Effect of supplementing an α-amylase enzyme or a blend of essential oil components on the performance, nutrient digestibility, and nitrogen balance of dairy cows.

Lowering dietary protein content is a promising strategy to reduce N excretions in cattle but it requires improved N utilization by the animal. Feed enzymes (e.g., exogenous α-amylase) and plant extracts (e.g., essential oils [EO]) are 2 additives that may enhance rumen function and possibly also microbial protein yield. This may increase fat- and protein-corrected milk yield (MY) and milk nitrogen efficiency and thus lower N losses from dairy cows. Both types of additives were studied in an experiment including 39 Holstein cows that had (average ± SD) 40.7 ± 7.95 kg/d MY, 89 ± 43 DIM, 2.7 ± 1.5 lactations, and 677 ± 68.6 kg of BW, consisting of a covariate (4 wk) and treatment period (5 wk). During the whole experiment cows were fed a typical Benelux diet (CTRL), supplemented with concentrates to meet individual requirements for energy and MP, which were fulfilled for 100% and 101%, respectively. The total diet was low in CP (15.5%) and relatively high in starch (22.6% and 6.6% rumen bypass starch). Cows were balanced for parity, DIM, MY, and roughage intake and randomly assigned to one of 3 groups, which received the following treatments in the treatment period: (1) CTRL (n = 13); (2) CTRL + 14 g/cow per day Ronozyme RumiStar α-amylase enzyme (AMEZ, n = 13; DSM); and (3) CTRL + 2.5 g/cow per day Crina Protect, a blend of EO components (ESOL, n = 13; DSM). Animal performance, ruminal pH, and enteric gas emissions were monitored throughout the experiment. During the last week of the covariate and treatment periods, nitrogen balances were conducted, total-tract nutrient digestibility was determined, and urinary allantoin and uric acid were determined as indicators for microbial N production. The statistical model applied to these variables contained group and DIM during treatment period as fixed effects and the values from the covariate period as covariate. Post hoc Dunnet-corrected comparisons between each treatment group and the control group were explored. The α-amylase enzyme tended to increase apparent total-tract starch digestibility and increased milk lactose concentration. The EO blend tended to increase MY and increased milk N output, milk nitrogen efficiency, and feed efficiency. Therefore, when feeding reduced dietary protein levels, EO have potential to improve the N-use efficiency in cattle, whereas the α-amylase enzyme might increase starch digestibility and milk lactose. However, additional research is necessary to substantiate our findings.

Effect of supplementing rumen-protected methionine, lysine, and histidine to low-protein diets on the performance and nitrogen balance of dairy cows.

Lowering the dietary protein content can reduce N excretions and NH3 emissions from manure and increase milk N efficiency of dairy cows. However, milk yield (MY) and composition can be compromised due to AA deficiency. Methionine and Lys are known as first limiting EAA for dairy cows, and recently His is also mentioned as limiting, especially in grass-based or low-protein diets. To examine this, a trial was conducted with a 3-wk pre-experimental adaptation period (diet 16.5% crude protein), followed by a depletion period of 4 wk, in which 39 cows (average ± standard deviation: 116 ± 29.3 d in milk, 1.8 ± 1.2 lactations, 638 ± 73.2 kg of body weight, and 32.7 ± 5.75 kg MY/d) received a low-protein diet (CTRL) (14.5% crude protein). Then, taking into account parity, His plasma concentration, and MY, cows were randomly assigned to 1 of 3 treatment groups during the rumen-protected (RP) AA period of 7 wk; (1) CTRL; (2) CTRL + RP-Met + RP-Lys (MetLys); (3) CTRL + RP-Met + RP-Lys + RP-His (MetLysHis). Products were dosed, assuming requirements for digestible (d) Met, dLys, and dHis being, respectively, 2.4%, 7.0%, and 2.4% of intestinal digestible protein. In the cross-back period of 5 wk, all cows received the CTRL diet. During the last week of each period, a N balance was conducted by collecting total urine and spot samples of feces. Total feces production was calculated using the inert marker TiO2. Statistical analysis was performed with a linear mixed model with cow as random effect and data of the last week of the pre-experimental period used as covariate for the animal performance variables. No effect of supplementing RP-Met and RP-Lys nor RP-Met, RP-Lys, and RP-His on feed intake, milk performance, or milk N efficiency was observed. However, the plasma AA profile indicated additional supply of dMet, dLys, and dHis. Nevertheless, evaluation of the AA uptake relative to the cow's requirements showed that most EAA (exclusive Arg and Thr) were limiting over the whole experiment. Only dHis was sufficiently supplemented during the RP-AA period due to an overestimation of the diet's dMet and dLys supply in the beginning of the trial. The numerically increased milk urea N and urinary N excretion when RP-Met, RP-Lys, and RP-His were added to the low-protein diet suggest an increased catabolism of the excess His.

