[Who will be a good physician? Admission procedures for medical and dental students]. / Wer wird ein guter Arzt? Verfahren zur Auswahl von Studierenden der Human- und Zahnmedizin.

Since 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.

[Differential and common characteristics of patients with atypical facial pain and craniomandibular dysfunction]. / Differenzielle und gemeinsame Merkmale bei Patienten mit atypischem Gesichtsschmerz und kraniomandibularer Dysfunktion.

BACKGROUND: Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. METHOD: A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. RESULTS: The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CONCLUSIONS: CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.

[Psychic and somatic findings in jaw or facial pain of unclear origin. Comparison of patients with severe and mild symptoms]. / Psychische und somatische Befunde bei ätiologisch nicht eindeutigen Kiefer- bzw. Gesichtsschmerzen Vergleich zwischen hoch und niedrig symptomatischen Patienten.

BACKGROUND: Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease. OBJECTIVE: To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters. METHOD: We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index). RESULTS: The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group. CONCLUSIONS: These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.

Etiology of dental erosion--intrinsic factors.

Dental erosion due to intrinsic factors is caused by gastric acid reaching the oral cavity and the teeth as a result of vomiting or gastroesophageal reflux. Since clinical manifestation of dental erosion does not occur until gastric acid has acted on the dental hard tissues regularly over a period of several years, dental erosion caused by intrinsic factors has been observed only in those diseases which are associated with chronic vomiting or persistent gastroesophageal reflux over a long period. Examples of such conditions include disorders of the upper alimentary tract, specific metabolic and endocrine disorders, cases of medication side-effects and drug abuse, and certain psychosomatic disorders, e.g. stress-induced psychosomatic vomiting, anorexia and bulimia nervosa or rumination. Based on a review of the medical and dental literature, the main symptoms of all disorders which must be taken into account as possible intrinsic etiological factors of dental erosion are thoroughly discussed with respect to the clinical picture, prevalence and risk of erosion.

[Radiographic changes in the jaw bones of children with chronic renal failure]. / Röntgenologische Veränderungen im Kieferbereich bei chronischer Niereninsuffizienz im Kindesalter.

Thirty-four children with chronic renal failure were examined to evaluate the character and frequency of radiographic changes in the jawbones as related to radiographic abnormalities in other skeletal regions and laboratory data. Twenty-seven children showed signs of renal osteodystrophy on the roentgenograms. Radiographic changes in the jawbones including alterations of the laminae durae were observed in twenty-three children. Total loss of laminae durae was only seen in connection with other skeletal signs of renal osteodystrophy. In all these cases the serum parathyroid hormone (iPTH-C) and alkaline phosphatase levels were remarkably increased so that even in the uremic child total absence of laminae durae cannot be considered a first symptom of renal osteodystrophy. However, radiographic changes in the jawbones are important signs for early detection of renal insufficiency in childhood, as these symptomes appeared with similar frequency as pathologic changes in other skeletal regions and were already present in stage of preterminal renal insufficiency.

Oculodentodigital syndrome: report of a case.

The clinical and radiographic changes in a case of oculodentodigital syndrome are presented. The characteristic features of this rare developmental disorder, microphthalmus with microcornea and iris anomalies, hypertelorism, thin nose with hypoplastic alae and anteverted nostrils, syndactyly with camptodactyly and clinodactyly of the fourth and fifth fingers associated with bony anomalies of the middle phalanges of the fifth fingers and toes, were all present. In addition, histological examination of a lateral incisor showed the enamel dysplasia to be due to enamel hypoplasia; the dentine also showed marked hypocalcification. There were widespread pulp denticles and hypercementosis throughout the dentition. Both the patient and his mother had coronoid hypoplasia.

[Alpha-amylase isoenzymes in serum and saliva of patients with anorexia and bulimia nervosa]. / alpha-Amylase-Isoenzyme im Serum und Speichel bei Patienten mit Anorexia und Bulimia nervosa.

In the serum and saliva of 45 patients with eating disorders and in 30 normal controls, alpha-amylase activity and isoamylase levels were measured. Of the 45 patients evaluated, 12 had restrictive anorexia nervosa, 13 were bulimic anorectics and 20 had bulimia nervosa. In all these groups, the mean alpha-amylase values in serum and saliva were higher than that of the control group. The proportion of pancreatic (P)- and salivary (S)-alpha-amylase isoenzymes in serum were within the normal range for the patient group with restrictive anorexia nervosa, whereas the bulimic anorexia nervosa and bulimia nervosa patients showed significantly greater increases in S- than P-isoamylase activity. The correlation of the salivary alpha-Amylase isoenzym pattern in serum and saliva pointed to the salivary glands as origin of the elevated salivary isoamylase levels in serum. Hyperamylasemia was found in 10 (25%) of the 45 patients with eating disorders. Three of these patients showed besides an increased S-alpha-amylase activity also pathologically elevated P-alpha-amylase and lipase activity in serum; however there were no abdominal symptoms, laboratory data or ultrasonic signs of pancreatitis. In all patients with eating disorders, the mean concentration and secretion of alpha-amylase in saliva were increased. Swelling of the salivary glands was present in 14 patients. In these cases the percentage of salivary-isoamylase activity in total serum alpha-amylase activity was increased significantly, whereas the alpha-amylase secretion in the resting saliva was decreased.

[Effect of light cured sealants for occlusal surfaces on discoloration and plaque accumulation on removable partial dentures]. / Der Einfluss lichthärtender Oberflächenversiegelungslacke auf Verfärbung und Plaque- akkumulation an herausnehmbarem Zahnersatz.

According to increased surface hardness and decreased solubility, as revealed in laboratory tests, an improved surface-quality of denture-base polymers after glazing with light-polymerized acrylic coating materials could be expected. However, in the present clinical study on 150 dentures half-side treated with light activated coating materials, already after 3 months of use the coated denture-halfs showed more frequently discolouration and increased plaqueaccumulation in comparison with the uncoated control-sides. Scanning microscopic examination revealed an increasing roughness of the glazed surfaces during period of use.

[Possibilities and limitations of Caridex System as an alternative to conventional caries removal]. / Möglichkeiten und Grenzen des Caridex-Systems als Alternative zur herkömmlichen Kariesentfernung.

Exclusive use of chemo-mechanical Caridex-Caries removal system allows only in a few cases sufficient removal of caries. In histological investigation 108 of 120 cavities (90%) treated with the Caridex-system showed residual caries. In 92 cavities (77%) remaining bacteria could be observed. Whereas if combination of Caridex and spoon excavator was used in 25% respectively 23% a better caries removal as in case of using a spoon-excavator alone respectively a round bur was obtained. Scanning microscope examination of cavity wall after treatment with Caridex showed an increased roughness of the dentin surface. Therefore a superior shear bond strength of bonding and composite materials can be expected.

[Alterations of teeth and jaws in children with chronic renal failure]. / Zahn- und Kieferveränderungen bei chronischer Niereninsuffizienz im Kindesalter.

Dental examination of 50 children with chronic renal failure revealed enamel hypoplasia in 26 (52%), retardation of dental age in 18 (36%) and delay of dental eruption in 16 (32%) cases. In comparison to normal children the prevalence of caries was significantly lower. Half of the children showed radiologic changes in the jaw-bones already during preterminal stage of renal insufficiency. The possible role of the dentist concerning early diagnosis of renal failure is discussed.