Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal.

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0-15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case-control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04-1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13-8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

OBJECTIVE: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. METHODS: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. RESULTS: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545). CONCLUSION: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. CLINICAL RELEVANCE: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

OHRQoL in a Sample of Alcohol and Drug Abusers.

AIMS: To determine oral health related quality of life (OHRQoL) in a large sample of substance abusers and to evaluate the effect of dental treatment on OHRQoL. DESIGN: A longitudinal observational study. SETTINGS: A dental care clinic specialized in treating severely addicted patients. PARTICIPANTS: A sample of severely addicted substance abusers. MEASUREMENTS: OHRQoL was measured using the OHIP-14, which was filled out at baseline (T0), prior to the first treatment session (T1), after about 6 treatment sessions (T2) and on the last day of treatment (T3). FINDINGS: Mean OHIP scores did not change from T0 to T1. At T1, a mean OHIP-14 total score = 37.1 (sd=12.4, N = 392) was found. The highest mean scores were observed for the subscales physical pain and psychological discomfort. Data from 129 patients was available on both T1 and T2. The mean OHIP-14 total score reduced significantly (mean difference = 5.63, 95% CI 3.76 - 7.51), t(128)=5.94, p <0.001. The highest reduction in mean score was found for the subscale physical pain (mean difference = 1.24, 95%CI 0.81 - 1.66). Also between T2 and T3 a significant reduction in OHIP-14 total score (mean difference = 2.41, 95%CI 0.06-4.76) took place. CONCLUSION: The oral health status of substance abusers does have a substantial effect on their quality of life, which can be improved to a great extent by dental treatment based on a model tailored to addicted patients.

Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors.

An unfavourable and unanticipated pattern of the bilateral sagittal split osteotomy (BSSO) is generally referred to as a 'bad split'. Patient factors predictive of a bad split reported in the literature are controversial. Suggested risk factors are reviewed in this article. A systematic review was undertaken, yielding a total of 30 studies published between 1971 and 2015 reporting the incidence of bad split and patient age, and/or surgical technique employed, and/or the presence of third molars. These included 22 retrospective cohort studies, six prospective cohort studies, one matched-pair analysis, and one case series. Spearman's rank correlation showed a statistically significant but weak correlation between increasing average age and increasing occurrence of bad splits in 18 studies (ρ=0.229; P<0.01). No comparative studies were found that assessed the incidence of bad split among the different splitting techniques. A meta-analysis pooling the effect sizes of seven cohort studies showed no significant difference in the incidence of bad split between cohorts of patients with third molars present and concomitantly removed during surgery, and patients in whom third molars were removed at least 6 months preoperatively (odds ratio 1.16, 95% confidence interval 0.73-1.85, Z=0.64, P=0.52). In summary, there is no robust evidence to date to show that any risk factor influences the incidence of bad split.

Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial.

BACKGROUND: Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET. METHODS: This study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants' dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis. DISCUSSION: This study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia. TRIAL REGISTRATION NUMBER: ISRCTN25824611 , Date of registration: 26 October 2015.

Self-reported gagging in dentistry: prevalence, psycho-social correlates and oral health.

Although gagging has a profound effect on the delivery of dental care, it is a relatively under-investigated phenomenon. This study aimed to derive a prevalence estimate of gagging during dental treatment based on patient-reported information, to determine some socio-demographic and psychological correlates and to assess the relationship of gagging with self-reported oral health and avoidance of dental care. Data were collected with a survey among Dutch twin families (n = 11 771). Estimated overall prevalence of gagging during dental treatment was 8·2% (95% CI 7·7-8·7). Patients' self-report of gagging was found to be significantly associated with female sex, a lower level of education and higher levels of dental trait anxiety, gagging-related fears (e.g. fear of objects in the mouth), anxious depression and neuroticism. Gagging also appeared to be significantly associated with untreated cavities, gingival bleeding and wearing full dentures, but not with avoidance of dental care. It can be concluded that individuals who report to gag during dental treatment are moderately dentally anxious, fear-specific situations that can trigger a gagging response and, albeit visiting the dentist equally frequently, report to have a poorer oral health compared to those who do not gag.

Predictors for the development of temporomandibular disorders in scuba divers.