The effect of maize silage type on the performances and methane emission of dairy cattle.

To examine whether type of maize silage is important for milk production performances, maize silage LG30224 (LG) was compared with Falkone (FA), the latter having a 4.0% points lower rumen NDF digestibility and 19 g/kg dry matter (DM) more starch. To bridge the lower energy content of FA, a third treatment was involved by adding maize meal (MM) in a ratio of 92/8 on DM (FA+MM). Maize and grass silage were fed ad libitum in a ratio of 65/35 on DM basis. Concentrates were supplemented individually to meet energy and protein requirements. The experiment was set up as a Latin square with three groups of nine Holstein cows during three periods of 3 weeks. In the last 2 weeks of each period, DM intake (DMI) and milk performances were measured. Each group included one cannulated cow to study effects on rumen fermentation. During the last 4 days of each period, two cows from each group were placed in gas exchange chambers to measure nutrient digestibility and methane production. Total DMI was higher (p < 0.05) for FA+MM (20.8 kg/day) than for FA (20.3 kg/day), while DMI for LG was intermediate (20.6 kg/day). Treatment did not affect milk production nor composition, whereas fat-protein-corrected milk was higher for LG (30.5 kg/day) and FA+MM (30.3 kg/day) than for FA (29.9 kg/day). The ration did not affect pH nor volatile fatty acid composition in the rumen. Further, total tract digestibility of OM, crude protein, NDF and starch did not differ among treatments. The ration with LG gave higher methane production per day and per kg NDF intake than both rations with FA, but the difference was not significant when expressed per kg DMI or FPCM. Thus, maize silage type is of little importance for milk production if energy and physical structure requirements are met.

The effect of supplementing leaves of four tannin-rich plant species with polyethylene glycol on digestibility and zootechnical performance of zebu bulls (Bos indicus).

The effect of supplementing leaves of four tannin-rich plant species with polyethylene glycol 6000 (PEG) on nutrient intake and digestibility as well as on weight gain, feed conversion ratio (FCR) and N retention of zebu bulls (Bos indicus) was studied. Leaves of Albizia gummifera, Grewia ferruginea, Prunus africana and Syzygium guineense, containing, respectively, 85, 55, 76 and 172 g condensed tannins (CT) per kg dry matter (DM), were combined with natural pasture hay in a ratio of 40:60 on DM basis. The four diets were fed both without and with addition of PEG, at a dose of 40 g per kg DM, to eight zebu bulls during trials of 25 days in an 8 × 8 randomized crossover design. Supplementation with PEG increased nutrient intake, digestibility, FCR, N retention and average daily gain (p < 0.01). A diet × PEG interaction was observed for nutrient intake as well as for crude protein, neutral detergent fibre and acid detergent fibre digestibility (p < 0.05), but the effect size of PEG addition could not be attributed to the CT content as such, and also digestibility without PEG was not related to CT content of the diets. The reason why the efficacy of PEG addition did not relate to the CT content pointed the need to evaluate other factors that can help to predict the efficacy of PEG, for example, tannin type or interaction with other nutrients.

