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PubMed1994

Outcome measures in split mouth caries trials and their statistical evaluation.

The split mouth study design in trials of fissure sealants and restorative materials neatly controls for confounding by many of the variables associated with poor retention of sealants and occurrence of dental caries. Traditionally, the outcome measures used in split mouth trials have been material retention, (per cent) effectiveness and net gain. A survey of the literature revealed that a large proportion of split mouth studies report no statistical evaluation of outcome measures. In those studies in which statistical evaluation had been conducted, McNemar's X2 was the test most frequently used. This statistic is appropriate for comparing differences between "success" and "failure" tooth pairs (or "positives" and "negatives" in split mouth terminology) but it cannot evaluate directly effectiveness and net gain. The distributions of effectiveness and net gain are different and it would be desirable to estimate confidence intervals for them. In this paper, we consider these statistics, suggest methods by which confidence intervals may be calculated, and provide examples of the calculations. We demonstrate the close relationship between effectiveness (as used in split mouth trials) and relative effect and relative risk (as used in general epidemiological analysis) and recommend that relative risk should be the preferred outcome measure for split mouth trials. Whatever outcome measure is chosen in split mouth trials should always be subjected to statistical evaluation, preferably by the calculation of confidence intervals.

Bias↗
PubMed1997

Prevalence of perceived symptoms of dry mouth in an adult Swedish population--relation to age, sex and pharmacotherapy.

The aim of the study was to evaluate the prevalence of subjective perception of dry mouth in an adult population and to determine the prevalence of pharmacotherapy in this population. An additional aim was to assess a possible co-morbidity between symptoms of dry mouth and continuing pharmacotherapy. Four-thousand-two-hundred persons were selected at random from the national census register of the adult population of the southern part of the province of Halland, Sweden. The sample was stratified according to age and sex, and 300 men and an equal number of women aged 20, 30, 40, 50, 60, 70 and 80, were included. A newly developed questionnaire was mailed to each individual. In addition to questions about subjective perception of dry mouth, the subjects were asked to report on present diseases and continuing pharmacotherapy. Three-thousand-three-hundred and thirteen (80.5%) evaluable questionnaires were returned. The estimated prevalence of xerostomia in the population was 21.3% and 27.3% for men and women, respectively. This difference between the sexes was statistically significant. In non-medicated subjects, women tended to report a higher prevalence of xerostomia compared with men, 18.8% vs. 14.6%, and also among medicated subjects the estimated prevalence of dry mouth was higher for women than for men, 32.5% vs. 28.4%. There was a strong association between xerostomia and increasing age and also between xerostomia and continuing pharmacotherapy. The average prevalence of dry mouth among medicated and non-medicated subjects was 32.1% and 16.9%, respectively, the difference being statistically significant. There was also a strong association between xerostomia and the number of medications. In a logistic regression, the probability of reporting mouth dryness was significantly greater in older subjects and in women, and the probability increased with the number of medications taken. In conclusion, this epidemiological survey of an adult population has demonstrated that women, independent of age, do report a higher prevalence of xerostomia than men and that the symptom of dry mouth is strongly associated with age and pharmacotherapy. It is, however, not possible to discriminate between disease and pharmacotherapy as causal factors.

Adult↗
PubMedDate not supplied

Perception of dry mouth in a sample of community-dwelling older adults in Japan.

The purpose of this study was to examine the prevalence of perceived dry mouth among a group of independently-living elderly persons in Japan, and to determine its association with general disease, medication, and dental status, as well as its effect on oral function. The study population consisted of participants of the Senior Citizens' College. The subjective sensations of oral dryness on waking and while eating a meal were measured by a questionnaire. The number of usable questionnaires was 1003 or 77.9%. The mean age of the subjects was 66.3 +/- 4.2 years, and 53.0% were male. More than one-third (37.8%) of the subjects reported oral dryness on waking. Only 9.1% of them noticed a subjective feeling of dry mouth during eating. Persons who had at least one of these symptoms made up 41.0%. A multiple stepwise logistic regression analysis indicated the following results: Perception of dry mouth on waking was more frequent among males (p < 0.001), persons who had a low BMI (p < 0.05), and those taking two or more prescribed drugs (p < 0.01). Sensation of dry mouth when eating was more frequent among subjects with a low BMI (p < 0.001) and those who wore a denture in the maxillary arch (p < 0.05). Perception of dry mouth when eating was associated with self-assessed chewing ability (p < 0.01) and dissatisfaction with speaking clearly (p < 0.05), as well as dental status. However, dissatisfaction with tasting a meal had a significant relationship with the reports of mouth dryness on waking (p < 0.01). Our findings suggest that a substantially higher percentage of persons have the perception of dry mouth on waking than when eating, which was associated with medications, being male, and having a low BMI. This perception may influence oral function, especially the reported dissatisfaction with tasting foods.

