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PubMed2003

Successful treatment with low-dose thalidomide in a patient with both Behçet's disease and complex regional pain syndrome type I: case report.

Thalidomide is a recognized treatment of Behçet's disease. Low-dose thalidomide seems to be effective in the treatment of orogenital ulcers and is potentially safer with a lower incidence of adverse effects than higher doses. We wish to report a case of Behçet's disease in a 33-year-old woman who responded well to thalidomide 50 mg 2 to 4 times per week. Her disease manifestations (severe orogenital ulceration, pseudofolliculitis, mild thrombophlebitis, positive pathergy response, and fatigue) were previously resistant to courses of prednisone, dapsone, colchicine, various types of mouthwash, and topical steroid preparations. She also gave a history of complex regional pain syndrome type I (CRPS 1) over her left patella (severe pain, intermittent edema, hyperalgesia, allodynia, cold skin, and loss of movement) after a fall onto her left knee 6 years previously. This had only partially responded to a variety of treatment modalities. After starting thalidomide for her Behçet's disease, the pain in her left knee unexpectedly disappeared. There are rat experiments showing that thalidomide improves neuropathic pain, probably by selectively blocking tumor necrosis factor-alpha production in activated macrophages. We believe this is the first report of successful use of thalidomide in a human being with CRPS 1, and we therefore recommend that thalidomide should be considered in the treatment of CRPS 1.

Journal Article↗

PubMed1992

Topical tretinoin: a new treatment for black hairy tongue (lingua villosa nigra).

Black hairy tongue is the name given to the appearance of an abnormal coating of the tongue and occurs only in adults. It is the result of hyperkeratosis of the filiform lingual papillae which, on gross examination appear hair-like with a variable tinctorial aspect from yellow-brown to black. The pathogenesis is unknown and often no definite cause can be identified. A number of aetiologic factors have been implicated including the administration of topical or systemic antibiotics, poor oral hygiene, smoking, alcohol and the use of mouthwashes. Often there are no symptoms other than the aesthetic or anxiety over its aetiology. Some patients complain of gagging, nausea, alteration of taste or halitosis. The condition may be very persistent and recognized treatments include brushing with a soft tooth brush which is enhanced by the prior application of a 40% solution of urea, scraping, topical triamcinolone acetonide, gentian violet, thymol, salicylic acid, vitamin B complex, and surgical excision of the papillae.

Administration, Topical↗

PubMed1990

Stimulation of the growth of Streptococcus sanguis (NCTC 7864) by zinc in vitro.

Zinc, which is present in many materials used in dentistry, including restorative and endodontic materials and mouthwashes, is reputedly bactericidal. However, the addition of this element at concentrations in the range 10-50 ppm to cultures of Streptococcus sanguis (NCTC 7864) stimulated the growth of the micro-organism relative to that of controls. A second antibacterial element, namely fluoride, reduced growth. Similar results were obtained whether the organism was grown aerobically or anaerobically. In view of the susceptibility of some organisms to zinc, the results of this study may help to explain conflicting reports in the literature; the results will vary depending on which organism is predominant.

Streptococcus mutans↗

PubMed2005

Microradiographic study on the effects of salivary proteins on in vitro demineralization of bovine enamel.

The aim of this investigation was to evaluate the effects of various proteins on in vitro demineralization of bovine enamel. From each of 100 bovine incisors two samples were prepared. The specimens were embedded in epoxy resin and polished up to 4000 grit. Subsequently, the specimens' surfaces were partly covered with nail varnish, thus serving as control of sound enamel. The specimens were divided randomly into five groups (n = 40) and demineralized in a solution of constant composition (pH 5.0; 10 days). For each subgroup of specimens (n = 10) 4 L were taken and either low (50% of medium conc.), medium, or high (150%) concentrations of the proteins [human albumin (100% conc. = 7 mg L(-1)), mucin (577.5 mg L(-1)), immunoglobulin G (IgG) (46 mg L(-1)), casein isolated from bovine milk (1.2 g L(-1))] or amino acid [l-Proline (7 mg L(-1))] were added to 1 L of the demineralizing solution, whereas 1 L served as control. Mineral loss and lesion depth (LD) were evaluated from microradiographs of thin sections (110 mum) by a dedicated software package (TMR 1.24). No differences were found between the five control groups (P > 0.05; ANOVA). Albumin, l-Proline, and IgG did not affect enamel demineralization, whereas the addition of both casein and mucin resulted in significant reductions of both mineral loss and LDs (P < 0.01; Tukey's test). Within the limitations of an in vitro study, the present investigation indicates that casein and mucin seem to affect enamel demineralization significantly. Thus, these proteins might be helpful as an additive to saliva substitutes or mouthwashes if the quality of saliva is altered.

