Knowledge, attitude and practice on exposure to Bisphenol A among dental surgeons in Southern India.

BACKGROUND: Bisphenol A (BPA) is a product in the manufacture of Bis-GMA, which is commonly used in dentistry, and is known to have a number of adverse effects. OBJECTIVES: The aim of this study is to evaluate to assess the knowledge, attitude and practice based on exposure and handling of BPA containing materials among dental surgeons for better understanding about the level of care rendered to the patients. MATERIAL AND METHODS: A questionnaire survey was conducted on 400 dental surgeons in Southern India. The questionnaire consisted of 20 objective type questions out of which ten questions assessed knowledge and five questions assessed the attitude and five questions to understand the practice related measures taken by the dentist. The data collected were analysed using SPSS version 23. RESULTS: A total of 402 responses were collected for this online questionnaire survey over a period of 2 months. It was found that females showed higher knowledge and attitude towards exposure to BPA which was statistically significant when compared to males. It showed that dentists with more than 20 years of practice had a higher level of knowledge. Though most of the groups agreed fairly on safety practice to be undertaken related to BPA exposure in their clinics, the ones with experience more than 20 years displayed the least positive attitude and dentists with 6-10 years of practice had the least positive behaviour among all. CONCLUSIONS: In spite of having a good knowledge regarding the harmful effects of BPA, dental surgeons are not very cautious while using materials containing them on a regular basis. Therefore, there is a need to enhance the awareness with the help of Continuing Dental Education programs or proper instructions on the packaging.

Radiographic and histochemical assessment of root resorption during canine retraction through piezocision site.

Introduction: The number of adult patients seeking orthodontics treatment has increased drastically. There is increased need for faster tooth movement and good esthetics. Piezocision is one of the methods used for accelerating the rate of tooth movement. Aims and Objectives: To assess the amount of root resorption after retraction of canine through piezocision site and compare it with that of recently extracted site using cone-beam computed tomography (CBCT) and assessment of dentin sialoprotein (DSP) levels in gingival crevicular fluid (GCF). Materials and Methods: A split mouth design was used in 15 patients who were undergoing first orthodontic treatment with premolar extractions. Randomly one of the sides was chosen as control (Group I) and the other side underwent piezocision procedure (Group II). 0.022 × 0.028'' MBT system was used with 0.017 × 0.025 SS wire for canine retraction using 150 grams of force. GCF samples were collected from mesio-buccal and disto-buccal of the canine with micropipette at baseline (TO) and day 90(T1) to detect the levels of DSP and the root resorption was measured using CBCT. Results: Statistically significant amount of root resorption was observed after retraction in both the groups. DSP levels were increased in both the groups, though little higher in Group II when compared to group I. Conclusion: DSP level was increased on the piezocision side but it was statistically insignificant which suggests the amount of root resorption on both the sides is similar.

Optimal sites for mini-implant insertion in the lingual or palatal alveolar cortical bone as assessed by cone beam computed tomography in South Indian population.

OBJECTIVES: To determine the optimal sites of mini-implant placement in the palatal alveolar cortical bone by using cone beam computed tomography (CBCT). SUBJECTS AND METHODS: Cone beam computed tomography records of 60 patients were divided into two groups of equal sizes, based on age and sex. The images were analysed using Planmeca Romexis Software (Version 4.1.2). The measurements were made in axial sections of the maxilla and mandible, at 2, 4 and 6 mm from the CEJ. The optimal sites were defined in terms of (a) Palatal or lingual alveolar cortical bone thickness and (b) Mesiodistal palatal or lingual inter-radicular width. RESULTS: The optimal site for mini-implant insertion, anteriorly, was the canine-lateral incisor embrasure in both the jaws. Posteriorly, the inter-molar embrasure in the mandible and the molar-premolar embrasure in the maxilla were optimal sites. Females demonstrated significantly lesser bone widths in all areas of the maxilla (P < .05) but greater bone thickness in the mandibular regions, as compared to males. The adolescent age group demonstrated a significantly lesser bone thickness but greater mesiodistal widths than the adult population in both the jaws (P < .05). CONCLUSION: The optimal sites for mini-implant insertion were the anterior canine-lateral incisor and posterior buccal inter-radicular embrasures, in both the jaws. Significant differences existed between age and gender groups, which need to be kept in mind while choosing the locations for placing mini-implants.

