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    ABSTRACT: The transverse skeletal effects of rapid maxillary expansion (RME) have previously been assessed using cone-beam CT (CBCT). However, to date the majority of studies assess the changes based on two-dimensional slice images, which under utilises the three-dimensional (3D) data captured. This study optimizes the volumetric CBCT data by generating 3D rendered surface models to quantity and visualize the immediate 3D changes of the mid-facial bone surfaces following RME. The sample consisted of 14 patients who required RME prior to fixed appliances. Pre-treatment (T0) and immediate post expansion (T1) CBCT images were taken. Following superimposition the mid face was divided into six anatomical regions. A one-sample t-test was used to determine if the differences between the two surfaces were significantly ≥0.5 mm. All regions showed a change following RME ≥ 0.5 mm. The maxillary and nasal bones showed 2.3 mm and 2.4 mm expansion respectively, followed by the zygomatic bones (1.4 mm), 2 cases showing asymmetric expansion. The use of 3D surface rendered models allows quantification and visualisation of 3D changes in the mid-facial skeleton at anatomical sites distant of RME activation. Following activation there can be a pan mid-facial expansion, including not only the maxilla but also the nasal lateral bones and zygomas. The response was highly variable and asymmetric expansion can occur.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 12/2013;
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    ABSTRACT: Feline chronic gingivostomatitis (FCGS) is an inflammatory disease of the oral cavity that causes severe pain and distress in affected cats. Treatment methods are currently very limited. The aims of this study were to assess the feline innate immune response by investigating the levels of cytokine and Toll-like receptor (TLR) mRNAs in tissue biopsies of cats with and without FCGS, and to relate this to the presence or absence of putative oral pathogens identified previously within these cats. Mucosal biopsies were collected from 28 cats with FCGS and eight healthy cats. The levels of TLR (TLR2, TLR3, TLR4, TLR7, TLR9) and cytokine (IL-1β, IL-4, IL-6, IL-10, IL-12, TNF-α, IFN-γ) mRNA was determined using quantitative PCR. In the FCGS group a statistically significant increase was seen in TLR2, TLR7, TNF-α, IFN-γ, IL-1β and IL-6 mRNA levels compared to the healthy group. In cats where Tannerella forsythia was present, statistically significant increases were seen in TLR2, TLR4, TLR7, TLR9, TNF-α and IL-1β mRNA levels compared to cats where this putative pathogen was absent. Statistically significant increases in mRNA expression were also seen in cats harbouring feline calicivirus (FCV) (TLR2, IL-1β, IL-6, IFN-γ) and Porphyromonas circumdentaria (TLR2, TLR3) compared to cats where these putative pathogens were absent. Pasteurella multocida subsp. multocida and Pseudomonas sp. did not significantly alter the expression of any TLR or cytokine mRNAs when compared to animals who tested negative for these species, while cats colonised with P. multocida subsp. septica demonstrated a statistically significant reduction in the expression of TLR7, TNF-α and IFN-γ mRNAs compared to cats free of this species. The expression of mRNA for several TLRs and cytokines is elevated in FCGS. A positive correlation was observed between clinical disease severity and the presence of FCV (p=0.001; Rho=0.58). Although the number of cats harbouring T. forsythia was low by comparison, 80% of samples in which it was present were from cases with the highest clinical disease severity. Positive correlations with clinical disease severity were seen for TLR2 (p=0.00086), TLR7 (p=0.049), TNF-α (p=0.027), IFN-γ (p=0.0015), IL-1β (p=0.004) and IL-6 (p=0.00001) mRNAs. The putative pathogens FCV and T. forsythia may be important in stimulating a host immune response to FCGS and may play a role in the pathogenesis of this disease.
    Veterinary Immunology and Immunopathology 12/2012;
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    ABSTRACT: Transplantation of teeth has been done for hundreds of years. In the late 18th and early 19th century transplants of teeth between individuals were relatively common at specialist dental practices in London. Surprisingly tooth allotransplants have been found to last 6 years on average. In Scandinavia during the 1950 and 1960's autotransplantation of teeth began to be carried out under increasingly controlled conditions. These have proved to be very successful in long term studies with autotransplants surviving up to 45 years post-surgery. Recent developments in cone beam CT and rapid 3D prototyping have enabled the fabrication of accurate surgical templates which can be used to prepare the recipient site immediately prior to transplantation. This has resulted in a drastically reduced extra-oral time for the transplant teeth which can be expected to improve success rates further. Autotransplants provide significant advantages compared to single tooth implants and should be considered the treatment of choice in the growing child.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 11/2012;
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    ABSTRACT: Alcohol use and abuse play a major role in both crime and negative health outcomes in Scotland. This paper provides a description and ethical and legal analyses of a novel remote alcohol monitoring scheme for offenders which seeks to reduce alcohol-related harm to both the criminal and the public. It emerges that the prospective benefits of this scheme to health and public order vastly outweigh any potential harms.
