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Background: The majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS).Aim: Our aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries.Methods: A clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others' diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI.Results: Forty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect; k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001.Conclusion: Our findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this systematic review was to assess the effect of a whitening dentifrice (WDF) relative to a regular dentifrice (RDF) on the reduction of natural extrinsic tooth surface discoloration (ETD). Materials and methods: The MEDLINE‐PubMed, Cochrane‐CENTRAL and EBSCO‐Dentistry and Oral Sciences databases were searched, up to April 2017. The inclusion criteria were as follows:(randomized)controlled clinical trials, healthy subjects ≥18 years of age, studies comparing WDF with RDF, a follow‐up period of at least 6 weeks and studies scoring ETD as the stain area/extent, stain intensity or a composite score. Studies using an induced staining model were excluded. Results: Independent screening of 851 unique papers resulted in 21 eligible publications, which included 32 comparisons. The descriptive analysis illustrated that the majority of comparisons showed a significant effect on ETD, in favour of WDF over RDF. The meta‐analysis substantiated this observation and revealed that the difference of means (diffM) comparing WDF and RDF was a reduction for stain area of −0.44 [(95% CI: −0.55; −0.339) (P<.00001)] according to the original Lobene Stain Index; this result is in favour of the WDF. For the modified Lobene Stain Index, the diffM was −0.41 [(95% CI: −0.71; −0.10) (P=.009)]. For overall stain intensity, the diffM was −0.35 [(95% CI: −0.44; −0.25) (P<.00001)], and the composite score was −0.39 [(95% CI: −0.57; −0.21) (P<.0001)] and −0.54 [(95% CI: −0.66; −0.43) (P<.00001)]. Subgroup analysis differentiating between products that contained added chemical antidiscoloration agents showed a similar pattern. Conclusion: In this review, nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing ETD, irrespective of whether or not a chemical discoloration agent was added. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this systematic review was to establish the effectiveness of brushing with a triple‐headed manual toothbrush compared to a single‐headed manual toothbrush on plaque removal. Materials and methods: The MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched. The inclusion criteria were clinical trials conducted with humans without fixed orthodontic appliances who were not dental care professionals. Papers that evaluated the effect of toothbrushing with a triple‐headed manual toothbrush compared to a single‐headed manual toothbrush on plaque removal were included. Data were extracted from the eligible studies, and a descriptive analysis was performed. Result: The search retrieved 15 eligible publications including 18 relevant comparisons. Heterogeneity was most obvious with respect to the person who performed the brushing, either the participants themselves or a caregiver responsible for daily oral hygiene. Additionally, participant characteristics such as age and individual disabilities varied. A lack of appropriate data and a variation in the indices used allowed only a descriptive analysis. Of the 14 comparisons with self‐performed brushing by the participants, the majority showed no difference between triple‐headed and single‐headed toothbrushes, with a few favouring the triple‐headed. In the comparisons in which a caregiver performed the brushing, three of the four showed that the triple‐headed toothbrush performed significantly better on the reduction in plaque scores. Conclusion: From this review emerges the recommendation that the use of a triple‐headed manual toothbrush instead of a single‐headed manual toothbrush might be favorable with respect to plaque removal in case a care‐dependent individual is brushed by a caregiver. [ABSTRACT FROM AUTHOR]

Background: There is no valid and reliable instrument that evaluates injury severity and treatment effects for medial tibial stress syndrome (MTSS) patients. Objective: The aim was to generate items for the MTSS score, a new patient-reported outcome measure for patients with MTSS. Methods: The authors consulted experts in the field of MTSS to generate items that measure the severity of MTSS and to reach consensus on the relevance of items for the MTSS score. This research consisted of a pilot study and two Delphi rounds. The Delphi approach entails the consultation of experts about a topic for which no evidence is available during which consensus is sought on this topic. Additionally, 20 MTSS patients appraised the MTSS score on readability and comprehension. Results: Nineteen experts consented to participate, 13 of whom reached consensus. Generated items address the following domains: 'limitation in sporting activities', 'pain while performing sporting activities', 'pain while performing activities of daily living' and 'pain at rest'. Patients with MTSS confirmed the good readability and comprehension of the items. Conclusion: This study supports the importance of items in the aforementioned domains while evaluating treatment effects in patients with MTSS. [ABSTRACT FROM AUTHOR]