Assessment of dentofacial widths in adults with anterior open bite.

CONTEXT: Anterior open bite is a complex condition involving a combination of various dental and skeletal components in three dimensions. The data on the differences and changes in the transverse relation in individuals with anterior open bite are limited. AIMS: To assess the dental arch widths in individuals with anterior open bite using study casts and facial widths using frontal cephalogram and to compare these widths with that of individuals without anterior open bite. MATERIALS AND METHODS: Eighty adults [40 with and 40 without anterior open bite, mean (standard deviation) age = 20.68 years] were selected. The study group was divided into skeletal (n = 19) and dental (n = 21) open bite groups according to Jarabak's ratio. Posteroanterior cephalograms and study casts were analyzed. RESULTS: The mean width of zygomatic arch (112.18 mm) and condylar region (100.55 mm) in the control group was significantly higher (P < 0.05). The mean gonial width in the skeletal open bite group (81.143 mm) was significantly (P < 0.05) lesser than the dental open bite group (84.842). The maxillary intercanine width for the skeletal open bite group (36.48 mm) was significantly (P < 0.01) higher than that of the dental open bite group (34.26 mm). CONCLUSION: A transverse deficiency was seen in in the zygomatic and condylar regions in adults with anterior open bite. Individuals with a skeletal open bite showed a narrow gonial and wider maxillary intercanine width compared with individuals with dental open bite.

A proposed classification for orthodontic practice in India.

AIM AND BACKGROUND: Dental practice is blooming in India with many conventional and advanced setups providing orthodontic services. Orthodontics as a specialty has come to the forefront, as awareness of orthodontic therapy has increased. It is important to classify any health practice to understand, compare, and research the implications of various organizational setups in the country. It should possess the ability to chart the similarities and distinctions between different setups for ease of communication and patient awareness. Presently, there is no defined system that classifies the type of orthodontic practice in the country. Lack of any classification of the organizational setups makes it impossible to categorize or compare the various setups for research purpose, recognition of the dental personnel and facilities provided. This article aims to propose a simple 3-stage classification to orthodontic practices in India. TECHNIQUE: Three-stage classification of orthodontic practice in group, type, and subtype gives a comprehensive coverage to all types of orthodontic setups in India. The group explains the center in three levels based on the armamentarium and services provided. The type explains the center in five levels based on ownership and scope of providing care. Finally, the subtype explains the availability and qualification of the operating personnel. CONCLUSION AND SIGNIFICANCE: This classification aims to provide a tool for communication and recording the levels of orthodontic care possible at any given center. It also facilitates continued study of its impact on practice efficacy and patient awareness.

Immune responses to Aspergillus antigen in IL-4-/-mice and the effect of eosinophil ablation.

BACKGROUND: Exposure to Aspergillus fumigatus allergens results in enhanced total serum IgE and peripheral blood eosinophils in mice. The associated pulmonary inflammation and immunologic responses are comparable to those detected in human allergic bronchopulmonary aspergillosis. Allergen-induced cytokines are thought to regulate the inflammatory and immune responses in these animals. METHODS: In the present study, we exposed C57BL/6 and BALB/c mice to A. fumigatus antigen. Both wild-type and IL-4 knockout phenotypes of animals of both strains were used. Some animals were also treated with anti-IL-5 or anti-IFN-gamma. Total serum IgE, Aspergillus species IgG subclass, peripheral blood eosinophils, and lung histology were studied. RESULTS: The results demonstrate similar lung inflammation in all wild-type and IL-4-/- animals exposed to A. fumigatus antigen. Similarly, in spite of the diverse immune response produced by the anticytokine treatment, no major differences were detected among any of the animal groups studied. CONCLUSIONS: It can be concluded that A. fumigatus exposure in an immunologically unaltered host is predominantly of a Th2 type, and that depletion of the Th2 cytokine leads to a similar lung inflammation but with a characteristic Th1 response, suggesting that the pathogenesis of allergic aspergillosis is the result of multiple induction pathways.