    Journal of medical ethics 04/2012;
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    ABSTRACT: Periodontal disease is one of the most common diseases of adult dogs, with up to 80% of animals affected. The aetiology of the disease is poorly studied, although bacteria are known to play a major role. The purpose of this study was to identify the bacteria associated with canine gingivitis and periodontitis and to compare this with the normal oral flora. Swabs were obtained from the gingival margin of three dogs with gingivitis and three orally healthy controls, and subgingival plaque was collected from three dogs with periodontitis. Samples were subjected to routine bacterial culture. The prevalent species identified in the normal, gingivitis and periodontitis groups were uncultured bacterium (12.5% of isolates), Bacteroides heparinolyticus/Pasteurella dagmatis (10.0%) and Actinomyces canis (19.4%), respectively. Bacteria were also identified using culture-independent methods (16S rRNA gene sequencing) and the predominant species identified were Pseudomonas sp. (30.9% of clones analysed), Porphyromonas cangingivalis (16.1%) and Desulfomicrobium orale (12.0%) in the normal, gingivitis and periodontitis groups, respectively. Uncultured species accounted for 13.2%, 2.0% and 10.5%, and potentially novel species for 38.2%, 38.3% and 35.3%, of clones in the normal, gingivitis and periodontitis groups, respectively. This is the first study to use utilise culture-independent methods for the identification of bacteria associated with this disease. It is concluded that the canine oral flora in health and disease is highly diverse and also contains a high proportion of uncultured and, in particular, potentially novel species.
    Veterinary Microbiology 06/2011; 150(3-4):394-400.
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    ABSTRACT: In the last year there has been a great deal of public debate about homeopathy, the system of alternative medicine whose main principles are that like cures like and that potency increases relative to dilution. The House of Commons Select Committee on Science and Technology concluded in November 2009 that there is no evidence base for homeopathy, and agreed with some academic commentators that homeopathy should not be funded by the NHS. While homeopathic doctors and hospitals are quite commonplace, some might be surprised to learn that there are also many homeopathic dentists practising in the UK. This paper examines the statements made by several organisations on behalf of homeopathic dentistry and suggests that they are not entirely ethical and may be in breach of various professional guidelines.
    British dental journal official journal of the British Dental Association: BDJ online 11/2010; 209(10):493-6.
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    ABSTRACT: To report on the dental health of three-year-old children in Greater Glasgow, and to examine the amount of dental caries associated with deprivation in this young age group. Dental inspections in nursery schools. The national inspection programme using BASCD criteria was extended to include an additional group of nursery attending three-year-olds in Greater Glasgow in 2006/7 and 2007/8. Caries experience was analysed by logistic regression models and ROC plots. Fourteen percent of this population was sampled in 2006/7 and 19% in 2007/8 (usable data n = 1,711 in 2006/7, 2,428 in 2007/8). Mean d(3)mft was 1.1 in 2006/7 and 1.0 in 2007/8. The prevalence of caries experience was 26% in 2006/7 and 25% in 2007/8 (33% and 32%, respectively, for children in deprived areas). The adjusted odds-ratio for caries experience for children living in the most deprived areas was 2.90 (2.31, 3.64), p <0.001. There was a high rate of caries in the upper anterior teeth. It was feasible to conduct large scale caries surveys of three-year-olds in a nursery setting. Poor dental health and inequality commence early in life. Caries prevention should be targeted toward deprived families from birth.
    British dental journal official journal of the British Dental Association: BDJ online 08/2010; 209(4):E5.
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    Journal of medical ethics 03/2010; 36(3):130-1.
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    ABSTRACT: Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal's Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the "no lose philosophy" in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal's Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the "belts and braces" approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal's Wager, are based on faith rather than evidence.
    Heart (British Cardiac Society) 01/2010; 96(1):15-8.
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    ABSTRACT: Alex McMahon and colleagues critique the International Conference on Harmonisation (ICH) guidance on good clinical practice (GCP), arguing that it is having a disastrous effect on noncommerical randomized clinical trials in Europe.
    PLoS Medicine 11/2009; 3(11):e1000131.
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