Diagnostik und Therapie der Dysphagie

Zusammenfassung

Die meisten Schluckstörungen können abhängig vom Störungsbild behandelt werden. Ein multidisziplinäres Team aus Kopf-Hals-Chirurgen, Phoniatern und Logopäden ist erforderlich, um die richtige Behandlungsstrategie zu entwickeln. Anamnese, klinische Untersuchung der Schluckmuskulatur und endoskopische Evaluation des Schluckakts mit unterschiedlicher Nahrungskonsistenz verhelfen zu der Entscheidung, ob Schluckübungen allein ausreichen oder die zusätzliche medikamentöse oder operative Therapie zur Vermeidung von Aspiration, Mangelernährung oder Dehydratation benötigt werden.

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IL4Rα and ADAM33 as genetic markers in asthma exacerbations and type-2 inflammatory endotype

Abstract

Background

Genetic markers of susceptibility to asthma exacerbations in adults remain unclear.

Objective

To identify genetic markers of asthma exacerbations, particularly in patients with type-2 inflammatory endotype.

Methods

In this observational study of patients enrolled in the Kinki Hokuriku Airway disease Conference multicenter study, frequency of exacerbations requiring systemic corticosteroids during 2 years after enrolment and associated risk factors were determined. For genetic marker analysis, interleukin-4 receptor α (IL4RA) rs8832 and a disintegrin and metalloprotease 33 (ADAM33) S_2 (rs528557), T_1 (rs2280091), T_2 (rs2280090), and V_4 (rs2787094) variants were included. Elevated serum periostin levels at enrolment (≥95 ng/mL, defined as type-2 inflammatory endotype) were considered in the analysis.

Results

Among 217 patients who were successfully followed up for 2 years after enrolment, 60 patients showed at least one asthma exacerbation during the 2 years. Airflow limitation (%FEV₁ <80%) and recent exacerbations but not genetic variants were identified as risk markers of exacerbations. A total of 27 patients showed type-2 inflammatory endotype (serum periostin ≥95 ng/mL at enrolment) and subsequent exacerbations; risk factors in these patients were airflow limitation (odds ratio, 6.51; 95% confidence interval, 2.37 to 18.6; P = 0.0003), GG genotype of IL4RA rs8832 (odds ratio, 4.01; 95% confidence interval, 1.47 to 11.0; P = 0.007), and A allele of ADAM33 T_2 (odds ratio, 2.81; 95% confidence interval, 1.05 to 7.67; P = 0.04) by multivariate analysis. In addition, GG genotype of IL4RA rs8832 was associated with type-2 endotype, whereas A allele of ADAM33 T_2 was associated with mixed type of eosinophilic/type-2 and neutrophilic inflammations.

Conclusions and Clinical Relevance

IL4RA and ADAM33 variants may be risk markers of asthma exacerbations in type-2 inflammatory endotype. Precise endotyping may facilitate the identification of genetic risk markers of asthma exacerbations.

This article is protected by copyright. All rights reserved.

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Efficacy of calcium oxide and calcium hydroxide nanoparticles on the elimination of Enterococcus faecalis in human root dentin

Abstract

Objectives

The objective of this study was to compare the antibacterial effect of calcium oxide nanoparticles (CONPs) and calcium hydroxide nanoparticles (CHNPs) against Enterococcus faecalis in a dentinal block model.

Materials and methods

E. faecalis strain JCM 7783 was introduced into dentinal tubules of semicylindrical dentin specimens by centrifugation and incubated for 1 week. Fifty microliters of CONPs or CHNPs was placed on the root canal side of the infected dentin specimens. The specimens were then incubated in aerobic condition at 37 °C and 100 % relative humidity for 1 week. The treated dentin specimens were subjected to fluorescent staining and confocal laser scanning microscopy (CLSM) to analyze the proportions of non-vital and vital bacterial cells inside the dentinal tubules. Scanning electron microscopy (SEM) was used to confirm the effect of the medicaments on the bacteria in the dentinal tubules. Calcium oxide (CO) and calcium hydroxide (CH) were used as controls.

Results

Based on the CLSM and SEM analyses, CHNPs were more efficient than CONPs in the elimination of the bacteria in the dentinal tubules. CONPs significantly killed more E. faecalis than CO and CH (P < .05). Neither CO nor CH was able to kill the bacteria.

Conclusions

CHNPs were more effective than CONPs in the elimination of E. faecalis in dentinal tubules.

Clinical relevance

CHNPs are effective nanoparticles in killing endodontic bacteria present in dentinal tubules. They have potential as an intracanal medicament, which may be beneficial in root canal therapy.

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Does Botulinum neurotoxin type A treatment for sialorrhea change oral health?

Abstract

Objectives

Botulinum neurotoxin type A (BNT-A) intrasalivary gland injections in patients with neurological disorders have been known to effectively treat hypersalivation. However, oral health can be compromised with increasing the dose. The aim of this study was to find out the therapeutic effect of low-dose, ultrasonography-controlled BNT-A injections into the bilateral parotid and submandibular glands on oral health in the treatment of sialorrhea.

Material and methods

Twenty patients diagnosed with Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and other neurological disorders, including stroke or birth trauma, received BNT-A injections with salivary tests before and 1 month after the injections. Drooling was evaluated using subjective scales and objective assessment of salivary flow rate and oral health (salivary composition and cariogenic bacterial counts).

