 7 days). The gold standard for validation was gonococcal culture and chlamydia antigen detection. RESULTS: 140 male patients with a complaint of urethral discharge were enrolled; 119 had confirmed discharge and entered the decision tree: 107 were followed and 104 (97%) were clinically cured. Of the three patients with persistent discharge, one had a purulent urethral discharge, diagnosed as gonococcal urethritis and he was probably reinfected; two patients had a serous discharge and microbiological tests were negative. Overall, 106 out of 107 patients (99%) were microbiologically cured. Sensitivity of the algorithm is 100% and its positive predictive value (PPV) is 75% or 97% if validated against gold standard microbiological tests or Gram stain, respectively. Cost per patient is rupiah (Rp)5.894 ($US2.56) for the algorithm compared with Rp43.024 ($18.70) for full microbiological diagnosis. The cost estimate for an algorithm of urethral discharge with microscopy available is Rp6.432 ($2.80) CONCLUSION: The "symptom and sign" algorithm is fully adapted to the prevailing situation in primary healthcare settings, is acceptable to healthcare workers and patients (who are effectively treated at their first visit), is highly cost effective, is 100% sensitive (no false negatives, which is not the case with microbiological diagnosis), and has a high PPV, between 75% and 97%. It is an excellent patient management tool and a sound basis for partner notification so that it should have a major impact on STD/HIV control and prevention in both men and women.

Genital herpes infection: a review.

Genital herpes infection is life-long and may result in painful and recurrent genital lesions, systemic complications, serious psychosocial morbidity, and rare but serious outcomes in neonates born to infected women, including permanent neurological handicap and death. Herpes simplex virus (HSV)-2 is the principal cause, with an increasing proportion of first-episode disease caused by HSV-1. Genital HSV transmission is usually due to asymptomatic viral shedding by people who are unaware that they are infected and clinical screening fails to detect most infections. Type-specific serological assays can distinguish the two viral subtypes, but these are expensive and currently restricted to a few research settings. Most infections are asymptomatic, or cause a mild illness which does not lead to health service attendance; but the limited evidence suggests a rise in disease incidence, perhaps related to a fall in HSV-1 age-specific prevalences. The prevalences of HSV genital infections increase with age and numbers of sexual partners, with higher rates in specific ethnic and low socioeconomic groups. However, infection is not restricted to high-risk populations. Antiviral agents, such as acyclovir, can reduce disease severity, prevent recurrences and shorten periods of viral shedding, but currently there are no effective population control measures. This may change with the advent of HSV vaccines, if their safety and long-term efficacy are confirmed. Possible applications for vaccines may include the suppression of disease and recurrences in patients with genital infections (immunotherapy), the prevention of viral transmission to their seronegative partners, and immunoprevention through vaccinating the latter. Economic evaluations of existing and potential control strategies, age-specific population HSV-1 and 2 seroprevalence studies for targeting future interventions, and cohort studies to elucidate the natural history of HSV-2 infections are needed.

Trauma in patients with temporomandibular disorders: frequency and treatment outcome.

Controversy exists on the aetiological importance and the effect of jaw macrotrauma (fractures excluded) on the occurrence of temporomandibular joint disorders (TMD). The purpose of this study was to assess the incidence of jaw injury in TMD patients and to compare the severity of the symptoms, the clinical characteristics and the treatment outcome in TMD patients with or without a history of trauma to the head and neck region directly linked to the onset of symptoms. The study sample included 400 consecutive TMD clinical patients. In 24.5% of patients the onset of the pain and dysfunction could be linked directly to the trauma, mainly whiplash accidents. No significant differences could be found between the two groups in daily recurrent headache, dizziness, neck pain, joint crepitation and pain in the joints. Maximal mouth opening was less than 20 mm in 14.3% of patients with a history of trauma and in 4.1% of those without such a history. According to the Helkimo dysfunction index (DI), more trauma than non-trauma TMD patients belonged to the severe dysfunction groups (DI 4 and 5) at first examination. The outcome of a conservative treatment procedure (counselling, occlusal splint, physiotherapy, occasionally occlusal therapy and non-steroidal anti-inflammation drugs was not different between the two groups at the 1 year evaluation. The degree of maximal opening was similar: less than 20 mm in 3.7% and 2.2% in trauma and non-trauma patients respectively. Forty percent and 41% respectively were symptom free or had DI = 1. The results suggest that external trauma to the joint or to the jaw in general is an important initiating factor in the aetiology of TMD but also that the prognosis is favourable.

Otalgia in patients with temporomandibular joint disorders.

Otalgia without organic causes is a common symptom in temporomandibular dysfunction (TMD) patients even though the etiology is controversial. Investigations of the influence of TMD treatment on otalgia are scarce. This follow-up study analyzed the clinical profile of TMD patients with otalgia and evaluated the treatment outcome. A total of 400 consecutive TMD patients (75% women) were divided in two groups: group 1 consisted of 233 patients (58%) with no complaint of ear symptoms and group 2 consisted of 167 patients (42%) with complaint of otalgia. The patients were examined with a standardized protocol and treated similarly with conservative methods. Group 2 was referred and examined by otolaryngologists. Otalgia patients (group 2) had statistically significantly higher pain scores (p 0.02). They belonged to the greater dysfunction scores (Di III) according to the Helkimo Pain and Dysfunction index (41%) vs. 24%; p < 0.001). There was a statistically significant association with pain on condyle palpation and otalgia (p < 0.01). One year after the first examination, the patients exhibited no pain or occasionally mild pain in 66% (group 1) and 74% (group 2) (p 0.35). Of the otalgia patients, 48% no longer had otalgia and 32% of the patients experienced mild or occasional otalgia. The changes in dysfunction scores after 1 year revealed significant improvement. No difference was found between group 1 and 2 in pain and dysfunction score. For the dysfunction index readings 0 and I, 77% and 73% had no or only mild symptoms (Di 0 and I). The conclusions of this study are that TMD patients with otalgia are not a separate TMD group and they responded well to conservative treatment.