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Positional changes in the mandibular condyle and amount of mouth opening after sagittal split ramus osteotomy with rigid or nonrigid osteosynthesis.

PURPOSE: The purpose of this study was to investigate postoperative positional changes in the mandibular condyle and mouth opening in patients undergoing sagittal split ramus osteotomy with either rigid or nonrigid osteosynthesis. PATIENTS AND METHODS: The forty-six patients with mandibular prognathism underwent sagittal split ramus osteotomy for mandibular set back followed by fixation with one of four methods: circumferential wire (n = 11), lag screw technique (n = 10), positional screw technique (n = 10), or miniplates (n = 15). The changes in the condylar position were assessed by measuring the angle of the condylar long axis (the condylar angle) on submentovertex radiographs. Mouth opening was evaluated by measuring the interincisal distance immediately after the release of maxillomandibular fixation and by monitoring the duration of trismus. RESULTS: Regardless of the procedure used the condylar angle increased in most patients after surgery (80 of 92 condyles). Although the amount of increase tended to be higher with rigid osteosynthesis than with nonrigid osteosynthesis, no significant differences were observed among the groups. Mouth opening was not significantly influenced by the type of osteosynthesis, and no patient complained of limitation 1 year after surgery. CONCLUSIONS: Although inward rotation of the condyle frequently occurs after osteosynthesis regardless of the procedure used, the changes in condylar position are within the range of adaptability of the patient.

Adaptation, Physiological↗

Contributing factors of mandibular deformation during mouth opening.

OBJECTIVES: A decrease in mandibular arch width during forced opening has been documented. However, the contributing factors of mandibular deformations are still unclear. This study investigated the mandibular deformation during mouth opening, and searched for contributing factors related to this phenomenon. METHODS: Sixty-two dental students volunteered for this study. A linear variable differential transducer (LVDT) was cemented on the mandibular first molars to record mandibular deformation during mouth opening. Proposed factors including geometric factors of the mandible such as lower gonial angle, mandibular length, symphyseal width and height were measured from cephalometric analysis. Densitometric analysis was performed to detect symphyseal area and bone density. RESULTS: The changes in width between the mandibular first molars ranged from 20 to 437 microm, which was negatively correlated to the symphyseal width, area, and bone density. Where the lower gonial angle had a positive influence, the arch width changed during mouth opening. A multifactorial model showed a significant correlation between the set of predictor variables (symphyseal area, bone density, and mandibular length) and mandibular deformation. CONCLUSIONS: Mandibular arch width narrowed during forced opening. Subjects with smaller symphysis, lower bone density and longer mandible tend to have larger arch width changes.

Adult↗

[Carcinoma of the mouth and pharynx--better prognosis by an early diagnosis!].

Carcinomas of the mouth and pharynx rank sixth of all malignant tumours worldwide. They are responsible for 10% of the newly diagnosed malignant tumours. The median five year survival rate is 50%, depending on tumour localisation and size, but mainly determined by lymph node metastases. Carcinomas of the mouth and pharynx cause symptoms that resemble those of common harmless diseases of the head and neck such as pharyngitis. This can lead to misinterpretation by both, the patient and the doctor. Since the initial delay by the patient is difficult to influence it is very important that the doctor is aware of a possible malignant disease. Persistent common symptoms such as swallowing impairment or hoarseness, mucosal lesions, such as leukoplakia, a persistent cervical lymph node and unresponsiveness to initial treatment, must prompt the doctor to initialise appropriate diagnostic steps (incisional biopsy, e.g.). Only early diagnosis can help to improve the prognosis of patients with carcinomas of the mouth and pharynx.

Adult↗

Effect of triclosan dentifrices on mouth volatile sulphur compounds and dental plaque trypsin-like activity during experimental gingivitis development.

