Dental anomalies associated with cleft lip and palate in Northern Finland.

AIM: Despite the reported occurrence of dental anomalies of cleft lip and palate, little is known about their prevalence in children from Northern Finland with cleft lip and palate. The aim was to investigate the prevalence of dental anomalies among patients with different types of clefts in Northern Finland. MATERIALS AND METHODS: Design and Statistics: patient records of 139 subjects aged three years and older (with clefts treated in Oulu University Hospital, Finland during the period 1996-2010 (total n. 183) were analysed for dental anomalies including the number of teeth, morphological and developmental anomalies and their association with the cleft type. The analyses were carried out using Chi-square test and Fisher's exact test. Differences between the groups were considered statistically significant at p values < 0.05. RESULTS: More than half of the patients had clefts of the hard palate, 18% of the lip and palate, and 13% of the lip. At least one dental anomaly was detected in 47% of the study population. Almost one in three (26.6%) subjects had at least one anomaly and 17.9% had two or three anomalies. The most common type of anomaly in permanent teeth were missing teeth followed by supernumerary teeth. Supernumerary teeth were significantly more apparent when the lip was involved in the cleft compared with palatal clefts. Missing teeth were less prevalent among those 5 years or younger. The prevalence of different anomalies was significantly associated with the cleft type in both age groups. CONCLUSIONS: Dental anomalies are more prevalent among cleft children than in the general population in Finland. The most prevalent anomalies associated with cleft were missing and supernumerary teeth.

Dental arch relationships assessed by GOSLON Yardstick in children with clefts in Northern Finland.

AIM: Our purpose was to evaluate the dental arch relationships using the GOSLON Yardstick in children with cleft lip and or cleft palate in Northern Finland. MATERIALS AND METHODS: The subjects consisted of 62 Finnish patients (36 girls and 26 boys) with clefts born between 1995-2005 in the Northern Ostrobothnia Hospital District of Finland. There were 36 patients with cleft palate, 9 with unilateral cleft lip and palate, 6 with cleft in soft palate, 5 with bilateral cleft lip and palate, 2 with cleft lip and 4 with submucous clefts. The study casts were obtained at the mean age of 6.3 years (5.8-7.8 years) and the cases were selected randomly. The dental arch relationships were assessed by the GOSLON Yardstick method by one calibrated researcher. RESULTS: After the assessment, 77.1% of cases were allocated to categories 1 and 2 (excellent and good), 10.4% category 3 (fair), and 12.5% categories 4 and 5 (poor and very poor). Patients with cleft palate had good prognosis in 84.6% of the cases. Of the patients with soft palate clefts and unilateral cleft lip and palate, 66.7% were allocated to categories 1 and 2. Bilateral cleft lip and palate patients had the poorest prognosis. Patients with submucous cleft and cleft lip had all good prognosis. CONCLUSION: The GOSLON Yardstick is a useful method for assessing dental arch relationships and treatment prognosis not only in cleft lip and palate patients, but also in cleft palate patients.

Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate.

Thirty-five patients (range 16-59 years) with cleft-lip nasal deformity treated by external rhinoplasty were evaluated for satisfaction and perception of outcomes. Treatment involved alar base relocation and augmentation of the asymmetric nasal tip with auricular cartilage grafts. The patients completed a satisfaction survey and interview at the 2-year follow-up visit. A visual analogue scale (VAS) numbered 0-10 was also used by the patients to grade outcome compared to preoperative appearance at 4 anatomic sites. Prior to surgery, the nasal tip was perceived as being most deformed (15/35), followed by alar position (12/35) and nasal apertures (8/35). The site on the nose most improved by surgery was the tip (15), followed by alar position (10), symmetry of nostrils (6) and dorsum (4). The highest VAS score was for the tip (8.32), followed by alar position (7.59), dorsum (7.41) and symmetry of nostrils (6.73). No patients suffered long-term pain for more than 2 months following surgery. All patients were prepared to undergo such procedure for a second time, if necessary. The unilateral cleft-lip nasal deformity can be improved in the eyes of the patient, using the combination of external rhinoplasty with alar base relocation, where necessary, and auricular cartilage augmentation of the nasal tip.

The relationship between MMPs and pH in whole saliva of radiated head and neck cancer patients.