Albumins↗

PubMedDate not supplied

Quantitative assessment of the efficacy of oral ketoconazole for oral candidosis in HIV-infected patients.

Fifteen male patients with manifest oral candidosis due to Candida albicans, suffering from AIDS-related complex (ARC) or full-blown AIDS, were investigated both clinically and microbiologically before and about 1 and 4 weeks after 7 to 10 days of treatment with 200 mg ketoconazole p.o. per day. Candida albicans was quantitated in mouthwash fluid. The antimicrobial susceptibility of the Candida albicans isolates was assessed using the IC30 test. In the short term, clinical cure was obtained in 87%, mycological cure in 53%. In the long term, the corresponding figures were 56 and 9%, respectively. Eradication of Candida albicans was not possible if IC30 values exceeded 256 micrograms ml-1. While pretreatment counts of Candida albicans in those patients also taking zidovudine did not differ from those in the rest of the study population, both the clinical and the mycological efficacy of ketoconazole seem to be higher both in the short and the long term when administered together with zidovudine. In consideration of the high relapse rate after about 4 weeks, an interval treatment protocol with oral ketoconazole is proposed.

AIDS-Related Opportunistic Infections↗

PubMed2006

Oral care provided by certified nursing assistants in nursing homes.

The purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real-time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. CNAs were blinded to the study's specific focus on oral care. Adherence to individual standards was low, ranging from a high of 16% to a low of 0%. Teeth were brushed and mouths rinsed with water in 16% of resident observations. One resident had her tongue brushed. Standards never met were brushing teeth at least 2 minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during oral care. Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self-reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.

Adult↗

PubMed1997

A survey of adolescents' knowledge regarding toxicity of over-the-counter medications.

OBJECTIVE: With prior research suggesting that up to 17% of adolescents believe that acetaminophen (APAP) cannot cause death at any dose, this study surveyed adolescents regarding their knowledge of over-the-counter (OTC) medication toxicity. METHODS: A convenience sample of 13- to 18-year-olds presenting to the acute care clinic or ED at 2 teaching hospitals were given a survey requesting demographic data and information regarding common OTC medications. The respondents were asked to identify those OTC medications found at home, those they thought poisonous or lethal when taken in overdose, and those they thought contain alcohol. They also were asked to indicate whether they ever had made a suicidal overdose gesture. RESULTS: There were 203 of 210 (96% response rate) surveys completed. Recognition of the potential for overdose lethality with specific OTC medications was limited: aspirin (63%), APAP (57%), antihistamines (46%), iron (24%), camphor (22%), methyl salicylate (21%), and bismuth subsalicylate (19%). Additionally, adolescents commonly believed many OTC medications generally considered nonlethal would be fatal in an overdose: ibuprofen (51%), decongestants (45%), guaifenesin (29%), mouthwash (25%), kaolin-pectin (22%), antacids (21%), and vitamin C (12%). More than half of the respondents correctly identified agents that normally contain alcohol. Also, of the 5 respondents who previously made suicidal gestures, 4 indicated the ingested item could kill them, reflecting serious intent. CONCLUSION: Surveyed adolescents possess poor knowledge of the lethal potential of OTC medications; the fact that many adolescents believe several of these OTC medications are benign is concerning. Emergency physicians should adjust their assessments of individual overdose patients' suicidal intents accordingly.

Adolescent↗

PubMed2006

IL-1RN gene polymorphism is associated with peri-implantitis.

OBJECTIVES: Interleukin (IL)-1alpha, IL-1beta and their natural specific inhibitor IL-1 receptor antagonist (IL-1ra) play a key role in the regulation of the inflammatory response in periodontal tissues. Polymorphisms in the IL-1 gene cluster have been associated with severe adult periodontitis. We aimed to investigate the IL-1 gene cluster polymorphisms in patients with peri-implantitis. MATERIAL AND METHODS: The study included 120 North Caucasian individuals. A total of 71 patients (mean age 68 years, 76% smokers) demonstrating peri-implantitis at one or more implants as evidenced by bleeding and/or pus on probing and bone loss amounting to >3 threads on Brånemark implants and 49 controls (mean age 66 years, 45% smokers) with clinical healthy mucosa and no bone loss around the implants were recruited for the study. The titanium implants, ad modum Brånemark, had been in function for at least 2 years. Mouthwash samples were collected and used for genotyping of the bi-allelic polymorphisms IL-1A(-889), IL-1B(+3953), IL-1B(-511) and a variable number of tandem repeat IL-1RN gene polymorphisms using PCR technique. RESULTS: Significant differences were found in the carriage rate of allele 2 in the IL-1RN gene between peri-implantitis patients and controls (56.5% vs. 33.3%, respectively; odds ratios (OR) 2.6; 95% confidence interval (CI) 1.2-5.6; P=0.015). Logistic regression analysis taking smoking, gender and age into account confirmed the association between the IL-1RN allele 2 carriers and peri-implantitis (OR 3; 95% CI 1.2-7.6; P=0.02). CONCLUSIONS: Our results provide evidence that IL-1RN gene polymorphism is associated with peri-implantitis and may represent a risk factor for this disease.

