• Title/Summary/Keyword: Tooth number

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A STUDY OF ADDITIONAL VIBRATION EFFECT ON DENTIN BOND STRENGTH (진동이 상아질 결합력에 미치는 영향에 관한 연구)

  • Lee, Jin;Kim, Jung-Wook;Lee, Sang-Hoon;Kim, Chong-Chul
    • Journal of the korean academy of Pediatric Dentistry
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    • v.29 no.4
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    • pp.632-640
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    • 2002
  • The objective of the study was to apply the vibration technique to reduce the viscosity of bonding adhesives and thereby compare the bond strength and resin penetration into dentinal tubules achieved with those gained using the conventional technique. Eighty-eight noncarious extracted human permanent molar teeth were sectioned to remove the coronal enamel and were embedded in 1-inch PVC pipe with acrylic resin. The occlusal surfaces were placed so that the tooth and the embedding medium were at the same level to form one flat surface, and the samples were subsequently polished with silicon carbide abrasive papers. The samples were randomly assigned to 4 groups(n=22). On Group 1 and 2, Single Bond(3M-ESPE, St. Paul, USA) was used, and on Group 3 and 4, One-Step(Bisco Inc., Schaumburg, USA) was used, and each was applied according to its manufacturer's instructions. For Group 2 and Group 4, vibration was applied with ultrasonic scaler for 10 seconds, and the adhesive was light-cured for 10 seconds. Resin composite was condensed on to the prepared surface in two increments using a mold kit(Ultradent Products Inc., USA) and each was light-cured for 40 seconds. After 24 hours in tap water at room temperature the specimens were thermocycled, and shear bond strengths were measured with a universal testing machine(Instron 4465, Canton, USA). To investigate infiltration patterns of the adhesive materials, the surface of specimen was examined with scanning electron microscope. The results were as follows. 1. The shear bond strengths of vibration groups(Group 2, Group 4) were significantly greater than those of the non-vibration groups(Group 1, Group 3)(p<0.05). 2. The shear bond strengths of Single Bond and One-Step were not significantly different (p>0.05). 3. The vibration groups showed greater number of resin tags in tubules and lateral branches under SEM.

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In-Depth Interview of Parents Experienced First Infant Oral Examination (1차 영유아 구강검진을 경험한 부모의 심층면담)

  • Lee, Su-Na;Lim, Soon-Ryun
    • Journal of dental hygiene science
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    • v.17 no.6
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    • pp.543-551
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    • 2017
  • The purpose of this study is to analyze the experience of the parents who examined the first infant oral examination and to understand how to improve the practical oral examination business. In-depth interviews were held with 10 parents who did the first infant oral examination, and their children's age was less than 18 to 29 months. The following conclusions were obtained by deriving the concepts and categories of the recorded contents. First, the main reason for the unsatisfactory examination of this study was that it was formal. Parents were disappointed in the fact that they did not look at the mouth of the child at the same time as it was fast and they said because it is carried out free of charge, it is more formal than the examination for general dental treatment. Second, most of the participants questioned whether they should resume infant oral examination. Third, it appears that the tooth number or dental terminology in the result notice is difficult to understand. Fourth, the opinion on the improvement of the infant oral examinations was should provided that the oral health management information after examination and the direct oral health management method education at the examination. In addition, we identified the need for parents' oral health care education for infants. Therefore, it has been confirmed that in order for the infant oral examination and young children to be practically carried out, the problems should be improved by collecting opinions of the parents. Also it is necessary to search for efficient business management method through repeated research related to infant oral examination.

EFFECT OF NERVE GROWTH FACTOR GENE INJECTION ON THE NERVE REGENERATION IN RAT LINGUAL NERVE CRUSH-INJURY MODEL (백서 설신경 압박손상모델에서 신경성장인자 유전자 주입이 신경재생에 미치는 영향)