BACKGROUND: The objective of this study was to evaluate the effect of three commercial anti-plaque dentifrices containing 0.3% triclosan + 2% pvm/ma (Colgate Total), 0.3% triclosan + 0.75% Zn (Signal Global) and 0.3% triclosan + 5% PPi (Crest Complete) in comparison with an experimental dentifrice (0.3% triclosan + 2% pvm/ma + 0.75% Zn + 4% PPi) and a control dentifrice without anti-plaque agents on trypsin-like activity in dental plaque (detected by the hydrolysis of [Na-Benzoyl-DL-Anginine p-Nitroanilide (BAPNA)] and volatile sulphur compounds (VSCs) in mouth air during experimental gingivitis development. METHOD: A 5-step double blind, crossover experimental gingivitis study was conducted on 19 volunteers during a 21-day period. The volunteers refrained from brushing an experimental quadrant of teeth. The dentifrices were applied to those teeth via toothshield three times per day; simultaneously they brushed the other teeth with the same dentifrice. After each period, VSCs in mouth air and BAPNA hydrolysis by dental plaque accumulated in the experimental quadrant were determined. RESULTS: There was an increase (p < 0.05) in VSCs in mouth air when experimental gingivitis was induced in only one quadrant of teeth. None of the dentifrices was able to avoid the increase of VSCs during the experimental gingivitis development. The majority of the antiplaque dentifrices evaluated reduced the increase of VSC formation in comparison with the control (p < 0.05). There was no relationship between the ability of the dentifrices in reducing VSC formation and the inhibition of trypsin-like activity in dental plaque. CONCLUSIONS: Anti-plaque dentifrices reduce the increase of VSCs that occurs during the development of experimental gingivitis.

Adult↗

Effect of toothpaste on the plaque inhibitory properties of a cetylpyridinium chloride mouth rinse.

BACKGROUND AND AIMS: Cetylpyridinium chloride (CPC) mouth rinses have moderate plaque inhibitory activity when used alone but rarely have shown adjunctive benefits to tooth brushing with toothpaste. Several explanations for this apparent anomaly can be proferred, including loss of antiseptic activity due to interactions with toothpaste ingredients. The aim of this study was to measure the effect of toothpaste on the plaque inhibitory properties of a CPC mouth rinse using paired rinses of CPC, toothpaste slurry (TP) and water (W). METHODS: The study was a single blind, randomised, seven-treatment, cross over design balanced for residual effects, involving 21 healthy, dentate subjects. The paired rinses were: W-CPC, CPC-W, TP-CPC, CPC-TP, W-TP, TP-W and W-W. Rinsing with solutions or slurries was done for 60 s twice per day. On day 1, subjects were rendered plaque free, suspended tooth cleaning and commenced the allocated rinse regimen. On day 5, plaque was scored by index. A 2(1/2) day wash out of normal oral hygiene was allowed between each regimen. RESULTS: The order from lowest to highest plaque scores was as follows: W-CPC = CPC-W < CPC-TP < TP-CPC < or = W-TP < TP-W < W-W. Several differences in pairs of treatments were statistically significant, the most relevant of which were significantly less plaque with W-CPC compared to TP-CPC, TP-W and W-TP, and significantly more plaque with W-W compared to all other regimens except TP-W. CONCLUSIONS: Toothpaste, whilst possessing some plaque inhibitory activity, when used immediately before a CPC mouth rinse adversely affected the plaque inhibitory action of this antiseptic. This in part may explain the reported lack of adjunctive benefits of CPC rinses to normal oral hygiene practices and supports the suggestion, made for chlorhexidine rinses, that their use should follow toothpaste by at least 60 min.

Adult↗

Survival rate and fracture strength of incisors restored with different post and core systems after exposure in the artificial mouth.

The survival rate and fracture resistance of 40 decapitated endodontically treated maxillary central incisors using four different post and core systems covered with all-ceramic copings was evaluated after exposure in the artificial mouth. Ten samples of the following post and core systems were investigated: high precious metal post (Permador) and core (Olympia) (A), zirconia post (Cerapost) with a pre-fabricated bonded ceramic core (Ceracap) (B), resin-ceramic post (experimental) with a pre-fabricated bonded ceramic core (Ceracap(R)) (C) and a zirconia post (Cerapost) with a custom made ceramic core (Cosmo Ingots) (D). The all-ceramic copings (Procera) were cemented using Panavia TC. The survival rates after 1 200 000 cycles in the artificial mouth are as follows: 90% (A), 80% (B), 60% (C) and 100% (D). The results of the means and standard deviations (s.d.) of the fracture resistance during static loading are: 1270 +/- 312.5 (A), 1494.5 +/- 333.5 (B), 1146.7 +/- 182.6 (C) and 463.3 +/- 46.2 (D). There are statistically significant differences between all groups with the exception of A and B, and A and C (Wilcoxon test). None of the zirconia posts with custom made ceramic cores covered with all-ceramic copings fractured during dynamic loading in the artificial mouth. The mean fracture strength during static loading was less favourable than that of groups A, B and C but above the clinical necessary level.