Aged↗
PubMed2006

Influence of mouth washing procedures on the removal of drug residues following inhalation of corticosteroids.

Mouth washing after inhalation of corticosteroids is effective for prevention of local adverse effects such as hoarseness and oropharyngeal candidiasis. To establish an optimal procedure for such mouth washing, we investigated the removal rates of drug residues remaining on the oropharyngeal mucosa using various mouth washing methods following inhalation. A beclomethasone dipropionate metered dose inhaler (BDP-MDI) (100 microg) and a fluticasone propionate dry powder inhaler (FP-DPI) (100 microg) were used. The effects of different mouth washing methods were evaluated by quantification of drugs in the expectorated rinse solution using an HPLC method. The amounts of BDP recovered in the rinse after gargling and rinsing for 5 s each were 47.1+/-13.6 microg, while they were 42.9+/-9.4 microg after rinsing alone for 10 s and 38.7+/-9.2 microg after gargling alone for 10 s. Under the same conditions, FP amounts were 32.9+/-7.3 microg, 28.9+/-2.4 microg, and 27.1+/-7.9 microg, respectively. In a comparison of washing time, the amounts of BDP recovered were 49.8+/-9.7 microg after gargling and rinsing for 2 s each, 53.5+/-10.2 microg after those for 3 s each, and 47.1+/-13.6 microg after those for 5 s each, while the amounts of FP under the same conditions were 36.4+/-2.4 microg, 33.3+/-6.4 microg, and 32.9+/-7.4 microg, respectively. As for the effect of time lag before mouth washing, the amount of BDP recovered decreased by 65.7% with a lag time of 1 min and by 5.6% after 10 min, while that of FP decreased by 51.1% with a lag time of 1 min and by 7.7% after 10 min. Our results suggest that the amount of drugs removed by mouth washing is significantly associated with the time lag between inhalation and mouth washing. We concluded that immediate gargling and rinsing after inhalation is most useful for the removal of drugs following inhalation of corticosteroids.

Administration, Inhalation↗
PubMed1995

An analysis of the reinforcing properties of hand mouthing.

Hand mouthing often has been described as a stereotypic response that is maintained by nonsocial (automatic) reinforcement; however, data supporting this conclusion can be found in relatively few studies. This series of studies presents an experimental analysis of conditions associated with the maintenance of hand mouthing. In Experiment 1, a functional analysis was conducted for 12 individuals who engaged in chronic hand mouthing, to determine whether the behavior is usually maintained independent of social contingencies. Results obtained for 10 subjects were consistent with an automatic reinforcement hypothesis; the remaining 2 subjects' hand mouthing was maintained by social-positive reinforcement. Based on these results, Experiment 2 was designed to identify the specific reinforcing properties of hand mouthing. Each of 4 subjects was provided with a toy that substituted for hand mouthing, and preference for a specific topography of toy manipulation (hand-toy contact or mouth-toy contact) was measured. Results indicated that hand stimulation was the predominant reinforcer for all subjects. Experiment 3 provided an extension of Experiment 2 in that the same responses were measured across a variety of toys presented to each of 5 subjects. Results again indicated that hand stimulation was the predominant reinforcer for all subjects. Implications of these results are discussed with relevance to treatment.

Adult↗
PubMed1978

Partial and full mouth recording of gingivitis scores.