  • Gao, En-Feng;Chung, Hun-Jong;Ahn, Kang-Min;Kim, Soung-Min;Kim, Yun-Hee;Jahng, Jeong-Won;Lee, Jong-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.5
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    • pp.375-395
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    • 2006
  • Purpose: Lingual nerve (LN) damage may be caused by either tumor resection or injury such as wisdom tooth extraction, Although autologous nerve graft is sometimes used to repair the damaged nerve, it has the disadvantage of necessity of another operation for nerve harvesting. Moreover, the results of nerve grafting is not satisfactory. The nerve growth factor (NGF) is well-known to play a critical role in peripheral nerve regeneration and its local delivery to the injured nerve has been continuously tried to enhance nerve regeneration. However, its application has limitations like repeated administration due to short half life of 30 minutes and an in vivo delivery model must allow for direct and local delivery. The aim of this study was to construct a well-functioning $rhNGF-{\beta}$ adenovirus for the ultimate development of improved method to promote peripheral nerve regeneration with enhanced and extended secretion of hNGF from the injured nerve by injecting $rhNGF-{\beta}$ gene directly into crush-injured LN in rat model. Materials and Methods: $hNGF-{\beta}$ gene was prepared from fetal brain cDNA library and cloned into E1/E3 deleted adenoviral vector which contains green fluorescence protein (GFP) gene as a reporter. After large scale production and purification of $rhNGF-{\beta}$ adenovirus, transfection efficiency and its expression at various cells (primary cultured Schwann cells, HEK293 cells, Schwann cell lines, NIH3T3 and CRH cells) were evaluated by fluorescent microscopy, RT-PCR, ELISA, immunocytochemistry. Furthermore, the function of rhNGF-beta, which was secreted from various cells infected with $rhNGF-{\beta}$ adenovirus, was evaluated using neuritogenesis of PC-12 cells. For in vivo evaluation of efficacy of $rhNGF-{\beta}$ adenovirus, the LNs of 8-week old rats were exposed and crush-injured with a small hemostat for 10 seconds. After the injury, $rhNGF-{\beta}$ adenovirus($2{\mu}l,\;1.5{\times}10^{11}pfu$) or saline was administered into the crushed site in the experimental (n=24) and the control group (n=24), respectively. Sham operation of another group of rats (n=9) was performed without administration of either saline or adenovirus. The taste recovery and the change of fungiform papilla were studied at 1, 2, 3 and 4 weeks. Each of the 6 animals was tested with different solutions (0.1M NaCl, 0.1M sucrose, 0.01M QHCl, or 0.01M HCl) by two-bottle test paradigm and the number of papilla was counted using SEM picture of tongue dorsum. LN was explored at the same interval as taste study and evaluated electro-physiologically (peak voltage and nerve conduction velocity) and histomorphometrically (axon count, myelin thickness). Results: The recombinant adenovirus vector carrying $rhNGF-{\beta}$ was constructed and confirmed by restriction endonuclease analysis and DNA sequence analysis. GFP expression was observed in 90% of $rhNGF-{\beta}$ adenovirus infected cells compared with uninfected cells. Total mRNA isolated from $rhNGF-{\beta}$ adenovirus infected cells showed strong RT-PCR band, however uninfected or LacZ recombinant adenovirus infected cells did not. NGF quantification by ELISA showed a maximal release of $18865.4{\pm}310.9pg/ml$ NGF at the 4th day and stably continued till 14 days by $rhNGF-{\beta}$ adenovirus infected Schwann cells. PC-12 cells exposed to media with $rhNGF-{\beta}$ adenovirus infected Schwann cell revealed at the same level of neurite-extension as the commercial NGF did. $rhNGF-{\beta}$ adenovirus injected experimental groups in comparison to the control group exhibited different taste preference ratio. Salty, sweet and sour taste preference ratio were significantly different after 2 weeks from the beginning of the experiment, which were similar to the sham group, but not to the control group.

Case report: Application of Implant Supported Removable Partial Denture due to Multiple Dental Implant Loss of the Fixed Implant Supported Prosthesis (다수의 임플란트발거로 임플란트 고정성 보철이 실패한 환자에서의 잔존 임플란트를 이용한 부분 가철성 국소의치 수복증례)

  • Kang, Jeong Kyung;Nam, Gi Hoon
    • Journal of the Korean Academy of Esthetic Dentistry
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    • v.23 no.1
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    • pp.34-40
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    • 2014
  • There are several treatment options for rehabilitation of partial edentulism including the use of conventional or implant-retained fixed prostheses. However, such prosthetic options cannot always be possible because of compromised general and oral health (i.e. loss of supporting tissues, medical reasons, extensive surgical protocol and osseointegration failure of dental implant) as well as the affordability of patients. In some cases, removable partial denture provides easier access for oral hygiene procedures and the ability to correct discrepancies in dental arch relationships than implant fixed prosthesis. Recently, Implant Supported Removable Partial Denture (ISRPD) where to place dental implant in strategic position has been suggested to improve the limitation and shortcomings of conventional RPD. ISPRD can overcome mechanical limition of conventional RPD by placing implant in a favorable position and can be cost-effective, prosthetic solution for partially edentulous patients who are not immediate candidates for extensive, fixed implant supported restorations. Incorporation of dental implants to improve the RPD support and retention and to enhance patient acceptance should be considered when treatment planning for RPD. In this case, 59 years old male patient who received dental treatment of implant fixed prosthesis on both side of the upper jaw and implant overdenture on lower jaw showed implant abutment screw fracture on #15i and osseointegration failure on multiple number of implants. After removing failed implants, we planned ISRPD using #15i,24i,25i,26i and #23 natural tooth for RPD abutment. We fabricated #23 surveyed crown,#24i=25i=26i surveyed bridge and #15i gold coping for support,retention and stability for RPD. Periodic follow up check for 2years has been performed since the ISRPD delivery to the patient. No sign of screw loosening, fracture or bone resorption around abutment implants were detected.

