RESUMEN
In the United States, an estimate of 1.3 million women suffering from epilepsy are in their childbearing age. Potential teratogenicity of antiepileptic drugs (AEDs) is of concern to these women considering pregnancy because discontinuing pharmacotherapy during pregnancy may not be advised due to the risk of seizures that may be dangerous to the mother as well as the fetus. Using a Relational Online Analytical Processing (ROLAP) software licensed by Simultek, we searched for medications reported for congenital jaw and oral cavity malformation on the FDA Adverse Event Reporting System (AERS), a voluntary adverse event reporting program that contains over 55 million adverse event reports of medical products in the United.States. Our results indicate that various forms of valproic acid, and more importantly, newer generation antiepileptic agents including lamotrigine, topiramate, and gabapentin show signals for either congenital jaw or oral malformation. Although teratogenic potential of valproic acid has long been confirmed, information on teratogenicity of the newer generation antiepileptic drugs is relatively scarce and inconclusive. Early safety signals on the teratogenic potential of AEDs detected in this study are crude statistics that do not establish causation nor exclude confounding. The results require validation and further investigation via properly controlled epidemiological studies.
Asunto(s)
Anomalías Inducidas por Medicamentos/etiología , Anticonvulsivantes/efectos adversos , Anomalías Maxilomandibulares/inducido químicamente , Anomalías de la Boca/inducido químicamente , Embarazo , Sistemas de Registro de Reacción Adversa a Medicamentos , Aminas/efectos adversos , Ácidos Ciclohexanocarboxílicos/efectos adversos , Minería de Datos , Conjuntos de Datos como Asunto , Femenino , Fructosa/efectos adversos , Fructosa/análogos & derivados , Gabapentina , Humanos , Lamotrigina , Factores de Riesgo , Topiramato , Triazinas/efectos adversos , Ácido Valproico/efectos adversos , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
In the current era, various pharmacological agents exist for osteoporosis management, and synthetic parathyroid hormone (PTH) (Teriparatide, Forteo) is one of the treatment options. Depending on the timing of administration, PTH has a unique ability to cause both bone apposition and bone resorption. This review focuses on the effects of PTH on the bone, specifically the jaw bones mandible and maxilla. The article briefly describes the fundamental mechanism of PTH action at the molecular level, as well as in experimental animals and in humans. It differentiates intermittent administration of PTH, especially at doses tolerated by humans that increase bone strength and prevent bone fractures, from continuous use that may lead to bone loss. In particular, it shows how intermittent administration of PTH can play a significant role in periodontal repair and implant success via stimulation of bone mineral content especially in the pre-alveolar region.
Asunto(s)
Proceso Alveolar/fisiología , Conservadores de la Densidad Ósea/farmacología , Remodelación Ósea , Maxilares/fisiología , Hormona Paratiroidea/farmacología , Hormona Paratiroidea/fisiología , Teriparatido/farmacología , Proceso Alveolar/efectos de los fármacos , Animales , Densidad Ósea/efectos de los fármacos , Densidad Ósea/fisiología , Remodelación Ósea/efectos de los fármacos , Remodelación Ósea/fisiología , Humanos , Maxilares/efectos de los fármacos , Oseointegración/efectos de los fármacos , Oseointegración/fisiología , Osteoblastos/citología , Osteoblastos/efectos de los fármacos , Hormona Paratiroidea/efectos adversos , Ligamento Periodontal/citología , Ligamento Periodontal/efectos de los fármacos , Ligamento Periodontal/fisiología , Receptores de Hormona Paratiroidea/metabolismo , Proteínas Recombinantes/farmacología , Teriparatido/efectos adversosRESUMEN
BACKGROUND: We conducted an independent analysis of metallothionein 1 (MT-1) rs8052394, rs11076161, rs8052334, rs964372, rs7191779, and rs708274 in 587 individuals who were either healthy controls or subjects with oral squamous cell carcinoma (OSCC). METHODS: All participants provided a nucleic acid sample (blood) as well as epidemiologic information on covariates or "risk factors" for OSCC, including tobacco, alcohol, and areca quid use. The genotyping result was used in a logistic regression model that examined main effects as well as statistical interactions while controlling for confounders. RESULTS: MT-1 is involved in regulation of zinc and copper homeostasis. It also is a potent antioxidant and its polymorphisms correlate with the risk for OSCC. Rs11076161 A, rs964372 C, and rs7191779 C alleles were protective against OSCC (adjusted OR = 0.53, 0.49, 0.36, respectively; p < 0.05), whereas rs8052394 A alleles were associated with increased risk. Areca quid chewing and tobacco use were strong risk factors for developing the disease and were associated with 20- and 8-fold increases in adjusted risk (p < 0.05), respectively. CONCLUSIONS: Controlling for the effects of age, gender, areca quid, tobacco, and alcohol use, individuals with inherited the MT-1 rs11076161 AA, rs964372 CC, and rs7191779 GC genotypes may experience significant protection against OSCC, whereas individuals carrying the MT-1 rs8052394 A allele seem exposed to higher risk.
