Children’s oral health-related quality of life five to seven years after comprehensive care under general anaesthesia for early childhood caries

Early childhood caries (ECC) is one of the most common childhood diseases in preschool children. Untreated ECC can lead to pain, sepsis, periapical infection, malnutrition and may result in poor Oral Health Related Quality of Life (OHRQoL) and general health. Many children are treated successfully in the dental clinic with local anaesthesia. Children with ECC who cannot cooperate well for traditional restorative care require comprehensive dental care under general anaesthesia (GA). Many early studies suggest an improved OHRQoL immediately after the dental care under GA. However, none of these studies have looked at the OHRQoL in the mixed dentition period. While it has been reported that caries in preschool years is a significant indicator of caries risk in adolescence, it is unknown whether this risk is also evident in the mixed dentition. The significance of the current research is that this is the first study to investigate the OHRQoL during mixed dentition of the children five to seven years after they received comprehensive dental care under general anaesthesia for ECC. Furthermore, this study has compared the OHRQoL of children who had dental care under GA with children who had dental care without GA, and children who did not have caries. The aim of the study was to compare the OHRQoL in children in the mixed dentition period following comprehensive dental treatment and/or extractions for early childhood caries under GA with that of children who had received dental restorations in the chair or children of the same age who were caries-free. This was done by using the 16-item Short-Form Child Perceptions Questionnaire (CPQ11-14). The findings of this research will help with development of appropriate preventive strategies and recommendations to improve quality of life and dental outcomes. Following ethics approval, 346 children were invited to participate in the study. Children who had comprehensive dental care or extractions only for ECC under GA, before five years of age in 2009-2011, were age-matched with a group of children who had treatment for caries in the dental chair and a group of children who had been diagnosed as caries-free. Following consent from both the participants and parents, participants were recruited into one of the four groups, depending on the type of dental care they had received. Participants completed the Impact 16-item Short-Form Child Perceptions Questionnaire (CPQ11-14), to evaluate their current OHRQoL. Children who had comprehensive care under GA reported poorer OHRQoL mainly in the oral symptoms/functional limitation domains, whereas children who reported poorer OHRQoL also reported that their overall health was affected by their oral condition. There were no statistically significant differences in OHRQoL reported between children who had comprehensive dental care under GA and children who had teeth extractions only under GA. While all the children who had high caries in the primary dentition reported poorer OHRQoL, children who had dental care under GA had more caries currently than children in the other groups. Approximately 45% of these children had two or more carious lesions in the permanent dentition at the time of the study. The present study determined that the children who had dental care under general anaesthesia have a poorer OHRQoL in the mixed dentition period. Further research is needed to understand the factors that are contributing to the ongoing poorer OHRQoL

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report.

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening

Children’s oral health-related quality of life five to seven years after comprehensive care under general anaesthesia for early childhood caries

Early childhood caries (ECC) is one of the most common childhood diseases in preschool children. Untreated ECC can lead to pain, sepsis, periapical infection, malnutrition and may result in poor Oral Health Related Quality of Life (OHRQoL) and general health. Many children are treated successfully in the dental clinic with local anaesthesia. Children with ECC who cannot cooperate well for traditional restorative care require comprehensive dental care under general anaesthesia (GA). Many early studies suggest an improved OHRQoL immediately after the dental care under GA. However, none of these studies have looked at the OHRQoL in the mixed dentition period. While it has been reported that caries in preschool years is a significant indicator of caries risk in adolescence, it is unknown whether this risk is also evident in the mixed dentition. The significance of the current research is that this is the first study to investigate the OHRQoL during mixed dentition of the children five to seven years after they received comprehensive dental care under general anaesthesia for ECC. Furthermore, this study has compared the OHRQoL of children who had dental care under GA with children who had dental care without GA, and children who did not have caries. The aim of the study was to compare the OHRQoL in children in the mixed dentition period following comprehensive dental treatment and/or extractions for early childhood caries under GA with that of children who had received dental restorations in the chair or children of the same age who were caries-free. This was done by using the 16-item Short-Form Child Perceptions Questionnaire (CPQ11-14). The findings of this research will help with development of appropriate preventive strategies and recommendations to improve quality of life and dental outcomes. Following ethics approval, 346 children were invited to participate in the study. Children who had comprehensive dental care or extractions only for ECC under GA, before five years of age in 2009-2011, were age-matched with a group of children who had treatment for caries in the dental chair and a group of children who had been diagnosed as caries-free. Following consent from both the participants and parents, participants were recruited into one of the four groups, depending on the type of dental care they had received. Participants completed the Impact 16-item Short-Form Child Perceptions Questionnaire (CPQ11-14), to evaluate their current OHRQoL. Children who had comprehensive care under GA reported poorer OHRQoL mainly in the oral symptoms/functional limitation domains, whereas children who reported poorer OHRQoL also reported that their overall health was affected by their oral condition. There were no statistically significant differences in OHRQoL reported between children who had comprehensive dental care under GA and children who had teeth extractions only under GA. While all the children who had high caries in the primary dentition reported poorer OHRQoL, children who had dental care under GA had more caries currently than children in the other groups. Approximately 45% of these children had two or more carious lesions in the permanent dentition at the time of the study. The present study determined that the children who had dental care under general anaesthesia have a poorer OHRQoL in the mixed dentition period. Further research is needed to understand the factors that are contributing to the ongoing poorer OHRQoL