The fracture resistance of heat pressed ceramics with wire reinforcement (금속선 강화에 따른 열 가압 도재의 파절저항)

  • Jo, Deuk-Won;Dong, Jin-Keun;Oh, Sang-Chun;Kim, Yu-Lee
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.191-198
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    • 2009
  • Statement of problem: Ceramics have been important materials for the restoration of teeth. The demands of patients for tooth-colored restorations and the availability of various dental ceramics has driven the increased use of new types of dental ceramic materials. Improved physical properties of theses materials have expanded its use even in posterior crowns and fixed partial dentures. However, ceramic still has limitation such as low loading capability. This is critical for long-span bridge, because bridge is more subject to tensile force. Purpose: The wire reinforced ceramic was designed to increase the fracture resistance of ceramic restoration. The purpose of this study was to evaluate the fracture resistance of wire reinforced ceramic. Material and methods: Heat pressed ceramic(ingot No.200 : IPS Empress 2, Ivoclar Vivadent, Liechtenstein) and Ni-Cr wire(Alfa Aesar, Johnson Matthey Company, USA) of 0.41 mm diameter were used in this study. Five groups of twelve uniform sized ceramic specimens(width 4 mm, thickness 2 mm, length 15 mm) were fabricated. Each group had different wire arrangement. Wireless ceramic was used as control group. The experimental groups were divided according to wire number and position. One, two and three strands of wires were positioned on the longitudinal axis of specimen. In another experimental group, three strands of wires positioned on the longitudinal axis and five strands of wires positioned on the transverse axis. Three-point bending test was done with universal testing machine(Z020, Zwick, Germany) to compare the flexural modulus, flexural strength, strain at fracture and fracture toughness of each group. Fractured ceramic specimens were cross-sectioned with caborundum disc and grinded with sandpaper to observe interface between ceramic and Ni-Cr wire. The interface between ceramic and Ni-Cr wire was analyzed with scanning electron microscope(JSM-6360, JEOL, Japan) under platinum coating. Results: The results obtained were as follows: 1. The average and standard deviation in flexural modulus, flexural strength and fracture toughness showed no statistical differences between control and experimental groups. However, strain was significantly increased in wire inserted ceramics(P<.001). 2. Control group showed wedge fracture aspects across specimen, while experimental groups showed cracks across specimen. 3. Scanning electron microscopic image of cross-sectioned and longitudinally-sectioned specimens showed no gap at the interface between ceramic and Ni-Cr wire. Conclusion: The results of this study showed that wire inserted ceramics have a high strain characteristic. However, wire inserted ceramics was not enough to use at posterior area of mouth in relation to flexural modulus and flexural strength. Therefore, we need further studies.

MICROTENSILE BOND STRENGTH OF ALL-IN-ONE ADHESIVE TO CARIES-AFFECTED DENTIN (우식이환 상아질에 대한 all-in-one adhesive의 미세인장결합강도)

  • Moon, Ji-Deok;Park, Jeong-Kil;Hur, Bock;Kim, Hyeon-Cheol
    • Restorative Dentistry and Endodontics
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    • v.30 no.1
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    • pp.49-57
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    • 2005
  • The purpose of this study was to evaluate the effect of multiple application of all-in-one dentin adhesive system on microtensile bond strength to caries-affected dentin. Twenty one extracted human molars with occlusal caries extending into mid-dentin were prepared by grinding the occlusal surface flat. The carious lesions were excavated with the aid of caries detector dye. The following adhesives were applied to caries-affected dentin according to manufacturer's directions; $Scotchbond^{TM}$ Multi-Purpose in SM group, Adper Prompt $L-Pop^{TM}$ 1 coat in LP1 group, 2 coats in LP2 group, 3 coats in LP3 group, $Xeno^{(R)}$ III 1 coat in XN1 group, 2 coats in XN2 group. and 3 coats in XN3 group. After application of the adhesives, a cylinder of resin-based composite was built up on the occlusal surface. Each tooth was sectioned vertically to obtain the $1{\times}1\;mm^2$ sticks. The microtensile bond strength was determined. Each specimen was observed under SEM to examine the failure mode. Data were analyzed with one-way ANOVA. The results of this study were as follows; 1. The microtensile bond strength values were; SM ($14.38{\pm}2.01$ MPa), LP1 ($9.15{\pm}1.81$ MPa), LP2(14.08{\pm}1.75$ MPa), LP3 ($14.06{\pm}1.45$ MPa). XN1 (13.65{\pm}1.95$ MPa). XN2 ($13.98{\pm}1.60$) MPa, XN3 ($13.88{\pm}1.66$) MPa, LP1 was significantly lower than the other groups in bond strength (p < 0.05). All groups except LP1 were not significantly different in bond strength (p > 0.05). 2. In LP1, there were a higher number of specimens showing adhesive failure. Most specimens of all groups except LP1 showed mixed failure.

