[Application of peer-assisted learning in evidence-based dentistry teaching].

PURPOSE: To explore the effects of peer-assisted learning (PAL) for evidence-based dentistry (EBD) teaching. METHODS: Four hundred and eleven students who attended EBD class were randomly classified into PAL group (n=75) and traditional teaching group (n=326) via a ratio of 1:5. Students in traditional teaching group received traditional theoretical teaching; while PAL group received traditional theoretical teaching and group study with tutors introduced and finished study protocols given by the teachers. Teaching effects were evaluated by final examinations, questionnaires and published articles via bibliographic searching. Statistical analysis was carried out with STATA 11.0 software package. RESULTS: In the final examination, students in PAL group had 6.9 higher scores than traditional teaching group (P<0.05). The results of questionnaires showed that students in PAL group had higher interests and contentments in EBD class (P<0.05), and PAL had positive effects on their usage of EBD methodology and involvement in EBD research (P<0.05). In publication of articles, the number and ratios of article publication in PAL group were significantly higher than the traditional group (P<0.05). CONCLUSIONS: PAL has positive effects on EBD teaching.

[Study on the influence of psychological factors in developing manifestations of temporomandibular disorders].

PURPOSE: To determine whether psychological factors be a risk of temporomandibular disorders (TMDs) or not. METHODS: A case-control study was carried out in 100 patients with TMD and 100 controls without TMD. A self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used as the instruments to evaluate tendencies of anxiety and depression. The suspected confounding factors such as habit of eating hard food, chewing on one side, knocking teeth, night bruxism and history of extraction of teeth were also recorded. The data were analyzed by using Stata 11.0 software package to estimate risk strength of the psychological factors and confounding factors in occurrence of TMD. The cut point of significance was set up at 0.05. RESULTS: The mean scores of SAS and SDS of TMD group were significantly higher than those of control group (P<0.05).The trend tests of OR in SAS and SDS were both reaching to a significant level. The logistic analysis showed that only SAS and lateral chewing are significant risk factors of TMD (P<0.05). CONCLUSIONS: Tendencies of anxiety and depression are the significant risk factors related to TMD. However, when confounding factor such as chewing on one side exists, only tendency of anxiety remains a significant risk of TMD.

[Hyaluronate sodium treatment for internal derangement of temporomandibular joint: a systematic review based on randomized controlled trials].

OBJECTIVE: To assess the efficacy and safety of hyaluronate sodium (HS) for internal derangement of temporomandibular joint by means of systematic review on relevant randomized controlled trials. METHODS: After identifing the study question of the efficacy and safety of HS for internal derangement of temporomandibular joint, Medline, Cochrane Controlled Trials Register, EMBASE, OPEN SIGLE and CBM were searched electronically till October 3rd 2010. Hand-searching covering 19 dental journals in Chinese were also performed. Risk of bias assessment, with Cochrane Collaboration's tool, and data extraction of included studies were conducted by two reviewers in duplicate. Meta analysis was done with Revman 5.0.23 and the quality of evidence was evaluated by GRADE. RESULTS: 10 randomized controlled trials met the eligibility criteria and were included. All these studies had unclear risk of bias. When compared with negative control, HS showed a significant advantage on maximal mouth opening in short and long-term (P < 0.05), and clinical overall assessment in short-term (P < 0.05), but its effect on pain control and long-term effect on clinical overall assessment had no extra benefit (P > 0.05). Additionally, when compared with glucocorticoids, the participants who received HS injection would get a better clinical overall assessment in short-term and less adverse drug reactions (P < 0.05), but presented a similar temporomandibular joint pain relief and maximal mouth opening (P > 0.05). CONCLUSION: To a certain extent, HS had good efficacy and better safety than controls when treating internal derangement of temporomandibular joint. However, as the quality of some included studies were limited, more randomized controlled trials are needed to reinforce the conclusion.

[Preferred reporting items for systematic reviews and meta-analysis for reporting quality of Chinese meta-analysis on stomatology].

