Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to assess the effect of a whitening dentifrice (WDF) relative to a regular dentifrice (RDF) on the reduction of natural extrinsic tooth surface discoloration (ETD). MATERIALS AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EBSCO-Dentistry and Oral Sciences databases were searched, up to April 2017. The inclusion criteria were as follows:(randomized)controlled clinical trials, healthy subjects ≥18 years of age, studies comparing WDF with RDF, a follow-up period of at least 6 weeks and studies scoring ETD as the stain area/extent, stain intensity or a composite score. Studies using an induced staining model were excluded. RESULTS: Independent screening of 851 unique papers resulted in 21 eligible publications, which included 32 comparisons. The descriptive analysis illustrated that the majority of comparisons showed a significant effect on ETD, in favour of WDF over RDF. The meta-analysis substantiated this observation and revealed that the difference of means (diffM) comparing WDF and RDF was a reduction for stain area of -0.44 [(95% CI: -0.55; -0.339) (P<.00001)] according to the original Lobene Stain Index; this result is in favour of the WDF. For the modified Lobene Stain Index, the diffM was -0.41 [(95% CI: -0.71; -0.10) (P=.009)]. For overall stain intensity, the diffM was -0.35 [(95% CI: -0.44; -0.25) (P<.00001)], and the composite score was -0.39 [(95% CI: -0.57; -0.21) (P<.0001)] and -0.54 [(95% CI: -0.66; -0.43) (P<.00001)]. Subgroup analysis differentiating between products that contained added chemical antidiscoloration agents showed a similar pattern. CONCLUSION: In this review, nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing ETD, irrespective of whether or not a chemical discoloration agent was added.

Does playing a wind instrument influence tooth position and facial morphology? : Systematic review and meta-analysis.

PURPOSE: To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology. METHODS: The PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed. RESULTS: In total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited. CONCLUSIONS: Playing a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be "very low".

Schizophrenia-primary affective disorder discrimination. II. Where unclassified psychosis stands.

Cases of unclassified psychosis were assessed with a nine-variable diagnostic measure designed to discriminate schizophrenia and primary affective disorder. As a group, the unclassified cases occupied a midway position between and overlapping with cases of schizophrenia and primary affective disorder. Also, the mean discriminant-function score of the unclassified group was significantly different from the mean scores of the groups with affective disorder and schizophrenia, although one subgroup of unclassified cases was statistically indistinguishable from the group with schizophrenia. While this investigation was essentially unsuccessful in reclassifying unclassified psychosis, it demonstrates a method for reclassifying diagnostic groups. When this procedure is used in conjunction with follow-up and family studies, it provides a basis for modifying diagnostic criteria.

Exercise and anxiety neurosis: comparison of patients with and without mitral valve prolapse.

It has been hypothesized that mitral valve prolapse may account for a substantial number of patients who have symptoms of chronic anxiety neurosis. In a previous investigation, this hypothesis was confirmed in eight of 21 patients who had anxiety neurosis. In the present investigation, we reevaluated the hypothesis that persons with anxiety neurosis have impaired exercise ability by exercising 20 of the anxiety neurotics according to a standard treadmill exercise protocol. Compared with the control group, the anxiety neurotics required less exercise to achieve an equivalent heart rate and therefore their estimated maximum oxygen consumption was less, thus confirming the hypothesis. However, this difference was due entirely to the anxiety neurotics with mitral valve prolapse, and those without prolapse did not differ significantly from the controls. This suggests that impaired exercise tolerance in anxiety neurotics may be attributable to a subgroup of these patients with mitral valve prolapse.

The relationship of histrionic personality disorder to antisocial personality and somatization disorders.

The authors examined the association of antisocial personality disorder, somatization disorder, and histrionic personality disorder, both within individuals and within families, in 250 patients. All three disorders overlapped considerably within individuals; the strongest relationship was between antisocial personality and histrionic personality. A high prevalence of antisocial personality was reported in the families of patients with somatization disorder but not in the families of patients with histrionic personality. The authors suggest that histrionic individuals develop antisocial personality if they are male and somatization disorder if female; moreover, all three conditions may represent alternative manifestations or different stages of the same underlying diathesis.

Forty-year follow-up of United States prisoners of war.

The authors performed structured psychiatric examinations of 188 former prisoners of war (POWs). Sixty-seven percent had had posttraumatic stress disorder. Of those affected, 29% had fully recovered, 39% still reported mild symptoms, 24% had improved but had moderate residual symptoms, and 8% had had no recovery or had deteriorated. Presence of posttraumatic stress disorder was not significantly correlated with other mental disorders. Delayed onset was not seen. The findings confirm the DSM-III concept of and criteria for posttraumatic stress disorder.

Depressed women with panic attacks.

Of a group of 288 depressed female inpatients, 43 (15%) had secondary panic attacks. Compared to other depressives, the subgroup with panic attacks had significantly higher frequencies of anorexia, weight loss, gastrointestinal disturbances, hypochondriasis, and psychomotor agitation, and significantly lower frequencies of melancholic symptoms, including loss of interest in usual activities, guilt feelings, delusional thinking, psychomotor retardation, and orientation or memory impairment. Patients with panic attacks were less likely to have a depressed parent and were more likely to be described as having been nervous, worrisome, sensitive, and sexually dysfunctional before the onset of depression. Phenomenologically, they resembled "anxious depressives" as described by other authors.