PROPOSAL OF NEW DENIAL COLOR-SPACE FOR AESTHETIC DENIAL MATERIALS (치과용 심미 수복 재료들의 색상 연구를 통한 새로운 치과용 색체계의 제안)

  • Oh, Yun-Jeong;Park, Su-Jung;Kim, Dong-Jun;Cho, Hyun-Gu;Hwang, Yun-Chan;Oh, Won-Mann;Hwang, In-Nam
    • Restorative Dentistry and Endodontics
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    • v.32 no.1
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    • pp.19-27
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    • 2007
  • The purpose of this study is to develope new dental color-space system. Twelve kinds of dental composites and one kind of dental porcelain were used in this study. Disk samples (15 mm in diameter, 4 mm in thickness) of used materials were made and sample's CIE $L^*a^*b^*$ value was measured by Spectrocolorimeter (MiniScan XE plus, Model 4000S, diffuse/$8^{\circ}$ viewing mode, 14.3 mm Port diameters, Hunter Lab USA) The range of measured color distribution was analyzed. All the data were applied in the form of T### which is expression unit in CNU Cons Dental Color Chart. The value of $L^*$ lies between 80.40 and 52.70. The value of $a^*$ are between 10.60 and 3.60 and $b^*$ are between 28.40 and 2.21. The average value of $L^*$ is 67.40, and median value is 67.30. The value of $a^*$ are 2.89 and 2.91 respectively. And for the $b^*$, 14.30 and 13.90 were obtained. The data were converted to T### that is the unit count system in CNU-Cons Dental Color Chart. The value of $L^*$ is converted in the first digit of the numbering system. Each unit is 2.0 measured values. The second digit is the value of $a^*$ and is converted new number by 1.0 measured value. For the third digit $b^*$ is replaced and it is 2.0 measured unit apart. T555 was set to the value of $L^*$ ranging from 66.0 to 68.0, value of $a^*$ ranging from 3 to 4 and $b^*$ value ranging from 14 to 16.

A Study on the Stress Distribution of Tooth/Implant Connected with Konus Telescope Denture Using 3-Dimensional Finite Element Method (이중관으로 연결된 자연치와 임플랜트의 악골 내응력분포에 관한 3차원 유한요소분석)

  • Lee, Su-Ok;Choi, Dae-Gyun;Kwon, Kung-Rock;Woo, Yi-Hyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.4
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    • pp.381-395
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    • 2008
  • Purpoose: For decades dental implants have been used widely in the field of prosthetic dentistry. However there is confusion when establishing treatment plans in cases where some teeth are remained but an insufficient number of implants can be used due to limited anatomical status and ecomomical problems. Many clinicians have tried to connect natural teeth and implants, and it still has controversy. But, there have been few studies on mechanical analysis of connecting natural teeth and implants with konus telescopic removable partial dentures. The purpose of this study was to analyze the stress distribution of prosthesis, abutment and alveolar bone when teeth and implants were connected with the konus telescopic denture, by means of 3-dimensional finite element analysis. Material and methods: The assumption of this study was that there were 2 mandibular canine (11 mm in length, 4 mm in diameter) and 2 implants(10 mm in length, 4 mm in diameter) which are located in the second premolar region. The mandible, teeth, implants, abutments, and connectors are modeled, and analyzed with the commercial software, ANSYS Version 8.1(Swanson, Inc., USA). The control group used implants instead of natural teeth. 21038 elements, 23544 nodes were used in experimental group and 107595 elements, 21963 nodes were used in control group, Stress distribution was evaluated under 150 N vertical load on 3 experimental conditions - between teeth and implants (Load case 1), posterior to implants (Load case 2), between natural teeth (Load case 3). Results: 1. In all load cases, higher von mises stress value was observed in the experimental group. 2. Maximum von miss stress observed in all load cases and all locations were as follows ; a. 929.44 Mpa in the experimental group, 640.044 Mpa in the control group in outer crown and connector - The experimental group showed 1.45 times high value compared with the control group. b. 145,051 Mpa in the experimental group, 142.338 Mpa in the control group in abutment - The experimental group showed 1.02times high value compared with the control group. c. 32.489 Mpa in the experimental group, 25.765 Mpa in the control group in alveolar bone - The experimental group showed 1.26times higher value compared with the control group. 3. All maximum von mises stress was observed in load case 2, and maxim von mises stress in alveolar bone was 32.489 Mpa at which implant failure cannot occur. 4. If maximum von mises stress is compared between two groups, the value of the experimental group is 1.02 times higher than the control group in abutment, 1.26 times higher than the control group in alveolar bone. Conclusion: If natural teeth and implants are connected with the konus telescopic denture, maximum stress will be similar in abutment, 1.26 times higher in alveolar bone than the control group. With this result, there may be possible to make to avoid konus telescopic dentures where natural teeth and implants exist together.

