Search

BACKGROUND: Regular care and cleaning of positive airway pressure (PAP) devices are important for maintaining equipment in the home. Illness and hospitalization have occurred from inadequate cleaning and use of tap water in the humidifier. In recent years, ozone and ultraviolentlight disinfection devices have been advertised for cleaning home PAP equipment. Our clinic provides instructions; however, cleaning practices performed in the home are unknown. METHODS: A survey of home cleaning practices for PAP equipment was conducted in a pediatric sleep clinic during 2019-2020. Survey domains were method, cleaning and replacement frequency for each component, type of water used, instruction preferences, and demographics. The primary aim was to identify home PAP cleaning practices and compare with provided instructions. The secondary aim was to determine if respiratory-related symptoms (eg, congestion, runny nose, sneezing, coughing) occurred or increased with PAP use or inadequate cleaning. RESULTS: The survey was completed by 96 respondents. Most reported weekly cleaning of mask (36, 38%), tubing (41, 43%), and humidifier (31, 33%) with soap and water as the primary method for each. The majority used distilled water in the humidifier (74, 77%) and reported respiratory symptoms did not occur with PAP use (64, 67%). Very few indicated a device was used to clean equipment. No associations were found between length of time for PAP use and cleaning practices. There was a moderately low correlation between age and cleaning. Increased age was associated with decreased cleaning frequency (r 5 0.20, P 5 .048). CONCLUSIONS: Care and cleaning practices of home PAP equipment varied from instructions provided in clinic. Most reported at least weekly cleaning of items for which daily cleaning is recommended. Few reported using a device for cleaning or having respiratory symptoms from PAP treatment. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Border molding is one of the important biologic factors required to provide optimal retention of the denture by creating a peripheral seal. Purpose: Previous studies have evaluated different materials individually for the purpose of border molding. The literature does not report about comparative evaluation of the efficiency of different materials for the purpose of one step border molding. This clinical study compares and evaluates the effectiveness of different materials for the purpose of one step border molding. Aims: To evaluate and compare the effectiveness of different materials for the purpose of one step border molding. Methods and Material: One step Border molding was completed for each subject by manual manipulation of the soft tissues adjacent to the tray borders using three different materials -1) Low fusing Impression Compound Type I b, 2) Heavy bodied Elastomeric Material : Polyvinyl Siloxane and 3) Modified Zinc Oxide Eugenol Impression Paste. Three examiners evaluated the border molding based on tissue contact, tissue displacement, bond to the tray and overall peripheral seal. Each criteria was scored on a scale of 1-5, with score 1 as bad while score 5 was considered excellent. The average of the score recorded by the three examiners for each criteria was considered. Results: Heavy Bodied Elastomeric Material- Polyvinyl siloxane has the best efficiency, while Low fusing Impression Compound Type I a had the least efficiency amongst the three when used for the purpose of border molding. Conclusions: One step border molding is an viable and advantageous alternative to conventional border molding (sectional border molding) as it results in reduction of chairside time, less discomfort for the patient and less efforts for the dentist. [ABSTRACT FROM AUTHOR]

One of the most important determinants of the fit of an implant restoration is the accuracy of the impression. An accurate implant level impression would entail the correct three-dimensional recording of the implant position within the arch to the adjacent teeth and soft tissues and the transfer of this relation to the working cast. The complexity of the impression procedure is increased in cases involving multiple implants. Numerous techniques of impression making for multiple implants have been documented in the literature. This paper is a clinical report which describes a quick, simple and cost effective technique of splinting the implant impression copings to help transfer the coping accurately in the impression procedure for a case involving multiple implants. [ABSTRACT FROM AUTHOR]

With the use of implant therapy and its various benefits in dentistry, comes a handful of post treatment complications. The most commonly reported technical complication in implant retained restorations is screw loosening. In screw retained crowns, accessing the access hole is simple and it can be tightened immediately. In contrast, cement- retained crowns do not provide access to the abutment screw as they lack an access hole. Retrieving this type of restoration often may lead to damage of the components. This clinical tip presents the use of a vaccuum formed template that can be conveniently used to locate the occlusal position of the abutment screw in the event of a screw loosening for cement retained crowns. [ABSTRACT FROM AUTHOR]

