Occlusal wear and occlusal condition in a convenience sample of young adults.

OBJECTIVE: To study progression of tooth wear quantitatively in a convenient sample of young adults and to assess possible correlations with occlusal conditions. METHODS: Twenty-eight dental students participated in a three-year follow up study on tooth wear. Visible wear facets on full arch gypsum casts were assessed using a flatbed scanner and measuring software. Regression analyses were used to assess possible associations between the registered occlusal conditions 'occlusal guidance scheme', 'vertical overbite', 'horizontal overbite', 'depth of sagittal curve', 'canine Angle class relation', 'history of orthodontic treatment', and 'self-reported grinding/clenching' (independent variables) and increase of wear facets (dependent variable). RESULTS: Mean increase in facet surface areas ranged from 1.2 mm2 (premolars, incisors) to 3.4 mm2 (molars); the relative increase ranged from 15% to 23%. Backward regression analysis showed no significant relation for 'group function', 'vertical overbite', 'depth of sagittal curve', 'history of orthodontic treatment' nor 'self-reported clenching. The final multiple linear regression model showed significant associations amongst 'anterior protected articulation' and 'horizontal overbite' and increase of facet surface areas. For all teeth combined, only 'anterior protected articulation' had a significant effect. 'Self reported grinding' did not have a significant effect (p>0.07). CONCLUSIONS: In this study 'anterior protected articulation' and 'horizontal overbite', were significantly associated with the progression of tooth wear. Self reported grinding was not significantly associated with progression of tooth wear. CLINICAL SIGNIFICANCE: Occlusal conditions such as anterior protected articulation and horizontal overbite seem to have an effect on the progression of occlusal tooth wear in this convenient sample of young adults.

[Contact wear related to single- and multi-unit dental prostheses]. / Contactslijtage in relatie tot kronen en bruggen.

Occlusal surfaces of teeth and restorations wear by repeated antagonistic contact. Two-body wear is the result of direct contact between occlusal surfaces. In cases of three-body wear, food is found between antagonistic teeth. Contact wear is expressed predominantly by abrasion and material fatigue. Erosion is a type of wear which does not involve direct antagonistic contact. Qualitative methods exist for registering occlusal tooth wear. Wear of restorations can be measured using casts. An obvious method for comparing rates of wear of restorative materials is laboratory research. This method has demonstrated that the wear rates of composite and enamel are similar. Cast metals and in particular ceramic wear less than enamel. The relation between oral factors and the rate of tooth wear is not always clear. Wellpolished surfaces of restorations wear less quickly and have less effect on the wearing of antagonistic teeth than rougher restoration surfaces.

Occlusion and Temporomandibular Function among Subjects with Mandibular Distal Extension Removable Partial Dentures.

Objective. To quantify effects on occlusion and temporomandibular function of mandibular distal extension removable partial dentures in shortened dental arches. Methods. Subjects wearing mandibular extension removable partial dentures (n = 25) were compared with subjects with shortened dental arches without extension (n = 74) and with subjects who had worn a mandibular extension removable partial denture in the past (n = 19). Subjects with complete dentitions (n = 72) were controls. Data were collected at baseline and at 3-, 6-, and 9-year observations. Results. Occlusal activity in terms of reported awareness of bruxism and occlusal tooth wear of lower anterior teeth did not differ significantly between the groups. In contrast, occlusal tooth wear of premolars in shortened dental arches with or without extension dentures was significantly higher than in the controls. Differences amongst groups with respect to signs and symptoms related to temporomandibular disorders were not found. Occlusal support of the dentures did not influence anterior spatial relationship. Occlusal contacts of the denture teeth decreased from 70% for second premolars via 50% for first molars, to 30% for second molars. Conclusions. Mandibular distal extension removable partial dentures in moderate shortened dental arches had no effects on occlusion and temporomandibular function.

Systematic review of the prevalence of tooth wear in children and adolescents.