Cementation↗

Maximal inspiratory mouth pressures (PIMAX) in healthy subjects--what is the lower limit of normal?

BACKGROUND: Maximal inspiratory mouth pressures are suitable for non-invasive evaluation of respiratory muscle function. Different studies on PIMAX give predicted normal values and their relation to anthropometric data. Due to a large inter-subject variation of PIMAX, predicted values, however, maximal inspiratory mouth pressures are not suitable to define the individual expected normal PIMAX. What is the lower limit of the normal range? METHODS: PIMAX has been prospectively measured in a representative sample of 504 healthy volunteers (248 males and 256 females) between 18 and 82 years of age with normal lung function. Age, height, weight, body mass index (BMI) and smoking status were recorded and incorporated stepwise in a multiple regression analysis to determine prediction equations. Lower limits of the normal range were defined as the fifth percentile of the residuals derived from the regression model. RESULTS: Mean values of PIMAX were 9.95 kPa for men and 7.43 kPa for women. Significant correlations were found with height, weight, BMI, FEV1, PEF and FVC (P<0.01). The strongest correlation appeared with sex and age (P<0.001). Smoking status and smoked pack-years were not independent predictors of inspiratory pressures. Lower limits of normal were 59% for women and 60% for men of the predicted PIMAX. CONCLUSIONS: In the interpretation of maximal inspiratory mouth pressures, normal values should represent the lower limit of the normal range derived from the regression model in order to avoid false pathological results. Prediction equations as well as lower limits of normal resulting from a study cohort of healthy 18-82-year-olds are given and are recommended to be used by pulmonary function laboratories in young and old patients.

Adolescent↗

A simple noninvasive pressure-time index at the mouth to measure respiratory load during acute exacerbation of COPD A comparison with normal volunteers.

We assessed the validity of the pressure-time index (PTI) measured at the mouth as a noninvasive and simplified alternative to conventional tension-time index for assessing respiratory load and inspiratory muscle force reserve. PTI was measured within 48 h of hospital admission and at 24 h before discharge in 37 consecutive patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) using the equation PTI = (P(awo)/MIP)(T(I)/T(T)) 100, where P(awo) is the mean airway pressure measured at the mouth, MIP the maximal inspiratory pressure, and T(I)/T(T) the inspiratory time (T(I)) to total cycle length (T(T)) ratio. Controls were 30 normal volunteers with similar anthropometric features. Mean (+/- SD) PTI values were significantly higher in COPD patients (0.29 +/- 0.10) than in controls (0.11 +/- 0.04) (P < 0.001) primarily because MIP and T(I)/T(T) were significantly lower and P(awo) was higher in the COPD population than in controls. As a result of improvement of the respiratory condition, PTI values were significantly lower at discharge (0.20 +/- 0.10 vs. 0.29 +/- 0.10, P < 0.001) due to a drop in P(awo) and an increase in MIP. The accuracy of different PTI cutpoints was assessed by comparison of the receiver operating characteristics curves. Best cutpoint values for differentiating COPD patients on admission and at hospital discharge from controls were 0.13 (positive predictive value 76%) and 0.17 (positive predictive value 92%) respectively. Noninvasive PTI measured at the mouth provides a valid and easy method for assessing respiratory muscle load and reserve. Changes in PTI values reflect functional improvement following treatment of acute exacerbation of COPD.

Aged↗

[Treatment of drug-induced dryness of mouth in psychiatric pateints--a controlled comparative study (author's transl)].

