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Objectives —The aim of this study was to establish the treatment outcome of full denture treatment with or without implant support, in which the outcome assessment focuses on the patient's subjective evaluation (‘denture-satisfaction’). Design —A multicenter randomized clinical trial. Subjects —Thirty-two men and 118 women (mean age 56±9, range 35–84 years) participated in the study. The mean height of the mandible was 13±2 mm, measured on a lateral cephalometric radiograph. The patients were randomly assigned to either a group treated with implant-retained mandibular overdentures and a new maxillary denture, or to a control group treated with a new set of complete dentures. Main outcome measures —Denture satisfaction was assessed using questionnaires focusing on denture-related complaints and ‘a general satisfaction rate’. Results —Based on the baseline data, from the ‘denture complaints’ questionnaire six interpretable factors could be extracted. One factor did not vary following treatment and was excluded from the outcome analysis. At the 1-year evaluation three out of five factors showed significantly better scores for the group treated with implants than for the control-group. The same was found for the general satisfaction rate. Conclusion —For patients with a severely resorbed mandible, overdentures retained by dental implants appear to provide a more satisfactory solution to their denture-related problems.

Summary The periapical radiograph is a tool used in the diagnosis of periapical bone pathology. Radiographic diagnosis might therefore influence endodontic treatment planning and the quality and the cost of dental health care. The hypotheses were tested that (1) the subjective prevalence of a lesion would be associated with the accuracy with which it is diagnosed, (2) ‘confident dentists’ would be as accurate in their diagnosis as ‘doubtful dentists’ and (3) the diagnostic confidence of dentists for the diagnosis of periapical pathology would not influence their treatment planning. It was found that the probability of an appropriate treatment decision increased when dentists were relatively confident about a diagnosis. The results showed, furthermore, that the accuracy of diagnostic decisions increased when the dentist's confidence about a particular decision was high. Ways to increase diagnostic accuracy of radiopaque periapical pathology are proposed as a result of this study.

Objective. The development and validation of Modified Disease Activity Scores (DAS) that include different 28-joint counts. Methods. These scores were developed by canonical discriminant analyses and validated for criterion, correlational, and construct validity. The influence of disease duration on the composition of the DAS was also investigated. Results. No influence of disease duration was found. The Modified DAS that included 28-joint counts were able to discriminate between high and low disease activity (as indicated by clinical decisions of rheumatologists). Conclusion. The Modified DAS are as valid as disease activity scores that include more comprehensive joint counts.

This study aimed at comparing the Thylstrup-Fejerskov index (TFI) and the Dean's Index (DI) which were applied on three communities with different severity of dental fluorosis. A total of 1565 children aged between 11 and 18 yr with a mean age of 14.7 were examined for dental fluorosis with the TFI and 1155 of these children were also examined with the DI. The measurement error for the TFI was 0.50 (10 scale point) compared to 0.53 for DI (6 scale point). The Kappa values and the measurement-remeasurement correlation appeared to be better for the TFI. No difficulties were encountered in applying the TFI in contrast to the DI, which caused uncertainties in assessing the "questionable" and "very mild" scores, and this may explain the relatively better reproducibility of the TFI. The correspondence between both indices was determined. TFI 0 corresponded well with DI 0. The conversion values for TFI 1, 2, 3 and 4 into DI scores were 0.3, 0.8, 1.4 and 2.4 respectively. The TFI 5-9 corresponded with DI score 4. TFI could discriminate the severe forms of dental fluorosis which were categorized in Dean's highest score 4. TFI was able to reveal more dental fluorosis than DI in communities with minor and moderate dental fluorosis. In the community with severe dental fluorosis where more than 85% of all teeth exhibited a DI > or = 1, both indices revealed a comparable prevalence of dental fluorosis. The TFI is considered a near ideal instrument.

After de- and subsequent remineralization at 0.03 and 1.0 ppm fluoride and either 0, 1, 10, 20 or 25 mM carbonate, artificial lesions in bovine enamel were demineralized again. The amount of secondary demineralization was determined after 15, 30 and 70 h of demineralization by means of quantitative microradiography. The results showed that fluoride incorporated during the remineralization period retards lesion formation during secondary demineralization. Carbonate incorporated during the remineralization period enhances secondary demineralization. An interaction between both ions was observed.

Three putative risk factors to the pathogenesis of end-of-dose-related fluctuations--severity of Parkinson's disease (PD), duration of PD, and duration of levodopa therapy--were evaluated in 39 patients with PD by measuring response duration and response magnitude to a single levodopa dose. After discontinuing levodopa therapy for 12 hours, the motor status of each patient was assessed before a single dose of 100 mg of levodopa plus 25 mg of decarboxylase inhibitor was given and at five 45-minute intervals thereafter. Multiple regression analysis showed that the response duration was best predicted by the severity of PD. The response magnitude was significantly correlated both to the duration of PD and to the duration of levodopa therapy. It is argued, however, that the response magnitude was predicted by the duration of levodopa therapy. Our results are in accordance with those of other recent studies and indicate that variances in levodopa response duration and in levodopa response magnitude are caused by their own differential risk factor.

Contains fulltext : 53218.pdf (Publisher’s version ) (Closed access) The objective of this study was to evaluate the influence of professional background, age, gender, and geographical region of panel members on their evaluation of the facial aesthetics of adolescents, and to assess the optimal panel size for epidemiological studies on facial aesthetics. A panel of 76 adult laymen from two different regions (Belgium and The Netherlands) and a panel of 89 orthodontists from the same two regions, evaluated photographic sets (one frontal, one three-quarter smiling, and one lateral view) of 64 adolescents (32 boys, 32 girls) on a visual analogue scale (VAS) in relation to a reference set of photographs. The effects of the characteristics of the panel members on the VAS scores for boys and girls separately, as well as their interactions, were evaluated by multilevel models. The adolescents entered the model as a random effect and four characteristics of the panel members were included in the model as fixed effects. The multilevel model with main effects and first-order interactions revealed that laymen rated adolescents as more attractive than orthodontists. This finding was significant for all laymen, except for older males, and Belgian laymen, when rating girls. Older panel members rated boys significantly more attractive than younger panel members. Males rated adolescents more attractive than females. The latter was significant for all male subgroups, except for the lay male subgroup. There were regional differences. Based on the intraclass correlation coefficient, a panel of seven randomly selected laymen and/or orthodontists is sufficient to obtain reliable results in the aesthetic evaluation of adolescent faces, using photographs and a VAS.