Objective: To analyze the distribution, etiology, and patterns of oral and maxillofacial trauma among the subjects reporting to a dental institute in the Western Maharashtra region of India., Methods: This retrospective study was conducted by manually collecting data from the medical records of subjects who reported to the dental institute with a history of trauma from 1st January 2018 to 31st December 2022. All the injured subjects with complete clinical and radiographical records of maxillofacial injuries were included. The demographic data, etiology & site of trauma, and associated injuries were analyzed. Data were tabulated into four age groups (< 20 years, 21-40 years, 41-60 years, and > 60 years). Five etiological factors, i.e. road traffic accidents (RTA), stumble & falls, violence, animal attack, and strike by an object, were further evaluated based on age and gender. Maxillofacial injuries were classified into seven types: maxillary fractures (subcategorized), mandibular fractures (subcategorized), zygomaticomaxillary complex (ZMC) fractures, nasal, frontal, orbital, and naso-orbito-ethmoidal fractures. Data were tabulated and analyzed., Results: A total of 437 subjects were included, consisting of 84.2% males and 15.8% females, with the highest incidence of trauma between 21-40 years. Road traffic accident was the main reason for maxillofacial injuries (50.3%), followed by falls (26.5%), and violence (19.9%). ZMC fractures accounted for 55.4% (242 fractures), followed by mandibular fractures (42.3%)., Conclusion: RTA is the main factor responsible for maxillofacial injuries in this part of Maharashtra among subjects of both genders. Education and motivation regarding road safety measures are the two factors that need to be focused on to reduce the incidence of maxillofacial injuries., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interest., (© The Association of Oral and Maxillofacial Surgeons of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Inflammation of oral soft tissues, caused by periodontal disease, results in the loss of attachment to supporting therapy and is a severe threat to dental health. Although there are a number of therapeutic options available, mechanical debridement continues to be the gold standard. Scaling and root planing is the gold standard therapy for periodontitis, but this research aims to examine the efficacy of tetracycline fibers and simvastatin gel as local drug delivery methods. We evaluated 60 sites, splitting them into three groups: 20 sites received just scaling and root planing; 20 sites received scaling and root planing plus simvastatin gel; and 20 sites received scaling and root planing plus tetracycline fibers. Clinical indicators such as the gingival index, the modified sulcular bleeding index, and the probing depth were measured at the start of the study, after one week, after one month, after three months, and after six months. After six months, the simvastatin group reduced the gingival index and modified sulcular bleeding index more than the tetracycline group, whereas the tetracycline group reduced probing depth more than the simvastatin group., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jambhekar et al.)

This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6  ±  3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p  <  .0001) occurred over the 1998-2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p  <  .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p  =  .397, p  <  .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Obstructive sleep apnea (OSA) is diagnosed through polysomnography (PSG) testing and commonly treated with positive airway pressure (PAP). The initial recommended treatment for pediatric OSA is adenotonsillectomy, but when this is contraindicated or ineffective, PAP is the next option. Children followed in our pediatric sleep disorders center who are diagnosed with OSA and meet criteria for therapy are empirically prescribed a PAP device, usually auto-titrating PAP (APAP), to avoid delays in therapy. Titration PSG is performed later to assess adequacy of settings. The aims of this study were to determine how often PSG titration results in changes to empirically prescribed PAP and to assess adherence to therapy before and after PSG titration., Methods: A retrospective medical records review was completed for children diagnosed with OSA, prescribed PAP, and had a titration PSG within a 5-y consecutive period of 2008-2012. Demographic data, type of device, pressure settings, and adherence downloads were reviewed. Adherence was assessed before and after titration overall and compared for those who did and did not have therapy changes following titration., Results: The study included 121 participants. Median age at the time of the diagnostic PSG was 11 (interquartile range [IQR] 8-14) y. Most (106, 88%) were initially prescribed APAP. Median length of time between initial and follow-up PSG was 6.4 (IQR 4.4-10.1) months. The majority (94, 78%) had therapy changes following titration. Overall, adherence percentage > 4 h per night was not significantly increased post titration (P = .47). There were no statistically significant differences in adherence between those who had therapy changes and those who did not (P = .26)., Conclusions: Titration studies resulted in therapy modifications for most children. Adherence was not increased following the titration PSG. Changes in therapy did not result in increased adherence. Titration PSGs may optimize empirically prescribed settings., Competing Interests: Ms Willis serves as Section Editor for Respiratory Care. The authors have disclosed no other conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Purpose: Sleep related breathing disorders (SRBD) are seen at disproportionately higher rates in children with spina bifida compared with their same aged peers. SRBD such as obstructive sleep apnea (OSA) or central apnea are associated with developmental and cognitive consequences, and sudden death., Methods: Participants aged 1 to 20 years with a diagnosis of spina bifida were recruited from a pediatric academic hospital spinal cord specialty clinic to evaluate the prevalence and impact of sleep disorders in the spina bifida population; 76 polysomnogram (PSG) reports spanning a 3-year period were reviewed in this retrospective cohort study., Results: Of the PSGs reviewed, 37 (49%) indicated the presence of SRBD, and 28 (76%) of those children required an escalation of management (surgical intervention or additional respiratory support). These results are consistent with previous studies and further emphasize the clinical impact of SRBD on children with spina bifida by describing the interventions that followed an abnormal PSG., Conclusion: The high prevalence of SRBD in the spina bifida population supports the need for additional research to develop sleep questionnaires specific to spina bifida that can predict abnormal PSG clinically and to determine the standard of care following an abnormal PSG, chiefly in OSA and central apnea.