Asunto(s)
Carcinoma de Células Escamosas/etiología , Metalotioneína/genética , Mucosa Bucal/metabolismo , Neoplasias de la Boca/etiología , Polimorfismo Genético/genética , Consumo de Bebidas Alcohólicas , Areca , Carcinoma de Células Escamosas/patología , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Neoplasias de la Boca/patología , Reacción en Cadena de la Polimerasa , Pronóstico , Factores de RiesgoRESUMEN
Leishmaniosis is a zoonotic, parasitic disease caused by members of the genus Leishmania. The disadvantages of the traditional methods have currently rendered the polymerase chain reaction (PCR), the most reliable alternative for the laboratory diagnosis of this disease. Several relevant protocols have been described in the past but their application is in most cases limited to research use. The latter combined with the diagnostic problems that can be caused by the genetic variability of the different Leishmania strains or the presence of PCR inhibitors, indicate that an alternative approach should be followed for the development of a standard diagnostic tool for leishmaniosis. In the present study, we have evaluated several PCR-based protocols, in order to identify a primer combination that would allow the reliable detection of Leishmania DNA from clinical material and the verification of its results, in a manner that could be applicable even for routine use. The evaluation consisted of a BLAST verification of the specificity of the previously described primers, PCR testing, and optimisation of the reaction conditions. Our assessment was completed with the comparative evaluation of the results produced by the proposed PCR assay, light microscopy, and indirect fluorescent antibody technique (IFAT), on clinical samples collected from dogs suspected of leishmaniosis. The proposed assay which consists of a combination of two pairs of primers, targeted to different areas of the kinetoplast DNA of Leishmania spp., specific for Leishmania infantum, Leishmania donovani and Leishmania chagasi, showed optimum performance on our test samples, and detected 41.9% Leishmania-positive dogs from our 160 clinical cases. From the same number of cases, 46.25% were positive by IFAT (titre > or =200), and 19% by microscopic examination of lymph node aspirates.
Asunto(s)
Enfermedades de los Perros/parasitología , Leishmania/aislamiento & purificación , Leishmaniasis/veterinaria , Reacción en Cadena de la Polimerasa/veterinaria , Animales , Cartilla de ADN/química , Cartilla de ADN/genética , ADN de Cinetoplasto/química , ADN de Cinetoplasto/genética , Enfermedades de los Perros/sangre , Enfermedades de los Perros/diagnóstico , Perros , Técnica del Anticuerpo Fluorescente Indirecta/veterinaria , Grecia , Leishmania/genética , Leishmaniasis/sangre , Leishmaniasis/diagnóstico , Leishmaniasis/parasitología , Reacción en Cadena de la Polimerasa/métodos , Reproducibilidad de los ResultadosRESUMEN
UNLABELLED: In the developed world, intraoral malignancies are more frequent in males than females. Recent observations from Greece suggest that the number of females is increasing. AIM: The present study investigates gender and age statistics among subjects with cancers of the mouth or leukoplakia. METHODS: Five hundred and twelve subjects of Greek origin participated in this analysis. Chi-square and logistic regression statistics were used to compare if there are differences in participants' gender and age, stratified by histological type. RESULTS: Epithelial cancers and leukoplakia exhibited equal distributions among men and women. Men were diagnosed at a much younger age than women. Our data also indicates a progression in the process of epithelial cancer development, as benign leukoplakia was diagnosed 2-4 years earlier than epithelial dysplasia and 8 years earlier than squamous cell carcinoma (SSC). The same age difference was observed in non-Hodgkin's lymphoma, although the male to female ratio was 3:1. In regards to anatomy, 47% of SSC appeared in the tongue. The most prevalent site for the development of non-Hodgkin's lymphoma was the gingival (50%), followed by the palate (40%). CONCLUSION: Although oral cancer occurs earlier in men than women, the risk of females tends to be similar to that of males.