Sixty-six dental students, randomly assigned to one of three examiners, were scored initially for gingivitis using the Columbia gingival index (GI). After four weekly prophylaxes, gingival scores for all teeth were recorded at day 0. Following prophylaxes, all subjects were randomly assigned one of three mouthwash formulations. Gingival scores were taken on the full mouth after three weeks and again after six weeks. Pearson product moment correlation coefficients (r) were obtained for the gingivitis index from six selected teeth (partial score) with the full mouth score, usually based on 24 to 28 teeth. GI scores obtained from partial recording on the six selected teeth correlated very well with scores obtained from full mouth examinations. A special study was set up to obtain independent GI readings for the six target teeth and for the full mouth. GI scores obtained by independent examinations of the six selected teeth also correlated well with the full mouth scores, although not as well as when the partial scores were derived from the full mouth scores. Partial scores should only be compared with partial scores obtained from evaluating the same teeth and not with full mouth scores, in clinical trials or epidemiologic surveys.

Drug Evaluation↗
PubMed1996

[Mouth mask method for fiberoptic tracheal intubation in difficult intubations].

We tried 72 fiberoptic tracheal intubations (FTI) using a mouth mask in difficult intubation cases. In this method, ventilation is performed via only the mouth using a mask applied over the mouth (mouth mask) and FTI can be done via a nostril with no hindrance from the mask in anesthetized patients. We have been using an infant or child type Seal Mask (Gibeck Respiration) for the mouth mask or a specially made mouth mask. An oral airway is usually inserted and the nostril of one side is plugged with cotton. FTI is performed by another anesthesiologist. An endotracheal (ET) tube capped with a rubber diaphragm is passed through another nostril, and a fiberscope is inserted through the ET tube. The subsequent technique is the same as that of the usual FTI for awake patients. Intubations were successful in all cases except 2; in one, ventilation was impaired even with oral airway in place, and in the other, bleeding in upper airway due to jaw injury from traffic accident hindered the sight of the scope. Mouth mask method for FTI is safe, useful and practical in difficult intubations with little discomfort to the patient.

Adolescent↗
PubMed1998

Prevalence of symptoms of dry mouth and their relationship to saliva production in community dwelling elderly: the SEE project. Salisbury Eye Evaluation.

OBJECTIVE: To estimate the prevalence of dry mouth symptoms and their correlation with saliva production in a population based sample of elderly people in the United States. METHODS: Two dry mouth questions were administered to and a modified Saxon test was performed in participants in a population based prevalence survey conducted among 2520 noninstitutionalized community dwelling residents of Salisbury, Maryland, aged 65-84 years. RESULTS: Seventeen percent reported having either dryness of mouth or waking at night feeling dryness in the mouth and needing to drink fluids often or all the time; 10.7% noted the former and 11.5% the latter. The prevalence of dry mouth symptoms increased with increasing age, was greater in women than men, and was greater in whites than blacks. The mean (SD) amount of saliva production was 2.38 (1.00) g/min; mean saliva production decreased with increasing age and was lower in women than men; no difference was noted by race. Persons with dry mouth symptom either often or all the time had significantly lower salivary production, even after adjustment for age and sex. CONCLUSION: Symptoms of dry mouth are common in the community dwelling elderly population, especially in white women, and correlate with decreased salivary production.

Age Factors↗
PubMed2003

Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma.

The decreased mouth opening (microstomia) represents a frequent finding in patients with systemic scleroderma (SSD), but little information is available about the efficacy of nonsurgical management of this condition. The aim of this study is to assess the effects of a nonsurgical exercise program on the decreased mouth opening in a group of 10 SSD patients with severe microstomia (maximal mouth opening < or =30 mm). The subjects were instructed to perform an exercise program including both mouth-stretching and oral augmentation exercises. The effects of such exercises were assessed after an 18-week period by measuring the maximal mouth opening of each subject. All patients completed the study and no adverse effects occurred, with the exception of transient muscular fatigue. The exercise program improved the mouth opening of all subjects (mean increase: 10.7+/-2.06 mm, P<0.005), without significant differences between dentate and edentulous ones (P>0.1). At the end of the 18-week period, all patients commented that eating, speaking and oral hygiene measures were easier. The edentulous subjects also experienced less difficulty inserting their own dentures. These findings suggest that regular application of the proposed exercise program may be useful in the management of microstomia in SSD patients.

