Biomedical subjects
Publications and source records attributed to Anthony S Blinkhorn.
UNLABELLED: A case report is presented of the preventive and clinical care of an adolescent with a neglected mouth, complicated by the medical history of cerebral palsy. CLINICAL RELEVANCE: Knowledge of the treatment which ideally may be offered to patients with cerebral palsy may help such patients retain and maintain their dentition.
BACKGROUND: Polymorphisms in the promoter region of the interleukin (IL)-10 gene have been identified at positions -1082 (G-->A), -819 (C-->T), and -592 (C-->A). Linkage disequilibrium between alleles -819*C, and -592*C was observed. A previous study addressed the association between the -1082*A allele and gingivitis in white Caucasian children. The aim of this case-control study was to test whether differences could exist between children with and without gingivitis in the distribution of IL-10 alleles and haplotypes at positions -1082, -819, and -592. METHODS: A total of 248 subjects aged 8 to 12 years from the University Dental Hospital of Manchester were enrolled in this study. According to gingival and bleeding on probing indices, 84 children were classified as controls and 164 as children with gingivitis. Amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used for genotyping IL-10 polymorphisms. Allele and haplotype frequencies were calculated by direct counting and by a haplotype frequency estimation (EH) program. Differences between subjects with gingivitis and controls in the frequency of haplotypes were determined by a chi2 test of homogeneity. RESULTS: The GCC/GCC genotype, which has been associated with increased production of IL-10, was significantly more frequent in controls than in children with gingivitis (36% versus 23%) (P=0.036). In addition, there was a marginally significant difference between controls and cases in the frequency of haplotypes (P=0.06). The GCC haplotype was more frequent in controls than in children with gingivitis (60% versus 50%). In contrast, the ACC and ATA haplotypes were more frequent in children with gingivitis (27% and 23% versus 19% and 21% in controls). CONCLUSION: These findings suggest that IL-10 gene promoter polymorphisms could have an active role in the pathogenesis of gingivitis in Caucasian children.
OBJECTIVE: Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance. MAIN OUTCOME MEASURES: Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service. RESULTS: In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments. CONCLUSIONS: Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.
To estimate the prevalence of orofacial pain (OFP) by specific diagnostic subgroups in the general population. Cross-sectional population study. General medical practice in South East Cheshire, UK. Participants of baseline investigation who completed the full postal questionnaire (1510, adjusted study participation rate 81%). Clinical examination was attended by 126 (43%) of all the participants who reported OFP in the questionnaire. These individuals were classified as musculoligamentous/soft tissue type, dentoalveolar or neurological/vascular. OFP duration, location, descriptors and statements on OFP were predictors of classification group. The estimated prevalence in the general population of musculoligamentous/soft tissue type of OFP was 7%, dentoalveolar 7% and neurological/vascular 6%. This study has derived a statistical model to classify participants with OFP into three broad groups (musculoligamentous/soft tissue, dentoalveolar and neurological/vascular) based on questionnaire information about OFP (OFP chronicity, location and verbal descriptors of pain). It is potentially useful in large population studies of OFP, where a clinical examination is not possible, however, further validation of its performance in large populations are necessary.
UNLABELLED: Nitrite at acid pH has been shown to be antibacterial particularly against the highly cariogenic species Streptococcus mutans. Nitrite might yield nitrosamines in vivo but ascorbic acid (vitamin C) could counteract these potential ill effects. The aim of this study is to determine whether ascorbic acid would interfere with the ability of sodium nitrite to suppress growth and acid production of S. mutans, NCTC 10449(T) and NCTC 10832. Strains were grown in Fastidious Anaerobe Broth before exposure to 200 mM nitrite in the presence of various concentrations of ascorbic acid (0.0, 5.7, 11.4, 17.0, 22.7, 28.4, 56.8, 85.2 mM). End pH was measured after 24 h exposure and cultures were serially diluted for viable counts. Statistical significance of differences in end pH values, each from 10 experiments, was determined using the Mann-Whitney U-Test. At all concentrations of ascorbic acid plus 200 mM nitrite plus S. mutans the pH was higher than with controls lacking ascorbic acid and/or nitrite (p>/=0.001). S. mutans was viable (between 4.5 x 10 (8) and 7.9 x 10 (9) cfuml (-1)) after growth in the presence of ascorbic acid at all concentrations without nitrite, whereas it was not detected when 200 mM nitrite was also present. CONCLUSIONS: ascorbic acid does not prevent the action of nitrite against S. mutans. Therefore ascorbic acid could be used in conjunction with nitrite to help counteract potential ill effects for humans.
