The purpose of this study was to investigate the stigma of mental and physical handicap and its affects on the provision of dental care. Three groups of mentally and physically handicapped children, 4 year olds (n = 309), 14 year olds (n = 174) and 25 to 35 year olds (n = 265), were randomly selected from institutions in Hong Kong. The sample was dentally examined and dental status and treatment need assessed Their parents were also interviewed. Two psychometric scales, the Scale to Determine Attitudes Toward Disabled Persons (SADP), and the Parental Attitude Scale, a scale derived for this study, were used to assess attitude towards disabled persons in general, and specifically towards their own child. A questionnaire was also developed investigating parental experiences and feelings towards their handicapped child. Socioeconomic data was also collected and Information on the dental care delivery pattern experienced by their child. Dental practitioner members of the Hong Kong Dental Association were circulated with the SADP, the Dental Practitioner Attitude Scale, a scale derived for this study, and a questionnaire relating to qualifications and practice. A 62.5% response rate was achieved Canes experience was comparable to the non handicapped in the 4 year old group, lower in the other age groups, but with a high D component m the 25 to 35 year olds. Dental utilisation was low, the main reasons being financial, transport problems and a belief that the dentist would not treat. There was a gradation of parental attitude towards handicapped persons corresponding to education, age and socioeconomic factors. Dentists were not enthusiastic about treating handicapped patients for mainly financial reasons. Both parents and dentists felt strongly that government should provide facilities and be responsible for the treatment of handicapped individuals. The hypothesis of the study was mainly fulfilled. The stigma of handicap is a barrier to dental care, but is more socioeconomic than the way that handicapped persons present themselves.

Desmosomes and adherens junctions are intercellular junctions crucial for epithelial cell-cell adhesion and maintenance of normal tissue architecture. Desmoglein 3 (Dsg3), a member of the desmoglein sub-family, serves as an adhesion molecule in desmosomes. Its importance in cell-cell adhesion has been highlighted by the autoimmune blistering disease pemphigus vulgaris, where autoimmune antibodies directed against Dsg3 trigger a cascade of intracellular events, resulting in structural defects and blister formation in the skin and oral mucosa. In addition to its adhesive function, Dsg3 is also acknowledged to have other important roles in the regulation of cell proliferation and differentiation. Our group suggested that Dsg3 is involved in the regulation of keratinocyte stem cell differentiation, but the underlying mechanism(s) were unclear (Wan et al, 2003; Wan et al, 2007). We hypothesise that Dsg3 may be involved in the regulation of the E-cadherin-mediated cell adhesion and the reorganisation of actin cytoskeleton, which in turn contributes to differentiation programs and tissue morphogenesis. Thus, the aim of this study was to examine the interactions between Dsg3, E-cadherin and actin and to explore the underlying signalling pathways that are associated with these intercellular junctions. Using both a gain and loss of Dsg3 functional approaches, I demonstrate that Dsg3 is capable of interacting with E-cadherin and involved in the regulation of calcium-induced E-cadherin junction assembly and the activation of Src signalling pathway. Overexpression of Dsg3 increased E-cadherin/Src signalling with enhanced levels of Src and pSrc co-purified with E-cadherin. Knockdown of Dsg3 inhibited this pathway with reversed effect, suggesting that Dsg3 acts as an upstream regulator of Src signalling in the regulation of E-cadherin-mediated adherens junction formation. In addition, I show another novel function of Dsg3 in promoting actin dynamics through regulating Rac1 and Cdc42-GTPase activities, resulting in pronounced membrane protrusions and enhanced rate of actin turnover. Taken together, my work suggests that Dsg3 play an important signalling role in the assembly of E-cadherin-mediated cell adhesion and the dynamic of actin cytoskeleton.

