Orthodontic care provided by general practitioners and specialists in three Swedish counties with different orthodontic specialist resources

Three counties in Sweden (A, G, and W) with free orthodontic care and different orthodontic resources and geographic structures were studied in 1987. Samples of totally 942 young adults (mean age 18.8 years, SD 0.44) were examined concerning malocclusions and all orthodontic treatment provided by general practitioners or by orthodontic specialists. The care in a rural area (county G) with abundant specialist resources was based on specialist treatments easy assessable to the patients and supplemented by treatments, mainly without appliances and provided by general practitioners. There was a generous attitude of consultation with specialists and of providing treatment. The sparsity of specialist resources had in an urban area (county A) resulted in a greater restriction on providing treatments. The treatments were performed in a higher age and were, to a greater extent, not completed by the age of 19, and a smaller percentage of individuals were treated than in the other two counties. The care in a large rural area (county W) with long distances to the only specialist clinic was based on treatments provided by general practitioners. In spite of the few specialist resources there was a generous attitude of providing treatments. Interceptive methods were used to a great extent, and later completed with appliance therapy. According to a treatment priority index 44% of the untreated individuals in the three counties had malocclusions and an objective treatment need, and there were no significant differences between the counties. Regardless of differences in specialist resources and structure of the free public orthodontic care, a substantial and equal proportion of the untreated individuals in the counties had malocclusions with treatment need, but they had no treatment desire.     

Polyethylene ribbon and fixed orthodontic retention and porcelain veneers: solving an esthetic dilemma

The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.     

The first 100 cases: a personal audit of orthodontic treatment assessed by the PAR (peer assessment rating) index

The first 100 consecutively started cases treated by a specialist registrar in orthodontics were examined and pre- and post-study models were scored using the peer assessment rating (PAR) index. The PAR index proved both simple and reproducible to use: 92 cases had post-treatment records available, 91 patients registered a drop in PAR score, and one patient registered an increase. Of these 92 patients, 38 (41%) were greatly improved, 43 (47%) were improved, and 11 (12%) were made worse or no different (ie they failed to achieve a 30% drop in PAR score). Of the factors examined, only the appliance type used was significantly related to PAR score change. Of the 11 cases apparently made worse, individual examination revealed that four of these represented beneficial occlusal changes but due to limited treatment goals they did not register as improved using the PAR index according to previously agreed criteria. The PAR index measures 'good tooth position' which, although very important, is not the only factor in orthodontic treatment. The use of the PAR index to detect 'good' and 'bad' orthodontic treatment is not without problems. Its use in mixed dentition and adjunctive orthodontic treatments may not always be appropriate.     

Pain and discomfort during orthodontic treatment: causative factors and effects on compliance

Orthodontic patients experience pain and discomfort to a varying degree during the course of treatment. The aims of the present investigation were to follow the progress of adaptation after insertion of new appliances and to study the relationships between the type of appliance worn and pain or discomfort experienced, between pain sensations and attitude toward the treatment and their effects on patients' compliance. Pain and discomfort experienced by 84 patients undergoing orthodontic treatment, their attitude toward the treatment, and compliance were assessed 7 days, 14 days, 6 weeks, 3 months, and 6 months after appliance insertion, using specially designed protocols, questionnaires, and rating scales. Evaluation of the results showed that an adaptation to pain and discomfort occurred during the first 3 to 5 days after placement of the appliance. The severity of pain and discomfort experienced by the patients wearing functional or fixed appliances was significantly higher than by those treated with upper and/or lower removable plates. Patients who had higher personal perception of the severity of their malocclusion and displayed attitudes characteristic for internal control orientation according to the so-called locus of control theory, seemed to adapt faster and have less pain. The results of this study also indicate that acceptance of orthodontic appliances and treatment in general may be predicted by the amount of initial pain and discomfort experienced.     