OBJECTIVE: This study compares the geodemographic distribution of caries experience in neighboring fluoridated and nonfluoridated populations. METHODS: All 5-year-old children living in fluoridated (N=1,422) and nonfluoridated (N=4,779) areas of Cheshire, UK, were examined by trained and calibrated examiners. The Target Market level of the Super Profiles geodemographic classification was used to produce market penetration ranking reports for caries experience. The same area types were compared in fluoridated and nonfluoridated populations. Lorenz curves and Gini coefficients were generated from the outputs of the penetration rankings. RESULTS: There was a 12.4 percent difference in prevalence and a 29.4 percent difference in dmft between fluoridated (dmft>0=32.4%, dmft=1.01) and nonfluoridated (dmft>0=37.0%, dmft=1.43) areas. The area types at the top of both penetration rankings were deprived in nature and those at the bottom were affluent. The Gini coefficients in each area were 22.7 and 23.7 percent. CONCLUSIONS: The results demonstrate that water fluoridation is effective at preventing dental disease after controlling for confounding factors. In both populations the majority of disease was not confined to a small number of deprived area types. This undermines the contention that a targeted approach to caries prevention is a practical option.
OBJECTIVES: This study compares methods for detecting and correcting the bias associated with nonresponse to postal questionnaires. METHODS: Questionnaires were sent out in three sequential stages to parents of all 5-year-old children examined in a clinical survey. Each stage progressively targeted nonresponders. Data on dmft and area measures of socioeconomic status were available for all children. Estimates for whole population dmft were produced by different methodologies comparing the relationship between dmft and stage of response and three area measures of socioeconomic status. RESULTS: A total of 1,776 children were examined and 1,437 questionnaires were obtained, a response rate of 80.9 percent. The mean dmft of the total population (1.49) was 17.3 percent more than responders (1.27). The dmft of the nonresponders was 2.41, 89.7 percent more than responders. There were significant linear trends in dmft and socioeconomic status across the mailing stages. The methodology using mailing stage regressed against dmft produced the most accurate adjusted dmft value (1.42). The methods using area measures of socioeconomic status produced nearly identical adjusted dmft values ranging from 1.31 to 1.32. CONCLUSIONS: Even with an "acceptable" response rate, nonresponse bias can still be present. Researchers should report the outcomes of analyses to detect nonresponse bias when publishing questionnaire studies.
Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacial pain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population-based cross-sectional survey in the South-East Cheshire area of the United Kingdom involving 2504 individuals aged 18-65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread body pain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P<0.001). Several oral mechanical factors were significantly associated with both orofacial pain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of the process of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region.
STUDY OBJECTIVE: To determine the prevalence of oro-facial pain (OFP) in the population and within-population subgroups and to describe the associated disability. DESIGN: Cross-sectional population study. SETTING: General medical practice in South East Cheshire, United Kingdom. PARTICIPANTS: A random sample of 4000 adults aged 18-65 years of whom 2504 responded (adjusted participation rate 74%). MAIN RESULTS: The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18-25 year age group and the lowest (22%) in the 56-65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain. CONCLUSIONS: OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.
INTRODUCTION: Most dental treatment for children in the United Kingdom (UK) is provided by general dental practitioners (GDPs) working in the National Health Service (NHS). A working party of the British Society of Paediatric Dentistry, in a special publication from the Dental Practice Board, has suggested that failure to provide restorative care for the deciduous dentition is unacceptable, yet GDPs are filling fewer teeth in young children. The study aimed to evaluate the health outcomes obtained from restoring carious deciduous molar teeth. METHOD: The dental records of 677 children cared for by 50 GDPs in the north west of England were analysed. RESULTS: The results showed that 18.8% of deciduous molars with unrestored caries and 17.0% with a history of restorative care went on to be extracted because of pain or sepsis. CONCLUSION: The results suggest that the risk of carious deciduous molars being extracted is similar whether these teeth receive restorative care or not.