Adherence, helpfulness and barriers to treatment in juvenile idiopathic arthritis - data from a German Inception cohort.

OBJECTIVES: To develop and evaluate German versions of the Parent Adherence Report Questionnaire (PARQ) and Child Adherence Report Questionnaire (CARQ) and to evaluate adherence in patients with juvenile idiopathic arthritis (JIA). METHODS: The PARQ and CARQ were translated into German, cross-culturally adapted and administered to patients (age ≥ 8 years) and their parents enrolled in the Inception Cohort Study of newly diagnosed JIA patients (ICON). The psychometric issues were explored by analyzing their test-retest reliability and construct validity. RESULTS: Four hundred eighty-one parents and their children with JIA (n = 465) completed the PARQ and CARQ at the 4-year follow-up. Mean age and disease duration of patients were 10.1 ± 3.7 and 4.7 ± 0.8 years, respectively. The rate of missing values for PARQ/CARQ was generally satisfactory, test-retesting showed sufficient reliability. PARQ/CARQ mean child ability total scores (0-100, 100 = best) for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. Construct validity was supported by PARQ and CARQ scores for medications, exercise and splints showing a fair to good correlation with the Global Adherence Assessment (GAA) and selected PedsQL scales. Adolescents showed poorer adherence than children. About one third of the parents and children reported medication errors. Perceived helpfulness was highest for medication, and adverse effects were reported the greatest barrier to treatment adherence. CONCLUSIONS: The German versions of the PARQ and CARQ appear to have a good reliability and sufficient construct validity. These questionnaires are valuable tools for measuring treatment adherence, identifying potential barriers and evaluating helpfulness of treatments in patients with JIA.

Long-term results of implants and implant-supported prostheses under systematic supportive implant therapy: A retrospective 25-year study.

BACKGROUND: Long-term data (>10 years) concerning the survival and success rates of implants and implant-supported prostheses are scarce. PURPOSE: The present investigation represents one of the first studies on dental implants covering an observational period of 25 years. MATERIALS AND METHODS: This study presents the results obtained in 26 patients with 75 implants who participated over a 23- to 28-year period in a supportive implant therapy (SIT) program at a private dental practice. We extracted existing data from the patients' files (pocket depths [PDs], bleeding on probing [BoP], radiographic peri-implant bone loss, and survival rates of the implant-supported prostheses). RESULTS: After 25 years, the SIT-compliant patients' implants had a survival rate of 95% (prostheses: 88%). The mean peri-implant probing depth was 3.69 mm (median: 3.33; SD: 1.06; range: 2-8.33). The mean peri-implant bone level was 1.84 mm (median: 1.82; SD: 1.20; range: -0.97-5.2). Finally, the prevalence (moment of last consultation) and incidence (during the entire observational period) of peri-implantitis were 7% and 30%, respectively. CONCLUSIONS: Under SIT conditions, clinicians may expect survival rates for implant-supported prostheses of >80%. Most implants (60%) did not develop signs of peri-implantitis over a 25-year period.

Effectiveness of an innovative and interactive smoking cessation training module for dental students: A prospective study.

BACKGROUND: Smoking is one of the world's major health problems and dental professionals are in a unique position to promote smoking cessation. However, according to the current literature, neither dental students nor dentists feel adequately prepared to counsel smokers. The purpose of this study was to develop and implement a teaching intervention on smoking cessation for fourth-year dental students and assess its effectiveness in terms of learning outcome on knowledge, communication skills and attitudes. MATERIALS AND METHODS: In this prospective intervention study, students in the intervention group (n = 28) participated in a teaching module consisting of a podcast, an interactive lecture, a seminar, and small-group sessions with role-play interactions. Knowledge, communication skills and attitudes were measured using written examinations and an objective structured clinical examination (OSCE) at the end of the module and 6 months later. Results were compared with data from a historical control group (n = 27) receiving standard teaching. RESULTS: Compared with the control group, students in the intervention group had higher scores in the knowledge test (67.1% vs 41.8%; P < .001; d = 2.8) as well as in the OSCE (74.9% vs 44.7%; P < .001; d = 2.3) and also retained more knowledge (52.7% vs 36.5%; P < .001; d = 2.0) and skills (71.8% vs 47.6%; P < .001; d = 2.5) over a period of 6 months. Attitudes were similar across groups and time-points. CONCLUSION: The teaching intervention equipped dental students with specific knowledge and skills required to effectively counsel smoking patients. Further research is required to assess the transfer of these skills to the clinical setting.

Decontamination efficacy of antiseptic agents on in vivo grown biofilms on rough titanium surfaces.