Antitumor effects of the combination immunotherapy with interleukin-12 and tumor necrosis factor alpha in mice

Nickel hypersensitivity is an increasing problem in adolescents, especially in girls, with a prevalence of up to 30%. The presence of nickel in orthodontic appliances and the possibility of causing nickel hypersensitivity has been discussed in case reports. A review of the literature concerning nickel hypersensitivity in relation to orthodontic appliances has shown that the risk is very low for patients who are not nickel hypersensitive at the start of the treatment. A patient who is already nickel hypersensitive at the start of orthodontic treatment may in rare cases show adverse reactions induced by the appliance. The slow long-term release of nickel from orthodontic appliances may induce tolerance to nickel in individuals who are not hypersensitive at the start of orthodontic treatment.     

Suicide mortality in patients on lithium maintenance therapy

Mood disorders are frequently recurrent and it has been shown that maintenance treatment can reduce long-term morbidity in this condition. It has also been shown that mood disorders carry an increased risk of suicide and that a significant proportion of individuals who commit suicide suffer from a mood disorder. This paper reports the results of a long term follow-up of a cohort of patients attending a specialist mood disorder clinic over a period of 18 years. Sixty-seven suffered from unipolar depression and 36 had bipolar or schizo-affective disorders In order to qualify for entry to the cohort the unipolar patients had to have had at least three episodes of depression and those with bipolar disorders had to have had at least three episodes - with at least one manic episode and one depressive episode. All patients were treated with lithium. The initial treatment refusal rate and drop our rates were low. The mortality from suicide in this group was compared with that reported in five recent studies - all of which involved patients who had not been given maintenance therapy. The standardised mortality ratio (SMR) for all causes for the whole group was 0.93. There were two suicides. In one case the patient had continued treatment with lithium until death and in the other the patient had discontinued treatment 12 months before death. The overall suicide rate was 1.3 per 1000 patient years. Amongst similar groups of patients who had not been given maintenance therapy suicide rates of about 5.5 per 1000 patient years have been reported. It is concluded that maintenance treatment of mood disorders reduces the suicide rate in this vulnerable group of patients.     

Signs and symptoms of temporomandibular disorders in 19-year-old individuals who have undergone orthodontic treatment

Fifty-five per cent of the 1554 19-year old subjects in Halmstad, Sweden, born in 1975, have received orthodontic treatment. Among these, 520 have been treated by specialists (specialist group) and 340 by general practitioners after consultation with specialists (consultation group). The aims were to study the prevalence of signs and symptoms of temporomandibular disorders (TMD) in these two groups on a long-term basis, to identify any possible difference between the groups, and to compare the results with those from a previously presented epidemiological study (control group). From the population of orthodontically treated subjects, a sample was randomly selected to represent the two groups, and 260 subjects agreed to attend for investigation, the participation rate being 77%. The investigation consisted of a questionnaire and clinical examination focusing on function and dysfunction of the masticatory system. Severe signs and symptoms of TMD were rare, the prevalence did not differ significantly between the two orthodontic groups, and the results were similar in the control group. The prevalence of several signs and symptoms was more common in females than in males. No significant correlation between TMD signs and symptoms and occlusal contact recordings was found. It was concluded that the vast majority of the 19-year old individuals who had undergone orthodontic treatment had well-functioning masticatory systems, and severe signs and symptoms of TMD were rare.     

Influences of obesity and weight loss on thyroid hormones. A 3-3.5-year follow-up study on obese subjects with surgical bilio-pancreatic by-pass

Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.     

The cortical reactions during sensory and motor activities in healthy children and adults and in depression patients

We recruited 111 patients who were considered to be at significantly increased risk of preeclampsia on the basis of previous obstetric history or preexisting medical disorders. All patients were treated with low dose aspirin (75 mg/day) from the first occasion the patient attended the antenatal clinic, regardless of gestational age. If the maternal mean platelet volume (MPV) increased significantly (by > 0.8 fl) from the baseline, antiplatelet treatment was increased. Five pregnancies were lost during the second trimester and 106 of the treated patients had live infants. The incidence of neonatal death (3/106 infants) was much lower than in the previous pregnancies in these patients (32/134 infants). Patients who were treated from the first trimester of pregnancy (group A, 89 patients) did substantially better than those treated from the second trimester (group B, 17 patients) as assessed by the incidence of pre-eclampsia or intrauterine growth restriction (IUGR), gestational age and birthweight at delivery. These data suggest that longitudinal monitoring of the MPV may identify the women who could benefit from increased antiplatelet treatment, and that antiplatelet treatment may be more effective when initiated in the first trimester rather than later in pregnancy.     

