The metabolic syndrome and diabetes mellitus as predictors of thoracic aortic calcification as detected by non-contrast computed tomography in the Multi-Ethnic Study of Atherosclerosis.

AIMS: The metabolic syndrome (MetS) is a clustering of low levels of HDL cholesterol, hyperglycaemia, high waist circumference, hypertension and elevated triglycerides, and is associated with cardiovascular disease. Calcified atherosclerotic plaque in the thoracic aorta (TAC), measured by non-contrast cardiac computed tomography (CT) scans, is a marker for atherosclerosis and relates to mortality. We sought to evaluate the independent association of MetS and TAC on cardiac CT scans. METHODS: We examined the relation of the MetS, and each of its components, to the prevalence of TAC, measured from 2000 to 2002 in 6778 white, Chinese, African-American and Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA). RESULTS: Adjusting for age, gender, race, smoking, LDL cholesterol and lipid-lowering medications, relative risks and 95% confidence intervals (CI) for a TAC score > 0 were: 1.19 (95% CI 1.11 to 1.28) for participants with MetS, 1.34 (95% CI 1.21 to 1.49) for those with diabetes and MetS, and 1.33 (95% CI 1.11, 1.58) for those with diabetes and no MetS compared with participants who were free of the MetS and diabetes. Associations were found for most of the components of the MetS with TAC. CONCLUSIONS: We conclude that in adults without known heart disease, the MetS, most of its components and diabetes are associated with a higher prevalence of calcified atherosclerotic plaque in the thoracic arteries in a multi-ethnic population of men and women.

Chronic insulin therapy reduces adipose tissue macrophage content in LDL-receptor-deficient mice.

AIMS/HYPOTHESIS: Insulin has anti-inflammatory effects in short-term experiments. However, the effects of chronic insulin administration on inflammation are unknown. We hypothesised that chronic insulin administration would beneficially alter adipose tissue inflammation and several circulating inflammatory markers. METHODS: We administered two forms of long-acting insulin, insulin glargine (A21Gly,B31Arg,B32Arg human insulin) and insulin detemir (B29Lys[ε-tetradecanoyl],desB30 human insulin), to LDL-receptor-deficient mice. After 8 weeks on a diet that causes obesity, hyperglycaemia, adipose tissue macrophage accumulation and atherosclerosis, the mice received subcutaneous glargine, detemir or NaCl (control) for 12 weeks. Serum amyloid A (SAA) and serum amyloid P (SAP), metabolic variables, adipose tissue macrophages and aortic atherosclerosis were evaluated. RESULTS: Weight gain was equivalent in all groups. The glycated haemoglobin level fell equivalently in both insulin-treated groups. Plasma cholesterol and triacylglycerol levels, and hepatic triacylglycerol level significantly improved in the glargine compared with the detemir or control groups. Levels of mRNA expression for monocyte chemotactic protein-1 and F4/80, a macrophage marker, in adipose tissue were decreased only in the glargine group (p < 0.05). Visceral adipose tissue macrophage content decreased in both insulin groups (p < 0.05), whereas atherosclerosis decreased only in the glargine group. Circulating SAA and SAP did not decrease in either insulin-treated group, but IL-6 levels fell in the glargine-treated mice. CONCLUSIONS/INTERPRETATION: While chronic insulin administration did not decrease SAA and SAP, administration of glargine but not detemir insulin improved dyslipidaemia, IL-6 levels and atherosclerosis, and both insulins reduced macrophage accumulation in visceral adipose tissue. Thus, chronic insulin therapy has beneficial tissue effects independent of circulating inflammatory markers in this murine model of diet-induced obesity and diabetes.

Oral health-related quality of life and the IOTN index as predictors of children's perceived needs and acceptance for orthodontic treatment.