Effect of indoor energy restriction level and management on beef production in Belgian Blue double-muscled cow-calf pairs.

One hundred and twenty-six cows were involved to investigate the impact of energy (E) restriction (100%, 90%, 80% and 70% of total energy requirements) during the indoor period and two calf management systems (CMS: suckling or rearing). An E restriction during the indoor period resulted in a loss of body weight, even for E100, which was compensated during the re-alimentation period, but body weight remained lower in suckling than in non-suckling cows. The cows yielded 213 full-term gestations and 8 abortions. Abortion was not affected by E (p = 0.187) or CMS (p = 0.804). Calving interval was neither affected by E (p = 0.775) but tended to be longer in suckled cows (p = 0.087). E reduced body weight and body condition score (BCS) at the end of the calving interval, while CMS only affected BCS. E70 resulted in a higher colostrum yield than E100 and E 90 but immunoglobulin content was not affected (p = 0.759). Cow culling was not affected by E or CMS. It increased from 12.9% to 22.2% and 32.5% for cows with a BCS at parturition lower than 1.5 or between 1.5 and 2.0, or higher than 2 respectively. Calf birth weight was neither affected by E or CMS, but there was an interaction between E and dam age (p = 0.050). Increasing the E restriction tended to reduce calf survival (p = 0.089). Performance of the surviving calves was not affected by E, but suckling calves gained faster than rearing calves (p < 0.001). Beef production by the cow-calf pair was not different between energy levels (p = 0.738), but it was 10.8% lower for E70 than for E100 cows. It is not appropriate to apply an E restriction of more than 10-20% for maximum cow reproductive traits and calf performance.

Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner.

The Council of the European Academy of Craniomandibular Disorders charged the Educational Committee with the task of establishing Guidelines and Recommendations for the examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. It was not their purpose to present a thorough and critical review of the vast amount of literature available but to summarize the at-present generally accepted clinical approach. These recommendations are based as much as possible on scientific evidence and on sound clinical judgment in cases where only partial evidence or contradictory data were found.

Review: Pork production with maximal nitrogen efficiency.

During growth, pigs convert plant protein into animal protein. The major part of the ingested protein is excreted via manure, with potential nitrogen (N) losses to the environment. To limit N losses and increase sustainability of pork production, the efficiency of protein conversion should be maximized. The aim of this paper is to critically evaluate diet and management strategies linked with N efficiency. Besides nutrition, we discuss three management strategies observed in science and in practice to be linked with improved N efficiency: genetic selection, castration and slaughter weight. Because diet has a marked effect on eventual N losses, it must also be taken into account when evaluating management strategies. A reductionist approach, such as feeding the same diet across all management treatments, may overestimate the effect of a management strategy and eventually lead to incorrect conclusions. The amount of excreted N depends on the amount of ingested N, the amount of absorbed N, the amino acid (AA) balance in the diet and the animal's N and AA requirements. Daily multiphase feeding adapted to the individual animal's AA needs is likely to be the most N efficient. For animals housed in groups, phase feeding is necessary. When combined with periods of temporary AA restriction, N efficiency can be further improved. Specific AA consumption must be balanced by applying the ideal protein concept. With better knowledge of the requirements of individual animals and the commercial availability of certain AAs, the total dietary CP level can be lowered within limits. Further research is needed on the minimal CP level that allows maximal performance. For this end a useful parameter may be the ratio of standardized ileal digestible (SID) lysine : apparent total tract digestible CP level. By combining optimal nutrition and management, a whole body N efficiency approaching 60% may be achievable in the near future.

The nutritive value of condensed wheat distillers solubles for cattle.