The present study examined the effects of various substances on salivary secretion in 25 psychiatric inpatients suffering from depression or schizoprenic disorders. It is well known that tricyclic neuroleptics and anti-depressants lower the rate of salivary excretion and lead to hyposalivation and a dry mouth. The following methods were studied on their effect to compensate hyposalivation: Distigminbromid, sweets, Glandosane, a new synthetic saliva, and water which was gustatory adopted. Salivary flow was measured according to Matzker (7). Subjective feelings of thirst and mouth dryness were recorded by selfconstructed tests. Only Glandosane and Distigminbromid compensated mouth dryness. The recorded amount of salivary flow was within the range of normal controls. There were no significant correlations between the subjective test answers and the objective measurement of salivary rate. Improvement of depression by application of Glandosane could not be observed. Patients treated with Glandosane felt most comfortable whereas in those treated with Distigminbromid side effects as digestive disorders, urinary disorders and changes in perspiration were observed.

Adult↗

Parotid and whole-mouth secretion in response to viewing, handling, and sniffing food.

There was no significant change in flow rates of parotid saliva in nineteen of twenty subjects while they viewed photographs of lemons, or in fourteen of twenty subjects while they cut lemons in a glove box. Neither parotid nor whole-mouth secretion changed from baseline when subjects viewed fresh lemons and lemonade presented in a plastic box. Further, no significant changes in whole-mouth secretion rates were observed when subjects viewed photographs of two appetizing foods, or of fresh doughnuts in a plastic box, even though subjects knew they could eat the doughnuts after the experiment. In most cases, sniffing of the lemons or of the doughnuts resulted in increased flow rates. Subjects demonstrated large differences in their patterns of affective responses to full-strength and diluted lemon juice, which were independent of salivary flow. In the absence of olfactory or tactile stimulations, few subjects altered parotid or whole-mouth secretion rates in response to viewing food or photographs of food. A reevaluation of findings on 'psychic' stimulation of saliva may be in order to ascertain the role of olfactory, tactile, and even trigeminal clues in salivary response to food stimuli.

Citrates↗

Positive charges at the intracellular mouth of the pore regulate anion conduction in the CFTR chloride channel.

Many different ion channel pores are thought to have charged amino acid residues clustered around their entrances. The so-called surface charges contributed by these residues can play important roles in attracting oppositely charged ions from the bulk solution on one side of the membrane, increasing effective local counterion concentration and favoring rapid ion movement through the channel. Here we use site-directed mutagenesis to identify arginine residues contributing important surface charges in the intracellular mouth of the cystic fibrosis transmembrane conductance regulator (CFTR) Cl(-) channel pore. While wild-type CFTR was associated with a linear current-voltage relationship with symmetrical solutions, strong outward rectification was observed after mutagenesis of two arginine residues (R303 and R352) located near the intracellular ends of the fifth and sixth transmembrane regions. Current rectification was dependent on the charge present at these positions, consistent with an electrostatic effect. Furthermore, mutagenesis-induced rectification was more pronounced at lower Cl(-) concentrations, suggesting that these mutants had a reduced ability to concentrate Cl(-) ions near the inner pore mouth. R303 and R352 mutants exhibited reduced single channel conductance, especially at negative membrane potentials, that was dependent on the charge of the amino acid residue present at these positions. However, the very low conductance of both R303E and R352E-CFTR could be greatly increased by elevating intracellular Cl(-) concentration. Modification of an introduced cysteine residue at position 303 by charged methanethiosulfonate reagents reproduced charge-dependent effects on current rectification. Mutagenesis of arginine residues in the second and tenth transmembrane regions also altered channel permeation properties, however these effects were not consistent with changes in channel surface charges. These results suggest that positively charged arginine residues act to concentrate Cl(-) ions at the inner mouth of the CFTR pore, and that this contributes to maximization of the rate of Cl(-) ion permeation through the pore.