Age Factors↗

PubMed1987

The effects of a dentifrice containing a zinc salt and a non-cationic antimicrobial agent on plaque and gingivitis.

The antiplaque potential of metal salts in mouthwashes or dentifrices has been previously demonstrated. The purpose of the present investigation was to establish the effects on plaque and gingival health of a dentifrice which contained a combination of the metal salt, zinc citrate, and the anti-microbial agent, Triclosan. Plaque growth was reduced by a dentifrice which contained either zinc citrate or triclosan, but greater inhibition was achieved with dentifrices which contained both agents. A 4-day non-brushing study in which slurries of the dentifrice were used, confirmed that the test dentifrice which contained 1% zinc citrate and 0.5% Triclosan reduced the accumulation of plaque by 50%. In a double-blind crossover study of 28 days duration, a significant reduction in plaque accumulation and an improvement in gingival health was demonstrated for the test dentifrice compared to the placebo. Further analysis of the data indicated that the dentifrice was most efficacious for participants who brushed ineffectively. Also, the greatest benefit was obtained by subjects that used the largest amount of dentifrice.

Adolescent↗

PubMed1994

The antibacterial and anti-staining properties of the novel anti-adherent agent M239, 144 alone and in combination with chlorhexidine.

The anti-adherent agent M239,144 has been shown to reduce the adhesion of S. sanguis strains to saliva-coated hydroxyapatite by 27-94%. The purpose of this study was to determine any antibacterial properties of M239,144 which might inhibit replication of the organisms which do adhere and to determine whether M239,144 interferes with the antibacterial properties of the antiseptic agent chlorhexidine. Maximum inhibitory dilutions (MIDs) were calculated using both broth and agar methods. 0.1% M239,144 displayed no antibacterial activity against S. oralis NCTC 7864 or S. sanguis NCTC 7863 using the broth dilution method and had no antibacterial activity against a range of plaque-forming organisms using the agar dilution method. The anti-bacterial activity of chlorhexidine against four of five oral plaque-forming species was reduced by 0.1% M239,144. The effect of a novel anti-adherent agent, MK239,144, on chlorhexidine staining was assessed in an in vitro model. 1% M239,144 completely prevented chlorhexidine staining at concentrations from 0.0002% to 0.2%. M239,144/chlorhexidine formulations show potential for a non-staining anti-plaque mouthwash.

Anti-Bacterial Agents↗

PubMed1998

The rôle of a dentine-bonding agent in reducing cervical dentine sensitivity.

This double-blind split-mouth trial with 16 adult patients investigated the ability of a dentine bonding agent (DBA) to reduce cervical dentine sensitivity. Following stimulation of pairs of teeth by conventional tactile and air blast stimuli, together with controlled evaporative and cold fluid stimuli, sensitivity was recorded using tactile threshold, visual-analogue scale (VAS) and short-form McGill pain questionnaire (SFMPQ), prior to and 1 week following treatment with DBA. Prior to assessment, subjects recorded their perceived overall sensitivity using VAS and SFMPQ. Application of each stimulus was separated by 10 min. Sensitivity was recorded by a clinician blinded to the treatment status of each tooth. The control tooth was treated by applying DBA to coronal enamel. Dietary information was collected after the post-treatment assessment. There was a significant (p<0.05) improvement in tactile threshold and air flow and air blast VAS scores, together with reductions in sensitivity to evaporative stimuli when assessed by SFMPQ. Treatment response was not influenced by the subjects' age, gender, diet, use of fluoride-containing or silica-based toothpastes or fluoride mouthwashes, or a history of previous sensitivity treatment. It is concluded that topical application of DBA is an effective way to reduce cervical dentine sensitivity.

Adult↗

PubMed2004

CARD15 gene mutations in periodontitis.