The chemical composition and the energy and protein value of five batches of condensed distillers solubles (CDS) originating from wheat were determined. The net energy for lactation (NEL) was derived from digestion coefficients obtained with sheep. The true protein digested in the small intestine (DVE) and the rumen degradable protein balance (OEB) were based on the rumen degradation rate (kd D ), the rumen undegradable fraction (U) and intestinal digestibility of undegraded protein (%DVBE) predicted by regression equations derived from a data set of 28 protein feeds with kd D , U and %DVBE determined in situ. The CDS is a by-product with a high, but very variable CP content (238 to 495 g/kg DM). The CP contained on average 81% amino acids, with glutamine as main component (on average 21.8% of CP) and a relatively good lysine proportion (3.0%). Further, CDS contains quite a lot of crude fat (mean±SD: 71±14 g/kg DM), glycerol (95±52 g/kg DM) and sugars (123±24 g/kg DM) resulting in a high organic matter digestibility (88.6±3.0%) and high NEL content (8.3±0.4 MJ/kg DM). The protein value showed a large variation, with DVE ranging from 122 to 244 g/kg DM and OEB from 50 to 204 g/kg DM. Wheat CDS is a rich source of minerals and trace elements with exception of calcium.

Replenishment and nuclear retention of oestradiol-17 beta receptors in rat uteri during postnatal development.

1. Uteri of 6--10-day-old rats do not show a late growth response to oestrogen (increase in rate of DNA synthesis and cell division) exhibited by fully competent (20 days or older) uteri. We posed the question whether the lack of the late growth response is due to an inability to replenish the cytoplasmic pool of oestrogen receptors or to curtailed retention of oestrogen binding in the nucleus. Uterine nuclear and cytoplasmic receptors were measured by a [3H]oestradiol-17 beta exchange assay, at 1, 3, 6, 14 and 24 h after oestrogen injection. 2. The replenishment of cytoplasmic oestrogen receptors showed a similar pattern in the uteri of 6 and 10-day-old (partially responsive) and in 20-day-old (fully responsive) rats. 3. Oestrogen was retained longer in uterine nuclei obtained from 5 and 10-day-old rats than in uterine nuclei of 20 and 25-day-old rats. 4. Oestrogen receptors resistant to 0.4 M KCl extraction (residual receptors) were found in uterine nuclei of 6 and 25-day-old rats after oestrogen injection at all the times tested. The concentration of these residual receptors during the late period (6--24 h after injection) was not significantly different in uterine nuclei of 6-day-old and 25-day-old rats. 5. We conclude that neither lack of oestrogen receptor replenishment nor curtailed retention of oestrogen binding in the nucleus is the factor which limits the complete responsiveness to oestrogen in uteri of rats during postnatal development.

Murine fetal natural killer cells are functionally and structurally distinct from adult natural killer cells.

Natural killer (NK) cell phenotype and activity was studied by analyzing uncultured and short-time-cultured murine NK cells from fetal day 17 spleen and thymus. In contrast to NK cells from adult mice, freshly sorted fetal NK cells did not contain NK receptor transcripts for Ly-49A, B, C/I, D, F, G2, or H. The only NK receptor transcripts that could be detected were Ly-49E and CD94. It is important that Ly-49E was present at a 10- to 30-fold higher level compared with uncultured NK cells from adult mice. After short-time interleukin-2 culture, the level of Ly-49E mRNA was comparable between fetal and adult NK cells. Functionally, fetal NK cells only killed MHC class I-negative tumor cells when activating NK receptors were cross-linked with antibody. We show that fetal NK cells are mature but are different from NK cells in adult mice regarding their NK cell receptor repertoire and function.

A direct non-competitive idiometric enzyme immunoassay for serum oestradiol.