OBJECTIVE: Four common antimicrobial agents were evaluated for their efficacy in reduction of aerobic bacteria intraorally grown in biofilms on rough titanium samples. The solutions investigated contained chlorhexidine, essential oil, octenidine, or citric acid. METHOD AND MATERIALS: Twenty volunteers wore splints with titanium sleeves intraorally for 10 days. Following irrigation with the antiseptics, the sleeves were removed and biofilm samples were taken by swabbing. The bacteria were first examined microscopically by Gram staining. These samples from the surfaces were then cultured under aerobic conditions to identify and quantify the colonizing bacteria. RESULTS: Compared to untreated controls, significant (P < .05) differences in antimicrobial efficacy were observed for the different regimens depending on bacterial species or even the subtype. The reduction rates achieved varied from 30.0% after 2 minutes of rinsing with chlorhexidine to 99.8% after 8 minutes of rinsing with octenidine. CONCLUSION: The irrigation regimens studied in this investigation reduced bacterial colonization in a mature biofilm grown intraorally on rough titanium surfaces. The highest absolute reduction was achieved after 8 minutes, but only the 2-minute reduction rates are significant for clinical practice. Taking this into consideration, the distinct decontamination efficacy of octenidine and citric acid is evident.

Imaging of the midpalatal suture in a porcine model: flat-panel volume computed tomography compared with multislice computed tomography.

OBJECTIVE: An investigation was conducted to compare the image quality of prototype flat-panel volume computed tomography (fpVCT) and multislice computed tomography (MSCT) of suture structures. STUDY DESIGN: Bone samples were taken from the midpalatal suture of 5 young (16 weeks) and 5 old (200 weeks) Sus scrofa domestica and fixed in formalin solution. An fpVCT prototype and an MSCT were used to obtain images of the specimens. The facial reformations were assessed by 4 observers using a 1 (excellent) to 5 (poor) rating scale for the weighted criteria visualization of the suture structure. A linear mixed model was used for statistical analysis. Results with P < .05 were considered to be statistically significant. RESULTS: The visualization of the suture of young specimens was significantly better than that of older animals (P < .001). The visualization of the suture with fpVCT was significantly better than that with MSCT (P < .001). CONCLUSION: Compared with MSCT, fpVCT produces superior results in the visualization of the midpalatal suture in a Sus scrofa domestica model.

Dental therapy before and after radiotherapy--an evaluation on patients with head and neck malignancies.

The present investigation evaluates the dental care situation of patients with head and neck cancer before and after radiotherapy. The situations of these patients in 1993 and 2005 were compared to detect similarities, differences and developments. In the years 1993 and 2005, 37 and 36 patients, respectively, with head and neck cancer treated by the local departments of otorhinolaryngology and of radiotherapy were examined consecutively according to their aftercare appointments. Time points of radiotherapy treatment of the patients evaluated in 1993 varied from 1984 to 1993. The patients evaluated in 2005 had received radiotherapy between 1998 and 2005. Therefore the applied radiotherapeutic regimen differed not only between the two groups of patients, but also within each group. The information for these investigations was provided anonymously. It was evaluated with descriptive statistics. The evaluation of the data shows distinct differences with respect to preventive and therapeutic dental care measures. In 2005, 35 out of 36 patients (97.2%) had a dental consultation before radiotherapy (1993, 65%). All 27 dentate patients (100%) obtained a splint for fluoride application (1993, none). 29% fewer edentulous patients were seen than in 1993. The number of teeth destroyed decreased from 19.2% (1993) to 7.8% in 2005. Mycoses due to Candida spp. and chronic failures in wound healing were rare (5.5%). In the course of the 12 years, prophylactic measures, such as the application of splints for fluoride treatment, were intensified. However, concepts for the dental care of patients undergoing radiotherapy, especially following the radiation, should be widened to avoid ruined teeth and long delayed wound healings.

Decontamination efficacy of erbium:yttrium-aluminium-garnet and diode laser light on oral Candida albicans isolates of a 5-day in vitro biofilm model.