Contains fulltext : 52589.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The Atraumatic Restorative Treatment (ART) approach was compared with the traditional amalgam (TA) approach in order to test their appropriateness to complement a preventive and educational school oral health programme in Syria. METHODS: Using a parallel group design, 370 and 311 grade 2 children were randomly assigned to the ART and the TA group respectively. Eight dentists placed 1117 single- and multiple-surface restorations. A modified actuarial method was used to estimate survival curves. The jackknife method was applied to calculate the standard error in the cumulative survival percentages. RESULTS: A statistically significant difference in cumulative survival percentages between single-surface non-occlusal ART and comparable amalgam restorations was observed after 4.3, 5.3 and 6.3 years. The survival of single-surface non-occlusal ART posterior restorations (80.2 +/- 4.9%) was statistically significantly higher than that of occlusal posterior ART restorations (64.8 +/- 3.9%) at evaluation year 6.3. There was no statistically significant difference observed between survival percentages of large (55.8 +/- 10%) and that of small (69.2 +/- 4.6%) single-surface posterior ART restorations after 6.3 years. There was an operator effect observed for single-surface ART and comparable amalgam restorations. Secondary caries was observed in 2.3% of single-surface ART restorations and in 3.7% of single-surface amalgam restorations during the 6.3 year observation period. CONCLUSIONS: The ART approach provided higher survival percentages for single-surface restorations than the TA approach over 6.3 years and is therefore appropriate for use in school oral health programmes. Secondary caries was only a minor reason for ART restorations to fail. An operator effect was observed for both treatment approaches.

Contains fulltext : 49243.pdf (Publisher’s version ) (Closed access) INTRODUCTION: The difference in preventing dentine lesion development between resin-based and glass ionomer sealant materials is unclear. Two recently published reviews were unable to conclude on the difference because the comparison was an exclusion criterion in one review and there were statistical shortcomings in the relevant papers in the other (Cochrane) review. OBJECTIVES: The aim of the present investigation was to carry out a systematic review on the caries-preventive effect of these two types of sealant materials under more liberal exclusion criteria concerning the statistical presentations in the publications. METHODS: Based on five exclusion criteria, the literature search in the electronic libraries PubMed and MEDLINE and the publications retrieved in the Cochrane review, revealed 12 eligible publications for analyses. A variety of glass ionomers and resin-based sealant materials had been applied in the included studies. Attributable risk (AR) was chosen rather than relative risk (RR), as used in the Cochrane review, because RR is very instable in a low caries population. RESULTS: There was no consistent pattern observed with respect to the caries-preventive effect of either resin-based or glass ionomer sealants. Therefore, it was impossible to calculate an overall AR. CONCLUSIONS: There is no evidence that either resin-based or glass ionomer sealant material is superior to the other in preventing dentine lesion development in pits and fissures over time.

Item does not contain fulltext The aim of the present trial was to (1) compare the caries-preventive effect of glass ionomer sealants, placed according to the atraumatic restorative treatment (ART) procedure, with composite resin sealants over time and (2) investigate the caries-preventive effect after complete disappearance of sealant material. Forty-six boys and 57 girls, mean age 7.8 years, were randomly divided into two treatment groups in a parallel-group study design. A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups. Evaluation took place annually for 5 years by calibrated examiners. After 5 years, 86% composite resin and 88% glass ionomer sealants did not survive. Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished: 0-1, 1-2 and 2-3 years. In the 2- to 3-year group, 13 and 3% of pits and fissures previously sealed with composite resin and glass ionomer, respectively, were diagnosed as having developed a dentine lesion. The relative risks (95% CI) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3, 4 and 5 years were 0.22 (0.06-0.82), 0.32 (0.14-0.73) and 0.28 (0.13-0.61), respectively. The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1-2 and 2-3 years were 0.26 (0.14-0.48) and 0.25 (0.09-0.68), respectively. We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants, placed using the ART procedure, was between 3.1 and 4.5 times higher than that of composite resin sealants after 3-5 years. Furthermore, high-viscosity (ART) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period. A well-designed clinical trial using different types of oral health personnel should be implemented to confirm these initial results.

The question has been raised whether low-caries children regularly using fluoride toothpaste will benefit from the professional application of additional fluoride gel. To investigate the caries-reducing effect of semi-annually-applied neutral 1% sodium fluoride gel, we carried out a double-blind randomized controlled clinical trial (n = 594) in a child population, initially aged 9.5–11.5 years, with baseline caries experience of D3MFS = 0 (decayed, missing, and filled tooth surfaces of permanent teeth). The mean number of tooth surfaces saved from caries development by fluoride gel application after 4 years was 0.2 D3MFS (SE = 0.17). The preventive fraction (PF) showed a mean relative effect of professionally applied fluoride gel of 18%. The cariostatic effect of the fluoride gel on pits and fissures would have been influenced by the sealant strategy in the study. Professionally applied fluoride gel showed no statistically significant effect on mean D3MFS score in low-caries 9.5- to 11.5-year-olds.

Contains fulltext : 48898.pdf (Publisher’s version ) (Closed access) A new measuring system to judge facial aesthetics in young Caucasians is presented. The system uses sets of three photographs (one frontal, one three-quarter smiling, and one lateral) as a stimulus. Scores are performed on a visual analogue scale (VAS) with separate sets of reference photographs for girls and boys. The choice of the reference photographs was based on a panel evaluation of facial aesthetics of 40 boys and 40 girls from the archive of the orthodontic department. Reproducibility of the new measuring system was tested on a series of photographic sets (one frontal, one three-quarter smiling, and one lateral view) of 64 patients, using a panel of 78 adult laymen and 89 professionals. The panel members assessed these sets of photographs on a VAS, in relation to the reference sets. The system was shown to be reproducible. Although the intra-observer reproducibility was low, the reliability coefficient was excellent (Cronbach's alpha > or = 0.98). Validity was tested by comparing the scores on the new scales with those of the three-quarter smiling photographic views on an earlier published scale. The correlation between the ratings on the new measuring system and the earlier published scale was 0.82 for laymen and 0.77 for professionals. The new system is simple and flexible in its use, and reproducible and valid for assessing facial aesthetics in young Caucasians. The system can be used in further investigations on the evaluation of facial aesthetics.