Background: Although chlorhexidine digluconate (CHX) is currently the most effective mouthwash for reducing plaque and gingivitis, one of its side effects is extrinsic tooth staining. Interestingly, oxygenating agents may reduce this staining. Objective: The aim of this review was to systematically search the literature for data concerning the inhibiting effect of an oxygenating agent (OA) on CHX-induced tooth staining. Methods: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other relevant electronic databases were searched for articles that were published up to November 2011. Articles were included if they were randomized controlled trials or controlled clinical trials conducted with healthy subjects ≥ 16 years of age that compared the effects of CHX mouthrinse combined with an OA with the effects of CHX alone. Results: An independent screening of 1183 titles and abstracts resulted in 4 publications that met the inclusion criteria. The extracted data allowed meta-analyses of intermediate length studies and showed that combining an OA with CHX mouthrinses led to a significant reduction in tooth staining (mean difference: 0.27; P = 0.02) and plaque scores (mean difference: 0.10; P = 0.003) when compared with CHX alone. One of the included studies reported a side effect for one participant. The present review was limited by the availability of data, and the included studies were methodologically and clinically heterogeneous, which affected the quality and interpretation of the evidence. Conclusion: There is moderate evidence that a combination of CHX and an OA reduces tooth staining without interfering with plaque growth inhibition. [ABSTRACT FROM AUTHOR]

Introduction: Mid-portion Achilles tendinopathy (mid-AT) is currently the preferred term for persistent Achilles tendon pain, defined as located 2-7 cm proximal to the calcaneus, and with loss of function related to mechanical loading. Histologically, mid-AT is considered to represent a degenerative condition. Therefore, monitoring of tendon structure additional to pain and function may be warranted, to prevent progression of degeneration or even tendon rupture. The aim of this study was to determine the association between pain and function, relative to the Achilles tendon structure, in soldiers treated with a conservative programme for mid-AT., Methods: A total of 40 soldiers (40 unilateral symptomatic tendons) were included in this study. Pain and function were evaluated with the Victorian Institute of Sports Assessment -Achilles (VISA-A) questionnaire. Tendon structure was quantified using ultrasound tissue characterisation (UTC). We quantified both the Achilles tendon mid-portion (2-7 cm) and the area of maximum degeneration (AoMD) within the tendon mid-portion. VISA-A and UTC measurements were taken at baseline and after 26 weeks of follow-up. Spearman's rho was used to determine the correlation between VISA-A and UTC. Correlations were calculated for baseline, follow-up and change score values., Results: Negligible correlations were found for all analyses, ranging from -0.173 to 0.166 between mid-portion tendon structure and VISA-A, and from -0.137 to 0.150 between AoMD and VISA-A. While VISA-A scores improved, on average, from 59.4 points at baseline to 93.5 points at follow-up, no detectable improvement in aligned fibrillar structure was observed in our population., Conclusion: Pain and function are poorly associated with Achilles tendon structure in soldiers treated with a conservative programme for mid-AT. Therefore, we advise clinicians to use great caution in communicating relationships between both clinical entities., Trial Registration Number: NL69527.028.19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The purpose of the present study was to evaluate whether unilateral intracompartmental pressure (ICP) measurements correctly represent the contralateral ICP value in patients suspected to have bilateral chronic exertional compartment syndrome (CECS) in the anterior compartment of the leg., Methods: A retrospective cohort study was performed that included military service members who had been referred to a secondary care department for bilateral anterolateral exercise-related leg pain. The obtained ICP values were utilized to assess 2 possible measurement strategies to perform unilateral ICP measurements: the right-leg strategy (i.e., always testing the right leg) and the most-symptomatic-leg strategy (i.e., always testing the most symptomatic). The diagnostic