Asunto(s)
Leucoplasia Bucal/epidemiología , Neoplasias de la Boca/epidemiología , Factores de Edad , Carcinoma de Células Escamosas/epidemiología , Carcinoma Verrugoso/epidemiología , Distribución de Chi-Cuadrado , Femenino , Grecia/epidemiología , Humanos , Modelos Logísticos , Linfoma no Hodgkin/epidemiología , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de TiempoRESUMEN
Early detection and treatment improve the prognosis for oral cancer. Delays from the onset of symptoms to clinical diagnosis are common. Our aim is to identify factors associated with this delay. Between 1995 and 1998, we interviewed 105 consecutive patients with histologically confirmed oral cancer in Greece. If 21 or more days elapsed from the time the patient noticed major symptoms to a definitive diagnosis, we called it a delay (52% of cases). We used logistic and linear regression to estimate odds ratios of delayed diagnosis and to identify correlates of length of delay, respectively. Former smokers had a 4.3 times greater risk of delayed diagnosis compared with current smokers (95% confidence interval: 1.1-17.1). The length of delay was greater among single patients, non-smokers, or those with stage IV tumors. Clinicians should be advised that delay in the diagnosis of oral cancer occurs frequently, even in individuals who do not smoke heavily.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de la Boca/diagnóstico , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas , Peso Corporal , Carcinoma de Células Escamosas/genética , Estudios de Casos y Controles , Intervalos de Confianza , Empleo , Femenino , Grecia , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Estado Civil , Persona de Mediana Edad , Neoplasias de la Boca/genética , Estadificación de Neoplasias , Oportunidad Relativa , Salud Bucal , Neoplasias Faríngeas/diagnóstico , Neoplasias Faríngeas/genética , Factores de Riesgo , Factores Sexuales , Fumar , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
Oral and pharyngeal cancer (OC) mortality is very low in Greece, especially among men, compared to other European countries. We conducted a case-control study of OC in Athens, and obtained information on tobacco, alcohol use and other potential risk factors and confounding variables for 110 incident cases and 115 hospital-based controls. We used multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Tobacco smoking (pack years, P(trend)=0.01) and alcohol use (drinks/week, P(trend)=0.07) were independent risk factors, with a multiplicative effect for combined exposures (OR, 8.3; 95% CI, 2.4-29.1, for >28 alcohol drinks/week and >50 pack years of cigarette smoking). The type of alcoholic beverage also seemed important: drinking ouzo and tsipouro (liquors of high ethanol concentration) was associated with greater increased OC risk than drinking comparable amounts of wine, beer or dark spirits. While alcohol drinking is more common for male cases versus controls, few men reported regularly consuming large quantities of ethanol associated with highest risk of OC in other studies. This may partially explain the low rates of male OC mortality in Greece. Among the 38% of our cases who were women, however, neither smoking nor alcohol drinking frequencies were significantly elevated compared to controls, and so the etiology of OC risk in females requires further investigation.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Neoplasias de la Boca/etiología , Neoplasias Faríngeas/etiología , Fumar/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Bebidas Alcohólicas/efectos adversos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Factores SexualesRESUMEN
OBJECTIVES: Modeling new biomedical technologies and determining their expected cost is necessary before initiating formal clinical trials. This paper estimates an economic model for the potential cost impact of microbiological screening of toddlers for caries risk compared to the traditional method of managing pediatric caries. METHODS: Potential cost savings were calculated based on screening test properties (sensitivity and specificity) derived from a population of 1,180 children aged 1 to 3 years with a caries prevalence of 15 percent. An algorithm was then developed to allocate prevalent and anticipate incident caries, treatment effectiveness assumptions, and existing regional treatment costs. RESULTS: The cost analysis model conservatively predicts savings of 7.3 percent from screening and early intervention. Cumulative dental treatment costs for a child at age 4 years are $367.90 if the child has been screened and $396.70 otherwise. The model further predicts that cost savings increase significantly as caries prevalence increases. CONCLUSIONS: Microbiologic risk assessment for pediatric caries may be an example of a preventive public health screening technique that results in both clinical benefits and cost savings. If the model is validated by randomized clinical trials, microbiologic screening could be used by pediatric primary care providers to identify toddlers who require early referral to dentists for further risk assessment and early caries management.
