Depression embodied: an ambiguous striving against fading

Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative‐based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patient's struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in‐between.     

Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report,clinical findings,and influence on quality of life

Objective: To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations.

Material and methods: A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi² test.

Results: A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20–39 years compared to 4.9 for the age group 65–89 years. Conclusion: The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.     

Mercury vapor release from dental amalgam in patients with symptoms allegedly caused by amalgam fillings

The aim of this study was to determine whether a group of patients with symptoms, self-related to their amalgam restorations, experienced an exposure to mercury vapor from their amalgam restorations that reached the range at which subtle symptoms have been reported in the literature. Furthermore, the aim was to determine whether the mercury exposure for these patients was significantly higher than for controls with no reported health complaints. The symptom group consisted of 10 consecutively selected patients from a larger group, referred by their physicians for investigation into any correlation between subjective symptoms and amalgam restorations. The control group consisted of 8 persons with no reported health complaints. The intra-oral release of mercury vapor was measured between 7 :45 a.m. and 9 :00 p.m. at intervals of 30–45 min. following a standardized schedule. The mercury levels in plasma, erythrocytes, and urine were also determined. The calculated daily uptake of inhaled mercury vapor, released from the amalgam restorations, was less than 5% of the daily uptake calculated at the lower concentration range given by the WHO (1991), at which subtle symptoms have been found in particularly sensitive individuals. The symptom group had neither a higher estimated daily uptake of inhaled mercury vapor, nor a higher mercury concentration in blood and urine than the control group. The study provides no scientific support for the belief that the symptoms of the patients examined originated from an enhanced mercury release from their amalgam restorations.     

Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study.

The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.     

Clinical evaluation of all-ceramic onlays: a 4-year retrospective study

PURPOSE: The aim of the present study was to evaluate the clinical outcome of extensive Empress onlays retained with resin-bonded cement. MATERIALS AND METHODS: One hundred thirty extensive ceramic onlays were placed in premolar and molar regions in 91 patients treated by 2 general practitioners between 1997 and 2000. Seventy-seven percent of the constructions were luted with chemically cured resin composite cement and 23% were luted with dual-cured resin cement. Fifty-nine patients with 81 restorations were clinically evaluated independently by 2 calibrated examiners using the California Dental Association protocol. The mean time in function for all restorations at examination was 49 months. RESULTS: Seventy-five (93%) onlays were still in function after 4 years. Six onlays (7.3%) failed; 1 had lost retention as a result of caries, and 5 had fractured. All failures were in molar regions. CONCLUSIONS: Ceramic onlay therapy is an acceptable treatment alternative over a 4-year period, but further long-term data are necessary before this treatment should be considered for general dental practice.     

Increased activation of blood coagulation in pregnant women with the Factor V Leiden mutation

Background

The risk of venous thromboembolism is enhanced in pregnant carriers of the Factor V Leiden mutation. The primary aim of the study was to compare prothrombin fragments 1 + 2, soluble fibrin and D-dimer levels in pregnant Factor V Leiden mutation carriers with those in non-carriers. Secondary aims were to evaluate whether these biomarkers could predict placenta-mediated complications or venous thromboembolism, and to study blood coagulation after caesarean section with thromboprophylaxis and after vaginal delivery without thromboprophylaxis.

Material/Methods

Prothrombin fragments 1 + 2, soluble fibrin and D-dimer levels were studied longitudinally in 476 carriers with singleton pregnancies from gestational weeks 23–25 until 8–10 weeks postpartum.

Results

Prothrombin fragments 1 + 2 and D-dimer levels gradually increased during pregnancy. D-dimer levels were higher in carriers, both during pregnancy and puerperium, compared to non-carriers. D-dimer levels above 0.5 mg/l were found in about 30% and 20% of the heterozygous carriers at 4–5 and 8–10 weeks postpartum, respectively. Soluble fibrin levels were mainly unchanged during pregnancy, with no difference between carriers and non-carriers. Biomarker levels were similar in carriers with uncomplicated and complicated pregnancies.

Conclusion

Higher D-dimer levels indicate increased blood coagulation and fibrinolysis activity in carriers. The high proportion of carriers with D-dimer levels exceeding 0.5 mg/l postpartum must be considered when assessing the probability of venous thromboembolism. Large overlaps in biomarker levels in normal and complicated pregnancies suggest that these biomarkers cannot be used as predictors. Thromboprophylaxis following caesarean section may prevent increased activation of blood coagulation.