Electronic nose for microbial quality classification of grains

A subgingival crown-root fracture presents the clinician with a difficult restorative problem, including reaching the fracture line, and is complicated by the need to maintain the periodontal tissues in good health. The treatment options up to now have usually been limited to extrusion of the remaining root with a conventional orthodontic appliance, surgical intraalveolar transplantation of the root or extraction with bridge replacement. In this report, a new method of orthodontic extrusion with attractive magnets is presented. One or two neodymium-iron-boron magnets were attached to the remaining root and a second, larger neodymium-iron-boron magnet was incorporated in a removable appliance. The roots were extruded 2 to 3 mm with a force range from 50 to 240 cN during a treatment period of 9 to 11 weeks. Good force control at short distances, no friction, and no material fatigue of permanent rare earth magnets resulted in successful rapid extrusion. No evidence of soft tissue dehiscences, aberrant tooth mobility, or root resorption was found.     

Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance

Some adult cleft palate patients show severe maxillary transverse contraction and posterior crossbite. This case report demonstrates successful surgical-orthodontic treatment of such a patient. Surgically assisted rapid maxillary expansion (SA-RME) was completed prior to comprehensive orthodontic treatment. The osteotomy was performed on both the buccal and lingual aspects of the posterior maxillary alveolus. A Hyrax-type maxillary-expansion appliance was used, and the screw (0.2 mm, one quarter turn) was turned two or three times per day. Comprehensive orthodontic treatment was initiated after extraction of the mandibular first premolars and four third molars. The maxillary lateral incisors were also extracted after active orthodontic treatment. The amount of expansion achieved using SA-RME was greater at the posterior than at the anterior maxilla. Midpalatal suture opening occurred. After orthodontic treatment, occlusal stability was satisfactory. This case demonstrates the effectiveness of SA-RME in adult cleft palate patients with severe posterior crossbite.     

Aging of the population: demographics for the Liege region

We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.     

Lens transmission by fluorophotometry after brachytherapy and thermotherapy of choroidal melanoma

We studied the effect of transpupillary thermotherapy (TTT) by a diode laser at 810 nm combined with episcleral ruthenium-106 plaque treatment (106Ru) on lens transparency in patients with choroidal melanoma. Lens transmission of blue-green light was measured by fluorophotometry in 17 patients treated with 106Ru treatment and TTT (measured 0.36 years after treatment), 12 patients treated with 106Ru alone (measured 19 years after treatment) and 25 age-matched healthy controls. Differences in lens transmission were not significant between treated and untreated fellow eyes (p > 0.15) nor between patient and control eyes (p > 0.25). TTT of choroidal melanoma combined with 106Ru plaque irradiation did not have a significant effect on the lens transparency up to 6 years after treatment.     

Expression of integrins in marmoset (Callithrix jacchus) ovary during folliculogenesis

The model of 25 children with mild Class II, Division 1 malocclusions who had their upper buccal segments moved distally with an en masse appliance were measured at the beginning of treatment and at the completion of buccal segment retraction. A reflex microscope, interfaced to a personal computer, was adapted for this purpose. A custom-made jig and linear stepping motor permitted the recording of both buccal and incisal measurements of the teeth in occlusion, as well as individual arch parameters. Software was designed to record and calculate the required measurements. The method error associated with this approach ranged from 0.01 to 0.5 mm. Results indicated that mean distal movement of the buccal segments approximated 6 mm, equivalent to a full cusp of buccal segment retraction. A small spontaneous reduction in overjet was seen. The upper arch showed spontaneous alignment and increases in width, length, and perimeter. In the lower jaw, transverse expansion was accompanied by a small increase in arch perimeter. Arch length, however, was slightly reduced. It was concluded that the system was an acceptable method of recording occlusal changes during orthodontic treatment, supplementing routine cephalometry. Furthermore, a full unit of buccal segment retraction could be expected, by using a removable appliance/headgear technique.     