Contains fulltext : 58740.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To determine the need for orthodontic treatment among Tanzanian Bantu children. DESIGN: Prospective study using dental casts. SETTING: Sixteen randomly selected schools from the Ilala district, Dar-es-Salaam, Tanzania. SUBJECT: Six hundred and forty three Tanzanian children from an urban district. METHOD: Dental casts of 643 Tanzanian subjects in age groups 3-5, 6-8, 9-11 and 15-16 years, were assessed using the Index of Orthodontic Treatment Need (IOTN). MAIN OUTCOME MEASURES: Need for orthodontic treatment. RESULTS: Aesthetic treatment need (AC grades 8-10) and dental health component (DHC grades 4-5) occurred in 5-15% and 16-36% of the studied children, respectively. The need measured by DHC increased significantly between the two oldest age groups. An absolute need measured by combining AC grades 8-10 and DHC grades 4-5 was found in 3-12% of the subjects and it increased significantly with age (p

Contains fulltext : 48351.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS). METHODS: The Stoke Ankylosing Spondylitis Spinal Score (SASSS) was modified by adding a score for the cervical spine and defining squaring. This modified SASSS (mSASSS) is the sum of the lumbar and cervical spine score (range 0-72). 370 lateral views of the lumbar and cervical spine were used for development of the mSASSS, standardisation of observers, and for studying reliability. In a 48 week NSAID study of 57 patients, change over time and construct validity were studied. RESULTS: Interobserver correlations of the lumbar and cervical spine scores were good (r>0.95). The interobserver duplicate error was 0.55 in a range from 0 to 36. The mean change in the cervical and lumbar spine scores between weeks 0 and 48 of all patients was 1.45 (range 0-6.0) and 1.06 (0-5.0), respectively (paired t testing, p

The aim of this study was to assess post-operative stability of bilateral sagittal split set-back osteotomies using two miniplates and clinical parameters including nerve function, TMJ function, occlusal relapse and patient satisfaction. The stability was measured on cephalometric radiographs and possible condylar alterations on orthopantomograms. This prospective study implied a 2-year follow-up on a group of 24 patients. The same protocol was used at six participating institutions at which the patients were treated. A stable occlusion without appreciable relapse was seen in 91% after 2-year follow-up. Only two patients in this study had mild occlusal relapse. The mean skeletal horizontal relapse at pogonion of the whole group, after 2 years was 1.1 mm and appeared to be directed backwards. At occlusal level, however, the mean relapse was 1.2 mm forwards. The function of the inferior alveolar nerve 2 years post-operatively was reported to be normal in approximately 70% of the patients, yet 80% had no complaints about nerve dysaesthesia. In approximately 21% of the patients, signs and symptoms of TMJ dysfunction had disappeared. Another group (10%), however, without pre-operative signs and symptoms of TMJ dysfunction developed these signs or symptoms post-operatively. No condylar remodelling or resorption was seen in this group of patients. The sagittal split set-back osteotomy fixed with miniplates appeared to be a relatively save and reliable procedure giving rise to adequate results and a high degree of patients satisfaction.

Item does not contain fulltext We analysed the effect of three portion sizes Optocal Plus (small, medium and large) on swallowing thresholds in subjects with either conventional complete dentures or mandibular implant-retained overdentures (transmandibular and permucosal cylindric implants). Tests were carried out in 52 women and 15 men (mean age 59 years) 4 years after treatment in a randomised controlled clinical trial. The results indicated that the degree of mucosal support for the mandibular denture did not affect the number of chewing strokes, time till swallowing or swallowed particle size. Only the chewing rate differed: subjects wearing mandibular implant-retained overdentures chewed the food at a higher rate than complete-denture wearers. With larger portion sizes, subjects needed significantly more chewing strokes and time until swallowing and they would have swallowed larger particles. Men chewed their food more efficiently than women, as they used the same number of chewing strokes and time, but achieved a greater particle size reduction at the swallowing moment.

Item does not contain fulltext In 2002 a dental survey amongst 6- and 12-year-old schoolchildren (n = 832) in The Hague was carried out. The caries findings were compared with findings from earlier studies in The Hague. Caries prevalence (% of caries-free children) and caries experience (mean dmfs scores) among 6-year-old children had not changed significantly in the period 1996-2002. However, a significant increase of caries-free 12-year-old children of low socio-economic status was found in the period 1996-2002. The proportions of caries-free 12-year-old Dutch, Turkish and Moroccan children of low socio-economic status were 88, 69 and 78%, respectively, in 2002. The average DMFT score of 12-year-olds reached a minimum of 0.2. In 2002, 24% of the 12-year-olds exhibited signs of erosion, indicating that the presence of erosive wear was high among youngsters in The Hague.

Objectives : To test the recommended consensus conference methods in Tanzania by discussing the management of traumatic dental injuries, and to reach consensus on the feasibility of the treatment modalities of traumatic dental injuries recommended in western countries in the Tanzanian situation. Study participants : Fifteen dentists as representatives of the profession and two lay people as representative of potential consumers. Interventions: Presentation of treatment modalities for traumatic dental injuries recommended in western countries. Main outcome measure : Consensus on the feasibility of the recommended treatment modalities of traumatic dental injuries in the Tanzanian situation. Results : For most types of injuries, consensus on the feasibility of the recommended treatment methods for Tanzania was reached immediately. More time was spent to discuss management of some injuries where the members felt that the recommended management regimes for these injuries are not feasible in the current Tanzanian situation. Panel members made three recommendations. First, parents and teachers should be provided with guidelines or instructions about self-care following trauma. Second, teaching on the management of traumatic dental injuries at training institutions should be emphasised and third, dental practitioners at dental clinics in the country should get continuing education about the management of traumatic dental injuries. Conclusion : The methods for achieving consensus were useful in the Tanzanian dental situation, therefore it is recommended that the methods be adopted to reach consensus on other oral health issues.

Orthodontic procedures seem to be more time-consuming in adults than in juveniles. This might be related to delay in the initial tissue response or to a slower turnover of the bone and periodontal ligament in adults. To study this problem, we studied orthodontic tooth movement in two groups of 30 rats, aged 6 wks and 9–12 mos, respectively. At one side of the maxilla, 3 molars together were moved mesially with a standardized orthodontic appliance delivering a force of 10 cN. The other side served as a control. The results showed a faster initial tooth movement in juvenile than in adult animals. However, once tooth movement had reached the linear phase, the rate of tooth movement was the same in both groups. The results indicate that, besides a delay in the onset of tooth movement in adult animals, tooth movement could be equally efficient in adults once it had started.