OBJECTIVE: To determine the current status and influence factors of reporting quality of the Chinese meta-analysis on stomatology. METHODS: A comprehensive electronic search was carried out through Chinese BioMedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) and China National Knowledge Infrastructure (CNKI) and a hand searching was also performed through 19 stomatological journals in Chinese to identify meta-analysis on stomatology. Two reviewers took responsibility for study inclusion, data extraction and reporting quality assessment with preferred reporting items for systematic reviews and meta-analysis (PRISMA) in duplicate and any disagreement was resolved by discussion. RESULTS: A total of 34 meta-analysis on stomatology were eligible, most of them were on oral medicine and oral and maxillofacial surgery, and mainly focusing on etiology, prevention and treatment of oral diseases. The number of the meta-analysis increased during recent years. Reporting quality of the meta-analysis was not high and the PRISMA scored (13.6 ± 4.2). The main factors that influenced the reporting quality of meta-analysis were published on evidence-based medicine journals (adjusted ß = 0.53, t = 4.15, P < 0.001) and year of publication (adjusted ß = -0.44, t = -3.28, P = 0.001). The sensitivity analysis showed that this outcome was stable. CONCLUSIONS: Reporting quality of the Chinese meta-analysis on stomatology is low. To provide sufficient evidence to the clinicians and promote the development of evidence-based dentistry in China, experts on stomatology should study the knowledge of evidence-based medicine and comply with PRISMA statement when producing the meta-analysis.

Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis.

OBJECTIVE: The aim of this study was to investigate the effect of intra-articular sodium hyaluronate (SH) injections on the main components of plasminogen activator (PA) system in the synovial fluid of temporomandibular joint (TMJ) osteoarthritis (OA). STUDY DESIGN: Forty patients diagnosed with TMJ OA and 20 healthy control subjects were included in this study. Synovial fluid was collected in the OA group and the healthy group at baseline. The OA patients were randomly divided into 2 groups (20 patients for each group): One group received 5 injections of SH, and the other received 5 injections of physiologic saline solution in the upper joint space at weekly intervals. Synovial fluid was collected before and after treatment. Urokinase-type PA (uPA), soluble uPA receptor (suPAR) and PA inhibitor 1 (PAI-1) levels in synovial fluid were quantified by enzyme-linked immunosorbent assay. RESULTS: The OA patients had significantly higher uPA activity and levels of uPA (median 80.01 ng/L), suPAR (median 7.54 ng/L), and PAI-1 (median 54.9 ng/mL) than the healthy control subjects (median 20.47 ng/L uPA, 2.34 ng/L suPAR, and 19.9 ng/mL PAI-1; (P < .05). The uPA activity and levels of uPA, suPAR, and PAI-1 were significantly decreased after SH injections in TMJs of OA patients (P < .05), and there was no difference after saline injection. Visual analog pain score reduction correlated with changes in uPA and uPAR levels as well as uPA activity. CONCLUSION: The effects of SH on PA system provide new insight into a possible underlying mechanism by which SH alleviates pain of patients with TMJ OA.

[Expression of urokinase-type plasminogen activator and urokinase-type plasminogen activator receptor in synovial fluid of patients with temporomandibular disorders].

OBJECTIVE: To investigate the level of urokinase-type plasminogen activator (uPA) and urokinase-type plasminogen activator receptor (uPAR) in synovial fluid of patients with temporomandibular disorders and to analyze their relation with temporomandibular disorders (TMD). METHODS: Synovial fluid was obtained from 64 sides of 56 TMD patients and from 16 sides of 10 asymptomatic healthy volunteers (control). The concentrations of uPA and uPAR in the synovial fluid were measured by ELISA. Forty-eight sides of TMD were divided into 3 groups: arthrosis, structure disorder and osteoarthrosis, each including 16 sides. RESULTS: The levels of uPA and uPAR were significantly higher in the synovial fluid of TMD patients than that in the control group (P < 0.05), and the level of uPA and uPAR in osteoarthrosis group was significantly higher than that in arthrosis and structure disorder group (P < 0.05). However, there was no difference in expression of uPA and uPAR between arthrosis and structure disorder groups (P > 0.05). CONCLUSIONS: uPA and uPAR in the synovial fluid may play a role in the pathogenesis of TMD, and the level of uPA and uPAR in synovial fluid of TMD could be used as a biochemical markers to reflect pathological degree of TMD.

Survey of the patients with cleft lip and palate in China who were funded for surgery by the Smile Train Program from 2000 to 2002.