Immunohistochemical localization of endothelin-1 in placenta and fetal membranes in term and preterm human pregnancy

A case is reported in which an intruded incisor was initially treated by an endodontic dressing with calcium hydroxide and then extruded using a removable orthodontic appliance. A follow-up examination seven years after completion of endodontic therapy and bleaching showed a favourable response. A review of the relevant literature indicates that intrusion occurs in five to twelve per cent of luxation cases. In this type of injury maximum damage occurs to the pulp and all supporting structures because the tooth is driven into the alveolar process. Complications which have been reported include: pulp necrosis, apical radiolucencies, partial or total pulp calcification, root resorption (surface, inflammatory or replacement), marginal periodontal bone breakdown, and arrested or disturbed root development. The prognosis for pulp survival after intrusion is much more favourable for teeth with incomplete root formation than for teeth with complete root formation. Treatment options available to bring an intruded tooth into alignment are: to await spontaneous re-eruption which may occur if root formation is incomplete, uncovering of the intruded crown, orthodontic extrusion which is allied with gentle luxation if the tooth does not move, and immediate surgical repositioning.     

Homozygous deletion of the PTEN tumor suppressor gene in a subset of prostate adenocarcinomas

PURPOSE: Intracavernosal injection therapy is one of the most popular therapies for erectile dysfunction today. Yet, most clinicians consider intracavernosal injection a palliative treatment for erectile dysfunction because of the high patient initiated dropout rate. In contrast, penile prostheses appear to offer a more permanent cure for erectile dysfunction. We compare the long-term outcomes of both therapies in contemporaneously treated patients and determine the reasons for failure of each. MATERIALS AND METHODS: Telephone survey and chart review was conducted on the first 115 patients treated with intracavernosal injection and 65 patients undergoing insertion of a penile prosthesis during the same period at our institution. Mean patient age was 57 and 60 years, respectively, and mean followup of all patients was 5.4 years (range of 3.3 to 16). RESULTS: An equal percentage of patients were lost to followup in both groups, including 19% of the intracavernosal injection group and 18% of the penile prosthesis group. Of the intracavernosal injection patients 6 (6%) died during followup and 10 (19%) of the prosthetic patients died (p < 0.05). At the time of contact only 41% of the patients were still using intracavernosal injection. In contrast, 70% of the patients were still sexually active with the prosthesis (p < 0.01). Mean duration of use of the penile prosthetics was 63 months compared to 37 months for intracavernosal injection (p < 0.001). The most common reasons for discontinuing intracavernosal injection were inadequate erections (16 cases), lack of spontaneity (14), side effects (12), lack of partner (10), loss of sexual interest (6) and spontaneous return of normal erections (4). More than half of the patients (61%) who discontinued intracavernosal injection remain sexually active with other therapies, including penile prosthesis in 11, vacuum devices in 4, vascular surgery in 1 and oral medication in 1, and 14 without any therapy. We could not identify any significant clinical parameters that would accurately predict which patients most benefited by the long-term use of intracavernosal injection therapy. In contrast, only 6 patients discontinued use of the implant because of complications (infection, erosion and malfunction) and 7 for reasons independent of the implant (that is lack of partner, loss of sexual interest and co-morbidity). CONCLUSIONS: Intracavernosal injection serves as only a palliative therapy for the majority of patients with erectile dysfunction but there exists a core group who derives long-term satisfaction with its use. The majority of patients who discontinue intracavernosal injection remain sexually active yet do not progress to more invasive or effective therapies. The reason for discontinuing therapies for erectile dysfunction is often unrelated to the actual therapeutic modality. Our findings suggest that further improvements in intracavernosal injection therapy and the development of alternative methods of delivery of vasoactive agents will have only a limited impact on the overall outcome of therapy for erectile dysfunction and that increased attention to issues separate from the erection is warranted.     