Results

A significant decrease was found in salivary flow rate at 1- and 3-month follow-up in the BNT-A treated group. There was no significant change in salivary composition or cariogenic bacterial counts.

Conclusion

BNT-A injections according to the current protocol can effectively manage sialorrhea while maintaining oral health.

Clinical relevance

Oral health can be considered the mirror of general human health, as the cause of many diseases. Saliva plays a crucial role in protecting the oral cavity. The present study is of high clinical relevance because, although earlier research has proved the effect of Botulinum neurotoxin type A injections on reduction in saliva flow, data about the risks of the treatment method to the oral condition through affecting saliva composition has so far been missing.

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Responsiveness of the Prosthetic Esthetic Scale

Abstract

Objectives

The aim of the study was to evaluate the responsiveness of the Prosthetic Esthetic Index (PEI) in a population who received prosthetic replacements.

Materials and methods

Fifty-seven patients who received prosthetic replacement of at least one tooth by means of fixed or removable prosthesis were professionally esthetically evaluated using the PEI and the Dental Aesthetic Index (DAI) before and after treatment. The participants further evaluated their oral esthetics using the Oral Health Impact Profile Aesthetic (OHIP-Aes) and Orofacial Esthetic Index (OES). Responsiveness was determined by calculating effect size (ES) and standardized response mean (SRM) of the change in PEI score, testing the change in PEI score in different subgroups, and correlating the change in PEI score with the change in OHIP-Aes and OES scores. The change in PEI score was compared to the change in DAI score.

Results

The ES and SRM were large for the change in PEI score. Patients having anterior teeth replaced had a larger improvement in PEI score compared to participants not having anterior teeth replaced. The change in PEI score was moderately but significantly correlated to the change in OHIP-Aes and OES scores. The PEI was more consistent in responsiveness than the DAI.

Conclusions

The PEI shows sufficient responsiveness for use in longitudinal studies and for use as a follow-up measure in clinical practice.

Clinical relevance

The PEI can in a standardized manner monitor and document esthetic improvements and problems as seen by the dentist in clinical practice.

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Efficacy and safety of 1% ropivacaine for postoperative analgesia after lower third molar surgery: a prospective, randomized, double-blinded clinical study

Abstract

Objectives

The purpose of this study was to investigate postoperative analgesic effect of ropivacaine administered as main or supplemental injection for the inferior alveolar nerve block (IANB) in patients undergoing lower third molar surgery.

Materials and Methods

The double-blind randomized study comprised 72 healthy patients. All patients received two blocks, the IANB for surgical procedure + IANB after surgery for postoperative pain control, and were divided into three groups: (1) 2 % lidocaine/epinephrine + 1 % ropivacaine, (2) 2 % lidocaine/epinephrine + saline, and (3) 1 % ropivacaine + saline. The occurrence of postoperative pain, pain intensity and analgesic requirements were recorded. Data were statistically analyzed using chi-square, Fisher, and Kruskal-Wallis tests and analysis of variance (ANOVA) with Bonferroni and Tukey correction.

Results

Ropivacaine was more successful than lidocaine/epinephrine in obtaining duration of postoperative analgesia, reduction of pain, and analgesic requirements whether ropivacaine was used for surgical block or administered as a supplemental injection after surgery.

Conclusions

Ropivacaine (1 %, 2 ml) resulted in effective postoperative analgesia after lower third molar surgery.

Clinical Relevance

Since pain control related to third molar surgery requires the effective surgical anesthesia and postoperative analgesia, the use of 1 % ropivacaine could be clinically relevant in a selection of appropriate pain control regimen for both surgical procedure and early postsurgical treatment.

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Histological and radiological evaluation of sintered and non-sintered deproteinized bovine bone substitute materials in sinus augmentation procedures. A prospective, randomized-controlled, clinical multicenter study

Abstract

Objectives

The objective of this study is to histologically and radiologically compare a sintered and a non-sintered bovine bone substitute material in sinus augmentation procedures.

Materials and methods

Thirty-three patients were included in the clinically controlled randomized multicentre study resulting in a total of 44 treated sinuses. After lateral approach, sinuses were filled with either a sintered (SBM, Alpha Bio's Graft^®) or a non-sintered (NSBM, Bio Oss^®) deproteinized bovine bone substitute material. The augmentation sites were radiologically assessed before and immediately after the augmentation procedure as well as prior to implant placement. Bone trephine biopsies for histological analysis were harvested 6 months after augmentation whilst preparing the osteotomies for implant placement.

Results

Healing was uneventful in all patients. After 6 months, radiological evaluation of 43 sinuses revealed a residual augmentation height of 94.65 % (±2.74) for SBM and 95.76 % (±2.15) for NSBM. One patient left the study for personal reasons. Histological analysis revealed a percentage of new bone of 29.71 % (±13.67) for SBM and 30.57 % (±16.07) for NSBM. Residual bone substitute material averaged at 40.68 % (±16.32) for SBM compared to 43.43 % (±19.07) for NSBM. All differences between the groups were not statistically significant (p > 0.05, Student's t test).

Conclusion

Both xenogeneic bone substitute materials showed comparable results regarding new bone formation and radiological height changes in external sinus grafting procedures.

Clinical relevance

Both bone substitute materials allow for a predictable new bone formation following sinus augmentation procedures.

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