OBJECTIVE: To evaluate whether the index of orthodontic treatment need (IOTN) could be improved by adding an oral health-related quality of life measure to predict both the outcome of orthodontic consultation and the child's perceived need for orthodontic treatment. METHODS: The sample consisted of 187 children aged 11-16 years referred to orthodontic clinics in the Bedfordshire Personal Dental Service (PDS) in the United Kingdom. The children completed a questionnaire containing the Child Perception Questionnaire (CPQ11-14), were clinically examined and completed the Child-OIDP index in face-to-face interviews. Demographic information and perceived need for orthodontic treatment were also collected. Clinical data on orthodontic treatment need was collected using the IOTN. RESULTS: 49.3% of children reported one or more oral impacts. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study did not predict outcome of consultation, however it explained children's perceived need for braces. There were some discrepancies between need according to the orthodontist and children's perceptions. CONCLUSIONS: Adding an oral health-related quality of life measure to IOTN did not influence prediction of outcome of consultation but it explained the prediction of perceived need for braces. Importantly, children with an impact were denied orthodontic treatment.

Prediction of compliance and completion of orthodontic treatment: are quality of life measures important?

The main aim of the present investigation was to evaluate whether there is an association between completion of orthodontic treatment and quality of life measures, i.e. age, gender, socio-economic status, type of appliance and need for orthodontic treatment. The secondary aim was to evaluate whether compliance with orthodontic treatment (missed appointments and appliance breakages) was associated with age, gender, socio-economic status, or type of appliance. This was a multi-centre longitudinal observational study carried out on 144 patients (65 males and 79 females) aged 10-19 years. Baseline data were collected: patient age, gender, socio-economic status, Index of Orthodontic Treatment Need (IOTN), and type of appliance. Quality of life information, including orthodontic utility values and oral aesthetic subjective impact score (OASIS), were also collected at the start of treatment. The main outcome measure was whether a patient completed treatment. Compliance was assessed by recording the number of failed appointments and appliance breakages. Multiple regression analysis was used to investigate the association between independent and dependent variables. None of the baseline variables, including quality of life measures, were associated with a patient completing treatment, or their compliance with treatment (P > 0.05). Thus, quality of life measures (utility values or OASIS) do not add to our knowledge of who may complete, or co-operate with, orthodontic treatment. In addition, neither age, gender, socio-economic status nor clinical treatment need (IOTN) were useful in helping a clinician to choose potentially co-operative patients.

Orthodontic treatment for prominent upper front teeth in children.

