Treatment decisions regarding caries and dental developmental defects in children - a questionnaire-based study among Norwegian dentists.

BACKGROUND: Current knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children. METHODS: A pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice. RESULTS: After three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively. In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists' background characteristics. The reasons for dentists' treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons. CONCLUSIONS: A notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.

Early severe weight loss in newborns after discharge from regular nurseries.

AIMS: To study incidence and risk factors of early neonatal dehydration in a Norwegian population based cohort. METHODS: Term neonates admitted to a paediatric department during 2002-2008 with a weight loss > or = 12% within three weeks of age were identified retrospectively through review of medical records. For each patient a sex-matched control group of two full-term infants was selected to assess risk factors for dehydration. RESULTS: A total of 38 of 37 321 infants (1.0 per thousand) were admitted at a median age of 6 (interquartile range 5-12) days, and the admission rate increased during the study period (p for trend = 0.008). Simultaneously, mean nursery stay decreased from 3.5 to 2.7 days (p = 0.022). Mean weight loss was 15.0% of birth weight and 17 of 29 (58.6%) had serum sodium above 145 mmol/L. The only significant difference between patients and controls was that mothers of patients were older (32.3 +/- 5.0 vs. 29.4 +/- 5.4 years, p = 0.005). CONCLUSION: Short nursery stay may be a risk factor for dehydration in newborn infants.

[Prognosis in familial adenomatous polyposis. Results from the Polyposis Registry]. / Prognosen ved familiaer adenomatøs polypose. Resultater fra polyposeregistret.

Regional and national polyposis registries have been established all over the world over last decades, with the aim to improve survival in patients with familial adenomatous polyposis (FAP). The Danish Polyposis Register was founded in 1971 and coordinates screening and prophylactic treatment. At the end of 1992 the register included 321 histologically verified FAP patients: 142/205 probands (69%) had colorectal cancer at the time of diagnosis of FAP versus only 2/116 call-up cases (2%). The 10-year cumulative crude survival was 94% among call-up cases versus only 41% among probands (p < 0.00001), and the survival increased significantly after establishment of the Polyposis Register in 1971. We conclude that centralized registration with identification and prophylactic examination of relatives at risk results in a substantial improvement of the prognosis.

The incidence rate of familial adenomatous polyposis. Results from the Danish Polyposis Register.

Based on the Danish Polyposis Register epidemiological calculations on familial adenomatous polyposis (FAP) were carried out. The mean annual incidence was 1.85 x 10(-6) during the years 1971-1992, and the prevalence increasing to about 32 x 10(-6) at the end of 1992. FAP patients constituted a decreased percentage of all Danish patients with colorectal cancer (0.07% in 1980-1992). The completeness of registration was 97% in 1983-1992. The results are similar to Finnish estimates based on the same direct method of calculation, and as both series are based on almost complete national polyposis registration in well-registered populations we regard our results to be close to the true incidence rate.

Centralized registration, prophylactic examination, and treatment results in improved prognosis in familial adenomatous polyposis. Results from the Danish Polyposis Register.

BACKGROUND: Over the last few decades numerous regional and national registers have been established all over the world with the aim of improving survival in familial adenomatous polyposis (FAP). The Danish Polyposis Register was founded in 1971 and coordinates the screening and subsequent prophylactic colectomy of FAP patients. METHODS: The crude cumulative survival in 321 patients (205 probands and 116 call-up cases) with verified FAP was calculated in accordance with the life-table method. RESULTS: At the time of diagnosis of FAP only 2 of 116 (2%) had colorectal cancer versus 142 of 205 probands (69%). The 10-year cumulative survival was 94% (95% confidence limits, 89-99) in call-up cases compared with only 41% (34-49) in probands (p < 0.00001), and survival improved significantly (p < 0.00001) after the establishment of the Danish Polyposis Register. CONCLUSION: The establishment of a centralized polyposis register has resulted in a substantial improvement of the prognosis in FAP.

Optimization of a reactor assembly for the production of 6-APA from penicillin-V.

The design and operation of an industrial penicillin-V deacylation reactor is simulated, using a kinetic expression and mass transport parameters for the immobilized enzyme particles which were determined experimentally in a previous study. It is desirable to use a series of equalsized plug flow reactors with pH control at the entrance to each reactor, and with a possibility of recycling reactant in each reactor. These measures are necessary to avoid a steep pH profile through the reactor; the deacylation reaction is accompanied by an increase of acidity of the reaction medium, and H(+) is a strong inhibitor and may deactivate the enzyme. The optimization study which is carried out at a fixed penicillin conversion of x = 0.99 shows that it is uneconomical to use penicillin feed concentrations above 150mM-175mM, and that the buffer concentration in the reaction medium should not be less than 50mM-75mM. Increasing the number of reactors from 4 to 8 or 10 leads to higher productivity of 6-APA, and a moderate recycle in the first couple of reactors diminishes the sharp decrease in pH which will be found in a straight plug flow reactor operation of the equipment. Higher pumping costs and lower productivity are unavoidable drawbacks of an operation mode where the separation costs for the product mixture are desired to be low.

The kinetics of penicillin-V deacylation on an immobilized enzyme.

An immobilized Penicillin-V-acylase (commercial name, Novozym 217) with high specificity for the phenoxyacetyl-(V)- side chain was investigated in a recycle reactor and in a batch reactor to find the enzymatic reaction rate as a function of conversion, x, substrate concentration, c(A) (0) and pH. The reaction rate depends strongly on pH, and both products, phenoxy-acetic acid and 6-APA, inhibit the reaction. Nonspecific side reactions amount to only a few per cent when c(A) (0) <150 mM and pH& gt; 6.5. The effectiveness factor for commercial-size particles is found to be about 0.65, and a value of 1.3mM is obtained for the equilibrium constant, K(eq), of the deacylation reaction. A kinetic model for the deacylation process which includes the effect of pH and of the reverse (acylation) reaction is proposed. Rate data for particles of different size are fitted to the nonlinear model. Five kinetic parameters and an effective diffusivity for the immobilized enzyme particles are determined.