Purpose: The absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic β-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1 mm) and large (1 to 2 mm) particle sizes., Patients and Methods: A randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05., Results: The sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n = 11) or allograft (n = 12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40 ± 0.24 mm; small, 3.52 ± 0.59 mm) than in the allograft group (large, 3.82 ± 0.19 mm; small, 2.57 ± 0.16 mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P < .05)., Conclusions: Within the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Obese youth are more likely to report difficulties with sleep, depression, and quality of life (QOL). This study aims to characterize sleep problems, QOL, and symptoms of depression by degree of obesity., Method: The cross-sectional study was conducted in a specialized obesity clinic. Obese youth and their caregivers (N = 150) were evaluated with the Child Sleep Habits Questionnaire and Pediatric Quality of Life. Youth completed the Children's Depression Inventory. Regression models and correlations were calculated., Results: Degree of obesity was predictive of increased sleep difficulties and decreased QOL scores. Children's Depression Inventory scores showed that children with more symptoms of depression had more sleep problems, and these were not associated with the degree of obesity. Adolescents with more difficulties sleeping also reported more symptoms of depression and lower QOL., Conclusions: Degree of obesity negatively affected QOL and sleep variables. Patients with greater sleeping difficulties reported more symptoms of depression., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Although titanium dental implants are biocompatible, exhibit excellent corrosion resistance and high mechanical resistance, the material fails in providing resistance to infection because it exhibits poor antimicrobial activity. To address these issues, we deposited silver onto titanium abutments (Grade 5 titanium discs) using direct current (DC) sputtering and assessed the antimicrobial activity and biocompatibility of the modified implant material. Atomic absorption spectrometry and X-ray photoelectron spectroscopy were employed to investigate the concentration and elemental composition of the deposited silver. As expected, silver deposited using DC plasma was uniform and good control over the deposition could be achieved by varying the sputtering time. Moderate biocompatible responses (up to 69% viability) were observed in primary human gingival fibroblast cells incubated in the presence of Ti sputtered with Ag for 5min. Silver deposited titanium (Ti-Ag) showed excellent antibacterial effects on Pseudomonas aeruginosa and Streptococcus mutans at a very low concentration (Ag content 1.2 and 2.1μg/mm 2 ). However, higher concentration of silver (6μg/mm 2 ) was required to achieve a reduction in cell viability of Staphylococcus aureus and Candida albicans. The silver sputtered Ti abutments could maintain a long-term antibacterial activity as evidenced by the release of silver up to 22days in simulated body fluid. Our study illustrates that silver deposited titanium is indeed a promising candidate for soft tissue integration on dental abutments and prevents initial microbial adhesion., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT)., Materials and Methods: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement., Results: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology., Conclusion: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