Background: This study assumes that while all families are unique, families share common tasks that must be fulfilled as part of their functioning and the definition of whether the family process is functional or not is specific and may be unique to the family and is dependent upon what the family perceives as being normal, while considering cycle demands, resources and socio cultural influences. Objectives: To explore the role of family functioning in chronic periodontitis. Methods: The Outer North East London (ONEL) Oral Health Needs Assessments collected data in a representative sample of 2,343 adults aged16-65 and 1,174 children 3-4 years old in 2009-10. Data were collected through home visits by trained dentists and interviewers, and included dental clinical examinations and answers to questionnaires. Family function in the domains general functioning, problem solving, communication, roles, affective responsiveness, affective involvement and behaviour control was assessed using the Family Assessment Device (FAD) Epstein et al., 1983). Chronic periodontitis was defined as having at least one interproximal site with pocket depth of 4 mm or more. Results: Chronic periodontitis was associated with family functioning in the domains general functioning (odds ratio:0.45; 95%CI: 0.25-0.84), communication (odds ratio: 0.55 95%CI: 0.30-0.98), affective involvement (odds ratio:0.56; 95%CI: 0.34-0.94), affective responsiveness (odds ratio:0.47; 95%CI: 0.26-0.81) and behaviour control (odds ratio:0.40 95%CI: 0.22-0.74) after adjustment for ethnicity and socioeconomic position (NS-SEC). However, after adjusting for oral health related behaviour (tobacco consumption and plaque score) only the domain of general functioning (odds ratio: 0.51 6 95%CI: 0.27-0.97) affective responsiveness (odds ratio 0.52; 95%CI: 0.29-0.92) and behaviour control (odds ratio 0.46; 95 CI: 0.25-0.83) remained significantly associated with chronic periodontitis. Family functioning domains general functioning, communication, affective involvement, affective responsiveness and behaviour control also potentially partially mediates the relationship between socioeconomic position and chronic periodontitis experience. Conclusion: Efficient family functioning in the domains of general functioning, affective responsiveness and behaviour control may act as protective factors against chronic periodontitis.

The primary etiologic factor of periodontitis is bacterial plaque biofilm. Nevertheless, the factors that determine the progression of periodontitis are complex and poorly understood. Hence, the potential involvement of autoimmunity in the pathogenesis of periodontitis has been considered intermittently for years. The basic hypothesis for this PhD was that autoimmunity to native and/or posttranslationally modified periodontal extracellular matrix proteins is involved in the progression of periodontitis. Objectives The main objective of the study was to extend the understanding of periodontal disease pathogenesis beyond the common bacterial etiology and to address the hypothesis that periodontal disease is an auto-immune disease. This research will try to identify the exact neoepitope. Specific aims (i). To investigate the involvement of autoimmune reactivity towards native collagen type I (CI) and collagen type III (CIII), as well as CI and CIII posttranslationally modified by reactive oxygen specious (ROS) known to present in the inflamed tissue, ROS-CI and ROS-CIII, respectively. (ii). Develop human antibody fragment(s) specific to CI, ROS-CI, CIII and ROSCIII for diagnostic application. Methods Modification of CI or CIII was confirmed by SGS-PAGE, Capillary Electrophoresis and 3D-fluorescence. The presence of autoantibodies to ROS-CI and ROS-CIII in sera and saliva were then studied by ELISA and Western blotting using sera and saliva from individuals with Aggressive Periodontitis (AgP), Chronic Periodontitis (CP) and Gingivitis (G). Antibodies specific to ROS-CI and ROS-CIII were developed using phage display semi-synthetic human single chain fragment variable (scFv) libraries. Results Autoantibodies to native CI, native CIII, ROS-CI and ROS-CIII were observed exclusively in patients with AgP. Human antibody fragments specific to native and ROS-CI were developed and evaluated. Conclusions A. Autoimmune reactions to native and post-translationally modified self antigens may play a role specifically in the pathogenesis of AgP. B. Anti-ROS scFv specific to ROS-CI and ROS-CIII may have diagnostic future applications.