Characterisation of Regulatory T-Cells and Th17 Cells in Chronic Inflammatory Periodontal Disease

Periodontal diseases (gingivitis/periodontitis) are common chronic inflammatory diseases that are initiated by specific bacterial complexes present in dental plaque. In health/gingivitis, there is a state of balance between the antigenic challenge in the dental plaque and the host response. However in chronic periodontitis, plaque bacteria induce an immune response, which leads to destruction of supporting structures and ultimately loss of the tooth itself. The role of T-cells in mediating the immune response in gingivitis (stable lesion) and periodontitis (progressive lesion) is well recognized. Analysis of the cytokine profile of T-cells extracted from periodontal disease tissues demonstrated that Th1 cytokines predominate in stable lesions compared with Th2 cytokines in progressive lesions. The balance between Th1 and Th2 cells has been shown to be fundamental in the immunoregulatory control of periodontal disease. Further, regulatory T-cells (Tregs) with suppressive functions have been shown to play a crucial role in the regulatory networks that control this balance. These cells express a specific transcription factor, forkhead boxp3 (FoxP3), which acts as a master regulator in their development and function and provides a means for their identification. At the same time IL17 producing CD4+ T-cells (Th17 cells) have also been suggested to play a role in the development of inflammation such that the inter-relationship between Tregs and IL17+ T-cells seems to be important in the control of chronic inflammation. Hence I hypothesize that both Tregs and IL17+ Th17 cells may have a role in the pathogenesis of periodontal disease in a positive and negative fashion. In order to test the above hypothesis the aims of the present study were; firstly, ‘to determine the presence of FoxP3+ Tregs and IL17+ Th17 cells’, secondly, ‘to identify the cell types expressing FoxP3 and IL17’, and finally, ‘to determine their functional activity in terms of gene expression and protein expression’, in diseased periodontal tissues. Chronic inflammatory periodontal disease tissues were retrieved from 29 archival FFPE specimens. Immunohistochemistry was used to identify T-cells (CD3+), B-cells (CD19+), Tregs (FoxP3+) and IL17+ cells. Plasma cells were identified based on their morphology characteristics in H&E sections. NIH Image J software was used to quantify the percentage of immunohistochemically positive cells and plasma cells per 0.12mm2 of a specimen. Initially, archival FFPE specimens were grouped based on the intensity (minimally and intensely inflamed) and nature of inflammatory infiltrate (T-cell predominant/B and plasma cell predominant). The proportion of FoxP3+ and IL17+ cells were statistically compared between these groups. The results showed more FoxP3+ cells in the B and plasma cell predominant and intensely inflamed gingival specimens when compared with T-cell predominant and minimally inflamed gingival specimens respectively. However the difference was only statistically significant at the 10% level. On the other hand very small numbers of large ovoid/plasmacytoid shaped IL17+ cells was identified. The comparison of the proportion of IL17+ cells between the groups didn’t show statistical significance. Interestingly, the numbers of FoxP3+ cells were positively correlated with the B&P/T cell ratio only within the B and plasma cell predominant gingival specimens. Fresh tissue was obtained from a further 20 patients, 10 with healthy/gingivitis and 10 with chronic periodontitis. Each gingival specimen was cut into two parts; one half was used for grouping the specimens and also for identifying the cell types expressing FoxP3 and IL17. The other half was used for the gene and protein expression experiments. Gingival specimens were grouped according to clinical expression (healthy/gingivitis and periodontitis) and the nature of inflammatory infiltrate. There was no significant difference between the groups in terms of either FoxP3+ or IL17+ cells. However there were significantly more FoxP3+ cells compared with IL17+ cells in all the specimens. Overall there were very few IL17+ cells. Double immunofluoresence revealed that all FoxP3+ cells were also CD4+, while IL17+ cells were neither CD4+ nor CD8+ suggesting that they are not T-cells and therefore not Th17 cells. Further identification of the IL17+ cells showed that they were both toluidine blue granule positive and tryptase positive suggestive of mast cells. Quantitative reverse transcriptase PCR (qRT-PCR) was used in examining the Treg and Th17 cell related gene expression profiles. The RNA was extracted and purified (using TRIzol reagent), then reverse transcribed to cDNA. For gene expression profiling a 96-well human Th17 for autoimmunity and inflammation PCR array was used with SYBR/Rox detection system. The results showed a significant up-regulation of Treg cell related genes; STAT5A, TGFβ1, and IL10, and Th17 cell related genes; STAT3, SOCS1, and TGFβ1 in the B and plasma cell predominant tissue specimens when compared with T-cell predominant tissue specimens. Interestingly, IL17 gene was not detected in any of the gingival tissue specimens investigated. The phenol-chloroform phase, which was left at the end of RNA extraction, was investigated in protein expression experiments. ELISA was used to evaluate the concentration of TGFβ1, IL10, and IL17 cytokines. The results showed higher levels of the TGFβ1 and IL10 in periodontitis and in B and plasma cell predominant gingival tissue specimens than in healthy/gingivitis and T-cell predominant gingival tissue specimens respectively. However, the difference between the groups was statistically significant only for TGFβ1 but not IL10. In accordance with the IL17 gene expression results, IL17 protein was undetected (˂ detection limit of the assay) in any of the gingival tissue specimens examined. With the current state of knowledge, the precise role of Tregs and IL17 in the pathogenesis of periodontal disease is uncertain. However, based on the findings from this study, I suggest that Tregs may have a more prominent role than IL17 in the pathogenesis of periodontal disease. Accordingly, the results of this study have also shown that Th17 cells do not exist in periodontal disease and that the source of the relatively small amounts of IL17 may in fact be mast cells