Adult↗
PubMed2004

Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth.

The incidence of occult neck metastasis in early stage tumours of the tongue and floor of the mouth varies from 20% to 30%, and the survival rates in 5 years from 73% to 97%. This study analyzes the rates of occult metastasis and prognostic factors for clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. The records of patients with squamous cell carcinoma of the tongue and floor of the mouth, without prior treatment and treated by surgery between 1965 and 1998 were reviewed. All cases were re-staged and the surgical specimens were reviewed. This study included 193 patients, 145 men (75.1%), with ages ranging from 29 to 89 years old (mean, 60 years). The tumour site was the tongue in 132 cases (68.4%), the floor of the mouth in 45 (23.3%) and both in 16 (8.3%). With regard to stage, 85 cases were at clinical stage I (44.0%) and 108, clinical stage II (56.0%). One hundred and seventeen patients (60.6%) were submitted to a neck dissection and 27 (23.1%) had metastasic lymph nodes (pN+). The only factor associated with the presence of occult metastasis for all patients was the presence of muscular infiltration (p = 0.020); for tongue tumours the presence of vascular embolization (p = 0.043) and the presence of desmoplastic reaction (p = 0.050); for floor of the mouth tumours and T2 tumors, the histological grade (p = 0.025 and p = 0.035, respectively). Disease-free survival in 5 years was 66.4% and overall survival in 5 years 68.5%. The only factor associated with disease-free survival was the presence of muscular infiltration (p = 0.019) and with overall survival were gender (p = 0.002) and clinical stage (p = 0.031). Tumours of the tongue and floor of the mouth in the initial stages, which had muscular infiltration showed a higher probability of occult metastasis and lower disease-free survival; T2 tumours showed a worse survival as did patients of the male gender.

Adult↗
PubMed1985

Surgery for squamous cell carcinoma of the tongue and floor of the mouth.

Surgery for cancer of the tongue and floor of the mouth has become more varied and generally more conservative, influenced by advances in oncology and modern reconstructive methods. Combined therapy is favored, with postoperative irradiation and sometimes adjunctive chemotherapy, using cis-platinum. T1 carcinomas of the tongue and floor of the mouth can be treated with either wide local excision or irradiation alone, but surgery is the preferred method. T2-T4 tumors treated by resection combined with radiation therapy promise the best results. The indications and principles of the most important operative procedures are discussed: local excision; partial and total glossectomy; excision of the floor of the mouth with marginal mandibular resection; composite resection. Mandible sparing operations such as a modification of the "pull through" technique described by Stell or temporary splitting of the mandible are oncologically safe in many cases. A radical neck dissection is indicated in each carcinoma of the tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection appears justified in view of the high frequency of clinically occult lymph node metastases. Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining mobility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible. For immediate reconstruction, the most frequently used technique is the pectoralis major myocutaneous flap which has largely replaced the previously employed local and regional flaps. A significant problem remains with mandibular reconstruction.

Carcinoma, Squamous Cell↗
PubMed2004

In vitro study of the influence of physiological parameters on dynamic in-mouth flavour release from liquids.

Influences of shear rate (surface extension), airflow, in-mouth headspace volume, synthetic saliva and human epithelial cells (modelling mucosa) on the initial dynamic flavour release from liquids were analysed. Simulating physiological mouth parameters, initial dynamic flavour release experiments over a time period of 30 s were carried out using a proven mouth model apparatus. Flavour compounds of different chemical classes were dissolved in water or in aqueous starch hydrolysate in concentrations typically present in food ( micro g/l to mg/l). Forced by increasing shear rates the enlargement of the gas-liquid interface (vortex formation) caused an increased release of flavour molecules. The release of less soluble compounds was reduced by increasing shear forces due to an improved dissolution. Increasing volumetric airflow rates resulted generally in higher release rates and in a change of pattern of release kinetics. Maximum flavour release was found at a ratio of 1:1 for in-mouth headspace and liquid volume. Neither addition of saliva alone nor the combination of saliva and mucosa showed significant influence on in-mouth flavour release from liquids in the model mouth.