We report a novel non-competitive enzyme immunoassay for oestradiol based on the use of two types of anti-idiotypic antibody that recognize different epitopes within the hypervariable region of the primary anti-oestradiol idiotypic antibody (Ab1). The first anti-idiotype, the betatype, competes with the analyte for an epitope of the primary antibody at the binding site. On the other hand, the second anti-idiotype, the alphatype, binds to the Ab1 in the presence of analyte but does not bind to the betatype/Ab1 complex because of steric hindrance. In the present format the biotinylated alphatype was captured onto anti-biotin IgG which was adsorbed on the surface of microtitre wells. Reaction mixtures containing the Ab1 complexed sequentially with an enzyme labelled second antibody reagent, with oestradiol standards or serum samples and with the betatype anti-idiotypic antibody were then allowed to react with the immobilized alphatype anti-idiotypic antibody. The enzyme activity of the bound fraction measured at 405 nm increased with increasing oestradiol concentrations over the range 0.06-2.5 ng/ml. The detection limit of the assay was 28 pg/ml. The intra-assay variation ranged from 3.5 to 12.4%, and inter-assay variation from 6 to 13.4%. The results obtained by the colorimetric idiometric immunoassay correlated well with those obtained by a direct radioimmunoassay (n = 85, r = 0.97). This non-competitive immunoassay, termed idiometric assay, for haptens permits the development of sensitive immunoassays with a wide working range, and a variety of end-point determinations depending on the label used (e.g., enzyme, chemiluminescent or fluorogenic compound).

Correlation between peripheral CA-125 levels and ovarian activity.

Serum CA-125 concentrations were measured at three different times in normal cycles, pill-suppressed cycles, and cycles stimulated for intrauterine insemination (IUI) or oocyte retrieval, i.e., (1) during the first half of the cycle, (2) at midcycle or at the moment of oocyte retrieval, and (3) the second half of the cycle. Significant variations of serum CA-125 concentrations were not seen during the cycle in normally cycling women or in women taking oral contraceptives: mean +/- SD 28.9 +/- 13.3 U/mL and 26.9 +/- 11.3 U/mL, respectively. In patients stimulated for in vitro fertilization, luteal phase CA-125 levels (60.6 +/- 38 U/mL) were significantly higher than during stimulation (21.5 +/- 5.9 U/mL) or at oocyte retrieval (19.6 +/- 6.4 U/mL). In stimulated cycles for IUI, without laparoscopy or follicular puncture, a comparable rise of CA-125 was observed in the luteal phase (49.6 +/- 37.8 U/mL). However, in patients undergoing laparoscopic sterilization, serum CA-125 concentrations before and after laparoscopy were not significantly different (22.8 +/- 6.3 U/mL and 25 +/- 4.2 U/mL, respectively).

Ovulation stigma and concentration of progesterone and estradiol in peritoneal fluid: relation with fertility and endometriosis.

The relationship between the presence or absence of an ovulation stigma and (1) the fertility status, (2) the incidence of endometriosis, (3) the concentration of progesterone and estradiol in the peritoneal fluid, and (4) the blood levels of luteinizing hormone, follicle-stimulating hormone, progesterone, and estradiol in 21 fertile and 45 infertile patients who underwent a laparoscopy in the early (n = 48) or late luteal phase (n = 18) was investigated. An ovulation stigma was observed in about half of the patients, irrespective of their fertility status (past and subsequent), the presence of endometriosis, or the time of the luteal phase. Progesterone and estradiol concentrations in the peritoneal fluid were highest in the early luteal phase, but they were not correlated with the presence or absence of an ovulation stigma. No significant differences were observed in peripheral hormone levels between women with and those without an ovulation stigma nor between women with high or low concentrations of progesterone in the peritoneal fluid. From the data, it is concluded that hormone assays are of no aid in the diagnosis of the luteinized unruptured follicle syndrome and that the absence of an ovulation stigma on laparoscopic examination cannot be equated with the luteinized unruptured follicle syndrome.

The measurement of progesterone in serum by a non-competitive idiometric assay.