Becoming a ‘pharmaceutical person’: Medication use trajectories from age 26 to 38 in a representative birth cohort from Dunedin, New Zealand

Despite the abundance of medications available for human consumption, and frequent concerns about increasing medicalization or pharmaceuticalization of everyday life, there is little research investigating medicines-use in young and middle-aged populations and discussing the implications of young people using increasing numbers of medicines and becoming pharmaceutical users over time. We use data from a New Zealand longitudinal study to examine changes in self-reported medication use by a complete birth cohort of young adults. Details of medications taken during the previous two weeks at age 38 are compared to similar data collected at ages 32 and 26, and by gender. Major drug categories are examined. General use profiles and medicine-types are considered in light of our interest in understanding the formation of the young and middle-aging ‘pharmaceutical person’ – where one’s embodied experience is frequently and normally mediated by pharmaceutical interventions having documented benefit/risk outcomes

Toll-like receptors and cancer, particularly oral squamous cell carcinoma

It is becoming increasingly apparent that the tumour microenvironment plays an important role in the progression of cancer. The microenvironment may promote tumour cell survival and proliferation or, alternatively may induce tumour cell apoptosis. Toll-like receptors are transmembrane proteins, expressed on immune cells and epithelial cells, that recognise exogenous and endogenous macromolecules. Once activated they initiate signalling pathways leading to the release of cytokines and chemokines which recruit immune cells inducing further cytokine production, the production of angiogenic mediators and growth factors, all of which may influence tumour progression.This paper examines the actions of toll-like receptors in carcinogenesis with particular emphasis on their role in oral squamous cell carcinom