The aim was to determine predictors for the development of complaints of temporomandibular disorders (TMD) in a large sample of Dutch scuba divers who were free of any TMD complaints before they started diving actively. Five-hundred and thirty-six scuba divers (mean ± SD age = 40.4 ± 11.9 years; 34.1% women) completed a specifically developed questionnaire, either online or on paper. Stepwise forward logistic regression analysis was performed to predict the presence of TMD pain, with several potential risk factors as predictors. Four hundred and eighty-five of the 536 respondents were free of any TMD pain before they started diving actively. In this sample, TMD pain was present in 214 persons (44.1%). Four predictors contributed significantly to the presence of TMD pain, viz., clenching (OR = 2.466), warm water (OR = 1.685), biting on the mouthpiece (OR = 1.598), and the quality rating of the mouthpiece (OR = 0.887, that is, a higher rating means a smaller odds of having TMD pain). TMD pain is a common complaint among scuba divers who were free of such complaints before they started diving actively. Clenching, biting on the mouthpiece, and a low rating of the mouthpiece are predictors for the presence of TMD pain in scuba divers, while diving in cold water serves as a protective factor for TMD pain.

Attitudes towards individuals with halitosis: an online cross sectional survey of the Dutch general population.

OBJECTIVE: To derive an estimate of encounters with halitosis and to assess the impact of halitosis on their psychosocial interactions with halitosis patients. METHODS: Participants were 1,006 members of an online panel, being representative of the population of the Netherlands with regard to gender, age, family situation, education level and labour participation. They were invited to participate in a survey using an online questionnaire with four questions on becoming faced with people having halitosis. RESULTS: Almost 90% of the participants indicated being faced with a person having halitosis regularly, 40% at least once a week, and men significantly more frequently than women. Halitosis was reported to be a strong 'downer' when meeting a person for the first time. Whether one would draw a person's attention to his breath malodour proved to be related to the kind of person involved and appeared to decrease with the increase of the social distance to the person. Drawing a person's attention to his breath malodour would virtually always be performed personally. CONCLUSION: Halitosis is considered to be one of the most unattractive aspects of social interactions and has potentially damaging effects on psychosocial interactions and relationships.

A comparative study of the Osstell™ versus the Osstell Mentor™ to evaluate implant stability in human cadaver mandibles.

The aim of this study was to assess the primary stability of dental implants by resonance frequency analysis (RFA) using the Osstell™ and Osstell Mentor™ devices and to investigate the reproducibility and comparability of the results obtained with these devices. Twenty-four Straumann implants (Straumann AG, Basel, Switzerland) were placed in the anterior mandible of 12 fresh edentulous human cadaver mandibles. The implant stability quotients (ISQs) were measured with the Osstell™ and Osstell Mentor™ when implants were inserted at 50% of their length and following their complete insertion. The Osstell™ device measured lower scores compared with the Osstell Mentor™. This was significant for the full position (mean difference = 9·9), t (11) = 7·4, P < 0·001 and for the halfway position (mean difference = 5·9), t (11) = 2·41, P = 0·03. In conclusion, the Osstell™ produced relatively lower ISQ scores than the Osstell Mentor™.

A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears.

Evidence from twin studies suggests that genetic factors contribute to the risk of developing a fear or a phobia. The aim of the present study was to review the current literature regarding twin studies describing the genetic basis of specific phobias and their corresponding fears. The analysis included five twin studies on fears and ten twin studies on specific phobias. Heritability estimates of fear subtypes and specific phobia subtypes both varied widely, even within the subtypes. A meta-analysis performed on the twin study results indicated that fears and specific phobias are moderately heritable. The highest mean heritability (±SEM) among fear subtypes was found for animal fear (45%±0.004), and among specific phobias for the blood-injury-injection phobia (33%±0.06). For most phenotypes, variance could be explained solely by additive genetic and unique environmental effects. Given the dearth of independent data on the heritability of specific phobias and fears, additional research is needed.

[Self-perceived oral odour and social interaction]. / Subjectieve mondgeurperceptie en sociaal functioneren.

This study examined the influence of self-perceived oral odour on social interaction. A representative sample of 1,082 people from the Dutch population of 16 years and older, were surveyed. On average, the participants graded their oral odour as 66.8 on a scale 0-100; 4.2% judged their oral odour as 'not fresh' (score < or = 30). Approximately 65% indicated that they took into account the fact that, when meeting somebody for the first time, that person might smell their oral odour. Participants judging their oral odour to be not fresh were shown to keep significantly more distance when meeting somebody than participants judging their oral odour as fresh. Noteworthy was a subgroup of participants who judged their oral odour as fresh, but indicated that they always kept a certain distance to other people. The results suggest that self-perceived oral odour is a potential barrier in social interaction.

