An assessment of nutritional information in oral health education leaflets.

INTRODUCTION: Dental caries prevalence in UK children remains high and obesity, closely linked to Type 2 diabetes, is rising. Literature suggests that dentists may not give dietary advice due to a lack of clear and consistent guidelines. OBJECTIVE: The aim of the study was to determine whether oral health education leaflets with a food and nutritional focus conform to existing UK national nutritional guidelines from the Department of Health (DoH), the Food Standards Agency (FSA) and the Committee on Medical Aspects of Food and Nutrition Policy (COMA). METHOD: A sample of 30 information leaflets, aimed at parents and children aged 3-16 years, was sourced during the winter of 2005-2006. A qualitative content analysis was carried out to identify key recommendations on type, frequency and quantity of food and drink and general diet-related health advice. RESULTS: Most leaflets (21) promoted milk and water in agreement with nutritional guidelines. Timing of sugary food and drink to mealtimes (25) and decreasing frequency of 'sugary' e.g. non-milk extrinsic (NME) sugar containing foods (22) and drinks (25) reflected guidelines. Inconsistencies were, however, recorded in the leaflets. Five leaflets advised that frequency of consumption rather than the amount of sugary food or drink was important for oral health. This conflicts with nutritional guidelines, aimed at tackling obesity, to decrease both amount and frequency. There was conflicting advice on healthy snacks. Crisps were presented as 'healthy' by two leaflets; another two advised against snacking on dried fruit, conflicting with FSA guidelines that dried fruit contributes to "5 a day". Sixteen leaflets promoted cheese as 'healthy' with no limits on portion size; this could conflict with nutritional guidelines associated with percentage energy contribution of saturated fat to the diet. CONCLUSION: While there was agreement between leaflet content and nutritional guidelines, there were inconsistencies. Dental professionals should acknowledge these when selecting leaflets for lay dissemination.

Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?

INTRODUCTION: Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way. MATERIALS AND METHODS: Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures. RESULTS: Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation. DISCUSSION: The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry. CONCLUSION: Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education.

Dermatitis artefacta of the lip in an adolescent.

UNLABELLED: Self-inflicted trauma is found in several patient groups including those with learning and developmental delay, the very young and those suffering from psychiatric disturbance. The diagnosis of artefactual disease can only be made when all possible organic disease has been excluded by specific investigations. The case presented is that of a 15-year-old girl complaining of persistent bleeding and crusting of her lips. Investigations provided no real information as to the cause of the allegedly spontaneous bleeding. The diagnosis of artefactual disease was finally decided upon and a referral to a child and adolescent psychiatrist made. CLINICAL RELEVANCE: Patients with unusual clinical signs may be examined regularly by their GDP. This case clearly illustrates the importance of considering a psychological disorder and referral in the differential diagnosis of conditions appearing with unusual clinical signs.

The effects of cerulenin on lipid metabolism in vitro in cellular preparations from the rat.

The effects of the fatty acid-like antibiotic, cerulenin, on fatty acid biosynthesis in preparations of rat adipocytes and mammary cells in vitro have been investigated. Synthesis of palmitic acid was most strongly inhibited, although the magnitude of the effect was dependent on the nature of the tissue, and was especially diminished in the larger adipocytes from older rats. Cerulenin had no effect on the chain-elongation of preformed fatty acids in any of the tissues studied. Some inhibition of the esterification of preformed palmitic acid was also observed, but this appeared to be due to disruption of the cells rather than direct inhibition of the acyltransferases. It is concluded that cerulenin is a valuable experimental tool in studies of lipogenesis in preparations of intact mammalian cells in vitro.

Delayed circulatory failure due to the induction of nitric oxide synthase by lipoteichoic acid from Staphylococcus aureus in anaesthetized rats.

