Effect of Hydrogen and Carbamide Peroxide in Bleaching, Enamel Morphology, and Mineral Composition: In vitro Study.

AIM: The aim of the study was to evaluate the bleaching effect, morphological changes, and variations in calcium (Ca) and phosphate (P) in the enamel with hydrogen peroxide (HP) and carbamide peroxide (CP) after the use of different application regimens. MATERIALS AND METHODS: Four groups of five teeth were randomly assigned, according to the treatment protocol: HP 37.5% applied for 30 or 60 minutes (HP30, HP60), CP 16% applied for 14 or 28 hours (CP14, CP28). Changes in dental color were evaluated, according to the following formula: ΔE = [(La-Lb)2+(aa-ab)2 + (ba-bb)2]1/2. Enamel morphology and Ca and P compositions were evaluated by confocal laser scanning microscope and environmental scanning electron microscopy. RESULTS: ΔE HP30 was significantly greater than CP14 (10.37 ± 2.65/8.56 ± 1.40), but not between HP60 and CP28. HP60 shows greater morphological changes than HP30. No morphological changes were observed in the groups treated with CP. The reduction in Ca and P was significantly greater in HP60 than in CP28 (p < 0.05). CONCLUSION: Both formulations improved tooth color; HP produced morphological changes and Ca and P a gradual decrease, while CP produced no morphological changes, and the decrease in mineral component was smaller. CLINICAL SIGNIFICANCE: CP 16% applied during 2 weeks could be equally effective and safer for tooth whitening than to administer two treatment sessions with HP 37.5%.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study.

OBJECTIVES: To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. METHODS: Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. RESULTS: Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). CONCLUSION: Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

The application of casein phosphopeptide and amorphous calcium phosphate with fluoride (CPP-ACPF) for restoring mineral loss after dental bleaching with hydrogen or carbamide peroxide: An in vitro study.

OBJECTIVE: To conduct an in vitro evaluation of the effect of casein-phosphopeptide and amorphous calcium phosphate with fluoride [CPP-ACPF] upon the calcium [Ca] and phosphorus [P] composition and morphology of dental enamel and dentin after the application of two bleaching agents: 37.5% hydrogen peroxide [HP]) and 35% carbamide peroxide [CP]. MATERIALS AND METHODS: The crowns of 40 extracted human teeth were divided into four groups (n=10 each). The crowns were sectioned along the cervical-incisal axis, and each half was embedded in acrylic resin, leaving a window 3mm in diameter to explore the enamel or dentin (according to the study group involved). Groups 1a and 1b corresponded to the two halves belonging to the same tooth and were treated with HP applied to enamel three times for 10min. Afterwards, CPP-ACPF was applied in group 1b for five minutes. The same procedure was carried out in groups 2a and 2b, but application was done on dentin. Groups 3a and 3b were treated with CP applied to enamel once for 30min. Posteriorly, CPP-ACPF was applied in group 3b for five minutes. Groups 4a and 4b were treated in the same way as groups 3a and 3b, but application was done on dentin. The morphological changes were evaluated using confocal laser scanning microscopy (CLSM), and the changes in Ca and P composition were assessed by environmental scanning electron microscopy coupled to a microanalytical system (ESEM+EDX). Comparisons between groups were made using the Kruskal-Wallis test, and Duncan test was applied for two-by-two comparisons, with a significance level of p<0.05. RESULTS: Both HP and CP produced similar changes in enamel morphology and produced no changes in dentin. Groups treated with CPP-ACPF after bleaching improved the percentage of Ca and P. Statistical significance was reached only in the case of the percentage of Ca in enamel (group 1b versus group 1a, p=0.01) (group 3b versus group 3a, p=0.03). CONCLUSIONS: The application of CCP-ACPF for five minutes on the enamel surface after tooth bleaching is effective in restoring the Ca lost as a result of the bleaching process, while their effect in dentin could not be demonstrated.

Effects of in-office bleaching on human enamel and dentin. Morphological and mineral changes.