Immunodominant peptide epitopes of allergen, Asp f 1 from the fungus Aspergillus fumigatus.

Aspergillus fumigatus ribotoxin Asp f 1 is a major allergen with IgE binding activity to serum of a majority of patients with allergic bronchopulmonary aspergillosis (ABPA). The IgE binding epitopes or the T-cell stimulatory peptides of this molecule have not been studied. In the present investigation, we have synthesized linear decapeptides spanning the whole molecule of Asp f 1 and analyzed their IgE binding properties. We have also synthesized peptides based on their possible T-cell stimulatory properties and studied the stimulation of peripheral blood mononuclear cells from ABPA patients and normal controls. Several peptides demonstrated distinct IgE antibody binding response against sera from ABPA patients and proliferative response against peripheral blood mononuclear cells from the patients. From the results, it can be concluded that the carboxy-terminal region of Asp f 1 representing amino acid residues 115-149 involved in both humoral and cell mediated immunoresponses in ABPA.

IgE down regulation and cytokine induction by Aspergillus antigens in human allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA), occurring primarily in patients with asthma or cystic fibrosis (CF), is a hypersensitivity reaction to Aspergillus fumigatus (Af), and is characterized by increased serum IgE levels and peripheral blood and pulmonary eosinophilia. We evaluated the IgE and cytokine profile in ABPA through enzyme-linked immunosorbent assay (ELISA), and evaluated eosinophil activity with the eosinophil peroxidase (EPO) assay. IgE and cytokines were measured in supernatants from cultures of peripheral blood mononuclear cells (PBMC) from three subject groups: ABPA patients, patients with asthma, and healthy individuals. All cultures for the three subject groups were studied in the presence and absence of two purified Af antigens (the 35-kD antigen and heat shock protein 1). We found that increased in vitro levels of IgE in unstimulated PBMC culture supernatants correlated significantly with serum IgE concentrations in ABPA patients. We measured a decrease in IgE levels of up to 75% of baseline values in supernatants from PBMC cultured with Af antigens. Interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) concentrations in cultures with Af were increased in ABPA, whereas concentrations of IL-4 did not differ in the three subject groups. An inverse relation was noted between the changes in IgE and IFN-gamma measured in 4 of 5 ABPA patients. The PBMC supernatants also promoted EPO activity in purified eosinophils from ABPA patients, and to a lesser extent in purified eosinophils from healthy subjects. These results show that the 35-kD antigen and HSP1 from Af downregulate IgE in vitro but are capable of inducing eosinophilia in ABPA. Further studies could result in the characterization of epitopes leading to these disparate effects. An identification of the IgE-down-regulating epitopes in Af antigens might have therapeutic significance.

Development of bone marrow eosinophilia in mice induced by Aspergillus fumigatus antigens.

A model of allergic bronchopulmonary aspergillosis (ABPA) developed by exposing mice to Aspergillus fumigatus antigen (Af) exhibits peripheral blood (PB), lung, and bone marrow (BM) eosinophilia. Because the BM is a site of eosinophilopoiesis, we have investigated the role of Af in the induction of this process in the BM. Groups of mice were exposed intranasally (i.n.) or intraperitoneally (i.p.) to Af. BM cells from mice were cultured with either Af or allogenic spleen cell supernatant stimulated with Af. Eosinophil counts in different lymphoid compartments, eosinophil peroxidase (EPO), and mRNA for cytokines and IgE in BM cells were studied. Results indicate that the eosinophil numbers were significantly elevated in PB and BM of all Af-exposed mice. Lung lavage eosinophils increased only in the i.n. group. Af induced EPO activity only in BM cultures from Af-exposed mice. The EPO activity was further enhanced by supernatants from spleen cells from Af-exposed mice. mRNA transcription of IL-3 and IL-5 were measurable in BM cells of the ip exposed mice. These findings suggest that Af mediates eosinophil development in BM of mice and this process is promoted by hematopoietic factors generated within the BM and in other lymphoid tissue such as the spleen.

Role of particulate antigens of Aspergillus in murine eosinophilia.

