Controversial Aspects of Diagnostics and Therapy of Arthritis of the Temporomandibular Joint in Rheumatoid and Juvenile Idiopathic Arthritis: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Introduction: Due to potentially severe sequelae (impaired growth, condylar resorption, and ankylosis) early diagnosis of chronic rheumatic arthritis of the temporomandibular joint (TMJ) and timely onset of therapy are essential. Aim: Owing to very limited evidence the aim of the study was to identify and discuss controversial topics in the guideline development to promote further focused research. Methods: Through a systematic literature search, 394 out of 3771 publications were included in a German interdisciplinary guideline draft. Two workgroups (1: oral and maxillofacial surgery, 2: interdisciplinary) voted on 77 recommendations/statements, in 2 independent anonymized and blinded consensus phases (Delphi process). Results: The voting results were relatively homogenous, except for a greater proportion of abstentions amongst the interdisciplinary group (p < 0.001). Eighty four percent of recommendations/statements were approved in the first round, 89% with strong consensus. Fourteen recommendations/statements (18.2%) required a prolonged consensus phase and further discussion. Discussion: Contrast-enhanced MRI was confirmed as the method of choice for the diagnosis of TMJ arthritis. Intraarticular corticosteroid injection is to be limited to therapy refractory cases and single injection only. In adults, alloplastic joint replacement is preferable to autologous replacement. In children/adolescents, autologous reconstruction may be performed lacking viable alternatives. Alloplastic options are currently still considered experimental

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Contact angle for artificial saliva and diiodomethan; hardness measurment for instrumented indentio

Data from: In vitro aging behavior of dental composites considering the influence of filler content, storage media and incubation time

1. Objective: Over time dental composites age due to mechanical impacts such as chewing and chemical impacts such as saliva enzymes and food ingredients. For this research, the focus was placed on chemical degradation.The objective of this study was to simulate hydrolysis by using different food simulating liquids and to assess their impact on the mechanical parameter Vickers microhardness (MHV) and the physicochemical parameter contact angle (CA). 2. Methods: Specimen of three composites (d = 6 mm, h = 2 mm; n = 435) classified with respect to their filler content (wt%), namely low-filled, medium-filled and highly-filled, were stored for 0, 14, 30, 90 and 180 days in artificial saliva (pH 7), citric acid (pH 3; pH 5), lactic acid (pH 3; pH 5) and ethanol (40 %vol; 60 %vol) and assessed regarding to MHV and CA.Statistics: Kruskal-Wallis test, stepwise linear regression, bivariate Spearman Rank Correlation (p < 0.05). 3. Results: While stored in artificial saliva, acid and ethanol the CA decreased especially for the low- and medium-filled composites. It was shown that rising the filler content caused less surface changes in the CA. Storage in ethanol led to a significant decrease of MHV of all composites. Regression analysis showed that the effect of in vitro aging on MHV was mainly influenced by the composite material and therefore by filler content (R² = 0.67; p < 0.05). In contrast, the CA is more influenced by incubation time and filler content (R² = 0.2; p < 0.05) leading to a higher risk of plaque accumulation over time. Significance: In vitro aging showed significant changes on the mechanical and physicochemical properties of dental composites which may shorten their long-term functionality. In conclusion, it can be stated, that the type of composite material, especially rising filler content seems to improve the materials’ resistance against the processes of chemical degradation

Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis

This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings

Nasal screening for Staphylococcus aureus--daily routine with improvement potentials.