Statement of Problem: Several biomaterials and techniques have been reported for socket grafting and alveolar ridge preservation. However, the evidence for clinical and histologic outcomes for socket grafting with different types of materials in flapless extraction is not clear., Purpose: The purpose of this systematic review was to analyze the outcomes of a socket grafting procedure performed with flapless extraction of teeth in order to determine which graft material results in the least loss of socket dimensions, the maximum amount of vital bone, the least remnant graft material, and the least amount of connective tissue after a minimum of 12 weeks of healing. Secondary outcomes, including the predictability of regenerating deficient buccal bone, necessity of barrier membranes, and coverage with autogenous soft tissue graft, were also evaluated., Material and Methods: An electronic search for articles in the English-language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of randomized controlled clinical trials (RCTs) for flapless extraction and socket grafting was analyzed to derive results for the various objectives of the study., Results: The initial electronic search resulted in 2898 titles. The systematic application of inclusion and exclusion criteria resulted in 32 RCTs studying 1354 sockets, which addressed the clinical and histologic outcomes of flapless extraction with socket grafting and provided dimensional and histologic information at or beyond the 12-week reentry period. From these RCTs, the mean loss of buccolingual width at the ridge crest was lowest for xenografts (1.3 mm), followed by allografts (1.63 mm), alloplasts (2.13 mm), and sockets without any socket grafting (2.79 mm). Only 3 studies reported on loss of width at 3 mm below the ridge crest. The mean loss of buccal wall height from the ridge crest was lowest for xenografts (0.57 mm) and allografts (0.58 mm), followed by alloplasts (0.77 mm) and sockets without any grafting (1.74 mm). The mean histologic outcomes at or beyond the 12-week reentry period revealed the highest vital bone content for sockets grafted with alloplasts (45.53%), followed by sockets with no graft material (41.07%), xenografts (35.72%), and allografts (29.93%). The amount of remnant graft material was highest for sockets grafted with allografts (21.75%), followed by xenografts (19.3%) and alloplasts (13.67%). The highest connective tissue content at the time of reentry was seen for sockets with no grafting (52.53%), followed by allografts (51.03%), xenografts (44.42%), and alloplast (38.39%). Data for new and emerging biomaterials such as cell therapy and tissue regenerative materials were not amenable to calculations because of biomaterial heterogeneity and small sample sizes., Conclusions: After flapless extraction of teeth, and using a minimum healing period of 12 weeks as a temporal measure, xenografts and allografts resulted in the least loss of socket dimensions compared to alloplasts or sockets with no grafting. Histologic outcomes after a minimum of 12 weeks of healing showed that sockets grafted with alloplasts had the maximum amount of vital bone and the least amount of remnant graft material and remnant connective tissue. There is a limited but emerging body of evidence for the predictable regeneration of deficient buccal bone with socket grafting materials, need for barrier membranes, use of tissue engineering, and use of autogenous soft tissue grafts from the palate to cover the socket., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA)., Methods: At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries., Results: A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor., Conclusions: Surgery improved OPSG indices in the majority of obese children with OSA., (© 2015 American Academy of Sleep Medicine.)

Objective: To identify the characteristics of children with cystic fibrosis with low initial forced expiratory volume in 1 second (FEV1) % predicted and to investigate their outcome., Study Design: Patients were categorized into low or high initial FEV1 groups using cluster analysis. Comparisons of the demographic and clinical data were performed between the 2 groups., Results: From 122 children, 21 clustered into the low and 101 into the high FEV1 group. The mean FEV1 was 69% ± 12% predicted for the low and 95% ± 12% predicted for the high FEV1 group (P < .001). The low FEV1 group had lower body mass index percentiles (P = .003), were hospitalized more frequently (P = .001), and had been on dornase alfa longer (P = .006). Low FEV1 group had more patients with positive cultures for Pseudomonas aeruginosa (P = .002) and Stenotrophomonas maltophilia (P < .001) and had more total number of cultures positive for mucoid P. aeruginosa (P = .009) and methicillin resistant Staphylococcus aureus + P. aeruginosa (P = .005). The low FEV1 group continued to have low FEV1 measurements, their FEV1 declined slower, required more hospitalizations per year (P = .01), and had more cultures for mucoid (P = .003) and nonmucoid P. aeruginosa (P = .02) ± methicillin resistant S. aureus (P = .002) in comparison with the high FEV1 group. Poor adherence was associated with lower initial FEV1 values in females, and early, rapid decline of FEV1 in males., Conclusions: Some children with cystic fibrosis may present with poor lung function early in life and continue to have subnormal lung function associated with reduced body mass index, more frequent hospitalization, and higher rates of infection. Such children may benefit from careful evaluation and close follow-up., (Copyright © 2014 Mosby, Inc. All rights reserved.)

