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Biomedical subjects

L Abraham-Inpijn

Publications and source records attributed to L Abraham-Inpijn.

At least 19 recordsLinked to original sources
PubMed1996

Cardiovascular responses induced by dental treatment.

Changes in mean heart rate and mean systolic and diastolic blood pressure are induced in both the patient's anticipation of scheduled treatment and the actual dental treatment itself. Significant changes have been observed before application of a local anesthetic, during restorative treatment, during extractions, and when epinephrine-impregnated retraction cords were used. These cardiovascular responses may vary according to the local anesthetic used and the choice of vasoconstrictor. The individual changes in heart rate and blood pressure are affected by pain and such individual factors as age, gender, hypertension, dental experience, and psychological responses. Although for the most part the cardiovascular changes induced by dental treatment are limited and within the normal physiological variation, this review stresses the importance of eliminating pain and minimizing patient anxiety.

Age Factors↗
PubMed1996

Type-1 and type-2 CD8+ T-cell subsets isolated from chronic adult periodontitis tissue differ in surface phenotype and biological functions.

Cloning of CD8+ T cells expressing the alpha beta T-cell receptor from inflamed human gingiva revealed that at least two different subsets were found within the tissue and that these subsets were able to interact with each other. One subset produced high levels of interferon-gamma (IFN-gamma) and no interleukin-4 (IL-4) or IL-5, exhibited phytohaemagglutinin (PHA)- or anti-CD3-mediated cytolytic activity, and were CD28+. The other subset produced high levels of IL-4 in combination with IL-5, displayed no cytotoxicity and were CD28-. From the latter subset CD8+ T-cell clones were able to suppress the proliferative response of cytotoxic CD8+ T-cell clones. This suppression could be abolished by anti-IL-4 monoclonal antibodies. However, IL-4 alone was not able to induce the suppression. Our results indicate that CD8+ T cells might participate in local immune responses by the suppression of IFN-gamma-producing cells and by favouring humoral responses via the production of IL-4 and IL-5.

Adult↗
PubMed1995

Cloning, characterization, and antigen specificity of T-lymphocyte subsets extracted from gingival tissue of chronic adult periodontitis patients.

Chronic periodontitis is characterized by dense infiltrations of B and T lymphocytes within the gingival connective tissue. Distinct anaerobic gram-negative bacteria as well as autoimmunity to collagen have been reported to play a role in the etiology and the pathogenesis of this disease. Here we describe the cloning and characterization of CD4+ and CD8+ T lymphocytes isolated from inflamed gingival tissue obtained from four patients with chronic periodontitis. Clones were raised with phytohemagglutinin and interleukin-2 and tested for proliferation in response to whole-cell antigens of Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, human collagen type I, and two bacterial heat shock proteins. CD4+ T-cell clones reactive with collagen type I were obtained from all four patients. Eighty percent of these clones had phenotypes resembling the mouse type 2 T helper (Th) phenotype, i.e., they produced high levels of interleukin-4 and low levels of gamma interferon. No collagen-type-I-reactive CD8+ clones were obtained. Bacterial-antigen-reactive CD4+ and/or CD8+ T-cell clones were also obtained from each patient, and the majority of the clones showed a Th0-like cytokine pattern and produced equal amounts of interleukin-4 and gamma interferon. Although most clones were reactive with P. intermedia, it seems that the immune response is not strictly directed against this particular microorganism, as clones reactive with one of the other bacteria were also obtained from two patients. We propose that collagen-specific CD4+ Th2-like T cells contribute to the chronicity of periodontitis but that their modes of activation might be controlled by Th0-like T cells specific for periodontitis-associated bacteria.

Adult↗
PubMed1995

Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment.