Contains fulltext : 63004.pdf (Publisher’s version ) (Closed access) Aim: Dentists have a dual professional role: they have to focus on good oral health in their patients and, at the same time, they have to organise their practices. The aim of this analysis was to assess the extent to which dentists can be seen as business-oriented and/or willing to delegate to dental team members and others, and to investigate which personal and practice characteristics of dentists can be regarded as determinants for these two aspects of their professional role. Method: The data were collected in 2000 by means of a written questionnaire sent to a random stratified sample of 790 dentists. Results: 607 (77 per cent) dentists responded. Multivariate regression analysis showed that business oriented dentists distinguish themselves by having larger practices and a higher level of professional satisfaction. Furthermore, although to a lesser extent, on a regular basis, they treat patients from colleagues in the practice. There are proportionately fewer women dentists in this category. Dentists oriented on task distribution can also be typified by working in larger practices, but in addition they have a greater preventive treatment philosophy and have more hours of support provided by oral hygienists. Conclusion: Among Dutch dentists there exist clear differences in the way they take on their role as dentists with regard to business orientation and their willingness to distribute dental tasks.

Item does not contain fulltext This study compared the survival of restorations produced through the atraumatic restorative treatment (ART) approach using glass-ionomer with those produced through the traditional approach using amalgam (MTA) in deciduous dentitions over a period of 3 years. Using a parallel group design, 835 grade 1 children, aged 6-7 years, participated. A total of 482 children were treated through the ART and 353 children through the MTA approach. Eight dentists produced a total of 1891 single- and multiple-surface restorations. After 3 years, 22.1% of the restorations were lost for evaluation. There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach (p = 0.04). The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6%, respectively. The difference was statistically significant (p = 0.03). The main reasons for both single-surface ART and MTA restorations to fail was 'restoration missing' followed by 'gross marginal defect'. The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9%, respectively. The difference was not statistically significant (p > 0.05). The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect (p = 0.001) for multiple-surface MTA restorations. It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years. It is recommended to select the ART approach to complement the other activities of the school oral health programme.

Item does not contain fulltext The aim of this study was to compare the reproducibility of longitudinal cephalometric measurements between analogue and digital methods using two different resolutions. Cephalometric radiographs of 20 patients were selected at the start (T1) and end (T2) of treatment: 24 cephalometric variables were calculated at T1 and T2, and their increments (T2 - T1) were also evaluated. All measurements were performed twice by two observers. Quality of methods [analogue, digital: 300 and 600 dots per inch (DPI) resolution] was evaluated by comparing the reliability coefficients and the total error between the digital and analogue methods. The inter-observer agreement was good. The 300 DPI was comparable to the analogue method. The reproducibility for the variables was comparable, but mandibular incisor increments tended to show better results with the 300 DPI method, whereas skeletal jaw relationship increments were not reliable with either method. Maxillary incisor increments, however, were reliable with both methods. The 300 and 600 DPI resolutions were found to be comparable. Scanning of cephalometric radiographs at a resolution of 300 DPI is sufficient for clinical purposes and comparable to analogue cephalometrics. However, all methods were found to be poor in assessing skeletal jaw relationships longitudinally.

Item does not contain fulltext The purposes of the study were: (1) to assess the prevalence and distribution of smooth-bordered tooth wear in teenagers, and (2) to investigate the relationship between smooth-bordered tooth wear and social background, dietary pattern, drinking habits, oral hygiene practices and caries prevalence. In The Hague, The Netherlands, a sample of 345 10- to 13-year-olds and 400 15- and 16-year-olds was clinically examined. The criteria for the assessment of smooth-bordered tooth wear ('smooth wear') were in line with the diagnostic criteria for erosion developed by Lussi (1996). In the age group 10-13 years, the percentage of subjects with visible smooth wear (SW1 threshold) was 3% and in 1 subject (0.3%), deep smooth enamel wear was found. Due to the low prevalence, the results for this age group were not analysed further. In the age group 15-16 years, the proportion of subjects with visible smooth wear (SW1 threshold) was 30% and that with at least deep smooth enamel wear (SW2 threshold) 11%. Smooth wear into dentine was found in 1 subject. First molars and upper anterior teeth were affected predominantly. A significant effect on visible smooth wear (SW1 threshold) was found for gender and social background. At mouth level, no significant influence was found for dietary patterns, drinking habits or oral hygiene practices. The caries prevalence was similar in subjects with and without smooth wear.

Item does not contain fulltext BACKGROUND: Different prevalences of benzodiazepine (BZ) use are described in the literature. The present study assessed the effects of employing various definitions of BZ use and various observation periods on the prevalence rate of BZ use in an open population aged 18-74 years. METHOD: In a literature review, prevalence studies were systematically compared. In a second stage, a descriptive cross-sectional multipractice study was analysed using 48,046 prescriptions of BZ in the past year given to a population of 80,315 patients at 31 general practices in the Nijmegen Health Area. From this database, prevalence rates were calculated applying different definitions of BZ use and different observation periods. RESULTS: In the literature, prevalence rates varied between 2.2 and 17.6%. There was wide variation in definitions of BZ use and observation period. In our prescription database, depending on the definitions of BZ use and observation period, prevalence rates ranged from 0.2% to 8.9%. The ratio of female:male (2:1) remained constant irrespective of the prevalence rate. Age distribution varied according to the duration of use: among long-term BZ users, approximately 80% were older than 45 years; among short-term BZ users, approximately 55% were older than 45 years. CONCLUSIONS: The wide variation in prevalence rates of BZ use reported in the literature can largely be explained by differences in definitions of BZ use and observation period. This affected the distribution of some BZ-use-related variables such as age. For reliable comparisons of BZ use, standardisation of the definition of BZ use is required. A proposal for standardising methodology is presented.

A prospective longitudinal cohort study was performed to assess the prevalence of iron deficiency in European infants at 12 mo of age, and to study the influence of socio-economic status, dietary factors, growth and morbidity on iron status. The cohort consisted of 488 normal term infants from primary healthcare centres in 11 European areas. Assessed were socio-economic variables, dietary intake, anthropometry and morbidity at regular intervals from birth to 12 mo, and haemoglobin, serum ferritin, mean corpuscular volume, transferrin saturation and serum transferrin receptor concentrations at age 12 mo. The prevalence of anaemia was 9.4%, of iron deficiency 7.2%, and of iron deficiency anaemia 2.3%. More than 40% of anaemia was associated with normal iron status and associated with an increased frequency of recent infections. Iron deficiency anaemia was significantly more frequent with low (5.1%) than high socio-economic status (0%). Dietary factors accounted for most of this variation in multiple regression analysis. Early introduction of cows' milk was the strongest negative determinant of iron status. Feeding of iron-fortified formula was the main factor positively influencing iron status. Other dietary factors, including breastfeeding, did not play a significant role as determinants of iron status at age 12 mo. Conclusion. Iron deficiency anaemia is present in 2.3% of 12-mo-old European infants. The prevalence of iron deficiency anaemia varies strongly with socio-economic status. Avoidance of cows' milk feeding during the first year of life is the key measure in the prevention of iron deficiency.