BACKGROUND: Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. When treatment is provided during adolescence the orthodontist may provide treatment with various orthodontic braces, but there is currently little evidence of the relative effectiveness of the different braces that can be used. OBJECTIVES: To assess the effectiveness of orthodontic treatment for prominent upper front teeth, when this treatment is provided when the child is 7 to 9 years old or when they are in early adolescence or with different dental braces or both. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. The handsearching of the key international orthodontic journals was updated to December 2006. There were no restrictions in respect to language or status of publication. Date of most recent searches: February 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design - randomised and controlled clinical trials; participants - children or adolescents (age < 16 years) or both receiving orthodontic treatment to correct prominent upper front teeth; interventions - active: any orthodontic brace or head-brace, control: no or delayed treatment or another active intervention; primary outcomes - prominence of the upper front teeth, relationship between upper and lower jaws; secondary outcomes: self esteem, any injury to the upper front teeth, jaw joint problems, patient satisfaction, number of attendances required to complete treatment. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures and results were extracted independently and in duplicate by two review authors. The Cochrane Oral Health Group's statistical guidelines were followed and mean differences were calculated using random-effects models. Potential sources of heterogeneity were examined. MAIN RESULTS: The search strategy identified 185 titles and abstracts. From this we obtained 105 full reports for the review. Eight trials, based on data from 592 patients who presented with Class II Division 1 malocclusion, were included in the review.Early treatment comparisons: Three trials, involving 432 participants, compared early treatment with a functional appliance with no treatment. There was a significant difference in final overjet of the treatment group compared with the control group of -4.04 mm (95% CI -7.47 to -0.6, chi squared 117.02, 2 df, P < 0.00001, I(2) = 98.3%). There was a significant difference in ANB (-1.35 mm; 95% CI -2.57 to -0.14, chi squared 9.17, 2 df, P = 0.01, I(2) = 78.2%) and change in ANB (-0.55; 95% CI -0.92 to -0.18, chi squared 5.71, 1 df, P = 0.06, I(2) = 65.0%) between the treatment and control groups. The comparison of the effect of treatment with headgear versus untreated control revealed that there was a small but significant effect of headgear treatment on overjet of -1.07 (95% CI -1.63 to -0.51, chi squared 0.05, 1 df, P = 0.82, I(2) = 0%). Similarly, headgear resulted in a significant reduction in final ANB of -0.72 (95% CI -1.18 to -0.27, chi squared 0.34, 1 df, P = 0.56, I(2) = 0%). No significant differences, with respect to final overjet, ANB, or ANB change, were found between the effects of early treatment with headgear and the functional appliances. Adolescent treatment (Phase II): At the end of all treatment we found that there were no significant differences in overjet, final ANB or PAR score between the children who had a course of early treatment, with headgear or a functional appliance, and those who had not received early treatment. Similarly, there were no significant differences in overjet, final ANB or PAR score between children who had received a course of early treatment with headgear or a functional appliance. One trial found a significant reduction in overjet (-5.22 mm; 95% CI -6.51 to -3.93) and ANB (-2.27 degrees; 95% CI -3.22 to -1.31, chi squared 1.9, 1 df, P = 0.17, I(2) = 47.3%) for adolescents receiving one-phase treatment with a functional appliance versus an untreated control.A statistically significant reduction of ANB (-0.68 degrees; 95% CI -1.32 to -0.04, chi squared 0.56, 1 df, P = 0.46, I(2) = 0%) with the Twin Block appliance when compared to other functional appliances. However, there was no significant effect of the type of appliance on the final overjet. AUTHORS' CONCLUSIONS: The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence.

Orthodontic treatment for deep bite and retroclined upper front teeth in children.

BACKGROUND: Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth. OBJECTIVES: To establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. The handsearching of the main international orthodontic journals was updated to April 2006. There were no restrictions with regard to publication status or language of publication. International researchers, likely to be involved in Class II division 2 clinical trials, were contacted to identify any unpublished or ongoing trials. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No RCTs or CCTs were identified that assessed the treatment of Class II division 2 malocclusion in children. AUTHORS' CONCLUSIONS: It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

Academic dentistry--where is everybody?

If someone had told us, when we were undergraduates, that there was a career which allowed you the time, and gave you the support, to pursue and research the things about your profession which most interested you, we would have been intrigued. If we had then been informed that there was paid employment which encouraged you to travel extensively abroad, talking about your work, and also gave you the brightest young minds in the country to engage with, teach and learn from, we would have thought this job sounded very tempting. If we had then been told that it also provided secretaries and administrators to help you do your job, and was carried out in a non-hierarchical, collegiate environment where equality and diversity are valued--we would have jumped at the chance! And did! Because what is described above is the life of a clinical academic. Although all the above are part of the role of the academic, there is also immense value and joy to be obtained through scholarship, education and teaching, which are sometimes forgotten because so much of our time and energy is directed to dealing with our patients' problems, while wrestling with the intricacies of new contracts, clinical governance, evidence based practice, and so forth.

Teledentistry for screening new patient orthodontic referrals. Part 1: A randomised controlled trial.

OBJECTIVE: The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals. The secondary aims were to evaluate whether the teledentistry system affected i) referral rates ii) inappropriate referral rates iii) number of failed appointments. STUDY DESIGN: Randomised controlled trial. SAMPLE: Fifteen dental practices in Greater Manchester, UK, were randomly allocated to either a teledentistry test group (n = 8) or a control group (n = 7). They referred 327 patients over a 15 month period. METHOD: Practitioners in the test group referred patients to one of two consultant orthodontists via a 'store and forward' teledentistry system consisting of photographs sent as email attachments. The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic. This measured the validity of the system with the clinic's decision used as the gold standard. Patients in the control group were referred using the usual letter system. Referral rates, inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups. RESULTS: The sensitivity (true positive value) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92. The specificity (true negative value) was slightly lower at 0.73 with a negative predictive value of 0.50. The inappropriate referral rate for the teledentistry group was 8.2% and for the controls 26.2% (p = 0.037). There was no statistically significant difference in clinic attendance between teledentistry and control groups (p = 0.36). CONCLUSIONS: Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals. However, there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination. Teledentistry could be a significant factor in reducing the inappropriate referral rate. Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment.