1. This study investigates the effect of lipoteichoic acid (LTA) from the cell wall of Staphylococcus aureus, a micro-organism without endotoxin, on haemodynamics and induction of nitric oxide synthase (iNOS) in the anaesthetized rat. 2. Intravenous injection of LTA (10 mg kg-1) resulted in a decrease in blood pressure from 123 +/- 1 mmHg to 83 +/- 7 mmHg after 270 min (P < 0.001) and a reduction of the pressor response to noradrenaline (1 microgram kg-1) from 33 +/- 1 mmHg.min to 23 +/- 3 mmHg.min after 270 min (P < 0.05). 3. The delayed circulatory failure (hypotension and vascular hyporeactivity) caused by LTA was prevented by pretreatment of rats with dexamethasone (10 mg kg-1, 60 min prior to LTA) or the nitric oxide synthase inhibitor NG-monomethyl-L-arginine (L-NMMA, 10 mg kg-1 h-1, i.v. infusion starting 30 min prior to LTA). 4. In contrast, treatment of rats with polymyxin B (0.05 mg kg-1), an agent which binds endotoxin (lipopolysaccharides, LPS), did not affect the delayed circulatory failure caused by LTA. Polymyxin B, however, attenuated the hypotension and vascular hyporeactivity to noradrenaline afforded by endotoxaemia (2 mg kg-1 LPS, i.v.) for 270 min. 5. The delayed circulatory failure caused by LTA was associated with a time-dependent increase in (i) the expression of iNOS protein in the lung (Western blot analysis), and (ii) iNOS activity. This increase in iNOS protein and activity was prevented by pretreatment of LTA-rats with dexamethasone (10 mg kg-1). 6. Intravenous injection of LTA resulted in an increase in serum tumour necrosis factor (TNF)-alpha(maximum at 90 min after LTA), which was attenuated by pretreatment of rats with dexamethasone(10 mg kg-1, 60 min prior to LTA). The magnitude of the rise in TNF-alpha caused by LTA was similar to the one elicited by LPS (10mgkg-', i.v.).7. Thus, an enhanced formation of nitric oxide following the induction of iNOS contributes importantly to the delayed vascular failure (hypotension and vascular hyporeactivity) caused by LTA in the anaesthetized rat. We suggest that the endogenous release of TNF-alpha contributes to the induction ofiNOS caused by LTA in vivo.

Forest fragmentation and avian nest predation in forested landscapes.

The size of forest fragments, the use of land bordering fragments, and the distance of nests from an edge all affect the frequency of predation upon bird nests in Maine (USA), an area where the forest has been fragmented by roads, but not significantly reduced in area. We placed artificial nests containing quail eggs in forests of different sizes and at various distances from the edge to test which of these factors was most important in describing predation. Predation was greatest in small tracts surrounded completely by land. Large areas and those bordered on at least one side by a large water body had lower predation rates. This suggests that influx of predators from nearby habitats may be responsible for much of the nest predation in forest fragments.

A study of the association of fraenal attachment, lip coverage, and vestibular depth with plaque and gingivitis.

The effects of fraenal attachment, upper lip coverage, and mandibular vestibular depth on plaque and bleeding indices in the maxillary and mandibular anterior segments were studied in a group of 1015 school children aged 11.5 to 12.5 years. The position of the mandibular labial fraenum was relatively unimportant to plaque and mandibular gingivitis, but anterior fraenal attachment in the maxilla appeared to affect the retention of plaque and the degree of gingivitis. Maxillary and mandibular plaque and bleeding scores increased with decreasing upper lip coverage at rest. In the mandibular anterior segment, plaque and bleeding indices decreased with increasing vestibular depth. Further analysis demonstrated that fraenal attachment and vestibular depth and fraenal attachment and lip coverage were significantly associated. However, two-way analysis of variance indicated that the influence of fraenal attachment, vestibular depth, and lip coverage on plaque and gingivitis was independent. The influences of these soft tissue variables on plaque accumulation and gingivitis were of small clinical significance and not in themselves a justification for mucogingival surgery.

Effect of diet on the composition of cholesteryl esters of sheep adrenals.

Fatty acid components of cholesteryl esters from the adrenals of sheep, like those of nonruminants, were characterized by significant amounts of the longer chain metabolites of linoleic acid. Administration to sheep of diets rich in linoleic acid and protected against biohydrogenation did not alter the concentration of these components significantly. Although 18:2 levels were elevated, this was largely at the expense of cis-monoenoic fatty acids.

Erosion of deciduous and permanent dental hard tissue in the oral environment.