Item does not contain fulltext OBJECTIVE: To compare four different inception cohorts of patients with early rheumatoid arthritis (RA) with respect to treatment strategies, disease activity, and outcome during a five year follow up period. METHOD: Data from cohorts of patients with early RA, with a standardised assessment at least every six months for five years from four different centres, were included in one database. Owing to slight differences in the individual study designs, linearly interpolated values were calculated to complete the standard follow up schedule. RESULTS: Despite similar inclusion criteria, significant differences in demographic factors and baseline disease activity were found between the different cohorts. During the follow up an aggressive treatment strategy was followed in the Dutch and Finnish cohort, an intermediate strategy in the British cohort, and a conservative strategy in the Swedish cohort. A significant improvement in disease activity was seen in all cohorts, though the most rapid and striking improvement was seen in those receiving aggressive treatment. This resulted in less radiographic destruction in the long run. CONCLUSION: This observational study of cohorts of patients with early RA confirms that early aggressive treatment results not only in a more rapid reduction of disease activity but also in less radiographic progression in the long term.

Item does not contain fulltext The osteoinductive properties of porous titanium fiber mesh, with or without a calcium phosphate coating and loaded with recombinant human bone morphogenic protein-2 (rhBMP-2) or rhBMP-2 and native bovine BMP (S-300) were investigated in a rat ectopic assay model. A total of 112 calcium phosphate-coated and 112 noncoated porous titanium implants, either loaded with rhBMP-2 and S-300 or loaded with rhBMP-2 alone, were subcutaneously placed in 56 Wistar-King rats. The rats were killed 5, 10, 20, and 40 days postoperatively, and the implants were retrieved.Histologic analysis demonstrated that all growth factor and carrier combinations induced ectopic cartilage and bone formation at 5 and 10 days, respectively. At 20 days, bone formation increased and was characterized by trabecular bone and bone marrow-like tissue. At 40 days, more lamellar bone and hemopoietic bone marrow-like tissue were present. At both times, more bone had been formed in calcium phosphate-coated implants than in noncoated samples. Further, in rhBMP-2 and S-300-loaded specimens, bone formation was higher than in rhBMP-2 only-loaded specimens. In rhBMP-2 only-loaded specimens, bone formation was mainly localized inside the mesh material, whereas in specimens loaded with both rhBMP-2 and S-300, the bone was localized inside and surrounding the titanium mesh. The histological findings were confirmed by calcium content and alkaline phosphatase activity measurements. In addition, all specimens showed osteocalcin expression as early as 5 days postoperatively.Our results show that the combination of titanium mesh with BMPs can induce ectopic bone formation and that this bone formation seems to be similar to "enchondral" ossification. In addition, a thin calcium phosphate coating can have a beneficial effect on the bone-inducing properties of a scaffold material. Finally, rhBMP-2 and native BMP act synergistically in ectopic bone induction.

Background:The World Health Organization (WHO) recommends exclusive breast-feeding during the first 4 to 6 months of life, but limited information is available regarding the growth performance of infants fed according to the recommendation. The present study used data from the Euro-Growth st

BACKGROUND In many areas of Europe iodine deficiency disorders still exist. Urinary iodine excretion is a valuable tool in characterizing the iodine supply of a population. However, there is a continuing discussion on the most appropriate parameter to measure urinary iodine excretion. METHODS In 247 children (ages 3-5 years) from six European centers, spot urine samples were analyzed for urinary iodine concentration and urinary iodine-creatinine ratio. RESULTS The median values of urinary iodine concentration from the six centers were very similar (90-106 microg/l) corresponding to a normal or marginal iodine supply according to the criteria of the World Health Organization. However, the median values of the urinary iodine-creatinine ratio from the six centers differed significantly (143-445 microg/g, P < 0.001). The different results of the two urinary parameters to assess urinary iodine supply were due to large significant differences in the urinary creatinine concentration reported by the various centers, which probably reflect marked differences in water intake. CONCLUSIONS Iodine deficiency is still a significant health problem in many European countries. In comparable and homogeneous population subgroups (even from different countries), the urinary iodine-creatinine ratio appears to be a much better parameter for assessing iodine supply than urinary iodine concentration.

In 32 children with a solid tumor, the association between the change in weight for height, in response to 4 weeks of tube feeding during the intensive phase of treatment, and the occurrence of leukopenia, leukopenic infections, and nonleukopenic infections in a period thereafter (4-10 weeks) was studied. Factors possibly influencing the change in weight for height during the first 4 weeks of tube feeding were also assessed. A statistically significant negative correlation (rho = -0.59; p.001) was found between the change in z-score of weight for height in response to the first 4 weeks of tube feeding, and the occurrence of nonleukopenic infections between 4 and 10 weeks. A reduced occurrence of nonleukopenic infections resulted in a significant reduction of the number of days of infection-related hospital admission (rho = .45; p = .009), which, besides providing advantages for the patient, also had economical benefits. The change in weight for height in response to tube feeding was mainly influenced by the incidence of therapy-induced vomiting (r = -.45; p = .02) and by the amount of energy provided by tube feeding (r = .47; p = .007). Based on these findings, it is recommended that naso-gastric tube feeding be used in children with a solid tumor during the early intensive phase of treatment, and that one should aim for a considerable increase in weight for height during the first 4 weeks of administration, since this has been shown to reduce the number of nonleukopenic infections in a subsequent period. The increase in weight for height may be improved by providing an optimal antiemetic protocol, which will increase energy uptake, and an energy-enriched formula, which will increase energy intake.

