Biomedical subjects
Publications and source records attributed to T D Rees.
Drug abuse is a major problem in the U.S. and most other countries of the world today. Many studies, surveys, and case reports have described the adverse social and medical effects of drug abuse; yet surprisingly little is known about the specific effects of many of these drugs in the oral cavity. This article reviews the current state of knowledge concerning the systemic and oral effects of drugs of abuse and the dental management of addicted patients.
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A 15-year-old patient with an unoperated complete bilateral cleft of the lip and palate was operated in 1955. The premaxilla was sacrificed and replaced with a prosthesis. The prolabium was hypoplastic and was used to reconstruct the columella. A follow-up of 33 years is presented.
One hundred twenty-one of 200 patients requesting a rhinoplasty completed a study designed to assess their psychological reactions to the operation. Preoperatively, each patient filled out a questionnaire about their expectations (both cosmetic and psychological), relationships, self-confidence, self-esteem, what they disliked about their noses, and other questions pertinent to an evaluation of the psychological effects of rhinoplasty. They also completed the Brief Symptom Inventory (BSI), a standardized psychological test. One month and 6 months postoperatively, they completed similar questionnaires. Preoperative and postoperative information was also obtained from the surgeon and nurse. Statistical analysis showed several interesting findings. A number of patients had increased self-confidence and self-esteem. Male patients did not show any sustained changes on the BSI, but female patients did with improved scores on the obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and phobic anxiety scales. A number of patients described mild-to-moderate depression postoperatively. This was correlated with preoperatively high levels of anxiety. The surgeon was usually more critical of the surgical result than were the patients. The patients whose strong positive feelings about the results he most misjudged were actually depressed. These and other findings are noteworthy to enhance the understanding of postoperative psychological reactions and provide insight into the psychological management of rhinoplasty patients.
This study examined how differences in infection control procedures and patients' perceived knowledge of infection control, and how AIDS and hepatitis might affect attitudes toward the use of such measures. Patients receiving treatment at two sites where the methods of infection control and the frequency of their use differed (dental school and private dental practices) were surveyed concerning their approval/acceptance of infection control measures and self-report of knowledge concerning infectious disease and possible transmission of infectious disease during dental treatment. Data were collected from 379 patients, 272 from the dental school and 107 from five private practices. A high percentage (95 percent) of both dental school and private patients felt they were adequately protected, while fewer than 2 percent expressed anxiety about infection control procedures being used in either setting. Factors such as gender, age, and years of formal education did not significantly affect attitudes toward infection control measures, but age and education were correlated with perceived knowledge of infectious diseases. Patients' reported knowledge of infectious disease had a significant effect on their decision to leave a practice if the dentist was HIV positive. A significantly higher percentage of dental school patients felt that barrier infection control techniques should be used routinely. Patients treated where such techniques were not routinely used nevertheless expressed satisfaction with that level of protection, implying that patients tend to accept the level of infection control being practiced where they receive treatment.
Sixteen patients developed a variety of oral lesions following a change in the toothpaste they used. Mucosal biopsy demonstrated features consistent with application of a topical medicament and patch testing, towards the constituents of the toothpastes, indicated the flavouring agent cinnamonaldehyde as being the likely responsible agent. Avoidance of the implicated toothpastes resulted in a considerable improvement in clinical signs and symptoms, whereas rechallenge in ten patients resulted in recurrence of symptoms in eight patients. It is concluded that sensitivity to the cinnamonaldehyde constituent of certain toothpastes, although uncommon, should be considered as a possible aetiological factor in patients presenting with non-specific oral changes.
This study was designed to investigate the absorption of a topical steroid applied to the gingiva and buccal mucosa of patients with erosive lichen planus and to healthy control patients. In addition, adrenal suppression was assessed by measurements of serum and urine cortisol levels. Ten patients with erosive lichen planus and eight control patients provided urine and blood samples at baseline, day 3, and day 21. After establishment of baseline laboratory values, patients were instructed to apply 500 mg of a 0.05% fluocinonide gel to the gingiva and buccal mucosa three times a day for 3 weeks. Measurements of cortisol levels revealed no significant changes in either the disease or the control group. Although procedures were developed to detect fluocinonide, none of the patients showed evidence of the steroid during the study. It was concluded that the topical application of a fluocinonide gel to the gingiva and buccal mucosa over a 3-week period in patients with erosive lichen planus produced no adrenal suppression.
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The Schirmer's test for tear production has been recommended to identify patients with diminished tear production prior to blepharoplasty. The decision to operate may rest with this simple clinical test. This paper reports a prospective clinical evaluation of 100 consecutive blepharoplasty patients to determine the role of preoperative assessment of the orbital and periorbital morphology and the Schirmer's test in predicting the likelihood of the development of the dry-eye syndrome (DES) postoperatively. Our findings indicate that the morphology of the orbital region is a more important and reliable method of evaluating a predisposition to developing dry eyes postoperatively than is the Schirmer's test. The value of the Schirmer's test is to flag patients prior to blepharoplasty, but it should not be relied on as the sole method of screening patients and it is definitely of less importance than the history and physical examination.
Two cases are reported in which the patients presented with solitary ulcers on the gingiva. The lesions were excised and examined histologically. A connective tissue infiltrate of large mononuclear cells was identified with immunohistochemical staining as Langerhans cells and a diagnosis of histiocytosis X was made. Further medical evaluation revealed no other lesions in one of the patients but did locate an infiltrate in the right mastoid of the other patient. Solitary lesions of histiocytosis in oral mucosa are extremely rare. The manifestations of the disease, pathogenesis, and treatment are discussed.
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Considerable controversy exists regarding the malignant potential of lichen planus. Although a number of cases of malignant transformation have been reported, many have lacked adequate documentation. A histologically well-documented case of squamous cell carcinoma on the dorsum of the tongue arising in a long-standing lesion of erosive lichen planus is presented.
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Twenty-five patients with severe internal and external deviation of the nose characterized by deviation of the septum in several planes and almost total obstruction of the airway on one or both sides were operated on. The entire bony and cartilaginous septum was removed in each of these patients, preserving the mucoperichondrial and mucoperiosteal flaps. The extramucosal technique of septal dissection was used. A support graft was fashioned from cartilaginous remnants of the septal cartilage and placed between the mucoperichondrial flaps as a free graft. All patients were followed for a minimum of 1 year. The longest follow-up is 15 years. Aesthetic improvement of the nose was obtained in all patients. All patients experienced varying degrees of improvement in nasal blockade.
Hydrogen peroxide has been advocated for many years as an oral rinse useful in control of various oral conditions. Several authorities, however, have suggested that this material may be harmful to oral tissues, especially if the tissues have been previously injured. This article presents two case reports demonstrating harmful oral effects from hydrogen peroxide rinses. The findings suggest that oral hygiene techniques emphasizing the use of 3% hydrogen peroxide in periodontal therapy may require reevaluation.
A case is reported of a patient with sudden onset, generalized toothache accompanied with a numb chin and lower lip. A thorough oral examination was negative. A complete medical evaluation revealed a positive HTLV-III antibody titer and acute lymphoblastic leukemia (Burkitt's-type). An unexplained trigeminal neuropathy should prompt the dentist to refer the patient for complete medical evaluation. A high index of suspicion of a malignant process should be maintained in all cases of unexplained numb lower lip and/or chin.