BACKGROUND: The effects of HP-based products upon dental enamel and dentin are inconclusive. AIM: To evaluate changes in micromorphology and composition of calcium (Ca) and phosphate (P) in enamel and dentin after the application of 37.5% hydrogen peroxide (HP) and 35% carbamide peroxide (CP) METHODS: Crowns of 20 human teeth were divided in two halves. One half was used as control specimen and the other as experimental specimen. The control specimens were kept in artificial saliva, and the experimental specimens were divided into four groups (n=5 each): group 1 (enamel HP for 45min); group 2 (dentin HP for 45min); group 3 (enamel CP for 90min); and group 4 (dentin CP for 90min). The morphological changes were evaluated using confocal laser scanning microscopy (CLSM), while the changes in the composition of Ca and P were assessed using environmental scanning electron microscopy combined with a microanalysis system (ESEM+EDX). The results within each group and between groups were compared using the Wilcoxon test and Mann-Whitney U-test, respectively (p<0.05). RESULTS: Similar morphological changes in the enamel and no changes in dentin were assessed with both products. Ca and P decreased in enamel and dentin, without significant differences between them or with respect to their control specimens (p>0.05). CONCLUSIONS: When bleaching products with a neutral pH are used in clinical practice, both, the concentration and the application time should be taken into account in order to avoid possible structural and mineral changes in enamel and dentin.

[Effects of nutritional status on the multiple sclerosis disease: systematic review]. / Efectos del estado nutricional en la enfermedad de la esclerosis múltiple: revisión sistemática.

OBJECTIVE: To review the available scientific literature about the effects of nutritional status on the multiple sclerosis disease. METHODS: A systematic review of the scientific literature in the Medline (PubMed), Scopus, Cochrane Library and Web of Science databases through November 2016. Search equation: ("Multiple Sclerosis"[Mesh] OR "Multiple Sclerosis"[Title/Abstract] OR "Disseminated Sclerosis"[Title/Abstract] OR "Multiple Sclerosis Acute Fulminating"[Title/Abstract]) AND ("Nutritional Status"[Mesh] OR "Nutritional Status"[Title/Abstract] OR "Nutrition Status"[Title/Abstract]). The quality of the selected articles was discussed using the STROBE questionnaire. The search was completed through experts inquiry and additional review of the bibliographic references included in the selected papers. The concordance between authors (Kappa index) had to be higher than 80% for inclusion in this review. RESULTS: Of the 160 references recovered, after applying inclusion and exclusion criteria, 29 articles were selected for review. Concordance between evaluators was 100.00%. The most studies established vitamin D levels. Others focused their research on finding out which nutrient deficits might be related to the multiple sclerosis development. CONCLUSIONS: Vitamin D may influence multiple sclerosis improvement. Sunlight and physical activity would be important factors, with nutritional status, in the course of this disease. It is necessary to produce new specific works that will delve into the subject to find out more about the relationship between nutritional status and multiple sclerosis.

Biological agents in the management of Felty's syndrome: a systematic review.

OBJECTIVE: To review and summarize the information available on the effectiveness and safety of biological therapies in refractory Felty's syndrome (FS). METHODS: We describe a case of FS with severe neutropenia and recurrent bacterial infections unresponsive to disease-modifying antirheumatic drug treatment and long-term administration with granulocyte colony-stimulating factor, in which treatment with rituximab (RTX) was useful and resulted in a sustained neutrophil response. Current evidence on the use of biological therapies in FS is also analyzed through a systematic review of the English-language literature, based on a PubMed search. RESULTS: Available data on the use of biological therapies in refractory FS are based only on several case reports and are limited to the use of RTX and some anti-tumor necrosis factor α agents (etanercept, infliximab, and adalimumab). Including the case described here, data are available on 8 patients treated with RTX. A sustained increase in the absolute neutrophil count (>1500/mm(3)) was observed in 62.5% (5/8) of these patients after 1 cycle of treatment. In most of them, the hematological response was accompanied by a parallel improvement in biological markers of inflammation and other clinical manifestations of FS (arthritis, recurrent infections, systemic symptoms, etc). After a median follow-up of 9 months (range, 6-14), only 1 of these patients relapsed and neutropenia reappeared; in this patient, retreatment was rapidly effective. No significant adverse events related to RTX therapy were reported. Experience with anti-tumor necrosis factor agents is limited to 6 patients, none of whom presented any sustained increase in neutrophil count. CONCLUSIONS: Although it is not yet possible to make definite recommendations, the global analysis of all cases reported to date only supports the use of RTX as a second-line therapy in patients with refractory FS.