Aspects of the humoral immune response to Staphylococcus intermedius in dogs with superficial pyoderma, deep pyoderma and anal furunculosis

In order to evaluate the long term clinical and morphologic results of recapture of a displaced TMJ disk, we recalled for follow-up MR imaging 75 patients who had been treated by attempted disk recapture based on pre-treatment MR imaging 1-6 years earlier. The treatment included a day appliance with inclines to guide the mandible into the therapeutic position and a telescopic night appliance which prevented retrusion of the mandible during sleep. Appliance treatment was followed by rebuilding or resurfacing the posterior teeth of one arch to permanently support the mandible in the therapeutic position. After treatment of 115 joints with displaced disks, 52% of the disks were normally positioned, 23% were improved in position, and 25% showed persistent disk displacement. Symptom relief was 92% in patients with normalized (recaptured) disks, 84% in patients with improved disk position, and 49% in patients with persistent disk displacement. Failure to improve disk position occurred in 7% of the joints with anterior disk displacement and in 44% of the joints with a transverse (sideways) component to the displacement. Forty-five percent of the recaptured-disks improved in contour. We concluded that anterior mandibular repositioning was effective in the treatment of patients with reducing displaced disks primarily when the disks were displaced only in an anterior direction. This treatment can be recommended in anterior disk displacements if the patient has failed more conservative treatment measures, permanent occlusal reconstruction can be justified, and the patient understands that long-term use of a night appliance may be necessary. Anterior mandibular repositioning appears much less effective in cases with a transverse component to the disk displacement.     

Intermaxillary forces during activator treatment

The mode of action of the activator appliance is still unclear. Apart from a possible mandibular growth enhancing effect, some investigators believe that orthopedic forces may be applied to the maxilla, contributing to Class II correction by inhibition of maxillary growth. In addition, orthodontic forces may arise that produce dentoalveolar changes. The purpose of this study was to measure the magnitude of anteroposterior intermaxillary forces during wear of the activator appliance. Ten consecutive patients with Class II dental and skeletal relationships were treated with a modified activator appliance. The appliance had maxillary and mandibular segments that could be detached from each other during the measuring session. A force transducer was placed at the anterior part of the maxillary segment, and the anteroposterior force exerted by the mandibular segment was measured. Measurements were taken in the upright and reclined position at every patient visit for a period of 6 months. Results indicated that intermaxillary forces were generally in the orthodontic range (median values of 100 gf at the upright position and 123 gf at the reclined position). A wide variation in force levels was noted, both between patients and for the same patient during the experimental period. No statistically significant change in force levels was observed during the 6 month period and no difference was noted between upright and reclined posture.     

Treatment of advanced gastric cancer with oral etoposide, leucovorin and tegafur: experience with an oral modification of the etoposide, leucovorin and 5-fluorouracil (ELF) regimen

Recent data have suggested enhanced therapeutic activity with prolonged administration of both etoposide as well as fluoropyrimidines in the treatment of gastrointestinal malignancies. Based on this rationale, we investigated the clinical effectiveness and tolerance of an oral modification of the widely applied etoposide, leucovorin and 5-fluorouracil (ELF) regimen in patients with advanced gastric cancer. 32 patients with advanced gastric cancer were treated with oral etoposide (100 mg), leucovorin (3 x 100 mg), and tegafur (3 x 200 mg) over 14-21 days for a maximum of six cycles. Objective response was seen in only 5 patients (16%), stable disease was documented in 7 (22%), while the remaining patients progressed during therapy. The median time to progression was 2.8 months (range 0.7-12 months) and median overall survival was 6 months (range 1-18+ months). Due to grade 3 nausea/emesis, 8 patients discontinued treatment prematurely, while 12 patients experienced anorexia and progressive weight loss. Haematological toxicity was modest, with 4 patients developing asymptomatic grade 3-4 granulocytopenia. We conclude that this oral combination regimen cannot be recommended for the treatment of advanced gastric cancer.