cutoff value for CECS in this cohort was 35 mmHg in the first minute after provocation. Four outcome categories were created to describe the pressure classification of the second leg if only 1 leg would have been measured: correct (category 1: both values ≥35 mmHg; category 2: both values <35 mmHg) or incorrect (category 3: measured leg, ≥35 mmHg and contralateral leg, <35 mmHg; category 4: measured leg, <35 mmHg and contralateral leg, ≥35 mmHg)., Results: A total of 442 patients (884 legs) were included. In 88% of patients, the unilateral value would have correctly diagnosed the other symptomatic leg, whereas in 12% of patients, the contralateral leg would have been diagnosed incorrectly. The right-leg strategy had a slightly smaller proportion of cases in which the contralateral leg would have been incorrectly diagnosed (7% compared with 8% for the most symptomatic leg strategy). In 89% of the 390 patients in categories 1 and 2, the ICP values deviated by >5 mmHg from the 35-mmHg cutoff value compared with 40% of the 52 patients in categories 3 and 4., Conclusions: In military service members with bilateral chronic anterolateral exertional pain, a unilateral ICP measurement seems to be justified, especially among those with pressure values >5 mmHg above or below the diagnostic cutoff value. When a unilateral pressure measurement is within 5 mmHg above or below the cutoff value, a bilateral ICP measurement may be warranted., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

The aim of this study was to compare commercially available manometers and needles used for intracompartmental pressure measurements for accuracy. An experimental compartment simulation model was developed in order to compare four different terminal devices (Compass manometer, Stryker device, Meritrans transducer, and arterial line) and 22 types of needles. First, all possible device/needle combinations were introduced in rubber ports at the bottom of a water column. The water column was gradually drained three times for each device/needle combination and pressures were recorded by two researchers. This procedure was repeated after placement of a sample of homogenous porcine gluteal muscle tissue. When measuring the fluid column only, all Intraclass Correlation Coefficients were found to be ≥0.980, indicating good resemblance to the reference pressure. After addition of the muscle tissue to the experimental set up, accuracy of the Stryker device and arterial line remained the same. The accuracy of the Compass manometer and Meritrans transducer became less. Excellent reliability was found for 7 out of 22 needles when combined with the Stryker device and for 2 out of 22 needles when combined with the arterial line. The four terminal devices tested were all accurate when measuring pressure in a water column, whereas only the Stryker device and arterial line accurately represented the water column pressure in a porcine gluteal muscle model. Future research will have to verify whether these results can be repeated in human cadaver models and in vivo., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Previous studies in our department demonstrated that gait retraining as part of a conservative treatment program for service members with exercise-related leg pain can lead to persistent changes in vertical ground reaction forces while running in shoes and boots. It is not known which gait retraining cue has the largest effect and whether a combination of cues is advantageous., Methods: During a single gait retraining session, 12 male heel striking patients were given three cues in isolation: Cue 1. Change to a ball-of-foot strike; Cue 2. Increase cadence to 180 steps per minute; Cue 3. Stand up taller; and finally, all three cues combined. Runs were performed on an instrumented treadmill at 10 km/h, 1% incline and in running shoes. The three cues were randomly introduced. Measurements, taken during 30-second episodes, were stride length, cadence, and six force variables: maximum force (N) and maximum pressure (N/cm 2 ) on the heel, mid-foot and fore-foot., Findings: Each cue, i.e., each change in running technique, caused a different pattern of changes among the six force variables, mostly reductions. In isolation, cue 1 produced the largest reduction of force and pressure on the heel, resulting percentages 45.8 and 67.2 respectively (p = 0.00, p = 0.00). Overall, the combination of cues 1 + 2 + 3 ranked first in reducing forces for four of the six force variables., Interpretation: Three commonly used gait retraining cues, when applied in isolation, all resulted in a reduction of most vertical ground reaction forces. The combination of the three cues is advantageous., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To assess the effects of water on the parameters of 'morning bad breath' (MBB) and to evaluate whether there is a difference between rinsing with water and drinking a glass of water., Materials and Methods: A total of 50 participants were recruited and were randomly divided into two equal groups. One group rinsed with 15 ml of water for 30 s, and another group drank 200 ml of water within 30 s. Clinical assessments were carried out during one visit between 7:30 am and 12:00 pm. Pre- and post-intervention measures were assessed organoleptically as primary outcome parameters, and a secondary outcome parameter was assessed using both the Halimeter(®) and OralChroma(™) apparatuses to evaluate volatile sulphur compounds (VSCs), hydrogen sulphide (H2 S), methyl mercaptan (CH3 SH) and dimethyl sulphide ((CH3 )2 S). In addition, the presence of tongue coating (discoloration/thickness) and tongue fissures was assessed., Results: All 50 participants completed the study. In both groups, a significant reduction in the organoleptic score and the OralChroma(™) H2 S and CH3 SH readings was obtained after the intervention. Both regimens resulted in a CH3 SH reduction of approximately 60%, whereas the reduction in H2 S was between 30% and 50%. The acceptable change between pre- and post-assessments of the clinical parameters was not significantly different between the drinking and rinsing groups., Conclusion: Rinsing with water or drinking a glass of water had a statistically significant effect on the MBB parameters. No significant difference was obtained between the two regimens., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Focused Question: What is the effectiveness of a chlorhexidine (CHX) mouthwash used in combination with a sodium lauryl sulphate (SLS) dentifrice on the parameters of plaque and gingivitis?, Material and Methods: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched up to July 2014. The inclusion criteria were (randomized) controlled clinical trials, subjects ≥18 years of age with good general health. Papers evaluating the effect of CHX mouthwash used in combination with SLS dentifrice or a dentifrice slurry compared with CHX mouthwash as a single oral hygiene intervention or in combination with an SLS-free dentifrice were included. From the eligible studies, data were extracted, and a meta-analysis was performed when feasible., Results: Independent screening of 83 unique papers resulted in four eligible publications, with nine comparisons. The meta-analysis showed that when an SLS dentifrice was used as a slurry rinse, the interference on the plaque-inhibiting effect of a CHX mouthwash was significantly decreased (MD 0.33; P ≤ 0.00001; 95% CI: <0.24; 0.42>). No significant difference was observed when SLS dentifrice was applied as a paste in combination with CHX mouthwash (MD 0.08; P = 0.42; 95% CI: <-0.26; 0.11>). Descriptive and subgroup analyses support these findings. Moreover, the observed effect for the dentifrice paste occurred regardless of the order of use., Conclusion: This review demonstrates that when CHX mouthwash is recommended, it can be used in combination with an SLS dentifrice without any interference regarding its inhibiting effect on dental plaque, regardless of the order of use. Consequently, the collective evidence indicates that the combined use of dentifrice and CHX mouthwash is not contraindicated. However, this recommendation has been graded as moderate taking into account a potential publication bias because three of the four included studies emerged from the same research group., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To study the additional effect of a pneumatic leg brace with standard rehabilitation for the treatment of medial tibial stress syndrome (MTSS) in recruits., Methods: In a single blinded randomized study, 15 recruits (age 17-22) followed a rehabilitation programme consisting of leg exercises and a graded running programme. Recruits performed daily exercises and ran three times a week. The running programme consisted of 6 consecutive phases. One group was, after randomization, additionally provided with a pneumatic leg brace. Follow-up was provided every other week. Days to completing the running programme was the primary outcome measure, the Sports Activity Rating Scale (SARS) score and satisfaction with the treatment were secondary outcome measures., Results: In total 14 recruits completed the rehabilitation programme. No differences were found in the number of days until phase six of the running schedule was finished between the brace and the control group (Brace 58.8 +/- 27.7 (mean +/- SD) vs Non-Brace 57.9 +/- 26.2 (mean +/- SD, p = 0.57). Also no differences were found in the SARS scores between the groups. Overall satisfaction with the treatment was 6.4 +/- 1.1 (mean +/- SD) on a 1-10 scale for the brace group and 7.1 +/- 0.7 (mean +/- SD) for the control group (p = 0.06). Comfort of the brace was assessed as 4.8 +/- 1.3 (mean +/- SD) on a 1-10 scale., Conclusions: No additional large effect of the pneumatic leg brace could be found in recruits and wearing of the brace was not feasible, since the wearing comfort was low.