The use of postal reminders to reduce non-attendance at an orthodontic clinic: a randomised controlled trial.

OBJECTIVES: To evaluate the effect of issuing a patient reminder plus a confirmation slip on the attendance of orthodontic new patients. SETTING: Department of Orthodontics, University Dental Hospital of Manchester. DESIGN: A randomised controlled trial. METHODS: New patients were randomly allocated to:receive a reminder letter and return a confirmation slip ornot receive a reminder. OUTCOME MEASURES: Patient attendance at the clinic. RESULTS: A total of 232 patients were entered into the study between June 18, 2001 and August 29, 2001. These were randomly allocated to 115 (49.8%) in the reminder group and 116 (50.2%) in the no reminder group. If the patient received a reminder and returned the confirmation they were less likely to fail the appointment than if they did not receive a reminder (OR 0.4, 95% CI 0.2 to 0.96) There was an effect of social deprivation, if the patients lived in an area of high social deprivation they were 2.7 (95% CI 1.1 to 6.5) times more likely to fail to attend an appointment than people who were more affluent. CONCLUSIONS: The use of postal reminders for orthodontic consultation appointments appears to result in a useful increase of appointments that are kept or cancelled in advance.

The effect of apolipoprotein E deficiency on islet amyloid deposition in human islet amyloid polypeptide transgenic mice.

AIMS/HYPOTHESIS: Islet amyloid deposits are present in over 85% of Type 2 diabetic patients and have been suggested to be pathogenic. The mechanism that converts islet amyloid polypeptide (IAPP), the unique component of these deposits, into amyloid fibrils in vivo is not known. The amino acid sequence of IAPP is critical but insufficient for beta-pleated sheet formation. As apolipoprotein E (apoE), another component of islet amyloid deposits, plays a critical role in amyloid formation in Alzheimer's disease, we hypothesised that apoE could play an important role in islet amyloid formation. METHODS: Transgenic mice expressing the human form of IAPP ( hIAPP (+/0)) were crossbred with apoE deficient ( apoE (-/-)) mice and followed for 12 months, at which time the prevalence and severity of islet amyloid, as well as plasma glucose, hIAPP, immunoreactive insulin (IRI) and lipid concentrations were measured. RESULTS: The prevalence and severity of islet amyloid after one year of follow up were comparable among hIAPP (+/0) mice that were apoE (+/+), apoE (+/-) or apoE (-/-). Differences in glucose tolerance, lipid abnormalities or changes in pancreatic content or plasma concentrations of hIAPP and/or IRI did not account for these findings. CONCLUSION/INTERPRETATION: Our data shows that, unlike in the localized amyloidosis in the brain characteristic of Alzheimer's disease, apoE is not critical for islet amyloid formation in a transgenic mouse model of Type 2 diabetes mellitus. These results indicate that the mechanisms of localised amyloid formation probably vary among different amyloid-associated disorders. Therefore, therapeutic strategies targeting apoE might not apply equally to patients with different amyloid associated diseases.

Upper removable appliance or Jones Jig for distalizing first molars? A randomized clinical trial.

AIM: To compare the effectiveness of two intra-oral methods of distalizing upper first permanent molars: an upper removable appliance (URA) and a Jones Jig. SAMPLE: Twelve patients were randomly allocated to URA treatment and 11 patients to a Jones Jig. METHODS: Upper study models were collected at the start of treatment and after 6 months of appliance wear. The amount of distal movement, tipping and rotation of the upper first permanent molars and mesial movement of the upper first permanent premolars was measured using a reflex metrograph. RESULTS: There were no statistically significant differences between the two treatment methods for any of the outcome measures (P < 0.05). Distal movement obtained by both appliances was approximately 1 mm. CONCLUSIONS: The amount of distal movement obtained with both appliances was small and no differences were shown in the amount of molar tooth movement. It is suggested that there is no advantage in using the Jones Jig as a non-compliance appliance.