BACKGROUND: Radiation therapy for head and neck tumour patients may lead to decreased salivary flow, oral mucosal lesions and increased caries experience. Salivary matrix metalloproteinases (MMPs) may participate in the pathogenesis of mucosal lesions and dentinal caries. The aims of this study were: (i) to assay the presence, molecular forms and proteolytic activity of MMP-8 (collagenase-2) and MMP-9 (gelatinase B) in the whole saliva of head and neck cancer patients having radiation therapy; (ii) to see whether salivary pH affects the activity of MMP-8 and MMP-9; and (iii) to find out the possible connection between MMP-8 and MMP-9 with the eruption of oral mucosal lesions during radiation therapy. METHODS: The whole saliva samples of 39 head and neck cancer patients having radiation therapy were collected before, during and after radiation therapy, and saliva flow rate, pH, buffer capacity, Streptococcus mutans, Lactobacillus and Candida albicans were measured. Any oral mucosal lesions were examined during each visit. The levels of MMP-8 were measured by immunofluorometric assay (IFMA) and the presence of different MMP-8 forms was analysed using Western immunoblotting. The presence and molecular forms of MMP-9 were analyzed by gelatin zymography. MMP-9 capture activity assay was used to determine the APMA-activated MMP-9 activity (total) and the endogenously active MMP-9 (free activity). RESULTS: Salivary flow rate, buffer capacity and pH decreased, and the levels of Lactobacilli increased significantly, during the first half of the radiation therapy. The endogenously activated salivary MMP-9 correlated with low salivary pH (P = 0.013). No connection was found between the oral mucosal lesions and salivary MMP-8 or MMP-9. CONCLUSIONS: In this study, salivary MMP-8 or MMP-9 did not correlate with the presence of radiation induced oral mucosal lesions, but the activation of MMP-9 may be dependent on pH.

Repeatability of 5 clinical neurosensory tests used in orthognathic surgery.

Many patients undergoing orthognathic surgery experience some degree of neurosensory impairment as a normal consequence of surgery. This may also occur as a complication after mandibular third molar surgery. The condition is usually reversible, but it may also be permanent. Neurosensory tests are essential in making decisions regarding the nature of the nerve injury, the potential for recovery, and the possible need for secondary microneurosurgical intervention. The aim of this study was to evaluate the repeatability of 5 clinical neurosensory tests assessing the neurosensory function of the inferior alveolar nerve (IAN). Twenty healthy subjects (9 males, 11 females) ranging in age from 21 years to 27 years participated in this study. The methods of assessment were light touch (LT), 2-point discrimination (2-P), pin tactile discrimination (PIN), thermal discrimination, and sensibility (ST) testing of the mandibular teeth with a vitality scanner. All the measurements were evaluated by 2 examiners and repeated at an interval of 6 months. In the statistical analysis, intraexaminer and interexaminer variability, as well as the variability between the 2 observations at a 6-month interval, were calculated. All the subjects reacted positively to LT and thermal discrimination in every observation. For the 2-P and PIN tests, intraexaminer variability was smaller than interexaminer variability, and repeatability of the 2 observations at 6 months was also good. Repeatability of ST was best at incisors, but it was not numerically very accurate at any site. However, all teeth that reacted positively to the vitality scanner in the first observation also reacted positively in the second observation; this instrument thus provides a more meaningful measurement of neurosensory function as a positive/negative assessment than as a numeric value.

Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy.

PURPOSE: The current study evaluated the incidence of subjective neurosensory disturbances after bilateral sagittal split osteotomy (BSSO) in relation to gender, age, indication for osteotomy, magnitude of mandibular movement, degree of manipulation of the inferior alveolar nerve at operation, side of the mandible operated, and complications during and after surgery. PATIENTS AND METHODS: Thirty patients (60 sides) who had undergone a BSSO were followed up for 1 year after operation. The patients were classified into different groups according to gender, age, indication for osteotomy, magnitude of mandibular movement, degree of manipulation of the nerve, and complications during or after surgery. A self-administered questionnaire was used at every follow-up to evaluate the sensations in the mental region. RESULTS: A statistically significant positive correlation was found between subjective neurosensory loss and the patient's age (P = .039), magnitude of mandibular movement (P = .044), and degree of manipulation of the nerve (P = .0007). However, no significant correlation was found between disturbances of sensation and gender, indication for osteotomy, side of the operated mandible, or intraoperative and postoperative complications. Even if all patients evaluated their sensation as "normal" 1 year postoperatively, 31% of them reported slightly altered sensation in the mental region. CONCLUSIONS: After BSSO, a prolonged neurosensory deficit is strongly related to age, the intraoperative magnitude of mandibular movement, and the degree of manipulation of the inferior alveolar nerve. However, a long-term sensory loss is very rare, and patients seem to adapt to a mild neurosensory deficit and report sensory function as "normal" despite slightly altered sensation.