The change in surface roughness after different surface finishing techniques has attracted the attention of several prosthodontists regarding wear of opposing teeth or restorative material and the strength; plaque retention and appearance of the restoration. However, there is considerable controversy concerning the best methods to achieve the smoothest and strongest porcelain restorations after chair side clinical adjustments. The purpose of this in vitro study was to compare the average surface roughness of a self-glazed surface, a chair side polished surface and a reglazed surface of ceramic. Two feldspathic porcelain, namely VITA VMK94 (Vita Zahnfabrik, Bad Sachingen, Germany) and IVOCLAR CLASSIC (Vivadent AG, FL-9494 Schaan, Liechtenstein) were selected to fabricate 20 specimens of each in the shape of shade guide tabs. A medium-grit diamond rotary cutting instrument was used to remove the glaze layer, and then the surface of half the specimens were re-glazed and the other half were polished using a well-defined sequence of polishing comprising of: Shofu porcelain polishing system, White gloss disc/polishing wheel, Silicone cone with diamond polishing paste and finally with small buff wheel with pumice slurry. The surface roughness (Ra) (μm) of the specimens was evaluated using a profilometer and scanning electron microscope. The data were statistically analyzed by using Student's t test. The results had shown that there is no statistically significant difference both quantitatively and qualitatively, between the surface roughness of reglazed and chair-side polished surface. In addition, both reglazed and chair-side polished surfaces are better than the autoglazed surface. Within all the groups, there is no significant difference between companies. Polishing an adjusted porcelain surface with the suggested sequence of polishing will lead to a finish similar to a re-glazed surface. Therefore chair-side polishing can be a good alternative to reglazing for finishing adjusted porcelain surface.

Objectives: Positive Airway Pressure (PAP) devices are being increasingly used in pediatric populations for problems including Obstructive Sleep Apnea. There is limited literature regarding pediatric adherence with PAP treatment or successful interventions that improve adherence. This paper describes a clinical program for pediatric PAP users which was designed to improve adherence of patients prescribed PAP therapy and involves intensive assessment and behavioral intervention., Method: The design and implementation of the program is described, including the purpose, goals, programmatic structure, clinical content, type and training of personnel, strengths and limitations and financial concerns as well as the challenges with the development and application of the program's protocol., Results: Preliminary outcome data show short-term improvements in consistent usage for many of the patients., Conclusions: The program shows some promise and provides a framework for future program development and research.

Silicone elastomers have become the materials of choice for fabrication of facial prostheses. However such prostheses need periodic replacement due to the degradation of their physical properties due to weathering of polymers. The effect of environmental factors, disinfection solutions and skin secretions on weathering of silicones has been reported. However, the literature does not report on the comparative evaluation on the change in hardness of two commonly used maxillofacial prosthetic silicone elastomers, cured by different techniques and subjected to tropical climatic conditions. This study provides improved insight and understanding into the behavior of such materials for better material selection and treatment results.

Application of positive airway pressure is frequently indicated in pediatric patients with a diagnosis of obstructive sleep apnea. Adherence to equipment use is often less than optimal and can be more challenging when working with children with special needs. An in-patient protocol was designed utilizing various techniques and strategies from the medical adherence literature and applied to 2 cases. This protocol utilizes specialists from various disciplines, including respiratory therapists, psychologists, physicians, nurses, and child life therapists, as well as parental involvement. This paper outlines this protocol using 2 case studies. Both patients successfully used their equipment for greater than 4 hours at night by the end of their hospital stay of 4 days and maintained or advanced these gains at follow-up. These 2 cases suggest that more research should be conducted to further evaluate the effectiveness of similar programs.