Reliability and validity of a continuous pain registration procedure.

BACKGROUND: Conventional pain rating scales [i.e. visual analogue scales (VAS) or numerical rating scales (NRS)] only provide a summary for different levels of pain felt, while the duration of these levels is not accounted for. If pain can be rated continuously, the area under the curve (AUC) of varying pain intensity over time can be calculated, which integrates varying pain intensity with duration. The present study examined the reproducibility and validity of a continuous pain rating procedure. METHODS: Twenty-eight healthy volunteers participated. Pain was induced using constant current delivered to the non-dominant forearm using bipolar electrodes. Pain was rated continuously on an electronic VAS monitored by a computer. For each participant, the level of current needed to achieve a weak, mild, slightly moderate and moderate level of pain was determined (part I). Next, participants were asked to rate the painfulness of six periods of electrical stimulation (part II). Unknown to the participants, they were presented with the four levels of current obtained in part I, where the level of current for mild and moderate pain was presented twice (in order to assess consistency). The order of presentation was randomized for all subjects. RESULTS: In general, participants produced reliable mean AUCs. In addition, the AUC of pain intensity over time could clearly discriminate between the four levels of pain used in the present study. DISCUSSION: A continuous pain registration procedure, using an AUC approach, may be a promising direction to explore. Results can be improved by allowing more training on the use of the electronic VAS.

The internal responsiveness of the Oral Health Impact Profile-14 to detect differences in clinical parameters related to surgical third molar removal.

PURPOSE: The present study examined the internal responsiveness of the short-form Oral Health Impact Profile (OHIP-14) and its ability to differentiate between patients with and without pre- and postoperative complaints as well as other clinical variables. METHODS: The sample consisted of 97 patients undergoing surgical third molar removal. The OHIP-14 was filled in preoperatively, on each postoperative day for a week and once more after 1 month. In addition, pre- and postoperative status was measured along with other clinical variables. RESULTS: The OHIP-14 is able to differentiate between the first preoperative day (M = 16.85, SD = 5.35) and all the days within the postoperative week (first day M = 29.46, SD = 9.32). One month postoperatively, mean OHIP scores are reduced to preoperative levels. In addition, differences could be shown between patients with and without pre- (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9) and postoperative complaints (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9), partial (preop; M = 17.8, SD = 6.8, postoperative; M = 27.4, SD = 7.7) and complete mucosa coverage (preop; M = 15.9, SD = 3.2, postoperative; M = 29.5, SD = 10.6) and the level of impaction (Pell and Gregory classification) of the third molar (3B showing the highest increase in the mean OHIP score). CONCLUSIONS: The OHIP-14 can be considered internally responsive to changes in impacts of oral conditions as a result of surgical third molar removal and is able to differentiate the effect of several clinical variables.

Child dental anxiety, parental rearing style and referral status of children.

OBJECTIVE: Treating children can be difficult for both dentist and child. In some cases treatment fails and those children are referred to a specialist paediatric dentist. Different factors can be put forward for referral of children, such as factors relating to the child, dentist and parent. Possible child-related factors can be dental anxiety and the child's temperament. A possible parental factor is the parental rearing style. The objective of this study was to assess the possible associations between dental anxiety, parental rearing style and referral status of children. METHODS: Parents of 120 non-referred and 335 referred paediatric dental patients were asked to fill out the Child Rearing Practices Report (CRPR) and the Child Fear Survey Schedule Dental Subscale (CFSS-DS) on behalf of their children. RESULTS: The questionnaires were filled out by 115 (96%) parents of primary schoolchildren and by 331 (99%) parents of referred children. Referred children were younger than non-referred children, t(442) = 6.9, p < 0.01, and had significantly more dental anxiety, t(430) = -8.7, p < 0.01. No differences existed between parents of referred children and parents of non-referred children on parental rearing-style. No differences existed between fearful and non-fearful children on parental rearing-style and also no correlation existed between children's dental anxiety and their parent's rearing style. However, non-referred children with parents using an authoritarian parenting style were more anxious than the other non-referred children. CONCLUSIONS: In the present study, referral status and dental anxiety of 4-12 year old children were not associated with parental rearing style.