BACKGROUND: Cleft lip (CL) and cleft palate (CP) are two of the most frequent congenital malformations. Many epidemiologic studies on this deformity have been conducted worldwide, often producing inconsistent results. This study assessed epidemiology and some genetic aspects of cleft lip and palate in a Chinese sample from the Smile Train Program and to compare with other methodologically sound surveys. METHODS: The general information, family history, classification of cleft and associated malformations of 8000 CL and CP surgery patients were analyzed. RESULTS: Of the 8000 cases, 7812 had complete data. The distribution of cleft types is 17.04% with CP, 23.39% with CL and 59.58% with cleft lip and palate (CLP). Unilateral clefts were more common than bilateral, with unilateral to bilateral ratios being 10.4:1 for CL, and 3.42:1 for CLP. The overall male:female ratio was 2.01:1. Left sided defects were more common than right sided regardless of sex, 1.90:1 for CL and 1.96:1 for CLP. CLP and CL were more common in males than in females with sex ratios (SR) of 2.88:1 and 1.85:1 respectively, whereas CP was more common in females with SR of 0.76:1. Associated malformations (2.89%), involved 29 CP cases, 41 CL and 156 CLP. The frequency of associated malformations in CLP (3.35%) was higher than CL (2.24%) and CP (2.22%) (P < 0.05). Patients with CP or CLP were born less often in the winter than in the summer (P < 0.05). A history of family members having clefts occurred in 6.84% of patients. The proportion of CLP cases (7.56%) was significantly higher than that of CL cases (5.64%) (P < 0.05). CONCLUSIONS: The different types of clefts appeared in the highest proportion in CLP and lowest proportion in CP. Males are more common with CL and CLP and less common with CP. These characteristics are the same as those of other Chinese surveys but different from some European reports.

[The malocclusion of primary dentition in the suburb of Chengdu: a cross-section survey].

OBJECTIVE: To reveal malocclusion of primary dentition in the suburb of Chengdu. METHODS: Cross-section survey and malocclusion rate calculation were performed. RESULTS: There are 491 children with malocclusion from total 1 279 children; the rate of malocclusion is 38.38%. The most important malocclusion in primary dentition are over bite (III degrees), anterior cross bite, edge to edge bite, early loss of deciduous teeth, fused teeth. CONCLUSION: The rate of malocclusion of primary dentition in the suburb of Chengdu is a little bit light. Much work should be done to prevent or treat the malocclusion of primary dentition.

[Anesthetic efficacy of 2% mepivacaine in conservative dentistry].

OBJECTIVE: To determine the efficacy of 2% mepivacaine in conservative dentistry. METHODS: The patients who needed cavity preparation or access to pulp chamber received local infiltration with 2% mepivacaine. Anesthesia time, anesthetic efficacy and cardiovascular system influences were assessed. 3% lidocaine with epinephrine served as control. RESULTS: In experiment group, the anesthesia effects were quicker and anesthesia duration was longer than that in control group. Doctors highly appreciated the anesthetic efficacy. Two groups did not show any evident change in blood pressure and heart rate. CONCLUSION: 2% mepivacaine is a safe and efficacious local anesthetic drug in conservative dentistry.

[An outcome analysis of two methods of intra-capsular injection of sodium hyaluronate for temporomandibular disorders].

OBJECTIVE: To analyze the treatment outcome of the two methods of intra-capsular injection of temporomandibular joints, the upper capsule alone and both the upper and lower capsules, for different subtypes of temporomandibular disorders. METHODS: A retrospective cohort study was designed, based on the outpatients and the data which were obtained from West China Stomatological Hospital, Sichuan University. SPSS10.0 software was used to analyze the data, which were collected before the operation and one week after the operation. RESULTS: 294 patients were followed up. The group of double capsules injection gained better prospect, not only on the mouth-opening but also the pain-cured, especially in two subgroups such as the anterior dislocation of disc without reduction and the osteoarthritis of TMJ. CONCLUSION: It seems that the double capsules injection of sodium hyaluronate for TMD can gain better outcome than the upper capsule injection, but a clinical randomized controlled test and a long-term follow-up study of the two methods are needed to verify this finding.

[Tumor angiogenesis in node-negative breast carcinoma].