Obstructive sleep-disordered breathing is associated with upper airway obstruction during sleep, which negatively affects sleep quality, ventilation, and/or oxygenation. The condition affects 2-11% of children. In this paper we discuss the epidemiology, pathophysiology, clinical features, diagnosis, and management of obstructive sleep-disordered breathing in children and provide a brief overview of the Arkansas Children's Hospital Sleep Disorder Center.

Childhood obstructive sleep disordered breathing (OSDB), a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation, in turn leads to a variety of daytime symptoms and morbidity. In the past, childhood OSDB was classified into primary snoring versus obstructive sleep apnea (OSA) syndrome and it was widely assumed that childhood OSA required treatment, while primary snoring did not. Pediatric polysomnography (PSG) was originally developed to distinguish primary snoring from childhood OSA. However, the late 1990s saw an explosion of new research on the daytime manifestations and long-term morbidity of childhood OSDB, which resulted in expanded, more comprehensive definitions of childhood OSDB syndromes. It is now clear that even primary snoring, in the absence of classically defined OSA, can be associated with neurobehavioral abnormalities in children. Thus, in retrospect, we realize that 'classical' childhood OSA was only a subset of a larger affected population and that children previously classified as having primary snoring may have serious neurobehavioral dysfunction. Now, in the era of the expanded definition of childhood OSDB, the role of PSG in the routine evaluation of the snoring child is controversial. Given that overnight PSG is widely regarded as the 'gold standard' for the diagnosis of OSDB in children, we review the current usage of PSG in children for the diagnosis of OSDB, its value, limitations and possibilities for future improvements.

In an effort to improve the bioavailability of the insoluble drug indomethacin, three complexes were prepared with indomethacin and the soluble complexing agents beta-, hydroxyethyl-beta-, and hydroxypropyl-beta-cyclodextrin. The indomethacin content was similar among the complexes (P

The influence of formulation and extrinsic factors has been investigated for the in-vitro release of propranolol hydrochloride from controlled-release beads prepared using aqueous polymeric dispersions, Aquacoat and Surelease. A single-dose three-way crossover bioavailability study of two extended-release experimental formulations (80 mg), Inderal LA (80 mg) and an Inderal immediate-release dosage form (2 x 40 mg) was also conducted and a comparative analysis of pharmacokinetic parameters and the in-vitro release profiles was performed to assess in-vitro/in-vivo correlation. Analysis showed that the in-vitro release data appeared to follow zero-order release kinetics. Intensity of agitation and dissolution method were found to have no significant effect on drug release from beads prepared using either of the coating dispersions studied or Inderal LA. Release of drug from beads coated with Aquacoat was faster in basic media than in acidic media; Surelease-coated beads, however, showed release characteristics that were less sensitive to changes in the pH of the dissolution fluid, and Inderal LA beads showed slower release profiles in acidic medium than in other dissolution media studied. Pharmacokinetic analysis of the data revealed sustained-release absorption characteristics without any evidence of dose-dumping from any of the extended-release dosage forms studied. Regression analysis of the fraction of drug absorbed against the percentage of the drug released in-vitro, at the corresponding times, yielded good in-vitro/in-vivo correlation (level A) for all the extended-release formulations studied. The results showed that there was no dose-dumping from any of extended-release formulations and that the relative bioavailabilities of the experimental formulations were superior to that of the marketed formulation.

Slow-release tablets were prepared using a polyvinyl chloride--polyethylene matrix and sodium salicylate as a model drug. The in vitro release of salicylate was described adequately by a previously published equation. The release rate constant was independent of the pH of the dissolution fluid and the flow rate of the fluid past the tablet. Accordingly, the procedures used to test the in vitro drug release from this type of matrix tablet are not as critical as for conventional tablets. It may therefore be postulated that the in vivo performance of the tablet may be less subject to variations in the physiological parameters of the GI tract.

The release of drug through the planar surface of a nondisintegrating tablet with an insoluble matrix has been described mathematically using the Higuchi release rate constant (kH). The release of drug through a similar all-surface tablet has been described by using a cubic equation and the all-surface rate constant (kr). Using sodium salicylate and quinidine sulfate as model drugs, the relationship between kH and kr was verified for cylindrical slow-release tablets. Accordingly, the rate constant obtained from a single exposed planar surface can be used to predict the rate constant (kr) when all surfaces of the tablet are exposed to dissolution fluid.