OBJECTIVE: Allergic bronchopulmonary aspergillosis, a disabling hypersensitivity lung disease, results from inhalation of Aspergillus fumigatus antigens present in contaminated environments. A murine model has been developed to understand the immune mechanism involved in allergic bronchopulmonary aspergillosis. We have investigated the immunoregulatory role of different physical forms of A.fumigatus antigens, such as A.fumigatus spores, soluble antigens. and soluble antigen coupled inert particles, in the model. METHODS: BALB/c mice were exposed to soluble A.fumigatus antigens, spores, or inert particles of comparable size to the spores coupled with A.fumigatus soluble antigens. Antibody and eosinophil response, pulmonary pathology, and cytokine expressions were studied. RESULTS: Peripheral blood eosinophilia and pulmonary inflammation with influx of eosinophils into the lung was detected more in animals exposed to particulate antigens than in those exposed to soluble antigen. However, the total serum IgE and Aspergillus-specific IgG levels showed only a slight increase in the former groups as opposed to elevated levels in animals exposed to soluble antigen. The cytokine expression in in vitro antigen stimulated spleen cells showed a typical Th2 pattern in all antigen-exposed animals. IL-5 mRNA could be detected in the spleen cells cultured with antigen from all groups of antigen-exposed animals. CONCLUSION: Particulate A.fumigatus antigens induced eosinophilia in mice prior to the elevation of serum IgE levels. This pattern of IgE and eosinophilia is reversed with the soluble antigen exposure in this model.

Immunopathologic responses to Aspergillus antigen in interleukin-4 knockout mice.

Two strains of interleukin-4 (IL-4) gene knockout mice were studied and compared with wild strains to determine the role of IL-4 in the immunopathogenesis of murine allergic aspergillosis. Animals immunized intraperitoneally were subsequently challenged with Aspergillus antigen intranasally. The animals were evaluated for total serum immunoglobulin E (IgE) levels, Aspergillus-specific IgG antibody isotypes, peripheral blood eosinophils, cytokine and chemokine mRNA transcripts in spleen cells, and pulmonary histology. No serum IgE was detected in animals deficient in the IL-4 gene. Aspergillus-specific IgG1 was detected in all animals, while enhanced levels of IgG2a were detected in IL-4 knockout animals challenged with A. fumigatus antigen. There were no differences in the peripheral blood or lung eosinophils in the two groups of mice exposed to A. fumigatus. These results indicate that lung injury in Aspergillus-antigen challenged animals may be the result of the eosinophil mediators and that IgE-mediated injury may not be significant in this model, which may be a significant variation between the model and human allergic aspergillosis.

Anti-interleukin (IL)-4 and -IL-5 antibodies downregulate IgE and eosinophilia in mice exposed to Aspergillus antigens.

The effect of multiple divided doses compared with single-dose injections of antibodies to murine interleukin (IL)-4 and IL-5 in their respective downregulation of IgE and eosinophilia developing in a model of allergic aspergillosis is investigated. BALB/c mice were exposed to Aspergillus fumigatus antigens (Af) before and along with anticytokine antibodies. The kinetics of blood eosinophils, eosinophil peroxidase (EPO) in bone-marrow cells, serum levels of IgE and Af-specific antibodies, Af-induced cytokine production and mRNA, and lung histology were studied. The results indicate that only multiple anti-IL-5 antibodies were effective in maintaining baseline levels of blood eosinophils. Multiple anti-IL-4 antibodies also downregulated eosinophils in the bone marrow, lung, and peripheral blood, although to a lesser extent than in anti-IL-5 antibody-injected mice. Significant correlation between the EPO activity and the eosinophil numbers in anticytokine antibody-treated mice was observed. The different anti-IL-4 antibody treatments downregulated IgE to the same extent. We conclude that multiple divided doses of anti-IL-5 antibodies are required to sustain normal eosinophil levels in murine allergic aspergillosis. This information may be significant in the therapy of pulmonary allergic diseases.

Aspergillus fumigatus peptides differentially express Th1 and Th2 cytokines.