Chromatography, Gas↗
PubMed2005

Comparison of mouth guard designs and concussion prevention in contact sports: a multicenter randomized controlled trial.

OBJECTIVES: To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby. DESIGN: : Multicenter, cluster-randomized, controlled trial comparing the WIPSS Brain-Pad mouth guard against the standard use mouth guard of choice. Teams were monitored by their respective athletic therapist, trainer, or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma. Concussion symptoms were also recorded at the time of injury. SETTING: Five Ontario universities. PARTICIPANTS: University male football (394) and university male (129) and female (123) rugby athletes reporting to 2003 fall training camps. MAIN OUTCOME MEASUREMENTS: The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines. Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms. RESULTS: There was no significant difference in the number of concussions observed between the intervention and control arms of this trial (P = 0.79; odds ratio, 1.06, in favor of controls; 95% CI, 0.51, <<1.61). No dental trauma events occurred. The 5 most common symptoms experienced by concussed athletes were dizziness, general headache, nausea, loss of visual focus, and personality changes. CONCLUSIONS: In this study, concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards.

Adolescent↗
PubMed1987

The surface area of the adult human mouth and thickness of the salivary film covering the teeth and oral mucosa.

The surface area of the mouth was measured to calculate the average thickness of the salivary film which separates the opposing layers of the oral mucosa and which also overlies the dental plaque. The subjects were 10 adults of each sex, all of whom had essentially a full complement of teeth. Impressions were taken of the upper and lower jaws, the buccal and labial vestibular mucosa, and the ventral surface of the tongue, and stone models were cast. The dorsum of the tongue was assumed to have the same area as the palate plus that of the palatal surfaces of the upper teeth. The six separate areas considered were the teeth, the palate, the buccal and lingual gingival and alveolar mucosa, the buccal and labial vestibular mucosa, the ventral surface of the tongue, including the floor of the mouth, and the dorsum of the tongue. Aluminum foil, of known weight per unit area, was adapted to the models of the different regions of the mouth, and the surface areas were calculated from the weights of the foil. The mean total surface area of the mouth was 214.7 +/- 12.9 cm2, and there was no significant difference due to gender. The teeth, keratinized epithelium, and non-keratinized epithelium occupied about 20%, 50%, and 30% of the total surface area, respectively. Given that the average volumes of saliva present in the mouth before and after swallowing have been estimated to be 0.77 and 1.07 mL, respectively, it can be calculated that the average thickness of the salivary film in the mouth varies between 0.07 and 0.10 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Intermittent positive pressure ventilation via the mouth as an alternative to tracheostomy for 257 ventilator users.

Despite wider application of the use of nocturnal intermittent positive pressure ventilation (IPPV) via nasal access for the management of nocturnal hypoventilation, there continues to be a lack of familiarity with the use of IPPV via the mouth for ventilatory support. Unlike nasal IPPV, which is generally practical only for nocturnal use, up to 24-h mouth IPPV was the key method of noninvasive ventilatory support that permitted the avoidance or elimination of tracheostomy for 257 individuals with acute or chronic ventilatory failure. Mouth IPPV was delivered via commercially available mouthpieces for daytime aid and mouthpiece with lip seal or custom orthodontic interfaces for nocturnal support. The use of mouth IPPV alone or in a regimen with other noninvasive ventilatory aids was reviewed for these 257 individuals. Mouth IPPV was used for nocturnal aid by 163 individuals, 61 of whom had little or no measurable vital capacity or significant ventilator-free breathing time, for more than 1,560 patient-years with few complications. It was also the predominant method of daytime ventilatory support for 228 individuals for more than 2,350 patient-years. We conclude that for individuals with adequate bulbar muscle function but chronic respiratory muscle insufficiency, mouth IPPV can be an effective alternative to tracheostomy. It can significantly prolong survival while optimizing convenience, safety, and communication.

