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Biomedical subjects

Anne S McMillan

Publications and source records attributed to Anne S McMillan.

16 recordsLinked to original sources
PubMed2006

Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial.

PURPOSE: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H&N35) were completed at baseline and 2, 6, and 12 months after radiotherapy. RESULTS: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments (p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition (p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy. CONCLUSIONS: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach.

Adult↗
PubMed2006

Efficacy of a novel lubricating system in the management of radiotherapy-related xerostomia.

A comparison was made of Oral Balance gel delivered by slow release via a novel intra-oral device versus an oral bolus of gel on the oral health condition and oral health-related quality of life (OHRQoL) in patients who had received standard head and neck irradiation for nasopharyngeal carcinoma. Twenty-two participants took part in a randomized single-blind crossover clinical study. Each treatment lasted 4 weeks with an intervening 4 weeks washout period. The GOHAI, Xerostomia Inventory and patient satisfaction measures were self-completed and oral health condition assessed objectively at baseline (week 0) and weeks 4, 8 and 12. Oral Balance gel, in bolus and slow-release forms, was effective in improving aspects of oral health, notably a reduction in oral cariogenic micro-organisms. Slow release of gel via the intra-oral device did not appear to improve OHRQoL whereas gel alone reduced the severity of xerostomia symptoms and was the treatment of choice.

Adult↗
PubMed2006

Preservation of quality of life after intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: results of a prospective longitudinal study.

BACKGROUND: Xerostomia is a ubiquitous complication after conventional radiotherapy for nasopharyngeal carcinoma (NPC) that seriously impairs patient quality of life (QOL). The effect on QOL of parotid-sparing intensity-modulated radiotherapy (IMRT) for early-stage NPC was assessed prospectively. METHODS: Thirty-two patients with T1-2,N0-1,M0 NPC received IMRT. Saliva flow was measured, and the Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core, and EORTC head and neck module (QLQ-H&N35) questionnaires were completed at baseline and 2, 6, and 12 months after IMRT. RESULTS: Saliva flow recovered to at least 25% of baseline in most cases after 1 year. Physical function, fatigue, and vitality were problems at 2 months and then resolved (p < or = .002). Global health scales showed continuous improvement in QOL after treatment (p < or = .004). Xerostomia and sticky saliva were problems 2 months after treatment; thereafter, continuous improvement occurred (p < or = .001). Xerostomia scores correlated with general aspects of QOL (p < or = .044). CONCLUSION: IMRT for early-stage disease preserved key aspects of QOL, and a reduction in xerostomia symptoms enhanced broader aspects of QOL.

Adult↗
PubMed2006

Prevalence of orofacial pain and treatment seeking in Hong Kong Chinese.

AIMS: To estimate the prevalence and pattern of self-reported orofacial pain symptoms and treatment-seeking behavior in adult Cantonese-speaking Chinese people in Hong Kong. METHODS: A cross-sectional population survey involving a telephone survey technique was used to identify 1,222 randomly selected Cantonese-speaking people aged at least 18 years. Standard questions were asked on the experience of 8 orofacial pain symptoms in the previous month and on treatment-seeking behavior. RESULTS: Orofacial pain symptoms were reported by 41.6% of respondents when tooth sensitivity was included and by 24.2% when it was excluded. There was no gender- or age-related difference in pain prevalence (P > .010). Tooth sensitivity was the most common symptom (27.7%), followed by toothache (12.5%), and shooting pain in the face was the least common (1.1%). Almost half those with symptoms reported the pain as moderate to severe, and a fifth had frequent pain. Only 20.3% with pain symptoms sought professional treatment, and use of self-prescribed medication was very low (12.4%). CONCLUSION: Orofacial pain symptoms appear to affect more than a quarter of the adult population in Hong Kong, and prevalence estimates were consistent with those in Western countries. A substantial proportion of the pain symptoms were frequent and of moderate to severe intensity, with the potential for significant morbidity. Professional treatment seeking was very low and may be related to specific pain behaviors and effective coping strategies in this ethnic group.

Adolescent↗
PubMed2005

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia.

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device's utility.

Cranial Irradiation↗
PubMed2005

A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community.