A randomized clinical trial to compare the effectiveness of canine lacebacks with reference to canine tip.

AIM: To assess the effectiveness of canine lacebacks on the proclination of the upper incisors with reference to pre-treatment canine tip. STUDY DESIGN: Randomized clinical trial. SAMPLE: Patients receiving upper and lower fixed appliances attending the orthodontic departments of five orthodontic treatment providers. Sixteen patients received canine lacebacks as part of their treatment and 19 patients did not have canine lacebacks. METHOD: Patients were randomly allocated to receive canine lacebacks or not receive canine lacebacks. Upper study models were collected at the initial archwire placement and then when the working 0.019 x 0.025-inch stainless steel archwire was placed. The start canine angulation, change in upper incisor proclination/overjet, and any mesial movement of the upper first permanent molars during levelling and aligning was measured with a reflex metrograph. STATISTICS: The effect of the use of canine lacebacks on upper incisor proclination and mesial molar movement was assessed using Student t-tests. Regression analysis was used to evaluate any effect of the initial angulation of the canine. RESULTS: A mean incisor retroclination of 0.5 mm was observed in the canine lacebacks compared with a mean proclination of 0.36 mm when canine lacebacks were not used (P = 0.025). There was no statistically significant difference between groups for mesial movement of upper first molars (P = 0.99). If the canine was more distally inclined at the start of treatment, the incisors was more likely to procline, regardless of whether or not canine lacebacks were used (P = 0.027). CONCLUSIONS: The effect of canine lacebacks on preventing upper incisor proclination at the start of treatment is in the order of 1 mm and their effect on mesial molar movement is insignificant. Canines lacebacks have similar effects that are independent of pre-treatment canine angulation.

A randomized clinical trial to compare three methods of orthodontic space closure.

AIM: To compare the rates of orthodontic space closure for: Active ligatures, polyurethane powerchain (Rocky Mountain Orthodontics, RMO Europe, Parc d'Innovation, Rue Geiler de Kaysersberg, 67400 Illkirch-Graffenstaden, Strasbourg, France) and nickel titanium springs. SAMPLE: Patients entering the space closure phase of fixed orthodontic treatment attending six orthodontic providers. Twelve patients received active ligatures (48 quadrants), 10 patients received powerchain (40 quadrants) and 11 patients, nickel-titanium springs (44 quadrants). METHOD: Patients were randomly allocated for treatment with active ligatures, powerchain or nickel titanium springs. Upper and lower study models were collected at the start of space closure (T(o)) and 4 months later (T(1)). We recorded whether the patient wore Class II or Class III elastics. Space present in all four quadrants was measured, by a calibrated examiner, using Vernier callipers at T(o) and T(1.) The rate of space closure, in millimetres per month (4 weeks) and a 4-monthly rate, was then calculated. Examiner reliability was assessed at least 2 weeks later. RESULTS: Mean rates of space closure were 0.35 mm/month for active ligatures, 0.58 mm/month for powerchain, and 0.81 mm/month for NiTi springs. No statistically significant differences were found between any methods with the exception of NiTi springs showing more rapid space closure than active ligatures (P < 0.05). There was no effect of inter-arch elastics on rate of space closure. CONCLUSIONS: NiTi springs gave the most rapid rate of space closure and may be considered the treatment of choice. However, powerchain provides a cheaper treatment option that is as effective. The use of inter-arch elastics does not appear to influence rate of space closure.

So you want to be a specialist registrar?--What to put in your CV.