The viscoelastic properties of soft lining materials are of enormous interest and importance as they clearly govern the biomechanical function of these materials. Forced vibration (Non-resonant) dynamic mechanical analysis was used to characterise the viscoelastic properties of a wide range of commercial (8 brands) as well as experimental soft liners (7 formulations). Forced vibration DMA is the ideal way of studying these materials as it can closely and accurately mimic physiological temperatures and frequencies under which they operate. The materials were studied as processed, and subsequently after simulated ageing for time periods up to twelve months. The water absorption and the subsequent changes in the viscoelastic behaviour of these materials are important as they spend a large part of their working lifetime immersed in solution. The results, where possible, were compared with the work of other researchers, and any sources of discrepancy examined. It was noted that the materials whose glass to rubber transition (Tg) was near their operating temperature (i.e. the acrylics) were particularly prone to any changes in the time and temperature domain of the experiment. A large variation was observed in the properties of the commercial materials available. At 37°C and 1 Hz a seven fold range was seen in the real part of the modulus (2.79-19.7 MPa), and a fifty fold range was observed in the loss tangent (0.029-1.52). Given this wide disparity it is surprising that a universally recommended range of properties does not exist, although there is some speculation in the literature. The study of the ageing behaviour of these materials in water showed that the traditional hardening of the acrylics has been overcome. A heat cured silicone material was seen to be virtually unaffected by time, while for a cold cured competitor the opposite was true. New and experimental materials showed a wide range of behaviour after immersion in water.

Aims: To investigate the relationship between oral health and obesity in adolescents attending Public and Private Schools in Sharjah City, United Arab Emirates. Methods: 1094 adolescents attending secondary school in Sharjah City were asked to participate in a randomised cross-sectional study, (QMREC2007/60). Two separate structured questionnaires were used to determine; 1. The demographic details, dietary habits, physical activity and oral hygiene practice from the adolescents and 2. Socio-economic and general health from their guardian. A two part clinical examination i) dental caries (WHO, 1997) and oral cleanliness (Pitts et al., 1997), ii) measurement of height and weight to calculate BMI was also carried out. Data analysis included descriptive, univariate and multiple regressions. Results: Full dataset on 803 adolescents was obtained and used for analysis. The study response rate of 93% resulted in 50 % male, 40% UAE nationals and 66% attending Private school. The mean DMFT was 3.19 (SD 2.9), 25% were caries free, mean BMI was 21 and 15% were obese. A significant association between DMFT and BMI was found (r=0,097, p=0.006), with each extra 10 point in BMI there was a 0.57 increase in DMFT. The DMFT predictive model confirmed significant association of father’s education (p<0.001), gender (p=0.008) and ethnicity (p=0.001). Positive significance of age (p<0.001), consumption of tea with sugar (p=0.024) and soft drinks (p<0.001), whereas three daily meals (p=0.009) and visiting the dentist (p=0.007) were protective. The BMI model confirmed positive significance of age (p<0.001), school fees (p=0.005), obesity in family (p<0.001) and soft drink consumption (p<0.001). Three daily meals (p=0.007) and increased drinking frequency of milk (p=0.026) were found to be protective. Conclusions: Analysis of the final model suggests that there is no clear relationship between obesity and dental caries, but that the consumption of soft drinks was a leading predictor for both diseases (obesity and dental caries).

The room temperature polymerising heterocyclic polymer system, poly(ethyl methacrylate)/tetrahydrofurfuryl methacrylate (PEM/THFM) has been shown previously to be biocompatible and supported tissue repair, specifically for bone and cartilage, and biologically inert when in contact with the dental pulp. It proved more effective, than other glassy methacrylates in the release of active species. The PEM/THFM system is a rigid material. The aim of this study was to develop and characterise the use of this system as a flexible patch, for application and retention to the buccal mucosa, thus facilitating sustained regulated release. Model species, dextrans, were used to represent macromolecular drugs whereby the effect of molecular weight could be studied. N-methyl pyrrolidone was added to the polymer system as a biocompatible plasticiser to enhance molecular mobility, and hence the transport of species. The effect of the addition of chitosan was also studied, due to its bioadhesiveness and permeation enhancing ability. A range of systems was investigated both in terms of water and species release. The release of the agent was measured by a fluorometer, the leachable components by HPLC and Confocal microscopy demonstrated the transport of water and active species through the system. Immunological and viability studies established whether the leachants or released components of the polymeric systems had an inflammatory or irritant action on `in vitro' stratified epithelium. The addition of N-methyl pyrrolidone, dextran and chitosan substantially increased water uptake, thus affecting the release kinetics. Analysis of the kinetics of water uptake showed Case I, combination of Case I and Case II, and Case II kinetics, depending on the systems studied. Dextran release was largely diffusion controlled, from which diffusion coefficients were calculated; the amount released varied between the systems studied.