AIM: To investigate the oral health of elderly stroke survivors on discharge from hospital into the community after rehabilitation and six months later compared with community dwelling elderly people without stroke. METHOD: The study took place in the rehabilitation unit of a general medical hospital in Hong Kong. It was a longitudinal study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. Verified clinical examination techniques and measures were used to assess dental caries, periodontal disease, oral hygiene, oral candidiasis, prosthetic status/need and functional disability (Barthel Index [BI]). Socio-demographic information was also collected. RESULTS: Stroke survivors had significantly higher plaque and bleeding scores on hospital discharge and after six months compared with the control group (p<0.01). On hospital discharge, the stroke group also had a poorer periodontal condition with more 4-5mm pockets. The mean BI on hospital admission was 71 and 91 on discharge. Stroke survivors with a higher BI on discharge had lower plaque scores after six months. The tooth condition, number of functional tooth pairs, prosthetic status, presence of oral candidiasis and oral yeast carriage were similar between stroke and comparison groups. CONCLUSIONS: Despite significant objective improvement in functional ability after stroke, elderly survivors returning to the community had significantly poorer periodontal health compared with community dwelling elderly without stroke, and the situation did not improve dramatically over six months. The protracted recovery of hand, arm and oral sensori-motor function is the most likely cause.

Aged↗
PubMed2005

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people.

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.

Aged↗
PubMed2004

Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function.

BACKGROUND: Xerostomia is a uniform complication after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Dosimetric studies suggested that intensity-modulated RT (IMRT) can spare part of the parotid glands from high-dose radiation. Disease control and salivary function after IMRT for early-stage NPC was studied prospectively. METHODS: Thirty-three patients with T1,N0-N1,M0 NPC were treated with IMRT from 2000 to 2002. The prescribed dose was 68-70 grays (Gy) in 34 fractions to gross tumor volume, 64-68 Gy to the planning target volume, and 70 Gy to enlarged cervical lymph nodes. Nineteen patients had stimulated whole salivary (SWS) flow assessment and stimulated parotid salivary (SPS) flow assessment at baseline and at 2 months, 6 months, 12 months, 18 months, and 24 months after the completion of IMRT. RESULTS: At a median follow-up of 2 years, only 1 neck failure was observed. The 2-year and 3-year local control, distant metastases-free, and overall survival rates all were 100%. The lymph node control and progression-free survival rates were 100% at 2 years and 92.3% at 3 years, respectively. The average mean dose to the parotid gland was 38.8 Gy. The SWS and SPS flow showed continuous recovery: 60% and 47.1% of patients recovered at least 25% of their baseline SPS flow and SWS flow, respectively, at 1 year after completion of IMRT, and the proportions rose to 85.7% and 71.4%, respectively, by 2 years. The pH and buffering capacity of saliva also improved with time. CONCLUSIONS: Parotid-sparing IMRT achieved good locoregional control, and there was continuous recovery of salivary flow, pH, and buffering capacity in the first 2 years after IMRT in patients with NPC.

Adult↗
PubMed2004

A double casting technique to minimize distortion when constructing fixed partial dentures on implants.

The casting of extensive implant superstructures that have a good passive fit may be technically demanding. A simple, 2-stage casting technique is presented that avoids common problems associated with the casting of large superstructures. The fabrication of a 7-unit metal-ceramic screw-retained fixed partial denture supported by 5 implants is used to illustrate this technique.

Dental Abutments↗
PubMed2004

A modified implant healing abutment to optimize soft tissue contours: a case report.

The soft tissue profile created around a conventional healing abutment may be inadequate to accommodate an anatomically shaped abutment that is larger than a standard machined abutment. This causes difficulties in its insertion and subsequent impression-making and provisional restoration fabrication. This article presents a simple technique to overcome these problems.

Adult↗
PubMed2004

Oral health condition and saliva flow in southern Chinese with Sjögren's syndrome.

OBJECTIVE: To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS). METHOD: 51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross-sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups. RESULTS: Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05). CONCLUSION: Despite good oral hygiene and regular dental check-ups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.

Adult↗
PubMed2003

Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is rare among Caucasians but very common among southern Chinese. No information is presently available on the relationship between salivary gland function and xerostomia in irradiated southern Chinese. Salivary gland function and xerostomia were measured in irradiated NPC patients, recently diagnosed NPC patients, and a matched control group. Stimulated whole saliva was collected from each participant and flow rate, pH and buffer capacity measured. All participants completed a multi-item dry mouth questionnaire. Comparisons were made using Chi-square and Mann-Whitney tests and correlations assessed using Spearman's rank correlation coefficients. The mean saliva flow rate and pH were significantly lower and the buffer capacity impaired in irradiated NPC patients compared with the other groups ( P<0.01). Significantly more irradiated NPC patients had negative impacts associated with dry mouth generally, sticky saliva, and hoarse voice ( P<0.01). Subjective dry mouth symptoms and associated reduced saliva flow were also relatively common in non-irradiated participants. Salivary gland hypofunction and xerostomia were major complications in irradiated NPC patients. In irradiated and non-irradiated southern Chinese, subjective dry mouth symptoms appeared to be correlated with actual salivary gland function.

