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Biomedical subjects

M S Duggal

Publications and source records attributed to M S Duggal.

At least 19 recordsLinked to original sources
PubMed2006

The effect of copper on demineralization of dental enamel.

Previous studies have concluded that copper might inhibit enamel demineralization in vitro. Our aim was to assess the effect of copper (Cu2+), with and without amine fluoride, on human dental enamel under cariogenic challenge in situ. In a double-blind randomized four-leg crossover trial, 14 individuals wore a removable appliance containing 2 enamel slabs, 1 containing an artificial caries lesion. During each leg, the appliance was exposed twice daily to one of the test solutions: 1.25 mM CuSO4, amine fluoride (250 ppm F), copper and amine fluoride combined, or a placebo (water). A cariogenic challenge was provided in all cases by 5 daily exposures to 10% sucrose. Slabs were assessed before and after 21 days' exposure by Knoop microhardness and transverse microradiography. Significantly less demineralization was observed with Cu2+ and fluoride in combination than with fluoride treatment alone (p < 0.05), whereas copper alone had no significant protective effect.

Adult↗
PubMed2005

Soft drinks and dental health: a review of the current literature.

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

Age Factors↗
PubMed2005

Potential toxicity.

Explore the source record for details and available documents.

Aluminum Compounds↗
PubMed2005

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors.

OBJECTIVE: The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. DESIGN: A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. METHODS: The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. CONCLUSION: Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.

Adult↗
PubMed2005

Asthma inhalers and subsurface enamel demineralisation: an in situ pilot study.

AIM: The purpose of this pilot study was to identify the subsurface enamel demineralising potential of two possible acidogenic lactose-based powders and their corresponding generic pump inhalers. METHODS: Ten healthy non-asthmatic adults participated in a 5- leg randomised crossover study including a 10% sucrose control. A twice-daily 400 microg dose of inhaler was applied in vitro to a demineralised enamel slab on the buccal flange of a mandibular removable appliance before in situ placement for 14 days each. Lesion parameters were determined using transverse microradiography and digitised image analysis. RESULTS: Minimal demineralisation occurred with sucrose, both pump and one powder inhaler. The remaining powder was associated with remineralisation (p = 0.29). Overall, mean lesion depth increased (p = 0.12). CONCLUSION: Asthma inhalers failed to demonstrate a significant acidogenic/cariogenic effect.

Administration, Inhalation↗
PubMed2004

An evaluation of the acidogenic potential of asthma inhalers.

AIM: The aims of the present study were firstly to investigate the inherent pH and titratable acidity of commercially available paediatric asthma inhalers in the United Kingdom and secondly to assess their in vivo acidogenic potential (saliva pH and plaque pH (PpH) tests) in a group of healthy adult volunteers. MATERIALS AND METHODS: Manually actuated metered dose inhaler (MDI) and dry powder inhaler (DPI) formulations of all available preventor (glucocorticoids, disodium chromoglycate), reliever (beta(2) agonists) and combination asthma medication were investigated. The inherent pH and titratable acidity of 18 inhalers were determined and analysed using t-tests, ANOVA and post hoc Tukey's tests. Following this the oral pH responses after inhaler use were assessed in 14 healthy adult volunteers (complying with the FNDH criteria, 1985) who participated in a random blind study to determine both the salivary pH (SpH) and plaque pH following inhaler use. Non-parametric tests of significance (Mann-Whitney and Wilcoxon Signed-Ranked Tests) were used to analyse pH responses according to vehicle of delivery (MDI/DPI), lactose content and generic drug. RESULTS: The inherent pH of the DPIs (n=8, mean pH=5.06) was significantly lower (P<0.005) than that of the MDIs (n=10, mean pH=6.45) and the titratable acidity of the lactose-based DPIs was twice that of the non-lactose-based DPIs (P<0.000). Lactose-based DPIs produced significantly lower salivary pH and plaque pH readings, greater maximum pH drops from baseline pH and larger areas below baseline pH in comparison with that of all other inhalers tested (P<0.05). All inhalers, however, failed to depress plaque pH below pH 6. CONCLUSIONS: Although none of the inhalers were able to demonstrate an acidogenic response below the "critical" pH, the substantial pH drops observed with the lactose-based DPIs may be an important consideration for enamel demineralisation.

Adrenergic beta-Agonists↗
PubMed2004

Experts' opinions on the role of diet in caries prevention.