Data on the prevalence of tooth wear among children and adolescents are inconsistent. Given the impact of extensive tooth wear for over a lifetime, evidence on the extent is required. The aim was to systematically review the literature on the prevalence of tooth wear in children and adolescents. A PubMed literature search (1980-2008) used the keywords 'tooth' AND 'wear'; 'dental' AND 'attrition' AND 'prevalence'; 'dental' AND 'wear' AND 'prevalence'; 'erosion AND prevalence' AND 'abrasion AND prevalence'. Following exclusion criteria, 29 papers were reviewed using established review methods. There was a total of 45,186 subjects (smallest study 80 and largest study 17,047 subjects) examined from thirteen multiple random clusters, eight multiple convenience clusters and eight convenience clusters. Nine different tooth wear indices were used, but the common denominator among studies was dentin exposure as an indicator of severe wear. Forest plots indicated substantial heterogeneity of the included studies. Prevalence of wear involving dentin ranged from 0 to 82% for deciduous teeth in children up to 7 years; regression analysis showed age and wear to be significantly related. Most of the studies in the permanent dentition showed low dentin exposure, a few reported high prevalence (range 0-54%); age and wear were not related (regression analysis). The results of this systematic review indicate that the prevalence of tooth wear leading to dentin exposure in deciduous teeth increases with age. Increase in wear of permanent teeth with age in adolescents up to 18 years old was not substantiated.

[Unilateral surgically assisted rapid maxillary expansion using a transpalatal distractor]. / Unilaterale chirurgisch ondersteunde expansie van de bovenkaak door transpalatinale distractor.

A 46-year-old woman was referred for orthodontic surgery consultation because ofa retrognathic maxilla, unilateral cross bite and functional, aesthetic and speech problems. The maxilla was widened unilaterally by unilateral surgically assisted rapid maxillary expansion with a bone-borne transpalatal distractor. During post-operative orthodontic treatment, a temporary anchorage device was administered. With the help of composite veneers, crowns and a removable partial denture, a functionally and aesthetically satisfying result was achieved.

[Favourable short-term effects of a multidisciplinary, behavioural therapy, group treatment for overweight or obese children]. / Gunstige kortetermijneffecten van een multidisciplinaire gedragstherapeutische groepsbehandeling voor kinderen met overgewicht of obesitas.

OBJECTIVE: Evaluate the effect of a multidisciplinary, behavioural therapy, group therapy for obese children. DESIGN: Descriptive. METHOD: The treatment consisted of 8 child and 2 parent sessions over a period of 10 weeks, in the Sint Franciscus Gasthuis Hospital in Rotterdam, the Netherlands. Attention was devoted to eating behaviour, physical exercise and psychosocial aspects. Data were collected about children treated in the period 1999-2002. Inclusion criteria were: age 7-14 years, body-mass index (BMI) > or = 25 kg/m2, spoke Dutch, and no problematic behaviour according to the CBCL (total score < 70). Outcome measures were BMI, energy uptake, treadmill endurance time in the Bruce test, and problematic behaviour. There were three measurement points: 3 months before the treatment, immediately before the treatment and immediately after the treatment. RESULTS: 7 of the 78 children who were to participate dropped out. The study cohort consisted of 52 girls and 19 boys with an average age of 10.5 years. In the months prior to the treatment there was no statistically significant change in the outcomes. During the treatment period all of the children lost weight. The mean BMI decreased by 1.7 kg/m2 (-0.3 SDS), the mean daily energy uptake decreased by 1242 kJ and the maximal endurance time increased by 0.8 min (all: p < 0.001). There was no significant decrease in the score for problematic behaviour. CONCLUSION: For the overweight or obese children who followed the treatment programme the BMI and energy intake decreased during the programme and the fitness increased.

[The shortened dental arch concept: a treatment strategy for the mutilated dentition]. / Het verkorte-tandboogconcept: een behandelingsstrategie bij uitgebreide gebitsmutilaties.

The minimum number of teeth needed to satisfy functional demands has been subject of several studies. However, since functional demands can vary from individual to individual, this number cannot be defined exactly. It has been demonstrated that shortened dental arches comprising the front teeth and the premolars, can meet the requirements of a functional dentition. The shortened dental arch concept may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth. It implies that the prompt replacement of absent molars by a removable partial denture leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence, and not contradict current theories of occlusion and fits well in a problem-solving approach.

The developmental profile.

We describe the Developmental Profile and the development of the instrument, the theory on which it is based, and the manner in which information is collected, interpreted, and used in clinical practice. We present the results of the psychometric research that has been performed to date. Finally, we examine the extent to which this method is in accordance with recent insights within the field of personality diagnostics.

Measuring overall defensive functioning with the Defense Style Questionnaire: a comparison of different scoring methods.