Analysis of Variance↗
PubMed2002

Validation of a Chinese version of the Oral Health Impact Profile (OHIP).

OBJECTIVES: To translate the original English version of Oral Health Impact Profile (OHIP) into a Chinese version, to validate the translated instrument for use among the elderly in Hong Kong and to derive a Chinese short-form OHIP. METHODS: The original English version of OHIP was translated into Chinese. Elderly persons aged 60-80 years were interviewed by two trained interviewers and examined clinically by one of two calibrated dentists. Information on subjects' demographic background and oral health conditions were collected. RESULTS: A total of 586 elderly persons were interviewed and clinically examined. Cronbach's alpha of the translated OHIP subscales ranged from 0.69 to 0.84 and the test-retest correlation coefficient ranged from 0.72 to 0.92. Construct validity of the translated Chinese version was supported by the finding that the OHIP-49 and subscale scores increased as the subject's perceived oral health status changed from healthy to unhealthy. Also, those who had a perceived dental treatment need had higher mean OHIP-49 and subscale scores compared to those who did not. The short-form OHIP derived in this study demonstrated comparable validity and reliability with the full version of OHIP. CONCLUSION: The translated Chinese version of OHIP demonstrated good validity and reliability. It is available for use by researchers in oral health-related quality of life studies in Chinese elderly populations. In situations where a Chinese short-form of OHIP is desirable, there are now two validated Chinese versions for researchers to choose.

Aged↗
PubMed1999

Modulation of an inhibitory reflex in single motor units in human masseter by tonic painful stimulation.

Perioral electrical stimuli cause inhibitory reflex responses in single motor-units (SMU) and surface electromyographic (EMG) recordings from voluntary contracted human jaw-closing muscles. Tonic experimental masseter pain has recently been shown to reduce the inhibitory reflex response in surface EMG recordings but the effect on SMU activity has not been described. In this study, motor-unit action potentials were recorded with wire electrodes inserted into the left masseter in eleven subjects. The subjects kept the SMU firing rate around 10 Hz by feedback. Ninety-nine electrical stimuli were applied sequentially to the left mental nerve with increasing stimulus delays in steps of 1 ms after the preceding motor unit action potential. The inhibitory reflex in SMU was recorded before, during and after infusion of hypertonic saline (5%) into the ipsilateral masseter muscle. Spike train data were used to calculate (1) the mean pre- and post-stimulus inter-spike-intervals (ISI) in all of the 99 trials, (2) cumulative changes in firing probability, and (3) estimation of the compound inhibitory post-synaptic potential (IPSP) in the masseter motoneuron. Tonic masseter pain did not change pre-stimulus SMU firing characteristics but the mean ISI for the first post-stimulus discharge (158.2+/-9.2 ms) was significantly decreased compared to the pre-pain (175.8+/-11.3 ms, P<0.05) and post-pain conditions (172. 6+/-11.6 ms, P<0.05). The post-stimulus firing probability was significantly increased and the relative amplitude of the estimated IPSP significantly decreased during tonic masseter pain compared to pre-pain and post-pain conditions. In conclusion, this study indicates that tonic masseter pain has a net excitatory effect on the inhibitory jaw-reflexes, which could be mediated by presynaptic mechanisms on the involved motoneurons.

Adult↗
PubMedDate not supplied

Emotional effects of tooth loss in community-dwelling elderly people in Hong Kong.

PURPOSE: This study investigated the emotional effects of tooth loss among community-dwelling elderly people in Hong Kong and compared the effects among edentulous and partially dentate elderly. MATERIALS AND METHODS: A questionnaire study involved 233 southern Chinese elderly who were recruited and interviewed at social centers for elderly people throughout Hong Kong. Data were analyzed using chi-square or chi-square exact tests. RESULTS: Twenty-two percent of the participants reported difficulty accepting tooth loss, with no difference between the edentulous and partially dentate. However, 95% stated that their confidence was unaffected. For more than half of elderly people, tooth loss had a negative effect on food choice and enjoyment of food, with removable denture wearers having greater restrictions. Avoiding going out, eating in public, and forming close relationships were less-common problems. Twenty-two percent felt unprepared for the effects of tooth loss, and more than half said that better communication with the dentist would have helped. CONCLUSION: The emotional effects of tooth loss were not marked among elderly people, and there were no differences between edentulous and partially dentate individuals. However, significant disability was experienced because of restrictions in daily living activities. Restrictions were more severe in people who had lost enough teeth to necessitate denture wearing.

Adaptation, Psychological↗