Background: Oral pain has been reported to prevent successful tobacco cessation in Bangladeshi paan tobacco chewers. Aim: to investigate oral pain associated with paan tobacco chewing cessation. Objectives: to identify and assess the impact and association of predictors of oral pain with paan tobacco cessation. Methods: This prospective cohort study recruited UK resident adult Bangladeshi women. Socio-demographic, social capital, general and oral health condition, tobacco use, dependence and cessation data were analysed in four study groups; 1) oral pain at baseline, 2) continued oral pain 3) onset of oral pain during follow-up and 4) at study completion. Results: 150 participants (mean age 51, range 24-84 years) completed the study. Most (92%) were never employed, had no formal education (59%) and chewed both zarda and tobacco leaf (69%). Participants who chewed more paan tobacco (OR 2.270, 95% CI; 1.980-5.258), were anxious when going without paan tobacco (OR 1.908, 95% CI: 1.728-4.995) with dental calculus (OR 3.350, 95% CI; 1.716-15.680) and no completed formal education (OR 3.349, 95% CI; 1.395-8.039) reported baseline oral pain. Oral debris (OR 3.963, 95% CI; 1.045-15.031) and no completed formal education (OR 2.524, 95% CI; 1.866-7.359) predicted continued oral pain. Successful quitters at study completion (OR 4.213, 95% CI; 1.509-13.863) quitting with behavioural support alone (OR 2.932, 95% CI; 1.635-5.873) with tooth erosion (OR 3.880, 95% CI; 1.248-12.061) predicted onset of oral pain. Successful quitters (OR 2.497, 95% CI: 1.603-3.715) quitting with behavioural support alone (OR 2.139, 95% CI; 1.872-5.248) with filled teeth (OR 3.166, 95% CI; 1.826-12.134), tooth erosion (OR 2.849, 95% CI; 1.029-7.892) and living in a low status neighbourhood (OR 4.551, 95% CI; 1.068-19.398) predicted oral pain at study completion. Conclusions: Predictors of oral pain for all four study groups were multi-factorial, including lifestyle and behavioural factors, tobacco dependence and cessation, sociodemographics and oral clinical condition.

No description available.

The nature of dental implants as a treatment plan for patients is often viewed as something relatively new, but the idea of dental implants has long been a part of history. Dating back as far as the Mayan civilization, dental implants have increasingly become prevalent in modern society. As time progressed, various modern forms of dental implants materialized, with the first of these being the eposteal implant. Post 1943, the eposteal dental implants were then replaced by the more novel transosteal implants, and then followed by the current implant model, the endosteal implant. Presently, in the US alone, there are upwards of 700,000 implants being inserted annually so there is no question of the impact dental implants have, and will continue to have, on dentistry and quality of life for patients. Implants are often evaluated in terms of success versus survival, where "success" is denoted if a particular implant meets the success criteria it is being evaluated with, while "survival" simply means the implant exists in the mouth. The impasse that arises here is that the two terms of success and survival are so closely intertwined that implant success can be misrepresented, and wrongfully thought of as ubiquitous among all patients. This literature review takes a comprehensive look at dental implants, and proceeds to evaluate associated case studies as well as posit how implants affect modern day dentistry.