Patients demonstrate a physiological stress response during dental checkups and treatment. Local anesthesia and tooth extraction activate the adrenal cortex to produce cortisol. Changes in adrenaline or noradrenaline concentrations have been reported in plasma and urine after drilling and filling or extraction, and anticipation of a dental checkup increases blood pressure. Both diastolic and systolic blood pressure rise still further during restorative treatment without local anaesthesia and during extraction. In a study by the same authors, no significant changes in blood pressure were observed during restorative treatment with local anaesthesia, which suggests that the pain experienced by the patient contributes to the rise in blood pressure. Dentists must be aware that this increased blood pressure may induce cardiovascular complications during dental therapy.

Blood Pressure↗
PubMed1995

[The medical history through a list of medical risks. Practical use in dental medicine].

A medical risk related patient-administered history (MRRH) was developed for use in routine dental treatment with or without local anesthesia by the general dental practitioner. The fixed guidelines of the ASA classification may be under discussion. Of course, there are other divisions and combinations conceivable and deviation of the standards may be inevitable. However, the present proposal is to be used for investigation purposes, which makes fixed guide-lines imperative. This MRRH, tested in Belgium, proved to be valid in comparison with the "gold standard", a verbal history taken by a physician experienced in pre-assessment control. The most reliable results can be obtained by a combination of the medical questionnaire and the additional verbal history.

Coronary Disease↗
PubMed1995

Ambulant 24-hour blood pressure and heart rate of dentists.

PURPOSE: To investigate blood pressure fluctuations in dentists during their daily activities, including dental procedures, in comparison with a non-dentist population. MATERIALS AND METHODS: A pilot study on blood pressure and heart rate fluctuations was performed which involved 26 dentists working at a university clinic. A 24-hour blood pressure registration was obtained using the Oxford Monitoring System. RESULTS: In the dentist group, both blood pressure and heart rate were found to be significantly higher during work than during leisure activities. In the control group, no significant difference in blood pressure was recorded between these periods. This study also showed the feasibility of ambulant 24-hour blood pressure registration on dentists during daily activity. Our results ethically justify a more intensive cardiovascular study involving a larger number of dentists working in private practice in order to establish whether our results are valid for the dental practitioner in general.

Blood Pressure↗
PubMed1995

Anxiety and heart rate correlation prior to dental checkup.

The aim of this study was to investigate the possible relationship between dental anxiety and heart rate prior to a dental checkup. Anxiety was determined in 44 patients using the Dental Anxiety Scale (DAS). Heart rate was measured 24 hours before, and immediately prior to, a dental checkup. The mean heart rate was higher immediately prior to the checkup than it had been 24 hours previously. The DAS score showed no relation to the heart rate immediately prior to the dental checkup, but showed a significant relation to the heart rate of women 24 hours before the checkup. In men, this relation did not reach significance. It is concluded that anticipation of a dental checkup increases heart rate. The average increase in heart rate is higher in patients with a low DAS score.

Adult↗
PubMed1995

[Importance of proper implementation of the case history in the prevention of stomatological diseases].

In connection with ageing of population and an increasing number of older patients visiting the dental practice with multiple diseases, special prevention of possible medical complication during dental treatment is necessary. The advances in dentistry increase the chance of these complications. There is however no consensus about history taking in dental practice. For getting the maximum amount of information about the patient's health a Risk-Related Medical History (RRMH) patient-administered is proposed, that is checked by the dentist. The RRMH was composed in accordance with the modified ASA physical risk score. It allows to dyfine general patient's physical condition and to advise measures for prophylaxis of medical complication. The medical questionnaire showed a high sensitivity and specificity. In a study among 5000 patients the results of this history was analysed. The RRMH is simple and comfortable, it allows to obtain relible medical information in short time both for the dentist and for the patient.

Humans↗
PubMed1994

Salivary flow rate and acute-phase proteins in Bell's palsy.