Background: Treatment of cancer cachexia partly involves the administration of adequate amounts of energy. The aim of this study was to assess the tolerance and efficacy of two equal volumes of tube feeding, one with a standard (1 kcal/mL) and one with a high energy density (1.5 kcal/mL), during the intensive phase of treatment. Methods: Nutritional status was assessed weekly, in 27 children with a solid tumor, by measuring weight, height, midupper arm circumference, biceps and triceps skinfold, and serum proteins. Tolerance was assessed by recording the occurrence of vomiting and by expressing the administered volume as a percentage of the required volume. Results: Both formulas were equally well tolerated, leading to a significantly higher energy intake in the energy-enriched formula group. In both formula groups, all anthropometric variables increased significantly (range of mean increase, 5.2% to 25.5%; p < .05) during the first 4 weeks of intervention. Between 4 and 10 weeks, variables continued to increase significantly in the energy-enriched group, resulting in adequate repletion, in contrast to the standard formula group. The concentration of serum proteins, low at initiation of tube feeding, returned to the normal range within 2 to 4 weeks with no significant differences between the two groups. Conclusions: The energy-enriched formula was more effective in improving the nutritional status of children with cancer during the intensive phase of treatment than the standard formula. Intensive, protocolized administration of an energy-enriched formula should therefore be initiated as soon as one of the criteria for initiation of tube feeding is met.

OBJECTIVE—To investigate mortality, functional capacity, and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. METHODS—The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. RESULTS—Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficiency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. CONCLUSIONS—In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death.

Objective : To assess the performance of three different filling materials in overdenture abutment teeth. Methods : In 49 patients amalgam, resin composite and resin-modified glass ionomer cement were used to seal the root canal orifices of 155 overdenture abutment teeth. After initial preparation of the cavities, the three restorative materials were randomly assigned to the abutment teeth using a number of balancing criteria. All patients were reviewed every six months and received the same preventive regimen. Survival was assessed at two levels: S orig (survival of the restoration independent from eventual maintenance treatments) and S comp (restorations survived even without maintenance treatments). Results : The calculated overall survival percentage of the original restorations ( S orig ) after four years was 63±6% (mean±SE). Calculation for the overall complete survival ( S comp ) revealed a percentage survival of 57±6%. At both levels, the differences between the survivals of the investigated materials were not statistically significant ( p -values>0.05). Two abutments were lost, severe caries was the reason for one extraction and another abutment tooth was extracted for periodontal reasons. Conclusions : The results of this study did not point out a superior restorative material for the seal of root canal orifices of overdenture abutments. The distribution of failures over the patients indicates a certain patient dependency.

Primary Care Physician, Wageningen, the NetherlandsObjective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice(‘noticing patients’ overweight and guidance of treatment’), as well as their mechanism of action, in a cross-sectional and a longitudinal approach.Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October1992.Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20y.Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed tothe subjects in August 1997.Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action ofdeterminants of the dependent variable ‘noticing patients’ overweight and guidance of treatment’ with anadequate fit of the empirical data, both in the cross-sectional and in the longitudinal approach.Results: The same set of predisposing factors and intermediary factors explains the dependent variable both intwo different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study attwo points in time.Two dynamic LISREL-models were developed (the ‘determinant-longitudinal approach’ and the ‘earlybehaviour longitudinal approach’) which explain the dependent variable. The latter model has, as addedvalue, a gain in explained variance. In 5y time, the dependent variable decreased significantly (P

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Purpose: Venous hemodynamics were evaluated in relation to the postthrombotic syndrome (PTS) 7 to 13 years after deep venous thrombosis (DVT). Methods: The presence of flow, reflux, and compressibility of 1394 vein segments in 82 patients was assessed by means of duplex scanning. The venous outflow resistance was measured by means of strain-gauge plethysmography. The venous hemodynamics were related to the clinical severity of the PTS, characterized by the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification. Results: In patients with severe clinical symptoms of PTS, the prevalence of reflux was significantly higher. There was no relationship between the severity of the PTS and the noncompressibility or the combination of reflux and noncompressibility or an increased venous resistance. By means of multiple regression analysis with the variables of age, gender, reflux, and venous resistance, age and reflux were shown to be the main contributors to the severity of PTS. Significantly more patients (64%) with severe signs of PTS had a combination of deep and superficial reflux. In each of the traceable vein segments, the mean of the CEAP classification was calculated for the vein segments with and without reflux. In the proximal superficial femoral vein (P < .001), distal superficial femoral vein (P < .05), and popliteal vein (P < .05), a significantly higher mean CEAP classification was found in the veins with reflux, whereas in the distal, long, and short saphenous veins, no such relationship was found. Conclusion: Most patients with severe PTS had a combination of deep and superficial reflux. Reflux in the deep proximal veins contributes significantly to the PTS. (J Vasc Surg 1999;29:1071-6.)

Objective. Few data have been presented to document the impact of rheumatoid arthritis (RA) on socio-economic well-being. In this study, exact figures on socio-economic consequences were assessed. Methods. The socio-economic consequences were studied in an inception cohort (186 early RA patients, mean disease duration 3 yr) by measuring the change in work capability, income, rest during the daytime, leisure time activity, transport mobility, housing and social support occurring in the first years of the disease. Results. For 89% of the patients, RA had an impact on one of the socio-economic items; for 58%, at least three of these items were aVected simultaneously. Work disability appeared to be 4‐15 times higher than in the general population. After 3 yr, 42% of the patients were registered as work disabled. Nearly a quarter of the patients experienced income reduction. Over 40% of the patients claimed extra rest during the daytime. Leisure activity changed towards activities with a lower joint load. There was a decline in transport mobility for 52% of the patients. Social support increased strongly. Conclusions. Socio-economic change already presents in the first years of RA and appears to be influenced by age, gender, marital status and work disability. Furthermore, physical limitation appeared to be predictive for work-related income reduction, reduced transport mobility and development of social dependency.

OBJECTIVE—To study the influence of sulphasalazine (SSZ), methotrexate (MTX), and the combination (COMBI) of both on plasma homocysteine and to study the relation between plasma homocysteine and their clinical effects. METHODS—105 patients with early rheumatoid arthritis (RA) were randomised between SSZ (2-3 g/day), MTX (7.5-15 mg/week), and the COMBI (same dose range) and evaluated double blindly during 52 weeks. Plasma homocysteine, serum folate concentrations, and vitamin B12 were measured. The influence of the C677T mutation of the enzyme methylenetetrahydrofolatereductase (MTHFR) gene was analysed. RESULTS—A slight trend towards increased efficacy and an increased occurrence of minor gastrointestinal toxicity was present in the COMBI group, no differences existed clinically between SSZ and MTX. Only a slight and temporary increase in plasma homocysteine was found in the SSZ group, in contrast with the persistent rise in the MTX group and the even greater increase in the COMBI patients. Patients homozygous for the mutation in the MTHFR gene had significantly higher baseline homocysteine, heterozygous MTHFR genotype induced a significantly higher plasma homocysteine at week 52 compared with no mutation. No correlation was found between clinical efficacy variables and homocysteine. Patients with gastrointestinal toxicity had a significantly greater increase in homocysteine. CONCLUSION—A persistent increase in plasma homocysteine concentrations was observed in patients treated with MTX alone and more pronounced in combination with SSZ, in contrast with SSZ alone. An increase in plasma homocysteine is related to the C677T mutation in MTHFR. A relation in the change in homocysteine concentrations with (gastrointestinal) toxicity was found, no relation with clinical efficacy existed. Keywords: homocysteine; methotrexate; sulphasalazine; arthritis