OBJECTIVES: The CARD15 gene encodes the Nod2 protein, which is involved in intracellular recognition of bacterial products like peptidoglycan, activates inflammation and regulates apoptosis through nuclear factor-kappa B, a transcription factor that plays a central role in the innate immunity. Two functional mutations, an insertion mutation at nucleotide 3020 (3020insC) and a missense mutation C2104T in the CARD15 gene (originally NOD2 gene) have been reported to be associated with Crohn's disease. Our aim was to investigate the occurrence of CARD15 gene polymorphisms in adult patients with periodontitis taking into account smoking and presence of putative periodontal pathogens as additional variables. MATERIAL AND METHODS: A case-control study was performed in 104 Dutch Caucasian patients with severe adult periodontitis (54 non-smokers and 50 smokers, mean age 46 years) and in 97 ethnically matched, periodontal healthy controls (73 non-smokers and 24 smokers, mean age 40 years). DNA isolated from a mouthwash was typed with PCR technology. Presence of putative periodontal pathogens was established by culture technique. RESULTS: Frequencies of the CARD15 3020insC and 2104T mutations were similar in the periodontitis group and in the control group (5.1% and 13.3%; 5.2% and 10.3%, respectively). The highest carrier frequency of CARD15 mutations was found in non-smoking patients without Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans (29.4% versus 17.4% in controls); however it did not reach statistical significance. CONCLUSION: Our results suggest no role for CARD15 3020insC and C2104T mutations in adult periodontitis.

Adult↗

PubMed1980

Plaque inhibition by guanidino propyl piperazine (CKO 569A).

The plaque inhibiting effect of the antibacterial substance, guanidino propyl piperazine (CKO 569A) has been analized in a clinical study of 10 adults. Plaque formation was enhanced by three daily rinses with 15% sucrose. Normal hygiene was performed. The effects of a twice daily mouthwash of 30 s duration with 0.2, 0.1 and 0.05% CKO 569A, 0.05% chlorhexidine and a placebo on plaque formation were compared through a registration of plaque scores. Each solution was tested over a period of 5 days. As a result of this study it could be concluded that in humans CKO 569A is an effective inhibitor of plaque, and that lingual plaque scores appear to be a good indicator of plaque inhibiting activity.

Adolescent↗

PubMed1993

Experiments with a toothpaste containing polydimethylsiloxan/triclosan.

Polydimethylsiloxan (silicone oil) adsorbs to solid surfaces and to teeth because of its low surface tension, forming a thin, resistant layer. Triclosan is a lipid-soluble, antibacterial substance which is added to toothpastes and mouthwashes to inhibit plaque. Triclosan can be dissolved in silicone oil, conferring an antibacterial property on the layer of silicone oil which forms on solid surfaces. The aim of the present study was to determine whether a toothpaste containing triclosan/silicone oil has any effect on established gingivitis in a test panel of 33 teenagers. This toothpaste and a placebo paste were randomly distributed to the panel, and the number of gingival bleeding points was recorded. No instruction in oral hygiene was given. The panel was then examined 4 wk later and the number of bleeding points again recorded. It was found that the reduction in bleeding points was significantly higher in the group which had used the triclosan/silicone oil paste than in the placebo group. Deposition of a lipid-soluble, antibacterial agent in a layer of silicone oil which adsorbs to the tooth surfaces because of its physical properties represents a new and promising principle in preventive dentistry.

Adolescent↗

PubMed1993

Inhibition of the formation of oral calcium phosphate precipitates: beneficial effects of Chinese traditional (kampo) medicines.

Screening tests on the formation of calcium phosphate precipitates using 23 different kinds of Kampo medicines (Chinese traditional medicines) were carried out, at concentrations where the effects of chelation are not significant. Four of them, Hochu-ekki-to (TJ-41), Kyuki-kyogai-to (TJ-77), Oren-to (TJ-120) and Inchin-ko-to (TJ-135) showed an inhibitory effect on the formation of amorphous calcium phosphate (ACP). The inhibitory effect on the induction time and the rate of transformation to hydroxyapatite (HAP) varied greatly among the 23 Kampo medicines. We classified them according to their effects on increasing the induction time and/or decreasing the rate of HAP transformation. Ethane-1-hydroxy-1, 1-diphosphonate (EHDP) was used as the standard. This compound is a common toothpaste additive which decreases dental calculus formation. Two of the 23 Kampo medicines showed little or no inhibition either on the induction time or on the rate of HAP transformation. Twelve of them reduced the rate of HAP transformation by 20-40% and with 1.9- to 4.0-fold increases in the induction time. The remaining nine showed even greater activity. Keishi-ninjin-to (TJ-82), Dai-kenchu-to (TJ-100), Toki-to (TJ-102), Rikko-san (TJ-110) and San'o-shashin-to (TJ-113) showed the same inhibitory effect as EHDP. Shigyaku-san (TJ-35;5.2-fold), Dai-kanzo-to (TJ-84;4.9-fold), Oren-gedoku-to (TJ-15;12.7-fold) and Inchin-ko-to (TJ-135;9.5-fold) had a greater effect on the increase of induction time than EHDP and reduced the rate of HAP transformation by 50-60%. These results suggest that these nine kinds of Kampo medicines may have potential as anticalculus agents in toothpastes and mouthwashes.