A questionnaire was sent to 54 experts in preventive dentistry in 23 European countries in order to make an inventory of existing national dietary guidelines for the prevention of dental caries. In addition, the experts were asked to give their personal opinion on several issues concerning the relationship between diet and dental caries. Forty-five experts from 20 countries returned the questionnaire. In 13 European countries dietary guidelines for caries prevention were available issued by a National (Dental) Association or a Government Body. All guidelines emphasised a reduction of the frequency of intakes of cariogenic foods. Two of them included a threshold level for the amount of sugar. When asked for their personal opinions, almost all experts mentioned reduction of frequency of 'cariogenic' intakes as the principal dietary messages for caries prevention. Four experts, however, explicitly mentioned that proper oral hygiene with fluoride toothpaste is more important. There was no agreement among the experts about a daily number of cariogenic intakes in between meals that can be regarded as safe, nor whether the message: 'Use products with sugar substitutes' should be part of the dietary guidelines for the prevention of dental caries. There was no agreement amongst experts on preventive dentistry in Europe on the contemporary validity of the paradigm: 'Sucrose is the arch criminal of dental caries.' Taking the variation in opinions into account and the fact that a balanced diet may lead to a moderate eating and snacking frequency, the authors propose that the emphasis on good versus bad foods for caries prevention should be replaced by an emphasis on good versus bad diets.

Dental Caries↗
PubMed2003

A study investigating the formation of artificial sub-surface enamel caries-like lesions in deciduous and permanent teeth in the presence and absence of fluoride.

OBJECTIVES: Clinical and in situ studies have shown that caries formation and progression is faster in primary than in permanent teeth. Ambient levels of fluoride are also known to influence the processes of carious lesion formation. The aims were, firstly to investigate the incidence of artificial sub-surface caries lesion formation in the enamel of deciduous and permanent teeth in vitro. Secondly, to compare quantitatively the mineral content and distribution of these lesions and assess the possible influence of fluoride upon the lesion parameters. METHODS: Twenty primary molars and 20 permanent premolars were randomly assigned to one of four experimental groups. Samples in each experimental group were immersed in a 0.05M lactic acid gel (6% w/v hydroxyethyl cellulose, pH 4.5) either in the absence or presence of fluoride for 7 days. Subsequently, lesion parameters of mineral loss (vol x % microm) and lesion depth (microm) were assessed by transverse microradiography and image analysis. RESULTS: No significant differences existed between the lesion parameters of permanent and primary teeth (P=0.20). Irrespective of tooth type, lesion parameters were significantly reduced in samples demineralised in the presence of fluoride (P< or =0.002). CONCLUSIONS: Fluoride significantly reduces the severity of sub-surface caries lesions formed in vitro and in contrary to previous studies, there were no significant differences in lesions parameters between permanent and primary teeth.

Cariogenic Agents↗
PubMed2003

Root surface areas in long-term survivors of childhood cancer.

Treatment regimes for childhood cancer are known to affect the root development in the long-term survivors (LTS) but the available the data is subjective in nature with very few quantitative data in the literature. This study aimed to quantify the root surface area (RSA) of mandibular teeth in LTS compared with controls and relate this to the treatment regime and also to the age at which the cancer was diagnosed. Panoramic radiographs were obtained from 69 LTS and an equal number of appropriately matched healthy controls. RSA were calculated using Computer Linked Image Analysis. RSA in the LTS were found to be significantly smaller as compared with controls. Also, RSA were the least in those LTS who had Total Body Irradiation followed by Bone Marrow Transplantation (TBI/BMT) compared with other treatment regimes, the difference being statistically significant for all teeth studied. There was no relationship between the RSA and the age at which the cancer was diagnosed. Smaller root areas have implications for the oral health of LTS, as bone loss around such teeth will compromise further their periodontal support thus jeopardising the long-term survival of the tooth.

Adolescent↗
PubMed2003

Paediatric dentistry in the new millennium: I. Quality care for children.

This is the first in a series of articles on paediatric dentistry in the new millennium. The aim of the series is to present a structured approach to the management of children and the common dental problems that are encountered in paediatric patients. Starting with the philosophy of 'quality care', as presented in this article, the series is intended to update readers on modern approaches to both pharmacological and non-pharmacological behaviour management, restorative techniques and the management of common developmental defects that present in both primary and young permanent teeth. Finally, preventive approaches that are easy to administer in a general dental practice will be discussed.

Behavior Therapy↗
PubMed2003

Paediatric dentistry in the new millennium: 4. Cost-effective restorative techniques for primary molars.