A sample of 259 patients with vertical maxillary hyperplasia, mandibular hypoplasia and anterior vertical open bite, collected from three different institutions, was analysed regarding temporomandibular joint (TMJ) sounds, condylar remodelling, and condylar resorption. All patients underwent Le Fort I osteotomies, and bilateral sagittal split advancement osteotomies were performed in 117 patients. Intraosseous wire fixation was used in 149 and rigid internal fixation in 110 patients. Cephalometric and orthopantomographic radiographs were available before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20–210 months). The number of patients with TMJ sounds decreased from 38% to 31%. At the latest follow up 23.6% of the patients showed condylar remodelling, 7.7% unilateral condylar resorption and 7.7% bilateral condylar resorption. condylar contours, as dssessed on orthopantomographic radiographs, were classified as five different types. Condyles with preexisting radiological signs of osteoarthrosis or having a posterior inclination were at high risk for progressive resorption. Female patients with severe anterior open bite, high mandibular plane angle and a low posterior-to-anterior facial height ratio, who underwent a bimaxillary osteotomy, were prone to condylar resorption. Bone loss was predominantly found at the anterior site of the condyle. The incidence of condylar resorption was significantly higher after bimaxillary osteotomies (23%) than after only Le Fort I intrusion osteotomies (9%). Avoidance of intermaxillary fixation by using rigid internal fixation tended to reduce condylar changes, in particular in patients who underwent only a Le Fort I osteotomy. Rigid internal fixation in bimaxillary osteotomies resulted in condylar remodelling in 30% and progressive condylar resorption in 19% of the patients. Condylar changes were not significantly different after using either miniplate osteosynthesis or positional screws in bilateral sagittal split osteotomy procedures.

– Objectives: To assess orthodontic treatment need prior to treatment and 5 years postretention in a large university sample. Methods: A random sample of 920 patients (400 male and 520 females) from the Department of Orthodontics and Oral Biology, University of Nijmegen, the Netherlands, were included in this study. Dental casts were evaluated using the Index of Orthodontic Treatment Need (IOTN) at the pretreatment (TP) and 5-year postretention stages (T5). The mean age at TP was 12.2±3.0 years and at T5 21.6±3.1 years. At TP and T5 the aesthetic component (AC) and the dental health component (DHC) were assessed The difference between TP and T5 was compared for males and females and tested by the t-test. The changes in AC, DHC and treatment need categories were described at TP and at T5. Results: On the basis of combined AC and DHC treatment need categories, 83% of the patients fell into the Definite e need d category prior to treatment and 10% of the treated patients were categorised as having “Definite need” 5 years postretention. No significant differences were found between males and females for the change in AC and DHC between TP and T5. Conclusions: The results indicate that the policy used in the department for patient selection gives priority to patients with a high treatment need. The results also provide a general impression of treatment outcome utilising the IOTN to analyse the change in the treatment need categories.

In previous studies, highly heterogeneous uptake of 131I-labelled chimeric monoclonal antibody G250 ([131I]cG250) in primary renal cell carcinomas has been observed (intratumoral differences > factor 100). In this study, we investigated a possible correlation between intratumoral antibody uptake and four immunohistochemically determined parameters: G250 antigen expression, blood vessel density, neovascularization and percentage of viable tumour cells. Whole tumour slices of four different tumours were cut into 1-cm3 cubes, and in each cube the [131I]cG250 uptake was determined. The correlation between [131I]cG250 uptake and each individual parameter was determined in a multiple regression analysis. Additionally, the data were reanalysed after introducing arbitrary cut-off values for each parameter. If a sample showed expression of a parameter above the introduced threshold value, this sample fulfilled one condition. Subsequently, the Pearson correlation coefficients were calculated from [131I]cG250 uptake and the number of fulfilled conditions (0-3). All tumour samples with high [131I]cG250 uptake [> 0.1% of the injected dose per gram (ID g(-1))] showed high antigen expression (> 50%). However, not all samples with high antigen expression displayed high uptake. A statistically significant correlation between [131I]cG250 uptake and antigen expression was found (beta = 0.44, 0.69 and 0.74) in three out of four tumours analysed. Of the other determined parameters, no consistent correlation with [131I]cG250 uptake was found; only the percentage of viable tumour cells correlated significantly in two out of four tumours (beta = 0.80 and 0.26). Calculation of the Pearson correlation coefficients showed a statistically significant correlation between [131I]cG250 uptake and an increased number of fulfilled conditions in all tumours, indicating that each of the individual parameters contribute to the uptake of [131I]cG250. These observations indicate that high antigen expression is a prerequisite for high antibody uptake. However, regional differences in antibody uptake within a tumour cannot be explained by antigen expression alone. Images Figure 1 Figure 2 Figure 3

The Index of Orthodontic Treatment Need (IOTN) is currently widely used for clinical, as well as epidemiological purposes. The Aesthetic Component (AC) of this index focuses on dental aesthetics and does not include facial aesthetics. The aim of the present study was to evaluate whether dental aesthetics as measured by the AC of the IOTN correlates with facial aesthetics. Facial attractiveness of 69 males and 75 females was scored on facial photographs at two different ages (11-13 years and 14-16 years). Scoring of the AC of the IOTN was undertaken on the dental casts. Increments between the observations at the two ages were calculated. To assess the association between scores of dental and facial aesthetics, correlation coefficients were calculated. There was a highly significant influence of orthodontic treatment on facial and dental aesthetic scores in the group which was not treated orthodontically at the first observation, but was treated orthodontically at the second observation. No correlation, however, was found between the increments in the facial aesthetic score and those in the dental aesthetic score. The results indicate that facial and dental aesthetics are influenced by different factors, and both should be evaluated when judging dentofacial aesthetics.