OBJECTIVES: Staphylococcus aureus causes purulent bacterial infections with a considerable number of life-threatening complications and thus, is a serious cost factor in public health. Up to 50% of a given population could asymptomatically carry Staphylococcus aureus in their nares, thereby serving as a source for contact transmissions and endogenous infections. Nasal swab-based screening techniques are widely used to identify suchcarriers. This study investigated the skill of medical professionals in taking nasal swabs and the effect of teaching on improving bacterial recovery rates. METHODS: 364 persons with different medical educational background participated in this study. A novel anatomically correct artificial nose model was implemented and inoculated with a numerically defined mixture of Staphylococcus aureus and Staphylococcus epidermidis bacteria. Utilizing regular clinical swabs, participants performed screening of the inoculated nose models before and after standardized theoretical, visual, and practical teaching. Recovery of bacteria was measured by standard viable count techniques. Data were analyzed statistically by nonparametric tests. RESULTS: It could be demonstrated that combined theoretical and practical teaching improved bacterial recovery rates. Even experienced medical professionals increased their detection levels after training. Recovery rates of bacteria varied significantly between trained (158.1 CFU) and untrained (47.5 CFU) participants (Wilcoxon test, p<0.001; Kolmogorov-Smirnov test, p<0.001). CONCLUSIONS: Swabs are commonly used to detect nasal carriage of Staphylococcus aureus in patients. The present teaching algorithm combined with the novel nose model offers an excellent precondition to improve knowledge and performance of this technique. Increased detection rates may prevent from contact transmission due to suboptimum hygienic patient handling. Consecutively, this effect could reduce costs for patient care. This study highlights the tremendous potential of combined theoretical, visual, and practical teaching methods in this field--and uncovers its actual necessity. Therefore, this training method can be recommended for all medical institutions

Relative recovery of bacteria compared to inoculation dose after elution into Amies medium.

<p>Ratios were determined by comparison of viable counts of released bacteria to the inoculation dose, which was defined as 100%. Results from statistical analysis are shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111627#pone.0111627.s003" target="_blank">Table S2</a>.</p

Nasal Screening for MRSA: Different Swabs – Different Results!

<div><p>Objectives</p><p>Swab-based nasal screening is commonly used to identify asymptomatic carriage of <i>Staphylococcus aureus</i> in patients. Bacterial detection depends on the uptake and release capacities of the swabs and on the swabbing technique itself. This study investigates the performance of different swab-types in nasal MRSA-screening by utilizing a unique artificial nose model to provide realistic and standardized screening conditions.</p><p>Methods</p><p>An anatomically correct artificial nose model was inoculated with a numerically defined mixture of MRSA and <i>Staphylococcus epidermidis</i> bacteria at quantities of 4×10² and 8×10² colony forming units (CFU), respectively. Five swab-types were tested following a strict protocol. Bacterial recovery was measured for direct plating and after elution into Amies medium by standard viable count techniques.</p><p>Results</p><p>Mean recovered bacteria quantities varied between 209 and 0 CFU for MRSA, and 365 and 0 CFU for <i>S. epidermidis</i>, resulting swab-type-dependent MRSA-screening-sensitivities ranged between 0 and 100%. Swabs with nylon flocked tips or cellular foam tips performed significantly better compared to conventional rayon swabs referring to the recovered bacterial yield (p<0.001). Best results were obtained by using a flocked swab in combination with Amies preservation medium. Within the range of the utilized bacterial concentrations, recovery ratios for the particular swab-types were independent of the bacterial species.</p><p>Conclusions</p><p>This study combines a realistic model of a human nose with standardized laboratory conditions to analyze swab-performance in MRSA-screening situations. Therefore, influences by inter-individual anatomical differences as well as diverse colonization densities in patients could be excluded. Recovery rates vary significantly between different swab-types. The choice of the swab has a great impact on the laboratory result. In fact, the swab-type contributes significantly to true positive or false negative detection of nasal MRSA carriage. These findings should be considered when screening a patient.</p></div

SFE (%standard deviation) and ratio of polar/dispersive fraction (σ^p/σ^d).

<p>SFE (%standard deviation) and ratio of polar/dispersive fraction (σ^p/σ^d).</p

SFE with polar and disperse fractions over incubation time.

<p>SFE with polar and disperse fractions over incubation time.</p

Measurement principle and calculation of Vickers microhardness.

<p>Measurement principle and calculation of Vickers microhardness.</p