Relevant allergens from Aspergillus fumigatus associated with allergic bronchopulmonary aspergillosis (ABPA) have been cloned and expressed. The pathogenesis of ABPA probably depends on specific cytokines and immunoglobulins secreted by lymphocytes on stimulation with different epitopes of those allergens. In the present study, we synthesized peptides of 12-16 amino acids from the sequence of Asp fI and compared their immunological responses in four mice strains (BALB/c, C57BL/6, AKR, and CBA). Of the five peptides studied for their cytokine profile, one showed a clear Th1, whereas another showed a Th2 response. The remaining three peptides varied in their immunoreactivity. The results suggest that a number of epitopes of diverse activities are present in individual molecules and may be involved in the pathogenesis of ABPA through differential cytokine secretions.

Characterization of a major latex allergen associated with hypersensitivity in spina bifida patients.

Hypersensitivity to latex proteins present in health care products, particularly in latex gloves, has emerged as an important public health problem in recent years. Most of these latex allergens have not been purified or characterized. Here we report the purification and characterization of a 23-kDa latex polypeptide from nonammoniated natural rubber latex. This purified 23-kDa polypeptide reacted with IgE from 13 of 17 (76%) latex-allergic spina bifida patients, but from only 1 of 5 health care workers with latex allergy. Furthermore, all the sera of patients with anaphylaxis to latex showed reactivity with the 23-kDa polypeptide. This allergen also induced significant lymphocyte proliferation by PBMC from spina bifida patients, but not from health care workers. The 90 amino acid residues sequenced from the 23-kDa polypeptide showed a 45.6% homology with a previously reported latex protein, rubber elongation factor. By using a mAb LAM-1, produced against the 23-kDa allergen, we could also detect this allergen or its epitope in ammoniated latex and natural rubber latex products used in health care management, but not in non-latex extracts studied.

Investigations into the cellular immune responses in latex allergy.

Latex allergy is a hypersensitivity response to allergens in the natural latex products. Skin prick tests, which do not correlate very well with latex-specific immunoglobulin E (IgE), are yet the only reliable diagnostic tools for clinically determining hypersensitivity to latex. In this study, patients who were skin test (SPT) positive with (STP+/ANA+) or without (SPT+/ANA-) history of anaphylaxis formed the test groups. Healthy volunteers (SPT-/ANA-) served as controls. Lymphocyte proliferation in response to crude and purified latex antigens, serum immunoglobulin E-total, and latex-specific and in vitro immunoglobulin E (IgE) production in response to crude latex antigens were studied. Results indicate that both patient groups showed enhanced response to latex antigen by lymphoproliferation. In patient groups this response to the different antigens tested, or to crude versus purified antigens, was not statistically different. Serum total IgE (ng/ml) was elevated in patients (range, SPT+/ANA-, 40 to 1250; SPT+/ANA+, 40 to 4550) when compared with controls (40 to 450). Low levels (1 to 3 ng/ml) of IgE were detected in the peripheral blood mononuclear cell culture supernatants from the patient groups. These levels were < or = 1 ng/ml in the control group. Significant levels of IgE (log titer, mean +/- SD) specific to MFL1 and glove antigens were measured in serum from both SPT+/ANA- (MFL1, 1.85 +/- 0.23, p < 0.001; glove, 1.81 +/- 0.23, p < 0.001) and SPT+/ANA- (MFL1, 1.92 +/- 0.39, p < 0.007; glove 1.85 +/- 0.4, p < 0.006) and compared with results from the control group (MFL1, 1.50 +/- 0.1; glove, 1.38 +/- 0.19).(ABSTRACT TRUNCATED AT 250 WORDS)

IgE and eosinophil regulation in a murine model of allergic aspergillosis.

Exposure of BALB/c mice to Aspergillus fumigatus (Af), the antigen responsible for causing allergic bronchopulmonary aspergillosis in humans, caused elevated levels of serum immunoglobulin E (IgE) and peripheral blood and lung eosinophilia similar to that observed in the human disease. We have investigated the role of interleukin-4 (IL-4), IL-5 and interferon-gamma in regulating IgE and eosinophilia in the mouse model. Animals were immunized by intraperitoneal injections of soluble Af antigens adsorbed to alum. These animals developed elevated IgE and Af specific IgG1 and were then treated with anticytokine monoclonal antibodies before the final exposure to particulate Af antigens by the intranasal route. The results showed that anti-IL-5 abrogated eosinophilia in mice, while those treated with anti-IL-4 retained the same or reduced IgE levels compared to pretreatment levels. All anti-IL-5, anti-IFN-gamma, and control antibody-treated animals showed enhanced IgE levels. Anti-IFN-gamma treatment of mice resulted in marked enhancement of eosinophilia compared to all other groups. Eosinophil numbers observed in the histological sections of the lungs confirmed the eosinophilia detected in the peripheral blood. These results indicate that the increase in IgE and eosinophils after exposure to Af antigens in BALB/c mice are due to Af-induced production of IL-4 and IL-5 and that both IgE and eosinophilia are independently regulated.