Symptoms in veterans considering compensation claims.

The symptomatology of 56 male veterans considering compensation claims was compared to the symptomatology seen in 163 veterans not considering such claims. Antisocial behaviors, somatic/neurotic complaints, and persecutory ideas were all positively correlated with consideration of a claim. Although the symptom profile is consistent with diagnosis of antisocial personality, a correlation with this diagnosis was not established. Nonetheless, the clinical profile does suggest a link between noncompensable disorders and consideration of a claim. The implications of this finding for military and Veterans Administration psychiatry are discussed.

Monitoring the specific activities of dopamine and its metabolites in striatum and olfactory tubercle after intravenous administration of l-[(3)H]tyrosine: Complex relations, indicating more than two compartments.

It is still a matter of debate whether in dopaminergic nerve endings dopamine (DA) is present in different functional and/or metabolic compartments. To investigate this, DA metabolism was studied in vivo by measuring the specific activity of DA and its metabolites after intravenous administration of l-[3,5-(3)H]tyrosine (200 ?Ci/rat) to freely moving animals. The incorporation of (3)H into DA and metabolites was determined in striatum and olfactory tubercle at 5, 10, 20, 40, 60 and 80 min after [(3)H]tyrosine administration. In both structures the level of [(3)H]tyrosine initially declined monoexponentially, but deviated from that pattern later on. The curves representing the formation in time of [(3)H]DA and [(3)H]metabolites were very similar in both structures, although as a whole, the levels in the olfactory tubercle were higher. The relative patterns of the specific activities of DA and those of its metabolites, a possible clue to DA compartmentation, neither indicated a clearcut metabolic one-compartment, nor a two-compartment system. The flow of radioactivity through DA metabolism could in fact only be explained by assuming more complex metabolic relations.

A procedure to measure the specific activities of dopamine and its metabolites in rat striatum, based on HPLC, electrochemical detection and liquid scintillation counting.

A procedure to determine the specific activities (s.a.) of the putative neurotransmitter dopamine (DA) and its metabolites in rat striatum is described. For this purpose 200 mu Ci L-[3,5-3H]tyrosine was injected via a jugular vein cannula into freely moving rats. Contents and radioactivity of striatal tyrosine, DA, 3,4-dihydroxyphenylacetic acid (DOPAC), 3-methoxytyramine (3-MT) and homovanillic acid (HVA) were determined by means of HPLC, electrochemical detection (ECD) and liquid scintillation counting. In the phase system applied DA, DOPAC, 3-MT and HVA can be separated in a single run after direct injection of striatal supernatants. The selectivity of the phase system was sufficient to analyse the supernatant of two rat striata over a 150 X 4.6 mm column, even when DA turnover was strongly stimulated. Tyrosine levels and radioactivity were measured by re-analysis of the front peak with divergent mobile phase parameters. In order to demonstrate the applicability of the present procedure, the s.a. of DA and its metabolites, as found 20 min after [3H]tyrosine administration, and the effect of haloperidol thereupon, are presented.

Electrical stimulation of the nigrostriatal pathway after HA-966 block of triatal dopamine release.

Striatal dopamine (DA) of rats increased twofold 1 h after blockade of DA release by either an electrolytic lesion of the substantia nigra (SN) or systemic administration of 1-hydroxy-3-amino-pyrrolidone-2 (HA-966). If the treatments were combined, no further increase was observed. The decrease in DA induced by alpha-methyl-p-tyrosine (alphaMT) in otherwise untreated animals was not enhanced by a 20 min electrical stimulation of nigrostriatal fibres. If, however, in addition to synthesis blockade by alphaMT, DA release was interrupted by a lesion of the SN and/or by HA-966, electrical stimulation caused a significant decrease in striatal DA. It is assumed that HA-966 exerts its action in the dopaminergic nigrostriatal system by way of blockade of the nerve impulse flow at the level of the SN.

Differential effects of acute and subacute HA-966 treatment on storage and release of striatal dopamine.

Acute injections of HA-966 (100 mg/kg) into rats caused a rapid elevation of dopamine (DA) content in the striatum. 3,4-Dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels increased after a latency period of 0.5 h and 1 h respectively. Repeated ("subacute") HA-966 treatment produced a smaller DA increase than did single administration, while DOPAC and HVA rose at the same rate after both treatments. In HA-966-pretreated rats no tolerance for DA increase followed a lesion of the dopaminergic fibres. Acute as well as subacute HA-966 prevented the disappearance of DA after alpha-methyl-p-tyrosine for about 3 h. In both cases DOPAC and HVA levels dropped sharply after HA-966. HA-966 had no influence on the decline of DOPAC and HVA levels after monoamine oxidase inhibition. It is concluded that the rises of DOPAC and HVA after HA-966 did not occur because the capacity of the vesicular DA stores was exceeded. Instead, HA-966 affects the storage mechanism for newly formed DA. Possible explanations for the observed tolerance to DA accumulation after HA-966 are discussed.