[Quality of life related to oral health among addicts]. / Mondgezond heidgerelateerde levenskwaliteit van verslaafden.

In this study, the impact of oral health on the daily functioning of a group of individuals addicted to alcohol and/or drugs that were being treated at a centre for specialized dentistry in Amsterdam was investigated. Every new patient who reported to the clinic received the OHIP-14-questionnaire at home by post with the request that it be filled in and returned. A total of 110 usable questionnaires were returned (response 27.5%). The average OHIP-score (40.6; standard deviation 12.9) can be termed substantial when compared to other patient groups. On the subcategories 'physical pain', 'psychological discomfort' and 'psychological disability; the patients scored highest, and on the subcategory functional limitations' the lowest. The poor oral health of the patient group studied has a substantial impact on daily functioning. These baseline results will be used for measuring the effect of dental health treatment at this centre for specialized dentisty.

[Quality of life is a dynamic concept]. / Levenskwaliteit is een dynamisch concept.

Quality of life is a subjective evaluation/appreciation of the degree to which someone is satisfied with life in general. This subjective evaluation is not necessarily consistent. Factors determining one's quality of life may differ interpersonally, but also intrapersonally. Quality of life is a dynamic concept which cannot easily be expressed mathematically.

[Tooth development disturbances following haematopoietic stem cell transplantation]. / Langetermijneffecten op de gebitsontwikkeling na stamceltransplantatie.

Forty children treated with allogenic haematopoietic stem cell transplantation for haematological malignancies, were examined at least 2 years after transplantation. The researchers collected information concerning subjective oral symptoms, the results of a panoramic radiograph and the findings of an oral examination. Nearly all children had tooth development disturbances, including missing teeth, shortened roots, and arrested root development. The study group showed a significantly higher prevalence of missing teeth than the standard values for first and second premolars in both maxilla and mandible, as well as for second molars in the mandible. Children younger than 3 years of age at the start of the treatment missed significantly more teeth than older children. The mean root-crown length ratios of several tooth types were lower when compared with a control group of healthy Finnish children. The mean dental age was higher than the mean chronological age due to early final apical root formation.

[Patterns of tooth agenesis. A numerical code for describing dental agenesis]. / Patronen van ontbrekende gebitselementen. Een numerieke code om dentale agenesieën te beschrüjven.

A genetic or developmental disorder can be the basis for the failure of a normal dental development, resulting in the absence of 1 or more teeth. For genetic research or the development of a plan of treatment, it is important to determine whether certain patterns of dental agenesis are more common than others. In the present article a new method is described where unique values are assigned to certain patterns of tooth agenesis. Using the idea of binary arithmetic, the absence or presence of teeth are represented by 1 and 0, and translated into corresponding unique values, the 'tooth agenesis code' (TAC). This procedure has advantages over existing methods in that it allows for easier data analysis, can contribute to genetic research into the aetiology of tooth agenesis and enables researchers to communicate unequivocally the phenotypes of their studied case. It can also be used in other areas of oral pathology that require pattern recognition.

Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children.

PURPOSE: The purpose of this study was to assess late effects of cytotoxic therapy with hematopoietic stem cell transplantation (HCT) on dental development in survivors of childhood cancer. MATERIALS AND METHODS: Forty children who underwent allogeneic HCT for a variety of hematological malignancies were evaluated at a minimum of 2 years after transplantation. We obtained information on oral symptoms, exposed panoramic radiographs (PRG), and performed an oral examination. PRGs were scored for agenesis and root and/or crown abnormalities. The root-crown ratio was calculated, and dental age was assessed using Demirjian' s method. MAIN RESULTS: The studied group showed a significantly higher prevalence of tooth agenesis compared to normative data for first and second premolars in both the maxilla and mandible, as well as the second molars in the mandible (all p values <0.001). Children who were <3 years old at the time of cancer treatment had significantly more missing teeth than older children, F(2,37) = 7.58, p < 0.002. Root-crown ratios were lower in the study sample than those from normative data. In addition, the mean dental age was higher (as a result of earlier apical root closure) than the mean chronological age, t(28) = 2.47, p < 0.020. CONCLUSIONS: Nearly all children examined had dental development disturbances, including agenesis, short roots, and arrested root development. An oral/dental evaluation and preventative oral supportive care regimens should be part of programs monitoring late effects in long-term survivors of childhood cancer.