Animals↗

Management of mouth opening in patients with temporomandibular disorders through low-level laser therapy and transcutaneous electrical neural stimulation.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and transcutaneous electrical neural stimulation (TENS) on the improvement of mouth opening in patients with temporomandibular disorder (TMD). BACKGROUND DATA: TMDs are conditions that affect the form and/or function of the temporomandibular joint (TMJ), masticatory muscles, and dental apparatus. Often TMD is associated with pain localized in the TMJ and/or in the muscles of the face and neck. METHODS: This clinical trial was performed in 10 patients, 18-56 years old, diagnosed with TMD of multiple causes. All patients received both methods of treatment in two consecutive weeks. LLLT was delivered via a 670-nm diode laser, output power 50 mW, fluence 3 J per site/4 sites (masseter muscle, temporal muscle, mandibular condyle, and intrauricular). TENS therapy was applied with a two-electrode machine at 20 W, maximum frequency of 60 Hz, adjusted by the patient according to their sensitivity. The amplitude of mouth opening was recorded before treatment and immediately after using a millimeter rule; the measurements were performed from the incisal of the upper incisors to the incisal of the lower incisors. A paired t-test was applied to verify the significance of the results. RESULTS: A significant improvement in the range of motion for both therapies was observed immediately after treatment. Comparing the two methods, the values obtained after LLLT were significantly higher than those obtained after TENS (p < 0.01). CONCLUSIONS: Both methods are effective to improve mouth opening. Comparing the two methods, LLLT was more effective than TENS applications.

Adolescent↗

Retrieval of a retrograde catheter using suction, in patients who cannot open their mouths.

In difficulty, tracheal intubation can be facilitated by passing a retrograde catheter, but the mouth has to be opened for the retrieval of the catheter from the pharynx. Two patients with ankylosis of a temporomandibular joint were unable to open their mouth, and required general anaesthesia for gap arthroplasty. Because we did not have a flexible fibreoptic laryngoscope, we used a suction catheter to retrieve an epidural catheter from the pharyngeal cavity, which had been passed retrogradely from a cricothyroid puncture. Catheter-guided tracheal intubation was done without complication. A suction catheter can assist retrograde retrieval of a catheter to aid intubation in patients who cannot open the mouth.

Adolescent↗

Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening.

Passing a retrograde catheter/wire into the pharynx through a cricothyroid puncture can facilitate tracheal intubation in difficult situations where either a flexible fibre-optic bronchoscope or an expert user of such a device is not available. Some mouth opening is essential for the oral and/or nasal retrieval of the catheter/wire from the pharynx. Two patients with temporo-mandibular joint (TMJ) ankylosis and extremely limited mouth opening required gap arthroplasty of the TMJ under general anaesthesia. Because we did not have a flexible fibre-optic bronchoscope, we performed fluoroscopy-assisted nasal retrieval of the guide wire passed up through a cricothyroid puncture and subsequently accomplished wire-guided naso-tracheal intubation. In the absence of a flexible fibre-optic bronchoscope, this technique is a very useful aid to intubation in patients with limited mouth opening.

Adult↗

High-titer bicistronic retroviral vectors employing foot-and-mouth disease virus internal ribosome entry site.

Bicistronic retroviral vectors were constructed containing the foot-and-mouth disease virus (FMDV) internal ribosome entry site (IRES) followed by the coding region of beta-galactosidase (beta-gal) or therapeutic genes, with the selectable neomycin phosphotransferase gene under the control of the viral long terminal repeat (LTR) promoter. LNFX, a vector with a multiple cloning site 3' to foot-and-mouth disease virus IRES, was used to construct vectors encoding rat erythropoietin (EP), rat granulocyte colony-stimulating factor (G-CSF), human adenosine deaminase (ADA) and beta-gal. In transduced primary rat vascular smooth muscle cells the cytokines were expressed at high levels, similar to those obtained from vectors employing the viral LTR promoter. LNFZ, a vector encoding beta-gal, had a 10-fold increase in titer over that of LNPoZ, a comparable vector containing the poliovirus (Po) internal ribosome entry site. Primary canine vascular smooth muscle cells infected with LNFZ and LNPoZ expressed similar activities of beta-gal and neomycin phosphotransferase (NPT). Overall, these vectors had titers between 10(6) and 2 x 10(7) c.f.u./ml, indicating that foot-and-mouth disease virus IRES provides high-titer bicistronic vectors with high-level two gene expression.

3T3 Cells↗

A non-tooth-borne mouth-opening device for postoperative rehabilitation after surgical release of trismus.