Repeated administration of HA-966 and haloperidol to rats: similar tolerance to striatal dopamine accumulation after HA-966 challenge, but dissimilar effects on striatal [3H]spiperone binding.

Repeated administration of 1-hydroxy-3-amino-pyrrolidone-2 (HA-966) to rats induces tolerance, as shown by a decreased, drug-stimulated accumulation of dopamine (DA) in the striatum. In the present study we compared the adaptive response of the striatal dopaminergic system to repeated administration of HA-966 with the adaptive response observed after repeated haloperidol. These treatments deprive dopamine (DA) receptors from their agonist and cause a blockade of DA receptors, respectively. Tolerance to HA-966 was not accompanied by a change in the specific binding of [3H]spiperone to striatal membranes. This is in contrast to the well-documented up-regulation of DA receptors that occurs with tolerance to haloperidol. Repeated haloperidol pretreatment also diminished DA accumulation following a challenge dose of HA-966, to a similar extent as that caused by repeated pretreatment with HA-966. These similar effects of pretreatment with HA-966 or haloperidol on the response to the HA-966 challenge are in line with, and strengthen, the idea that an increased sensitivity of presynaptic DA receptors is responsible for the decreasing effect of HA-966 after its repeated administration. Haloperidol and HA-966 clearly have different effects on postsynaptic DA receptors, as is shown by their differential effects on striatal [3H]spiperone binding.

Effects of morphine on dopamine metabolism in rat striatum and limbic structures in relation to the activity of dopaminergic neurones.

Administration of morphine results in efflux of dopamine provided that the nerve impulse flow of the dopaminergic neurones is impaired. In the present study we investigated whether the morphine-induced increase in dopamine metabolite levels is related to impulse flow in a similar way. Pretreatment with gamma-butyrolactone to impair nerve impulse flow, abolished the effect of morphine on the concentrations of dihydroxyphenylacetic acid and homovanillic acid. Pretreatment with apomorphine had a similar effect, as well as combined pretreatment with gamma-butyrolactone and apomorphine. Since gamma-butyrolactone and apomorphine both reduce nerve impulse flow, but gamma-butyrolactone increases while apomorphine decreases dopamine biosynthesis, it would appear that the antagonism of morphine-induced increases in dopamine metabolites is due to the common property of impulse flow reduction. It was also shown, however, that pretreatment with alpha-methyl-paratyrosine, which inhibits dopamine biosynthesis, resulted in antagonism of morphine's effect on dopamine metabolite levels. It is concluded, therefore, that morphine-induced dopamine efflux is observed under conditions when no effect on dopamine metabolism is observed, and vice versa. Three effects of morphine on dopaminergic neurones can be distinguished: an increase in impulse flow in nigrostriatal dopaminergic neurones, increased dopamine biosynthesis and catabolism, and efflux of dopamine. The first effect probably is effected in the cell body areas, while the latter two effects may be produced at the level of the nerve terminals.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic depressions. Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions.

In this clinical, psychometric and polysomnographic study, primary dysthymics (N = 20) were compared with anxious depressives (N = 22), and non-psychiatric controls (N = 11). Beck and MMPI depression scores were similar in the two affective groups. Prominent insomnia occurred in 82% of the anxious group; hypersomnia was more characteristic of the dysthymic group. On night 1, the anxious group had the poorest sleep efficiency (P less than 0.001), while dysthymics had the highest REM% (P less than 0.05) and shortest REM latency (P less than 0.01). On night 2, differences tended to be minimized, although the number of awakenings was still high (P less than 0.05) in the anxious group, and REM% was highest (P less than 0.01) and REM latency shortest (P less than 0.01) in the dysthymics. These findings suggest that patients with primary anxiety disorders experience greater sleep continuity difficulties on the adaptation night. Despite significant clinical overlap in depressive symptomatology between the two groups, REM% and REM latency appear as sturdy psychophysiological markers in differentiating primary dysthymics and anxious depressives on both nights. These data suggest that distinct anxious depressive and subaffective dysthymic subtypes can be distinguished within the universe of the atypical depressions.

Molecular dosimetry of 7-alkyl- and O6-alkylguanine in DNA by electrochemical detection.

A methodology is described for the quantitation of 7-alkyl- and O6-alkylguanine in DNA isolated from experimental animals exposed to alkylating agents. Following purification, the DNA is hydrolysed under acid conditions after which 7-alkyl- and O6-alkylguanine are separated from unmodified bases by HPLC using a strong cation exchange column. The fractions containing the methylated purines are subsequently analyzed by HPLC using a reverse phase column coupled to an electrochemical detector (amperometric). This method allows the detection of 10-20 fmoles 7-alkyl- and O6-alkylguanine, when pure markers are analyzed. In practice, the detection limit is 0.5 adducts per 10(6) nucleotides for the methylated and 1 adduct per 10(6) nucleotides for the ethylated form of 7-alkyl- and O6-alkylguanine using 25 micrograms DNA.