Calcium↗

PubMed2000

The effect of sodium lauryl sulphate, triclosan and zinc on the permeability of normal oral mucosa.

OBJECTIVE: Sodium lauryl sulphate (SLS), an important component in many oral health products, is well established as a contact irritant in skin. Recent studies have suggested that it may also affect the structural integrity of oral mucosa. SLS is rarely used alone in dentifrices or mouthwashes and the aim of this study was to establish the effect of SLS both alone and in combination with Triclosan (TCN) and zinc (Zn) on the permeability barrier properties of normal human oral mucosa. METHOD: Ventral tongue mucosa was obtained from nine males and seven females within 60 h of death and stored frozen at -70 degrees C until use. The permeability of the tissue to tritiated water was measured after pretreatment for 15 min with SLS alone, SLS/TCN, SLS/Zn and a SLS/TCN/Zn mixture. Treatment with distilled water (DW) served as control. The histological appearance of the tissue before and after treatment was also examined by light microscopy. RESULTS: SLS treatment caused a significant increase in water permeability compared to control tissue (Kp = 11.7 +/- 1.00; 4.96 +/- 0.50 respectively; P < 0.005). Treatment with a SLS/TCN/Zn mixture, however, had no effect on the permeability to water (Kp = 5.5 +/- 0.56). Histological examination revealed that tissue exposed to SLS had a marked disruption of the epithelial surface whilst tissue treated with a SLS/TCN/Zn mixture was indistinguishable from controls. CONCLUSION: Although mucosa exposed to SLS alone showed an increase in permeability to water, the addition of TCN and Zn to SLS appeared to prevent this effect. As SLS is included in some dental products to solubilise compounds such as TCN, its presence may have no effect on the permeability barrier property of oral mucosa.

Adult↗

PubMedDate not supplied

Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: a review.

Using laboratory, animal, and human in situ caries models, investigators have shown that casein phosphopeptide amorphous calcium phosphate complexes (CPP-ACP) exhibit an anticariogenic activity. The casein phosphopeptides (CPP) are produced from a tryptic digest of the milk protein casein by aggregation with calcium phosphate and purification by ultrafiltration. The CPP have a remarkable ability to stabilize calcium phosphate in solution and substantially increase the level of calcium phosphate in dental plaque. Through their multiple phosphoseryl residues, the CPP bind to forming clusters of amorphous calcium phosphate (ACP) in metastable solution, preventing their growth to the critical size required for nucleation and precipitation. The proposed mechanism of anticariogenicity for the CPP-ACP is that they localize ACP in dental plaque, which buffers the free calcium and phosphate lon activities, thereby helping to maintain a state of supersaturation with respect to tooth enamel depressing demineralization and enhancing remineralization. The CPP-ACP, unlike fluoride, can be added to sugar-containing foods and therefore have commercial potential as an additive to foods as well as to toothpastes and mouthwashes for the control of dental caries.

Amino Acid Sequence↗

PubMedDate not supplied

Incidence of oral complications and application of a preventive protocol in children with acute leukemia.

This prospective, controlled study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL). During a 13-month period, 96 children from one to 16 years of age with a diagnosis of ALL were evaluated. When the study was initiated, 60 patients already undergoing chemotherapy received palliative treatment for complications (Group I). Thirty-six children (Group II) with newly diagnosed ALL received a daily preventive protocol consisting of: (1) elimination of bacterial plaque; (2) application of a mouthwash with a non-alcoholic solution of chlorhexidine 0.12% and (3) topical application of iodopovidone, followed by "swish and swallow" with nystatin 500,000 units. Children in both groups were examined every 7 to 14 days by our pediatric dentistry team. We found a significant improvement in oral hygiene (p = 0.001) and a significant decrease in the incidence of mucositis grade 2 (p = 0.0013) and oral candidiasis (p = 0.009) in the Group II children. These findings show that the systematic application of a preventive protocol significantly reduces the incidence of oral complications. The results of this study identify a need to include a pediatric dentist in a multidisciplinary team which provides oral care for cancer patients.

Adolescent↗