The different forms of superficial and systemic candidiasis are often associated with biofilm formation on surfaces of host tissues or medical devices. The biofilm formation of Candida spp., in general, necessitates significantly increased amounts of antifungal agents for therapy. Often the therapeutic effect is doubtful. A 5-day biofilm model with oral Candida isolates was established according to Chandra et al. (J Dent Res 80:903-908, 2001) on glass and titanium surfaces and was modified by Sennhenn-Kirchner et al. (Z Zahnärztl Implantol 3:45-51, 2007) to investigate different aspects unanswered in the field of dentistry. In this model, the efficacy of erbium:yttrium-aluminium-garnet (Er:YAG) light (2940 nm, 100 mJ, 10 Hz, 300 micros pulsed mode applied for 80 s) and diode laser light (810 nm, 1 W, continuous wave mode applied for 20 s with four repetitions after 30 s pauses each) was evaluated and compared to untreated controls. The photometric evaluation of the samples was completed by observations on morphological changes of yeast cells grown in the biofilm. Compared to the untreated controls Candida cells grown in mature in vitro biofilms were significantly reduced by both wavelengths investigated. Comparison between the different methods of laser treatment additionally revealed a significantly greater effect of the Er:YAG over the diode laser. Scanning electron microscopy findings proved that the diode laser light was effective in direct contact mode. In contrast, in the areas without direct contact, the fungal cells were left almost unchanged. The Er:YAG laser damaged the fungal cells to a great extent wherever it was applied.

Preoperative sterilization and disinfection of drill guide templates.

The aim of the in vitro study was to evaluate the decontamination potential of common antiseptic solutions for heat-sensitive implantological drill guide templates. One hundred implantologists were evaluated on the basis of a questionnaire for their measures of disinfection. On the basis of these results, 80% alcohol, Octenidine 0.1%, and Chlorhexidine 0.12% were tested in an in vitro model for their decontamination efficacy for heat-sensitive plastic material infected with Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Enterobacter cloacae, Escherichia coli, and Candida albicans. The microorganisms were selected on the basis of results of environmental testing of dental laboratories. The results of the questionnaire revealed that Chlorhexidine was used by 30%, 80% alcohol by 23%, and Octenidine by 7% of the dentists. Using the in vitro model, with the exception of S. aureus, Chlorhexidine was not able to completely eliminate the microorganisms after 15 min of application. In contrast, the treatment with Octenidine revealed no further growth of the tested microorganisms after that time. The 80% alcohol was more efficient. No growth of microorganisms could be detected in any of the tests after 5 min of incubation. On the basis of our results and due to the fact that suitable installations for sterilization were hardly used by the dental practitioners, the disinfection of templates should be preferentially performed with 80% alcohol or Octenidine using an incubation time of 15 min with ultrasonication.

Decontamination of rough titanium surfaces with diode lasers: microbiological findings on in vivo grown biofilms.

OBJECTIVES: The bactericidal efficacy of diode lasers has already been demonstrated in vitro. We investigated the reduction of aerobe bacteria - colonizing rough titanium samples in biofilms intraorally grown - by diode lasers of different wave lengths. MATERIAL AND METHODS: Twenty-two volunteers participated in the trial. They were fitted for 10 days with custom-made intraoral plastic splints carrying titanium sleeves. A part of the sleeves was then irradiated with diode lasers in different modes. The other part remained non-irradiated and served as control. Directly after irradiation, the sleeves were swabbed and the gained bacteria were first examined microscopically and then were cultured under aerobic conditions. RESULTS: The bacteria in the controls and in the treated samples were quantified. A comparison with the controls revealed a marked overall reduction of bacterial colonization in all irradiated sleeves. Continuous irradiation for 20 s reduced bacteria counts by 99.67% at 810 nm and 99.58% at 980 nm. Repeating the 20 s exposure five times reduced counts by 99.98% at 810 nm and by 99.39% at 980 nm. A 98.86% reduction was seen after irradiation in pulsed mode. A further analysis in respect of different isolated bacteria revealed that the streptococci group was reduced by 99.29-99.99%, while the staphylococci group was reduced to a lesser extent in the range 94.67-99.99%. CONCLUSION: The results are of clinical relevance. In comparison with the mean bacterial counts of the untreated samples, all irradiation programs studied in this investigation reduced mean bacterial colonization in a biofilm on intraoral rough titanium surfaces by more than 98%. The actual extent of reduction was dependent on the bacteria species as well as on the irradiation mode.

Traumatic injuries to the primary dentition and effects on the permanent successors - a clinical follow-up study.

This study investigated problems in the permanent dentition that, according to history and records, were attributable to dental alveolar injuries of the primary dentition. 106 children have been involved in the study, who had experienced primary anterior tooth trauma affecting a total of 200 teeth. Thirty-nine patients (81 teeth) were available for follow-up examinations. In 25% of the cases followed up, damage was found on the successors in the secondary dentition (16 children/20 teeth). In half of the cases, a comparatively mild form of lesion like enamel discoloration was observed. This was the result of an injury during the tooth maturation process causing enamel hypoplasia. Clinically more relevant were the dental deformities: cessation of root formation or retention caused by ankylosis, which made up the remaining 50% of cases. This was confirmed by clinical long-term observation. The different effects on the permanent teeth can only be detected by radiography after an interval of several months or may even be clinically assessed only after the eruption of the clinical crown.