The Jurisdictional Precedent Analysis of Medical Dispute in Dental Field (치과임상영역에서 발생된 의료분쟁의 판례분석)

  • Kwon, Byung-Ki;Ahn, Hyoung-Joon;Kang, Jin-Kyu;Kim, Chong-Youl;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
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    • v.31 no.4
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    • pp.283-296
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    • 2006
  • Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.

A Study on the Function of Oral Medicine as the Secondary Clinic Based on Analysis on Admissive Channel and Case Features (내원경위 분석과 환자 특성 평가에 따른 2차 진료기관으로서 구강내과 역할에 대한 연구)

  • Lee, You-Mee;Lee, Jung-Hyun;Lim, Hyun-Dae
    • Journal of Oral Medicine and Pain
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    • v.31 no.3
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    • pp.199-210
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    • 2006
  • The epidemiological researches on the inpatients hospitalized at the oral medicine ward have been continuously carried out since 1970, and most researches have been performed by centering around the oral medicine wards of college hospitals. Numerous specialists have been produced after the establishment of oral medicine, and they have been active in various fields. As dental clinics have gotten bigger, the function of oral medicine in the secondary clinics is being brought out. As admissive channel, case features, case composition and otherwise have not been researched for a long time, the related researches should be carried out from now on. Hereupon, this study was carried out by targeting the 100 inpatients hospitalized at the oral medicine ward of Sun Hospital located in Daejeon Korea, through questionnaire. As the result, the following results were derived. 1. The ages of the inpatients in Sun Hospital were $29.21{\pm}11.31$ on the average; 71 females' mean average was $29.63{\pm}11.29$ and 29 males' mean average was $28.17{\pm}11.48$. In regard of school career, the patients who finished high-school course or higher accounted for 78%; the patients' school career seemed to be relatively high. The patients who complained of temporomandibular pain accounted for the highest proportion with 65%. In motivation to visit this hospital, internet surfing was 11%, mass media was 10%, acquaintance's introduction was 38%. The patients, who were hospitalized at another hospital due to the same symptom, accounted for 56%. The dental clinics, which made the patients visit this hospital, accounted for 20%. The patients, who were previously aware that the present symptom should be treated by oral medicine, accounted for 38%. The patients, who were not aware of the fact in advance, were 62%. The respondents of 51% answered that they were aware of the fact one month or below before hospitalization. 2. The patients, who complained of craniocervical ache, accounted for 58%; the patients, whose ache aches affect dailylife, were 22%. Continuous ache was 14% and intermittent ache was 68%, and dull pain was 23%. 3. Life variations were compared with each other by using SRRS (Social Readjustment Rating Scale). In consequence, the variation within 3 years indicated a significant difference in the both groups but the variation within 6 months did not indicate any differences. 4. In regard of the questionnaire on the incidents happened for a week, the ache-group was compared with the group free from the ache. As the result, the number of strain arisen for a week, the decrease of favorite works and sudden fear indicated a significant difference. Pleasant feeling and the decrease of interests in looks did not indicate a significant difference, but came close to the significance. 5. In the questionnaire on impatience, the ache-group indicated higher value but there was not a significant difference. 6. In the questionnaire on the symptoms caused by stress, the two groups indicated significant differences in the item of 'the teethridge itches and feels a tooth rising' and 'the occiput or the nape is stiff.' In the item 'the inside of the cheek or the teethridge are widely peeled off, accompanied with ache and hemorrhage', 'the face has acne or pimple' and 'headache frequently attacks', a significant difference was not observed but the two groups came close to the significance.