Asunto(s)
Bacterias/crecimiento & desarrollo , Atención Dental para Niños/economía , Susceptibilidad a Caries Dentarias , Caries Dental/microbiología , Tamizaje Masivo/economía , Modelos Económicos , Medición de Riesgo , Algoritmos , Preescolar , Ahorro de Costo , Costos y Análisis de Costo , Índice CPO , Caries Dental/prevención & control , Caries Dental/terapia , Predicción , Necesidades y Demandas de Servicios de Salud , Humanos , Lactante , Prevalencia , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
BACKGROUND: One of the responsibilities of the dental profession is to protect and advance the well-being of the public through research of new pharmaceuticals and devices. The objective of this article is to present information about the scientific and regulatory process involved in the design and execution of randomized clinical trials. CONCLUSIONS: Dentists willing to serve as investigators in clinical trials--from Phase 1 to Phase 2 or Phase 3--need to be aware of the two main documents that contain the majority of guidelines and regulations governing clinical research: Title 21 of the U.S. Code of Federal Regulations and the guidelines for good clinical practice put forth by the International Conference on Harmonisation. CLINICAL IMPLICATIONS: Advancements in the frontiers of oral health science and the development of safe, innovative and effective treatment modalities are often the result of high-quality clinical research that is conducted by dental professionals. Knowledge of the research process, professionalism, scientific integrity and a detailed execution of the research plan are all required elements for a successful outcome.
Asunto(s)
Investigación Dental , Ensayos Clínicos Controlados Aleatorios como Asunto , American Dental Association , Materiales Dentales/normas , Investigación Dental/educación , Investigación Dental/métodos , Investigación Dental/normas , Aprobación de Recursos , Aprobación de Drogas , Comités de Ética , Guías como Asunto , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto/legislación & jurisprudencia , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Estados Unidos , United States Food and Drug AdministrationRESUMEN
The purpose of this study was to evaluate the effect of load on microleakage of pit and fissure sealants. In the first phase of the study load of maximal force (F = 880 N) on central and peripheral enamel was applied. Three groups of ten specimens were tested for microleakage. Group A no application of load, Group B application of load on the central pit of the tooth, and Group application of load on the peripheral enamel 2.5 mm away from the margin of the tooth, at the level of dentinoenamel junction. The results of that study showed significant increase of microleakage on the peripheral sealed enamel, as well as enamel microcracks. So, in the phase II sixty wisdom teeth were sealed with Ultra seal XT plus and load of different magnitude was applied on the peripheral enamel. The specimens were thermocycled for 500 cycles at 5 degrees C and 55 degrees C with a dwell of 30 seconds at each temperature prior to load application. Six groups of ten specimens were tested for microleakage under load. The force was applied at the peripheral enamel, 2.5 mm away from the margin of the tooth, at the level of dentin-enamel junction in cross-section view. Group A: F = 0 N; Group B: F = 300 N; Group C: F = 400 N; Group D: F = 500 N; Group E: F = 600 N; Group F: F = 700 N. Microleakage was scored as distance of dye penetration with 0 = no microleakage and 3 = microleakage to underlying fissure. A linear regression statistics was used with R-squared of 0.31. The groups with load applied (B, C, D, E, F) showed statistically significant results (p < 0.05) compared with group A (F = 0 N). Both, the magnitude of the force and tooth morphology may influence the degree of microleakage observed after the placement of sealants.