The evidence for the division of defenses measured with the Defense Style Questionnaire (DSQ) into immature, neurotic, and mature types appears to be lacking. We hypothesized that defenses can be represented unidimensionally. Classical multidimensional scaling was applied to the maturity ratings of items given by 279 experts. It appeared that the items of the DSQ can be represented unidimensionally. In a second study, two three-factor models of the DSQ were tested with confirmatory factor analysis, using scores of 543 psychiatric outpatients. Both three-factor models were implausible. A third study showed that the overall defensive functioning scores derived from the first study discriminated well between samples of 543 psychiatric outpatients, 69 medical students, and 68 graduate students attending a student counselor. We also found that the overall defensive functioning scores correlated positively with the current Global Assessment of Functioning in the psychiatric sample. We concluded that the DSQ is a useful instrument for measuring overall defensive functioning.

The developmental profile: preliminary results on interrater reliability and construct validity.

This study presents the preliminary results of research into the interrater reliability and construct validity of the Developmental Profile (DP). In the DP a number of developmental lines, such as Object-Relations, Self-Images, and Problem-Solving Capacities, are assessed and classified according to the level of functioning. A total of 108 profiles were assessed, drawn from three different categories of patients. The weighted kappa values for interrater reliability were sufficient. On the adaptive level, but also on the maladaptive levels Symbiosis and Resistance, significant differences were found between psychiatric patients, "normal controls" (dental patients) and somatic patients. No differences were recorded between the latter two groups. The conclusion is that the DP is a promising instrument, of which the reliability and validity has to be further investigated in order to contribute to scientific support for psychodynamic theory formation.

The autonomy paradox: predictive genetic testing and autonomy: three essential problems.

The development of genetics creates the possibility to acquire more and more information concerning our genetic constitution. In general this is considered as a contribution to the autonomy of patients and others. In this article it is pointed out that the relation between genetic information and autonomy is far from simple. The autonomy of people may even be threatened by genetic information. Counsellors should therefore be very careful in offering the opportunity of genetic testing; a general policy of restraint would be advisable. And when offering information, several considerations should be kept in mind in order to avoid doing more harm than good in the counseling process.

Psychological aspects of genetic counselling: a review of the experience with Huntington's disease.

Presymptomatic DNA-testing for adult-onset diseases has serious psychological consequences. Here the psychological consequences of presymptomatic DNA-testing for Huntington's disease are reviewed. Both carriers and non-carriers experience emotional reactions after disclosure of their test result. However, up to today no long-term adverse emotional consequences have been revealed. Future research on other adult-onset genetic diseases should provide information about the reactions of children. In genetic counselling, attention should be paid to the reactions of people with a decreased risk. Genetic counselling must focus on the whole family and not on the individual applicant.

Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980.

OBJECTIVE: In a review of the literature from 1980 to 1994 on psychological and psychiatric problems in patients with cancer, the prevalence, severity, and the course of these problems (i.e., depression, anxiety, and general psychological distress) were studied with the help of meta-analyses and qualitative analyses. Apart from this, qualitative analyses were also applied with respect to other relevant variables. METHOD: A literature search in MEDLINE was conducted and cross-references of articles identified via MEDLINE. Meta-analysis was applied when possible. RESULTS: There seemed to be a wide variation across studies in psychological and psychiatric problems. Meta-analysis showed no significant differences between cancer patients and the normal population with respect to anxiety and psychological distress. However, cancer patients seemed to be significantly more depressed than normals. Compared with psychiatric patients, cancer patients were significantly less depressed, anxious, or distressed. Compared with a sample of other medical patients, cancer patients showed significantly less anxiety. With respect to course, a significant decrease was found in the meta-analysis for anxiety, but not for depression. Further meta-analyses showed significant differences among groups of cancer patients with regard to tumor site, sex, age, design of the study, and year of publication. From the qualitative analyses, it seemed that medical, sociodemographic, and psychological variables were related inconsistently to psychological and psychiatric problems. CONCLUSION: With the exception of depression, the amount of psychological and psychiatric problems in patients with cancer does not differ from the normal population. The amount of psychological and psychiatric problems is significantly less in cancer patients than in psychiatric patients. The amount of anxiety is significantly less in cancer patients than in other groups of medical patients with mixed diagnoses, whereas depression is not. Future studies should aim at exploring possible causes for the sometimes impressive differences in psychological or psychiatric problems among patients with cancer.