Dentists applying to a specialist training programme often receive conflicting advice over what to put in their curriculum vitae (CV). We conducted a survey of the Training Programme Directors of the dental specialties to determine what aspects of CV content and presentation styles are considered important. This has allowed us to construct guidelines for what to put in a CV. Recently, structured application forms have become increasingly popular and may be a more objective way to carry out the shortlisting process. The guidelines presented could also be used as a framework for medical personnel departments if structured application forms eventually replace the CV.

Orthodontic teaching practice and undergraduate knowledge in British dental schools.

AIM: The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations. MATERIALS AND METHODS: Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school. RESULTS: In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39-72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC. CONCLUSION: Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.

The relationship between normative orthodontic treatment need and measures of consumer perception.

AIM: The first aim was to investigate whether there was an association between normative (clinician measured) orthodontic treatment need and the following consumer values, 1) child self-perceived aesthetic need, 2) child self-esteem, 3) oral aesthetic subjective impact score (OASIS). The secondary aim was to investigate whether there was an association between child self-esteem and 1) child self-perceived aesthetic need 2) OASIS. STUDY TYPE: Prospective, cross-sectional. SAMPLE: A random sample of 439, 11-12 year-old children was selected from schools in Greater Manchester. METHOD: Normative and child self-perceived orthodontic treatment need were measured using the Index of Orthodontic Treatment Need (IOTN). The subjects completed questionnaires to measure their self-esteem (Piers Harris) and OASIS score. RESULTS: Children with higher normative IOTN scores had more negative psycho-social impact from their malocclusion (P<0.001). However, there was no association between clinician IOTN grades and child self-esteem. Clinician and child-rated IOTN aesthetic component (IOTN AC) grades were statistically significantly different (P<0.05). Higher child self-esteem scores were associated with lower child rated IOTN AC grades (P<0.05) and lower OASIS scores (P<0.001). CONCLUSIONS: Only one of the consumer measures studies (OASIS) reflected normative/clinician IOTN grades. A high child self-esteem appears to be related to their self-perceived malocclusion and its psycho-social impact. It is still important to have additional information derived from consumer based measures rather than rely solely on normative measures of need. It remains to be seen whether these factors subsequently influence demand and uptake of orthodontic treatment.

Orthodontics and occlusion.

The discipline of orthodontics is directed towards alteration of the occlusion of the teeth and the relationships of the jaws. It is therefore somewhat surprising to find that there is little scientific evidence to support any of the concepts that suggest occlusal goals for orthodontic treatment. Most of the current concepts of orthodontic treatment are based upon personal opinion and retrospective studies. Nevertheless, an attempt is made here to provide a guide to the relationship of orthodontics and the occlusion that is evidence based. Where the evidence is weak, these areas have been highlighted.

Cellular FLIP is expressed in cardiomyocytes and down-regulated in TUNEL-positive grafted cardiac tissues.

OBJECTIVE: c-FLIP is a natural homologue of caspase 8, and may antagonize activation of death pathways mediated by FADD. c-FLIP is highly expressed in the heart, and a recent report suggests that c-FLIP may protect against certain types of myocyte death. The present study was designed to define the expression patterns of c-FLIP in the heart. METHODS: The expression pattern of c-FLIP in end-stage human hearts, and rat cardiomyocyte grafting models was analyzed by in situ hybridization, immunohistochemistry and TUNEL assay. In addition, to determine whether Fas-dependent pathway is active in cardiomyocytes in vitro, we examined whether activated monocytes can kill neonatal cardiomyocytes in a co-culture system. RESULTS: c-FLIP mRNA and protein were abundantly expressed in normal cardiomyocytes from failing human heart. In animal models, c-FLIP protein was absent in TUNEL-positive grafted cardiomyocytes. Double staining demonstrated that c-FLIP-positive cells rarely had fragmented DNA, while TUNEL-positive cells rarely contained c-FLIP. Finally, activated monocytes induced death of neonatal rat cardiomyocytes via the Fas/FasL system. CONCLUSIONS: Loss of c-FLIP expression correlates with cardiomyocyte cell death. We hypothesize that diminished c-FLIP expression may predispose cardiomyocytes to apoptotic death.