BACKGROUND & OBJECTIVE: This study was designed to investigate the vascular endothelial growth factor (VEGF) and the microvessel density(MVD) in node-negative breast carcinoma, and to discuss the relationship of MVD and VEGF to the tumor size, histologic grade, and relapse and metastasis. Meanwhile, the prognostic value of MVD and VEGF was estimated. METHODS: MVD and VEGF were evaluated after immunohistochemical staining using antibody of vascular endothelium for factor VIII antigen and VEGF in 62 patients with node-negative breast carcinoma respectively. The patients were followed up. RESULTS: VEGF and MVD were all associated with histological grade and relapse (P < 0.05), but no association with ER and tumorsize; the relapse-free survivals (RFS) and overall survivals of patients with high MVD or high VEGF expression were significantly lower than that of the patients with low MVD or low VEGF expression (P < 0.01). Moreover, the difference of survivals in the patients with high MVD and high VEGF expression were more obvious(P < 0.005). Meanwhile, there was association between MVD and VEGF (P < 0.01). CONCLUSIONS: The node-negative patients with high VEGF expression or high MVD would have poor prognosis. VEGF and MVD could be significant prognostic indicators for the patients with node-negative breast carcinoma. It has better prognostic value to connected VEGF and MVD. VEGF was an important factor in tumor angiogenesis.

[Randomized controlled trial of sodium hyaluronate for degenerative disorders of the temporomandibular joint].

OBJECTIVE: To assess the effect of sodium hyaluronate (HA) for degenerative disorders of the temporomandibular joint (TMJ). METHODS: A prospective randomized controlled clinical trial was conducted. The experimental group received injections in the upper compartments of the involved TMJs with 1% HA 6 mg, whereas the control group received prednisolone (PS) 12.5 mg once a week. Three to four injections were as one course. Before and one week after the treatment courses, clinical symptoms, amount of interleukin-6 (IL-6) and total protein of synovial fluid were measured and compared. RESULTS: Sixty-seven patients were included and 4 out of them were dropped out. There were 12 males and 51 females, among them, 14 cases with synovitis, 21 with anterior disc displacement without reduction and 28 with osteoarthritis of the TMJ. Thirty-five patients allocated in HA group and 28 in PS group. Both drugs could relieve the clinical symptoms of TMJ degenerative disorders. In HA group, marked improvement rate was 51.43% and failure rate was 2.86%, whereas marked improvement rate 39.29% and failure rate 17.86% in PS group. The declined levels of IL-6 in synovial fluid was notably greater in HA group than those in PS group. CONCLUSION: Intra-articular injection of HA is effective and safe to treat TMJ degenerative disorders with mild adverse reactions, better in terms of effective rate and declined level of IL-6 than PS.

[Comparative study on effects of sodium hyaluronate and prednisolone injections on experimental temporomandibular joint osteoarthritis of rabbits].

OBJECTIVE: To assess the treatment effect of sodium hyaluronate (HA) on experimental temporomandibular joint (TMJ) osteoarthritis of rabbits in comparison with prednisolone (PS). METHODS: The upper compartments of both TMJs of 12 Japanese White Ear Rabbits were injected with 0.2 ml of 1.6% papain, 3 days after the right TMJs were injected again with same amount of papain to induce osteoarthritis with different severity levels. Except 1 rabbit was died accidentally. After one week from final injection of papain, the upper compartments of both TMJs of 6 rabbits were injected with HA 1.3 mg, 5 rabbits with PS 1.6 mg weekly for 4 times. At 3, 5 and 7 weeks after the final injection, the rabbits were sacrificed and the TMJs were pathologically examined. RESULTS: The TMJs receiving PS showed predominant structural disorganization, and the right TMJs had much severe pathology. The manifestations were fibrillation, thinner or flaking of the articular cartilage of the temporal part of the joint, and the articular surface was covered with fibrous tissue. Whereas the TMJs receiving HA injections demonstrated limited changes of cartilage, less fibrillation, only local loss of cartilage on outside layer of the surface. In vicinity of the defect area, cluster of the chondrocytes appeared. Pathological scores of the TMJs receiving HA were significantly less than those of the TMJs revieving PS. CONCLUSION: The results suggest that hyaluronate have effect of cartilaginous reparation and protection for the osteoarthritis of rabbit. While prednisolone has no help or worsened for articular cartilage reparation.