A novel non-competitive idiometric time-resolved fluoroimmunoassay for the determination of serum progesterone was developed, based on the use of two types of anti-idiotypic antibody that recognize different epitopes within the hypervariable region of the primary antiprogesterone antibody. The first anti-idiotype, the betatype, competes with progesterone for an epitope of the primary antiprogesterone antibody at the binding site. The second anti-idiotype, the alphatype, binds to the antiprogesterone antibody in the presence of progesterone, but does not bind to the betatype antiprogesterone complex due to epitope proximity. In the present configuration, the biotinylated alphatype was captured onto anti-biotin IgG which was immobilized on microtiter wells. Reaction mixtures containing europium-labeled antiprogesterone antibody complexed sequentially with progesterone in standards or serum samples and with the betatype anti-idiotypic antibody were then reacted with the immobilized alphatype anti-idiotypic antibody. After 30 min of incubation, the fluorescence of europium is measured by time-resolved fluorescence and is proportional to the concentration of progesterone over the range 0-320 nmol/mL. The method demonstrates good sensitivity, precision, and comparability with a direct competitive radioimmunoassay. The idiometric assay for progesterone is suitable for dipstick technology and biosensors.

Bacterial invasion in root cementum and radicular dentin of periodontally diseased teeth in humans. A reservoir of periodontopathic bacteria.

In this study the viability and the distribution of bacteria within the radicular dentin and pulp of periodontally diseased caries-free teeth were studied. Healthy teeth served as controls. Samples were obtained from the pulp tissue and from the radicular dentin. Dentin samples were taken from the interdental surfaces in the subgingival area. Starting from the pulpal side, three to five successive dentin layers of approximately 1 mm thickness were sampled. The samples were processed and cultured using an anaerobic technique. Bacterial growth was detected in 87% of the periodontally diseased teeth. In 83% of the teeth, bacteria were present in at least one of the dentin layers. Fifty-nine percent of the diseased teeth, from which the pulp tissue was cultured, contained bacteria in the pulp samples. The mean bacterial concentrations in the pulp and dentin layers ranged from 1,399 to 16,537 colony-forming units (CFU) per mg of tissue. These concentrations were 259 to 7,190 times greater than concentrations found in healthy teeth. It is suggested that the roots of periodontally diseased teeth could act as bacterial reservoirs from which recolonization of mechanically treated root surfaces can occur, as well as infection of the dental pulp. These findings might change current concepts concerning root surface debridement in periodontal therapy.

Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth.

In this study the bacterial invasion in root cementum and radicular dentin of periodontally diseased, caries-free human teeth was examined. In addition, structural changes in these tissues, which could be related to the bacterial invasion, were reported. Twenty-one caries-free human teeth with extensive periodontal attachment loss were studied by light and scanning electron microscopy. At the base of the gingival pocket, bacteria were found in the spaces between remnants of Sharpey's fibers and their point of insertion in the cementum. In teeth that had been scaled and root planed, most of the root cementum had been removed. Bacterial invasion was found in the remaining root cementum. The invasion seemed to start as a localized process, often involving only one bacterium. In other areas bacteria were present in lacunar defects in the cementum. These lacunae extended into the radicular dentin. In 11 teeth bacteria had invaded the dentinal tubules. Most bacteria were located in the outer 300 microns of the dentinal tubules, although occasionally they were found in deeper parts. In two of the nontreated teeth, bacteria were detected on the pulpal wall. No correlation was found between the presence of bacterial invasion and the absence of radicular cementum. No bacteria were found in the portion of the root located apically to the epithelial attachment. These data are in agreement with our results from cultural studies of the bacterial flora in these structures. It was also demonstrated that in spite of meticulous scaling and root planning and personal oral hygiene, bacterial plaque remained present on radicular surfaces. Both the invaded dentinal tubules and the lacunae could act as bacterial reservoirs from which recolonization of treated root surfaces occurs. From these reservoirs bacteria could also induce pulpal pathoses. Since these bacterial reservoirs are not eliminated by conventional mechanical periodontal treatment, it seems appropriate to combine mechanical periodontal therapy with the use of chemotherapeutic agents.

Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study.