In the fourth article in this series the techniques for carrying out pulp therapy and stainless steel restoration in primary molars are discussed. Early pulp involvement in primary molars means that pulp therapy and the use of appropriate coronal restoration, such as stainless steel crowns, are indispensable if repetitive restoration of primary molars is to be avoided. These techniques themselves are not difficult to carry out once the child's co-operation is established and should be well within the capability of any dentist with an interest in the dental care of children.

Cementation↗
PubMed2003

A comparison of different kinds of European chocolates on human plaque pH.

AIM: To investigate the acidogenic response of plaque with various European chocolates of varying cocoa contents. METHODS: 14 subjects participated in the study. On each test day plaque pH measurements were taken at baseline and at 2, 5, 10, 15, 20 and 30 minutes after challenge with the test chocolates or control foods. A plaque sample was removed from the buccal surfaces of posterior teeth representing all quadrants, within 30 seconds. The plaque pH was measured on an ISFET electrode connected to a Sentron 2001 pH system. The test chocolates were: Diet chocolate (DC), Plain European chocolate (PEC 70% cocoa), Plain English chocolate (PenC 34% cocoa), Milk English chocolate (MenC 20% cocoa), Milk European chocolate (MEC 30% cocoa), White chocolate (WC no cocoa), Milk chocolate with hazelnuts (MHC 20% cocoa). 15 g of each chocolate was consumed by the volunteers and 10 ml of 10% sucrose and sorbitol solutions were included as controls. RESULTS: The data were analysed for: minimum pH, area below baseline, area below "critical pH", time spent below "critical pH" and Acidogenic Potential Index (API). DC was found to be significantly different to sucrose and all the other test chocolates, and similar to sorbitol for all the parameters studied. The area below baseline plaque pH was also significantly smaller for PEC (p<0.006) and MHC (p<0.028) as compared with sucrose. The mean area below the "critical pH" (5.7) for PEC and MHC was lower at 0.20-/+0.34 and 0.60-/+1.40 respectively, compared with sucrose at 1.38-/+1.03, but not statistically significant. The API of DC, PEC, PEnC, MEnC, MEC, WC and MHC was 0.03, 0.41, 0.66, 0.93, 0.94, 0.88 and 0.45 respectively compared with an API of 1.00 of sucrose. CONCLUSION: Diet chocolate was found to have no acidogenic effect on dental plaque. Also, the PEC and MHC had a lower acidogenic potential compared with sucrose.

Adolescent↗
PubMed2002

Clinical performance of a compomer and amalgam for the interproximal restoration of primary molars: a 24-month evaluation.

OBJECTIVES: To evaluate the clinical performance of a compomer material (Dyract) in comparison with dental amalgam (Contour) for management of proximal caries in primary molars in young children. SETTING: General dental practice, and a dental hospital paediatric clinic. METHOD: This was a prospective study. A split mouth design was used with identical pairs of minimal Class II cavities, of matched tooth type in the same dental arch, usually diagnosed with the use of bitewing radiographs. Seventy-eight pairs of restorations were completed of which 60 pairs were available for evaluation after 24 months. RESULTS: Comparable retention rates were observed for both Dyract and amalgam. The retention rates were high for both materials, with only four amalgam and two Dyract restorations failing over 24 months. Significantly better marginal integrity (P < 0.05) was observed for Dyract compared with amalgam with no significant differences between the two materials for recurrent caries, wear or surface texture. CONCLUSIONS: Dyract seemed to be a suitable alternative to amalgam for proximal restorations in primary molars of young children for use in general dental practice.

Child↗
PubMed2002

Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future.

AIM: The purpose of this paper is to consider evidence for the early involvement of the pulp in primary molars following a proximal caries attack and to consider the evolution of ferric sulphate as the possible alternative to formocresol for pulp therapy in primary molars. Concerns have been expressed over the wisdom of using products containing formaldehyde in children and alternatives should be considered, even though there is no substantive data to support the claims of formocresol toxicity. Pulp therapy is still often required in the management of large proximal caries in primary molars. General dental practitioners often comment on the futility of restoring primary teeth with the common perception being that restorations more often than not fail in the primary teeth. One common cause is abscess formation following proximal restorations. The main reason why this occurs is that proximal restorations in primary teeth are often carried out without consideration being paid to the state of the pulp. We have shown in a series of studies in Leeds that pulp inflammation in primary molars precedes its exposure. Most primary molars where caries had involved more than half inter-cuspal distance manifested pulp inflammation involving the entire pulp horn, but rarely the root canal tissue. This would mean that in most primary teeth with proximal caries, which are indicated for a pulpotomy, the removal of the coronal pulp alone would render them free of inflammation. This would then bring into question the use of formocresol on an otherwise uninflammed radicular tissue, which has a viable blood supply. CONCLUSION: Pulp inflammation in primary molars sets in at an early stage of a proximal carious attack. Also, in most cases, a medicament that would achieve haemostasis, such as ferric sulphate, rather than achieve fixation of the tissues is all that would be required for the preservation of the primary tooth until exfoliation.