Adolescent↗
PubMed1988

Detection of foot-and-mouth disease antigen in bovine epithelial samples: comparison of sites of sample collection by an enzyme linked immunosorbent assay (ELISA) and complement fixation test.

Serially collected epithelial samples from lesions in the mouth and on the feet of calves experimentally infected with foot-and-mouth disease (FMD) type O1 BFS 1860 were assayed for the presence of FMD viral antigen using a double antibody sandwich enzyme-linked immunosorbent assay (ELISA) and a complement fixation (CF) test. The amount of infectious virus in each sample was also determined. FMD viral antigen was detected by ELISA in 70 per cent of the mouth samples and 92 per cent of samples from the feet. The CF test was less sensitive; it detected antigen in 44 per cent of mouth and 85 per cent of foot samples. In mouth samples the amount of antigen decreased rapidly becoming undetectable by the fourth day of sampling whereas in foot samples the quantity of antigen declined more slowly, and could be detected until the seventh day of sampling. Therefore it was concluded that the age of lesion and the site from which epithelial samples are collected are both important determinants in the laboratory diagnosis of FMD. In cattle, foot lesions are more likely than mouth lesions to yield antigen and to remain positive for a longer period.

Animals↗
PubMed1984

Mouth protectors and sports team dentists. Bureau of Health Education and Audiovisual Services, Council on Dental Materials, Instruments, and Equipment.

A mouth protector must be easy to fabricate, comfortable, able to accommodate the needs of an individual's dentition, durable, easily held in place, and able to provide adequate protection to the teeth, jaws, and cranial structures. The thermoplastic mouth protector is recommended if it is to be placed or formed by the athlete; however, supervision of the fitting procedure by a dentist is recommended. The most desirable protector, however, is the custom-made mouth protector fabricated by a dentist from a thermoplastic material. With the custom-made protector, the dentist can optimize fit, comfort, and speech as well as tend to any control of form to the special dental requirements of the athlete. Thousands of football players have avoided oral injuries by wearing mouth protectors and faceguards. In other sports, dental safety still needs to be improved. National athletic organizations should be urged to require players to wear adequate mouth protectors. Dentists, health and physical education professionals, and other concerned persons should tell all athletes, patients, and parents, why mouth protectors are necessary and what types of protectors effectively reduce or minimize the incidence of injury. All organized sports teams should have their own team dentists to help ensure that players maintain the best possible oral health. If these actions are taken, fewer athletes will suffer the pain, inconvenience, and expense of unnecessary and frequently disfiguring oral injuries.

American Dental Association↗
PubMed2001

Location-probability profiles for the mouth region of human primary motor-sensory cortex: model and validation.

The mouth representation of the human, primary motor cortex (M1) is not reliably identified by surface anatomy but may be reliably localized by means of spatial coordinates. For this report, three quantitative metanalyses were performed which jointly described the mean location, location variability and location-probability profiles of the human M1-mouth representation. First, a literature metanalysis of intersubject functional-area variability was performed using eleven, per-subject studies, each of which reported a coordinate-referenced measure of intersubject variability for one or more brain areas. From these data, a weighted-mean value for intersubject variability was computed, which proved to be small (5.6 mm, standard deviation), consistent across coordinate axes (x, y, z), and consistent across brain areas. Second, a literature metanalysis of the location of M1-mouth was performed using seven, coordinate-referenced, group-mean studies (71 subjects in all), each of which reported a grand-average location for M1-mouth. From this, a weighted-mean location and weighted values for total variability (interlaboratory plus interindividual) were determined. Using these two literature metanalyses as input data, location-probability profiles were computed for the cardinal axes (x, y, and z) of the reference space, using the functional volumes modeling (FVM) statistical model. Third, an original-data metanalysis was performed on in-house PET data from 30 normal subjects performing overt-speech tasks. M1-mouth's mean location, location variability, and location-probability profiles were consistent with those conjointly modeled by FVM from the two literature metanalyses. Collectively, these observations provide a detailed, consensus probabilistic description of the location of the human M1-mouth representation in standardized coordinates.

Adult↗