BACKGROUND: The treatment of severe trismus requires a combination of surgical release and postoperative rehabilitation; the latter is essential for preventing a relapse due to postoperative inactivity and scarring. Mouth-opening devices for this purpose are placed between or fixed to the teeth to keep the dental arches apart; but patients suffering from severe trismus often present with partially or totally edentulous arches, decayed teeth, or periodontitis, which do not allow for the use of such devices. METHODS: In this article, a new mouth-opening device is described. It applies force to two intraoral screws placed in the vestibulum of the maxillary and mandibular bones. It can be used in patients with poor dental conditions and allows rehabilitation to start immediately after trismus release. RESULT: A case is presented. The interalveolar distance was improved from 5 mm to 45 mm and maintained at 6-month follow-up. CONCLUSION: Our non-tooth-borne mouth opening device is useful for postoperative rehabilitation after surgical release of trismus.

Bone Screws↗

Pre-lytic release of foot-and-mouth disease virus in cytoplasmic blebs.

The pre-lytic release mechanism of foot-and-mouth disease virus was investigated by immunofluorescence, acridine orange staining, and electron microscopy in infected bovine and porcine kidney coverslip cultures. Cells with cytoplasmic fluorescence and which were positive for single stranded RNA with acridine orange staining were observed at 2 h after infection. Scanning electron microscopy showed cytoplasmic blebs in all cultures examined 2 h after infection. Rounded cells with virus inclusions began to appear 3 h after infection. Rounded cells and cytoplasmic blebs were shown to have single stranded RNA by acridine orange staining. Immunofluorescence and transmission electron microscopy with immunoferritin tagging demonstrated foot-and-mouth disease virus in cytoplasmic blebs. This study presents evidence for a pre-lytic release of foot-and-mouth disease virus through virus-containing cytoplasmic blebs emerging from infected cells.

Aphthovirus↗

Quadrant root planing versus same-day full-mouth root planing. I. Clinical findings.

OBJECTIVES: The aim of this study was to test the hypothesis that same-day full-mouth scaling and root planing (FM-SRP) resulted in greater clinical improvement compared to quadrant scaling and root planing (Q-SRP) in chronic periodontitis patients over a period of 6 months. MATERIAL AND METHODS: Forty patients were recruited into this study. Subjects were randomised into two groups. The FM-SRP group received full-mouth scaling and root planing completed within the same day, while the Q-SRP group received quadrant root planing at 2-weekly intervals over four consecutive sessions. Whole-mouth clinical measurements were recorded with a manual periodontal probe at baseline (BAS) and at reassessment 1 (R1) (approximately 6 weeks after the completion of therapy), and at reassessment 2 (R2) (6 months after the initiation of therapy). Selected site analyses were performed on the deepest site in each quadrant before and after therapy (R1 and R2) and clinical indices were recorded with an electronic pressure sensitive probe. In addition, during the active phase of treatment clinical data were collected at 2-weekly intervals from the remaining untreated quadrants in the Q-SRP group only. RESULTS: Both therapies resulted in significant improvements in all clinical indices both at R1 and R2. A continuous clinical improvement was seen for both treatment groups during the experimental period, which reached peak levels at 6 months (DeltaPD=1.8 mm, DeltaCAL=1.1 mm, p<0.001; PD: pocket depth; CAL: clinical attachment level). The selected-site analysis revealed no significant differences in any clinical index between the two treatment groups at R2 (DeltaPD=2.8 mm, DeltaRAL=1.1 mm; RAL: relative attachment level). At the selected sites, the analysis of the deep pockets (>7 mm) showed a significantly greater gain in RAL for the FM-SRP group compared to the Q-SRP group at R2 (p<0.05). The results of this analysis however, should be interpreted with care due to the small number of deep pockets. Data from the Q-SRP group provided an insight into how treated and untreated quadrants responded during the initiation of plaque control measures. There were significant reductions in PD, suppuration (SUP), modified gingival index (MGI) and plaque index (PI) in the remaining untreated quadrants in the Q-SRP group during the initial phase of treatment (p<0.05), while minimum changes in RALs and bleeding on probing (BOP) occurred. Nevertheless, the improvement in PD was clearly inferior to that seen after scaling and root planing. CONCLUSION: Following both therapeutic modalities, there were marked clinical improvements at both R1 and R2 (6 months) from baseline. The current study, in contrast to previous findings, failed to show that FM-SRP is a more efficacious periodontal treatment modality compared to Q-SRP. However, both modalities are efficacious and the clinician should select the treatment modality based on practical considerations related to patient preference and clinical workload.

Adult↗