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The caries experience among 6- and 12-year-old children in the The Netherlands from the mid seventies showed a continued decreasing trend. A halt in the decline of caries experience of the primary dentition of 6-year-olds occurred after 1983, whereas among 12-year-old children the decrease in mean DMFS values continued in the period 1980–1989. The 1996 survey in The Hague showed that the decline in caries in 12-year-old native children of low socioeconomic status (SES) has come to an end (average DMFT of 1.1). However, in medium- and high-SES groups, the percentages of caries-free children have continued to rise. Of the medium-SES 6- and 12-year-old children, 79 and 89% were caries-free, respectively; in the high-SES children the respective figures were 84 and 86%. A DMFT of 0.3 in 12-year-olds of medium and high SES was found, the general value was 0.7 and 74% with zero caries experience.

Objectives - To investigate whether the conventional and quantitative EEGs of patients with vascular parkinsonism (VP) differ from those of idiopathic Parkinson's disease (PD) patients. Material and methods - The EEGs of 13 patients with vascular parkinsonism and 14 patients with idiopathic Parkinson's disease were scored on a simple scale regarding aspects of conventional EEG variables. Alpha band power asymmetry and EEG slowing (increased delta and theta power) were calculated by the neurometrics method of quantitative EEG data evaluation. Results - Analysis of both conventional and quantitative EEG data shows that VP patients had significantly less EEG slowing than PD patients. Conclusion - This study shows that the EEG in a group of patients with vascular parkinsonism differ from a patient group with idiopathic Parkinson's disease. Our results indicate that VP patients are not PD patients with subcortical vascular lesions, because then they would have had at least as much EEG slowing as PD patients.

The aim of this study was to investigate the nature of initial treatment provided by dental practitioners to children aged 1-17 years with various types of traumatic dental injuries at public dental clinics in Tanzania. Questionnaires on initial treatment were mailed to 188 practitioners and returned by 138 (73%). The reported treatments were analyzed in relation to the dental practitioners' qualifications and area of practice. Extraction of injured teeth was frequently reported for 64% of the injuries and prescription of antibiotics was reported by 67%, 48% and 46% of the practitioners for soft tissue injuries, concussion, and alveolar fracture respectively. Practitioners working at the Faculty of Dentistry were less involved in treating dental trauma than those at urban and rural clinics (P = 0.001), while no significant association was found with the level of education of the practitioners. Equal proportions of practitioners, about one-third each, reported correct, unnecessary and wrong treatment options. The quality of the treatments provided could not be explained by background variables. It can be concluded that dental practitioners in Tanzania provide a lot of over-treatment for traumatic dental injuries. Therefore, it is suggested that efforts should be made to improve and standardize treatment methods in Tanzania.

Sensitivity or pain of the mucoperiosteum covering the mandibular edentulous ridge is often thought to limit bite forces in complete-denture wearers. Therefore, bite forces with mandibular implant-retained overdentures may depend on the degree of implant support. This study analyzed the effects of different degrees of support for the mandibular denture on bite forces measured four years after denture treatment as part of a randomized controlled clinical trial. All subjects had received new maxillary dentures and (1) mainly implant-borne overdentures on a transmandibular implant (TMI), (2) mucosa-borne overdentures on two cylindric permucosal IMZ implants, or (3) new conventional dentures in the mandible. Fifty-three women and 15 men (mean age, 59.1 yrs; range, 41 to 77) participated in this trial. Both unilateral and bilateral bite forces were recorded at different positions with a miniature strain gauge transducer and a mechanical bite fork, respectively. The subjects were asked to bite at three force levels. Results indicated that women had significantly lower maximum bite forces than men. Persons with mandibular implant-retained overdentures had significantly higher unilateral and bilateral maximum bite forces than complete-denture wearers. However, bite forces did not differ between the mainly implant-borne (TMI) and mucosa-implant-borne (IMZ) implant systems. Therefore, it appears that differences in support for the mandibular overdenture by dental implants are not reflected in bite force capabilities.

To clarify the role of the primary care physician (PCP) in providing nutrition information to the public, we investigated in a random sample of Dutch consumers their referral to 11 nutrition information sources including the PCP, their perceived expertise of these sources, their interest in nutrition information, and their nutritional attitudes and beliefs. Factor analysis over these 11 sources of nutrition information resulted in two factors: noncommercial sources (alpha = 0.70) and commercial sources (alpha = 0.78). Respondents' referral to and perceived expertise on a five-point scale of noncommercial sources was higher than for commercial sources [respectively, 54% compared with 21%, P < 0.0001, and 3.9 +/- 0.6 compared with 2.7 +/- 0.6 (mean +/- SD), P < 0.01]. The individual Spearman correlation coefficient between referral scores and perceived expertise was p = 0.35 +/- 0.36 (mean +/- SD). For most sources, referral to that source was dependent on a higher interest in information about a healthy diet and on perceived expertise of the source. There were three leading noncommercial sources: the PCP, the dietitian, and the Netherlands Food and Nutrition Education Bureau (FNEB). Careful analysis revealed that because of their high referral scores, high perceived expertise, and reach to nearly all segments of the population, PCPs are in a unique position compared with dietitians and the FNEB.

The feasibility and possible effects of palatal soft-tissue expansion in palatal repair were studied. A prospective longitudinal animal experiment was performed in 75 growing cats assigned to 5 groups. In 31 cats, a midline defect was made, and bipediced flaps were raised at the age of 8 weeks (stimulated Langenbeck operation) in order to create palatal scars. At the age of 14 weeks, custom-made tissue expanders were inserted palatally in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expanders). Soft-tissue gain and its effects on maxillofacial growth and development were measured in the midsagittal plane on tracings from standardized lateral radiographs. The effects of the experimental interventions were evaluated for 8 weeks after removal of the tissue expanders. Not all the cats yielded results at all time periods. This study showed that soft-tissue expansion of palatal mucoperiosteum is feasible. The surgically induced scars did not cause significant differences between the different groups in the midsagittal plane, and the data from both expansion and sham groups could be pooled. Significant soft-tissue gain was achieved by the tissue-expansion technique. Iatrogenic side effects were significant anteroposterior growth retardation at the level of the bony palate and an increase in vertical growth of the anterior nasomaxillary height and the posterior skull height during active tissue expansion. After removal of the tissue expanders, some accelerated growth was found in the tissue expansion in the scarred tissue group, with initial correction of the abnormal growth at the cranial base level. It is concluded that palatal soft-tissue expansion is possible in growing cats. This technique, however, impaired maxillofacial growth and development.