The flow rate of extra-parotid and parotid saliva was compared in patients with Bell's palsy and in healthy volunteers. Samples were analysed for the concentration of total protein and seven acute-phase proteins. There was no difference between younger and older patients with regard to oral status, salivary flow rate, total protein or acute-phase proteins, in either extra-parotid or parotid saliva. No significant difference in flow rate for both extra-parotid and parotid saliva was found in the Bell's palsy patients in comparison with the controls. In the patients the salivary flow rate from the parotid gland on the paralysed side was slightly lower than on the healthy side, but not to a significant extent. The quantity of total protein was lower in the extra-parotid saliva in the patient group; there were no differences between the two groups with regard to parotid saliva. We were able to demonstrate small amounts of various acute-phase proteins in the control group. In the patients we found higher quantities per minute of acute-phase proteins in both extra-parotid saliva and parotid saliva than in the controls. In extra-parotid saliva there were significant differences in haptoglobulin, alpha 2-macroglobulin, C3-complement factor and ceruloplasmin; in parotid saliva the differences in haptoglobulin and ceruloplasmin were significant. However, there was a large inter individual variation in both groups studied. In the patient group no significant difference in the secretion of acute-phase proteins from the parotid gland could be demonstrated between the paralysed side and the healthy side.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute-Phase Proteins↗
PubMed1994

Experimental gingivitis during pregnancy and post-partum: clinical, endocrinological, and microbiological aspects.

The purpose of this study was to assess whether an intensive oral hygiene regimen practised during pregnancy results in a clinically healthy gingival state, and to assess whether experimentally-induced gingivitis differs in severity during pregnancy as compared to post-partum. In addition, levels of black-pigmented Gram negative anaerobes at subgingival and oral mucosal sites and plasma concentrations of free estrogens and prosterone were determined. These parameters were studied during a 14-day episode of experimental gingivitis induced in the 25th week of pregnancy, and again 6 months post-partum. The subjects were selected on shallow pockets < or = 4 mm and interproximal loss of attachment not exceeding 2 mm. As a result of controlled oral hygiene, the gingival condition improved both during pregnancy and post-partum. At day 0 during pregnancy, however, gingival swelling, redness, and bleeding on probing were found to be higher than post-partum. Free plasma levels of estrogens and progesterone were found to be normal throughout the study. It was hypothesized that the increase in severity of gingival symptoms during pregnancy reflect microvascular physiologic effects of increased levels of these hormones. During pregnancy, more swelling, redness and bleeding on probing developed during experimental gingivitis than post-partum, whereas the amount of plaque was similar in both phases. This suggests that as a result of dental plaque accumulation, gingival inflammation develops superimposed on pregnancy-associated physiologic alterations. Microbiological evaluation showed that the mean proportions of Prevotella intermedia in subgingival plaque increased during experimental gingivitis performed during pregnancy, whereas no increase of this micro-organism was found post-partum.

Adult↗
PubMed1994

A risk-related patient-administered medical questionnaire for dental practice.

This study deals with an improved medical questionnaire designed on the basis of the results of previous studies. The form consists of 27 items, each subdivided into a main question and one or more subquestions. The medical problems involved are categorised according to the risk-classification system of the American Society of Anaesthesiologists (ASA). An affirmative answer to the main question always results in ASA class II; the subquestions are designed to discriminate between ASA classes II, III and IV. For each of the 27 medical problems in the questionnaire, the implications for dental treatment are explained and an ASA risk classification proposed. The questionnaire can also be a useful tool in medical pre-assessment control.

Anemia↗
PubMed1993

Medical risk classification of dental patients in The Netherlands.

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.

Adult↗
PubMed1993

Experimental gingivitis during pregnancy and post-partum: immunohistochemical aspects.