Journal Article↗
PubMed2001

An evaluation of the acidogenic potential of maltodextrins in vivo.

Maltodextrins are a group of oligosaccharides, which are being increasingly used as a source of carbohydrate in many commercially available foods and drinks. This study investigated the effect of three different maltodextrins on the pH of dental plaque, in vivo, in 10 adult volunteers using the plaque harvesting method. The three maltodextrins tested in this study were DE=5.5, 14.0 and 18.5 (DE=dextrose equivalents), made up as 10% solutions. Also, three commercially available maltodextrin containing children's drinks were evaluated for their acidogenicity. 10% sucrose and 10% sorbitol solutions were used as positive and negative controls, respectively. The minimum pH achieved for DE=5.5, 14.0 and 18.5 was 5.83+/-0.30, 5.67+/-0.24 and 5.71+/-0.29, respectively, and were significantly higher as compared with that for 10% sucrose (5.33+/-0.17). The area under the curve was the least for DE=5.5 (12.03+/-4.64), followed by DE=18.5 (13.13+/-8.87) and DE=14.0 (17.35+/-6.43), but were all significantly smaller as compared with 10% sucrose (24.50+/-8.64). The minimum pH achieved for the infant drinks was 6.01+/-0.24, 5.99+/-0.28 and 5.8+/-0.19 for the Lemon Barley and Camomile Herbal baby drink, Mixed Citrus and Hibiscus baby drink, and Infant Milk, respectively. It was concluded that though maltodextrins appeared to be significantly less acidogenic than 10% sucrose, they can lead to a substantial drop in plaque pH and may, therefore, have a potential to cause demineralisation of enamel.

Adolescent↗
PubMed2001

The role of diet in caries prevention.

Over the last three decades the condition of the teeth of children has improved tremendously. This has generally been attributed to the increased use of fluoride toothpaste. During this period the total amount of sugars disappearing into the population per capita has hardly changed. This suggests that the relationship between diet and caries has to be reassessed, which provokes different opinions among dental experts. Some suggest a maximum threshold level for the daily amount of sugars to prevent caries. Others propose that in general the amount of sugars eaten is not an important determinant of caries experience. The scientific evidence for the various opinions on the role of diet in caries development will be discussed. It is concluded that the role of diet is not so much related to the diet itself but to the individual behaviour of people. Where oral hygiene and fluoride supplementation are adequate, the diet has become a lesser factor in caries prevention. However, those diets may cause caries when there is too little fluoride. It is a mistake to classify a diet as cariogenic it may be potentially cariogenic. When one wants to decrease this potency, one should modify those factors that are actually controlling it, which is, in most cases, the topical presence of fluoride and not the composition of the diet. A model is proposed to guide caries prevention. The (insufficient) use of fluoride, (insufficient) oral hygiene and (insufficient) clearance by saliva form a window of risk. The total burden of cariogenic food that can be seen through the window constitutes the actual caries risk.

Child↗
PubMed2001

Dental considerations for dietary counselling.

A decline in the prevalence of dental caries over three decades has occurred without a significant change in the consumption of fermentable carbohydrates, indicating that good dental health is achievable with the presence of cariogenic factors in the diet. Since, in many countries 80% of the caries is present in only 20% of the population, 'targeted intervention' would seem a better preventive option, stressing the judicious use of fluoride, plaque control, fissure sealants and a sensible diet. Dietary modification is notoriously difficult to achieve, being incumbent upon the subject's willingness to effect a change in behaviour. Many texts refer to the frequency of consumption of carbohydrates as being all-important, recommending a reduction in the frequency. However, recent evidence suggests it is the frequency of toothbrushing with a fluoride containing dentifrice which is of fundamental importance in promoting remineralisation of enamel. Dietary advice should be formulated which is both realistic and positive. Trying to dissuade children from consuming products, which they perceive to be tasty and pleasurable is counter productive and more emphasis should be given to tooth brushing using a fluoride toothpaste. Also, a fundamental shift away from the idea of 'good foods versus bad foods' is required and more emphasis laid on good diets as opposed to bad diets. Children should be able to enjoy foods traditionally considered 'bad' from a dental viewpoint, as long as they brush their teeth with a fluoride containing dentifrice and have a sensible approach to their consumption.

Bottle Feeding↗