The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis. Two groups were compared; one received the test minocycline ointment and the other a vehicle control. Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks. Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding. These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12. Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Subgingival minocycline ointment resulted in statistically significantly greater reduction of P. gingivalis at weeks 2, 4, 6, and 12; P. intermedia at weeks 2, 4, 6, and 12; and A. actinomycetemcomitans at weeks 6 and 12. Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment. Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Reasons that patients do not return for appointments in the initial phase of treatment of temporomandibular disorders.

Patients suffering form pain and dysfunction in the temporomandibular region sometimes ignore appointments after the initial examination. This from of noncompliance is well known and is often studied in patients suffering from recurrent headaches, arthritis, and lower back pain. Information on patients with temporomandibular disorders (TMD) who fail to attend the next visits and do not comply with the proposed treatment is scare. To 61 patients (aged 20 to 40 years) who did not attend the next visit after an initial examination and after discussing the treatment protocol, a questionnaire was mailed 6 months to 1 year after the first visit. The questions related to reasons for not attending and the possible treatment received. Some questions were also related to the present TMD state. The clinical profiles of the nonattenders were compared to those of a group of 400 TMD patients who did finish the proposed treatment (positive control). The nonattenders had more pain and dysfunction at initial examination than did the treated patients. The treated patients reported a shorter duration of symptoms before seeking treatment than did the nonattenders suggesting that the latter group had a more chronic pain state. The main reason for not returning was that symptoms improved enough or disappeared completely and spontaneously without the proposed treatment. Sixteen patients did not return for further treatment for reasons linked to the dentist-patient relationship. Fifty-seven percent of the nonattenders reported to be symptom free or sufficiently improved. One year after the initial examination and without the proposed treatment, most still had some symptoms such as clicking (59%) and reduced mouth opening (21%), but only 24% reported to be in need of treatment.

Longitudinal study of functional conditions in the masticatory system in Flemish children.

A 5-yr longitudinal study on occlusal and functional parameters has been made in 75 children aged 8-11. They were selected at random from an original group of 510 studied 5 yr earlier. The following parameters were measured: frequency of frontal open bite lateral and frontal crossbite, the attrition on molars and on front teeth, the contacts on lateral excursion, pain on condyle palpation, TMJ clicking, deviations in the opening and lateral movement, and the maximal interincisal distance. There was an increase in the percentage of deep bite and crossbite. Attrition on molars was seen in 41% and on front teeth in 13% of the children. No real pattern could be observed as a function of age. The mean maximal opening range was 43.7 mm, varying between 23 and 52 mm. Restricted opening was found in one girl. In 60% a deviation in the opening has been found. In 26% TMJ sounds were observed and 28% had pain on condyle palpation. In most of the children the symptoms were very mild to moderate. No significant correlation could be found between dysfunctional signs and occlusal parameters. The present results did not provide any conclusive answer to the tremendous increase in dysfunctional signs over this 5-yr period. The treatment need is, however, low and should not be overestimated.

Epidemiologic survey of functional conditions of the masticatory system in Belgian children aged 3-6 years.

In this epidemiologic survey 510 children aged 3-6 yr were investigated. Several occlusal and functional parameters were measured: the maximal interincisal distance, the frequency of lateral and frontal crossbite, open bite, the number of tooth contacts on lateral excursions of 3 mm, the wear facets, deviations in opening, pain in muscles and in the TM-joints, TMJ sounds, parafunctional habits. The interincisal distance varied between 25 and 55 mm. This distance increased with age. Only five children had a hypermobility of the mandible (opening more than 55 mm) and 11 a restricted opening movement (less than 30 mm). 7.2% showed a lateral crossbite on the right, and 8.9% on the left, side. The percentage of an open bite decreased with age from 66.7% in the 3-yr-olds to 20.0% in the 6-yr-olds. 33% of the children had only one contact on the working side. As reported by the parents 7.7% had regularly bruxism but 21.8% showed wear facets on the molars and 40.7% on the front teeth. Only in three girls were the TMJ painful to palpation. Dysfunction only occurred in 3.5% of the sample.