Immune responses to Aspergillus fumigatus and Pseudomonas aeruginosa antigens in cystic fibrosis and allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) in Cystic Fibrosis (CF) is well documented. Aspergillus fumigatus is the causative agent of ABPA, and Pseudomonas aeruginosa particularly the mucoid variety has been frequently isolated from the sputum of patients with CF. This study investigates the cellular and humoral immune response to both A fumigatus and P aeruginosa antigens in patients with CF and ABPA (CF/ABPA), CF only, and healthy controls. The A fumigatus and P aeruginosa antigen specific IgE and IgG in sera and peripheral blood mononuclear cell culture supernatants (PBMC sups), lymphoproliferation to antigens, and leukotriene B4 (LTB4) were measured. Results indicate significant elevated levels of A fumigatus specific IgG (A fumigatus-IgG) and Paeruginosa-IgE in serum. Significant Paeruginosa-IgG was measured in PBMC sups. The concanavalin A nonbinding A fumigatus antigen, previously shown to induce specific T-cell responses in vitro in patients with ABPA, elicited significant lymphoproliferative response in a greater proportion of patients with CF/ABPA and not in CF or controls, underlining the importance of this antigen in the diagnosis of ABPA. In contrast, a greater proportion of the CF group responded to P aeruginosa antigens compared with the controls and CF/ABPA. Hence, the CF and CF/ABPA groups respond to both P aeruginosa and A fumigatus antigens with the former group responding strongly to P aeruginosa and the latter to A fumigatus antigens.

Latex antigens induce IgE and eosinophils in mice.

Hypersensitivity to latex proteins has been reported with increasing frequency in recent years. Elevated levels of latex specific IgE have been detected in the majority of these patients. Severe anaphylaxis and death resulting from latex exposure has also been reported. Nevertheless, the immune mechanism of latex allergy is not fully understood. In this report, we describe a model of latex allergy developed in mice exposed to latex proteins. Animals exposed to latex proteins demonstrated enhanced levels of total IgE, peripheral blood and lung eosinophilia, and elevated levels of serum IL-4 and IL-5. mRNA transcripts of IL-4 and IL-5, but not IFN-gamma, could be demonstrated in spleen lymphocytes. Antibodies to latex belonging to all IgG subclasses were detected in the sera of mice exposed to latex antigens. The histology of the lung showed non-necrotizing granulomas and extensive interstitial chronic inflammatory infiltrates, particularly around bronchioles and small blood vessels. Although this model of latex allergy demonstrates a heterogeneous immunological response, the CD4-positive Th2 cell-mediated response predominated.

Hyperimmune serum modulates allergic response to spores in a murine model of allergic aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a disease in atopic asthmatics characterized by eosinophilia and elevated levels of immunoglobulin E (IgE) and IgG antibodies to the ubiquitous fungus Aspergillus fumigatus (Af). The role of specific antibodies in the disease process is not clear. In this study, BALB/c mice were injected with hyperimmune serum from syngeneic mice exposed to soluble antigen of Af. These mice were then exposed to either Af spores or soluble antigen. Total IgE, Af-specific IgG1 (enzyme-linked immunosorbent assay) in serum, and eosinophils (eosinophil peroxidase assay) in lungs and bone marrow were measured. Histologic sections of lungs were examined for cellular infiltration and morphologic changes. Results indicate a suppression of increase in levels of antibodies and eosinophilia in mice receiving immune serum and exposed to spores compared with controls receiving phosphate-buffered saline treatment. Spores being the primary source of exposure to Af in ABPA, these results are significant in understanding the role of preexisting specific antibodies in patients.