Asunto(s)
Fuerza de la Mordida , Filtración Dental , Selladores de Fosas y Fisuras , Resinas Compuestas , Fracaso de la Restauración Dental , Análisis del Estrés Dental , Humanos , Modelos Lineales , Ensayo de Materiales , Tercer MolarRESUMEN
Enameloplasty has been implicated in the successful application of pit and fissure sealants. The present study aimed to evaluate the effect of enameloplasty technique on microleakage of sealants when occlusal force was applied on the teeth. The study also allowed a direct comparison of the effectiveness of enameloplasty, when two different burs were used. Six groups of ten human extracted wisdom teeth were tested. Group A: no load, conventional (no enameloplasty--control); Group B: no load, enameloplasty 1/2 round bur (Brasseler USA); Group C: no load, enameloplasty diamond fissure bur REF/UP 791 (Ultradent); Group D: load 500 N, conventional, Group E: load 500 N, 1/2 round bur; Group F: load 500 N, diamond fissure bur. Specimens were thermocycled for 500 cycles at 5 degrees C and 55 degrees C with a dwell time of 30 seconds after load application. Microleakage was scored as distance of dye penetration with 0 = no microleakage and 3 = microleakage to underling fissure. The Kruskal-Wallis One Way Anova and Mann-Whitney U test showed group D having the greatest degree of microleakage statistically significant (p < 0.05) comparing with other groups. Sealants prepared with the conventional technique (A, D) had statistically significant differences in microleakage with those prepared with enameloplasty (B, C, E, F) (p = 0.01). Enameloplasty in groups with no load (B, C) did reduce microleakage, but not significantly (p = 0.3). However, loaded teeth with enameloplasty appeared to perform superior, as compared to those without (p = 0.005). Regarding the effect of load, teeth without load (Groups A, B, C) were found to have significantly less microleakage than teeth where mechanical force had been applied (Groups D, E, F), (p = 0.01). Microleakage in Group A (conventional technique without load) was significantly less than microleakage in Group D (conventional technique with load), (p = 0.04). However, load did not seem to influence microleakage when enameloplasty had been performed. This finding was true for both round bur enameloplasty (p = 0.29), and fissure bur enameloplasty (p = 0.26). There was no statistically significant difference between Groups B, E (round bur) and C, F (fissure bur) (p > 0.05), or between Groups B and C (p > 0.05) and between Groups E and F (p > 0.05). The results of the study indicated that enameloplasty reduced microleakage of pit and fissure sealants, especially when load was applied to teeth, irrespective of what bur was used to enlarge the fissure, as there was no statistical significant differences between the round and fissured diamond burs. The application of occlusal force to the tooth produces significantly more microleakage, unless enameloplasty is performed.
Asunto(s)
Fuerza de la Mordida , Preparación de la Cavidad Dental/métodos , Esmalte Dental/cirugía , Filtración Dental/prevención & control , Selladores de Fosas y Fisuras , Análisis de Varianza , Resinas Compuestas , Equipo Dental de Alta Velocidad , Instrumentos Dentales , Análisis del Estrés Dental , Humanos , Tercer Molar , Distribución Aleatoria , Estadísticas no ParamétricasRESUMEN
The effect of PerioGlas (synthetic bone particulate) on wound healing of experimental palatal periodontal defects in monkeys was evaluated. Chronic periodontal defects were created on the palatal aspects of maxillary molars and premolars. Open-flap debridement was performed. Experimental sites received PerioGlas, while control sites received no further treatment. Histologic measurements were performed on new bone, new cementum, epithelial downgrowth, and recession. Results showed significantly more new cementum and less epithelial downgrowth in the sites that received PerioGlas (P < 0.05). The present results indicate that PerioGlas may enhance periodontal wound healing outcomes.
Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Regeneración Ósea/efectos de los fármacos , Sustitutos de Huesos/farmacología , Cerámica/farmacología , Cicatrización de Heridas/efectos de los fármacos , Animales , Macaca mulatta , MasculinoRESUMEN
The purpose of this study was to assess the nasal volume and the cross-sectional areas of the nose in 7 to 12 year old children, and to identify factors that may influence those parameters. Specifically we investigated the effect of passive smoking at home, body mass, presence of allergies, and history of removal of the tonsils, controlling for the age, gender and race of the child. Fifty-four children participated in the study. Five consecutive nasal measurements were taken from each nostril in one visit, using the acoustic reflection technique (acoustic rhinometry). The nasal volume and the cross-sectional area were computed from the nasal readings. We observed that the minimal cross sectional area is located at the laminal valve, which has been considered one of the main anatomical structures that affect the regulation of breathing in the anterior part of the nose. We also concluded that body mass and exposure to environmental tobacco by-products play a significant role in determining reductions in a child's nasal volume. The clinical significance of such a finding and its effect to the normal craniofacial development of a growing child may force parents to reconsider smoking while at home.
Asunto(s)
Desarrollo Maxilofacial , Obstrucción Nasal/etiología , Nariz/anatomía & histología , Contaminación por Humo de Tabaco/efectos adversos , Obstrucción de las Vías Aéreas , Constitución Corporal , Niño , Femenino , Humanos , Modelos Lineales , Masculino , Respiración por la Boca/etiología , Factores de RiesgoRESUMEN
Child abuse and neglect is a serious social problem with global dimensions. The purpose of this study was to assess attitudes and perceptions of students of medicine, dentistry and public health at three Boston institutions about child abuse and neglect issues that they may encounter in their future professional lives. Among others, we investigated how participants rank the public health importance of child abuse and neglect in comparison with violent acts against other social groups, their willingness to report it and their potential interest to supplement their knowledge with additional course work. Two hundred and fourteen students participated in the study by completing our questionnaire. The results of the statistical analyses indicate that child abuse is considered the most serious problem, followed by domestic violence, child neglect and abuse of the handicapped and the elderly. We also documented that a significant educational need exists in this group, regarding diagnostic methods and interventions aimed to reduce the incidence and the impact of violence or neglect against children.
Asunto(s)
Actitud del Personal de Salud , Maltrato a los Niños/psicología , Estudiantes del Área de la Salud/psicología , Adulto , Boston , Niño , Femenino , Humanos , Masculino , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
The purpose of this study was to determine if there are any differences in the nasal geometry of children with nasal respiration or predominantly oral respiration (mouth breathing). The technique utilized was the acoustic reflection technique or acoustic rhinometry. Acoustic rhinometry is a non-invasive method, which can be easily applied to young children. Twenty children participated and both nostrils were evaluated. Statistically significant differences were found in the total nasal volumes between the two groups, with the mouth breathers presenting with reduced nasal volumes. No differences were observed in the nasal cross sectional areas.
Asunto(s)
Respiración por la Boca/diagnóstico , Cavidad Nasal/fisiopatología , Obstrucción Nasal/diagnóstico , Pruebas de Función Respiratoria/instrumentación , Acústica , Adolescente , Resistencia de las Vías Respiratorias , Niño , Femenino , Humanos , Masculino , Manometría , Respiración por la Boca/etiología , Respiración por la Boca/fisiopatología , Cavidad Nasal/patología , Obstrucción Nasal/complicaciones , Obstrucción Nasal/fisiopatología , Encuestas y CuestionariosRESUMEN
Proper diagnosis, surgical management and application of biomechanics have paramount clinical significance in order to prevent potential mucogingival problems and to ensure the outcome of treatment in cuspid impaction cases.