Prediction of recovery from neurosensory deficit after bilateral sagittal split osteotomy.

OBJECTIVE: To observe the suitability of different combinations of readily available tests to predict recovery from a neurosensory deficit after bilateral sagittal split osteotomy (BSSO). STUDY DESIGN: Thirty patients scheduled for BSSO were examined before surgery and 4 days, 3 weeks, 3 months, 6 months, and 1 year after surgery. At each follow-up, the patients self-evaluated the subjective neurosensory deficit of the lower lip and chin of both sides. Neurosensory function was also measured by tests consisting of light touch, 2-point discrimination, pin tactile discrimination, thermal discrimination, and sensibility testing of the mandibular molars. The positive predictive values (PPV) of each test for recovery from the neurosensory deficit were calculated. Furthermore, different tests were combined, and the PPVs for recovery from the neurosensory deficit of these combinations were analyzed. RESULTS: A positive response to sensibility testing of the mandibular first and second molars 4 days and 3 weeks after surgery was related to a PPV of 100% and 87%, respectively, for full recovery from sensation loss at 1 year. However, none of the tests alone could reliably predict recovery from the neurosensory deficit after BSSO. When 3 different tests were combined, the best results were achieved by the combinations of a light test or a 2-point discrimination test and a pin tactile test with the sensibility testing of mandibular molars. CONCLUSIONS: Sensibility testing of mandibular molars can be used to predict recovery from the neurosensory deficit after BSSO. The best positive predictive ability can be achieved by combining a mechanoceptive test, a nociceptive test, and sensibility testing of mandibular molars.

Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy.

Different methods of assessing functional impairment of the inferior alveolar nerve after sagittal split osteotomy were compared with subjective reports. Thirty patients were tested preoperatively as well as after four days, three weeks, three months, six months, and one year of follow up. All the patients underwent bilateral mandibular ramus sagittal split osteotomy. The sensation of the mandibular teeth was assessed by an electric vitality scanner. Other neurosensory assessments included light touch, two-point discrimination, tactile discrimination, and thermal discrimination. It was shown that electric sensibility-testing of mandibular teeth is a useful method for evaluating neurosensory disturbance after sagittal split osteotomy, and it correlated even better with the patient's subjective evaluation than the other tests used in this study.

Doxymycine-cyanoacrylate treatment of recurrent aphthous ulcers.

OBJECTIVE: This study addressed the efficacy of singularly applied topical doxymycine in the pain relief treatment of recurrent aphthous stomatitis. STUDY DESIGN: Thirty-one patients with recurrent aphthous lesions were examined and divided randomly in two groups. Experimental group (n = 15) received a topical application of doxymycine and controls (n = 16) received calcii gluconase in the same manner. Medications were covered by isobutyl cyanoacrylate (Iso-Dent). Application was made only once during the recurrent aphthous ulcer episode. RESULTS: Patients recorded their pain level on a visual analog scale for 10 days during healing. Pain decreased more rapidly in the experimental group, and a statistically significant difference (p < 0.05) in the pain intensity was found from the second to the seventh day after application of doxymycine. CONCLUSIONS: In recurrent aphthous ulcers, singular treatment of topical doxymycine-cyanoacrylate relieves the pain intensity remarkably for 6 days after a 1 day latency period. Topical doxymycine treatment further exerts potential to directly prevent tissue destruction and to indirectly suppress host inflammatory reaction.

Chronic sclerosing osteomyelitis of the mandible in monozygotic twins.

Identical female twins with chronic sclerosing osteomyelitis of the mandible are presented. The diagnoses of both at the age of 12 years were based on typical history, and on clinical, radiographic, and histologic findings. High concentrations of IgA and IgG were detected in the serum of both patients, but deviations were not observed in other immunologic variables. The normally commensal organism, Propionibacterium acnes grew from a bone biopsy specimen from the mandible of one twin. No oral focus of the disease was confirmed in either case. We suggest that hereditary factors must have played a role in the pathogenesis of these cases of chronic osteomyelitis.