The histoimmunological response of 8 individuals was studied longitudinally in relation to the development of experimental gingivitis during pregnancy and post-partum. At day 0 as well as at day 14 of experimental gingivitis the mean periodontal pocket bleeding index (PPBI) was higher during pregnancy than post-partum, whereas the amount of plaque that accumulated was similar. The number of CD1 positive cells (mainly Langerhans) in the oral epithelium was found to be higher during pregnancy. In the sulcular epithelium, however, the number of these cells tended to decrease during pregnancy as compared to post-partum. The number of CD4 positive cells in oral and sulcular epithelium was increased during pregnancy (P < 0.05). It was speculated that this increase in the number of CD4 positive cells is confined to the Th-1 subset, since the number of CD14 positive cells (mainly macrophages and granulocytes) together with the number of B cells was found to be decreased during pregnancy. Th-1 cells are known to be cytotoxic against these HLA class II antigen bearing cells. Consequently, cytotoxicity directed against B cells and macrophages may result in diminished immunoresponsiveness in pregnancy gingivitis.

Adult↗
PubMed1992

Blood pressure response to routine restorative dental treatment with and without local anesthesia. Continuous noninvasive blood pressure registration with a finger manometer.

A continuous noninvasive blood pressure registration with the Finapres finger manometer was carried out during routine dental treatment, with and without local anesthesia. Forty patients (21 male), 21 to 64 years of age, were studied. Blood pressure was recorded continuously from 10 minutes before dental treatment to 10 minutes after treatment was completed. No local anesthetic was used in 25 patients. In 15 patients (seven men) local anesthetic was used. All patients showed a considerable blood pressure variation. During treatment a significant mean blood pressure increase was registered in the patients treated without local anesthesia. In the patients treated with local anesthesia no significant mean blood pressure changes during dental treatment could be established. However, during the actual administration of the local anesthetic solution a transient blood pressure increase was found, followed by a decrease shortly after removal of the needle from the mouth. After treatment of both groups of patients, a mean blood pressure decrease was established.

Adult↗
PubMed1992

Detecting medical problems in dentistry: a survey of 4,087 patients in The Netherlands.

OBJECTIVES: This study was conducted to determine whether a medical history could be an effective means of detecting medical problems in dental patients. METHODS: A risk-related patient-administered medical questionnaire was completed by 4,087 patients in 47 dental practices. The data collected were summarized by means of descriptive statistics; the number of medical problems and the relationship between these problems and the age of the patient were analyzed. RESULTS: In all, 37.2% of these patients reported at least one medical problem. Hypertension, chronic bronchitis, allergies and medication were the items most frequently mentioned. The frequencies of heart disease, hypertension, endocrinologic and neurologic disorders increased with age, while allergies and chronic obstructive pulmonary disease were evenly distributed over the different age groups. The differences between the health of the patients in the various dental practices were not significant. CONCLUSIONS: On the basis of these results, it can be concluded that taking a medical history by means of a patient-administered questionnaire is an effective method of detecting medical problems of dental patients.

Adolescent↗
PubMed1992

Nursing care for oral complications associated with chemotherapy. A survey among members of the Dutch Oncology Nursing Society.

The incidence of oral complications among adult cancer patients undergoing chemotherapy varies from 12% to 80%. Adequate oral hygiene has been shown to be important in prevention, and an essential role is reserved for the nursing staff. These considerations prompted the decision to survey, by means of a questionnaire, the nurses who give care to cancer patients. The questions were concerned with multidisciplinary treatment, inspection methods, nursing interventions, and nursing education. Data emerged regarding a shortage of dentists and dental hygienists, and knowledge of oral inspection and the appropriate interventions by nurses are insufficient. Extra attention to oral hygiene during training is warranted.

Antineoplastic Agents↗
PubMed1991

Validity of a risk-related patient-administered medical questionnaire for dental patients.

In this study the validity of a patient-administered risk-related medical questionnaire for dental patients was tested. The answers given on the questionnaire were compared with the results of a verbal history taken by a physician. This verbal history was considered the "gold standard." The sensitivity and specificity of the medical questionnaire appeared to be sufficiently high, and the kappa values of the separate questions were satisfactory. The questionnaire was found to be valid in the registration of medical problems in dental patients, but combination of the two methods is recommended.

Adult↗