OBJECTIVES: The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of a single low pH orange drink for 15days; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of the product 2 versus 4 times per day for 15days. METHODS: Sixteen healthy volunteers participated in a single centre, single blind, 2-phase crossover study, conducted according to Good Clinical Practice, and employing the validated model described by West and co-workers (Journal of Dentistry 1998; 26:329-335). RESULTS: In all tissues, erosion was progressive over time, the pattern being more linear in enamel than in dentine. In general, erosion of deciduous enamel was greater than that of permanent enamel, though this difference was significant only for those specimens exposed to 4 drinks per day. Conversely, erosion of dentine was generally greater in the permanent tissue, though differences rarely reached conventional levels of statistical significance. Increasing frequency of consumption resulted in increased loss of tissue, but this difference was neither proportional nor consistently statistically significant. CONCLUSIONS: It is concluded that statistically significant differences in susceptibility of deciduous and permanent enamel to erosion appear to emerge over time and with increasing frequency of consumption. This is of importance clinically given the reduced dimensions of the deciduous dentition and the element of 'abuse' of soft drinks by the child population. Further development of soft drinks with low erosive potential is recommended.

Relative susceptibility of deciduous and permanent dental hard tissues to erosion by a low pH fruit drink in vitro.

OBJECTIVES: The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following 15days' exposure to a single low pH orange drink; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following exposure to the product 2 versus 4 times per day for 15days. METHODS: This in vitro study employed the validated methodology described by West and co-workers [Journal of Dentistry, 1998;26:329-335.] RESULTS: In all four tissues, erosion was progressive over time, though this pattern was more linear in enamel than in dentine. In general, erosion of enamel was greater in the deciduous tissue, while erosion of dentine was greater in the permanent tissue. However, these differences were rarely of statistical significance. Increasing frequency of exposure resulted in a non-proportional increase in tissue loss. CONCLUSIONS: Differences in susceptibility of deciduous and permanent tissues to erosion by a low pH drink in vitro appear to exist, though these may not be of statistical significance. Care may be indicated in the delivery of dietary advice, since reduced frequency of exposure to a low pH drink does not appear to result in a proportional reduction in tissue loss.

Development of low erosive carbonated fruit drinks. 1. Evaluation of two experimental orange drinks in vitro and in situ.

OBJECTIVES: To determine the in vitro erosive potential and in situ erosive effect of two new formulation low calorie carbonated orange drinks with that of two conventional diet products and water. METHODS: In the in vitro study, six specimens of deciduous and permanent enamel were randomly allocated to each of the five products and a '4h' protocol employed. In the in situ study, 15 healthy volunteers participated in a single centre, single blind, 5-phase crossover study, conducted according to Good Clinical Practice, and employing a validated model. RESULTS: The in vitro erosive potential of the experimental formulations was less than that of the comparators at all time points. Conversely, the observed erosive potential of both experimental formulations was greater than that of the control. Consistent statistically significant differences were found in relation to permanent enamel only. Unfortunately, the in situ study did not produce results entirely consistent with those of the in vitro study. Notably, a generally progressive loss of enamel was observed in specimens exposed to the control. CONCLUSIONS: The data from the in vitro study show the experimental formulations to have low comparative erosivity. However, the methodologies in vitro and in situ somewhat unusually do not correlate in ranking the erosivity of drinks. The results of this study should therefore be viewed with caution, further research being clearly warranted.

The current status of dental health education in the training of midwives and health visitors.

In some areas of the United Kingdom, the dental health of young children is deteriorating, with levels of disease reverting to those of ten years ago. The recent enquiry into the education and training of personnel auxiliary to dentistry recognised that other health care staff working in primary care have an important role to play in the education of parents with young children and should be trained accordingly. This study sought to investigate, by questionnaire survey, the current status of dental health in the education of midwives and health visitors. It was found that the majority of courses in health visiting but only two-thirds of those in midwifery now include dental health in their curricula. The use of inappropriately qualified tutors may place these professionals at a disadvantage in providing advice on the prevention of oral disease to parents and prospective parents.

A longitudinal study of the condition of first permanent molars in a group of adolescents with special reference to elective orthodontic tooth extraction.

The aim of this study was to investigate changes in the condition of first permanent molars over the teenage years, with special reference to adolescents who lost premolar teeth for orthodontic purposes. A total of 453 South Wales schoolchildren (219 males and 234 females) were examined at the ages of 11-12 and 19-20 years. At 11-12 years, 89.6 per cent of the cohort had all four first permanent molars, while 3.3 per cent had already lost these teeth. Of those first permanent molars present, 61.7 per cent had some caries experience. At age 19-20, 80.6 per cent of subjects retained four first permanent molars while 4.4 per cent had none. Of the first permanent molars present, 80.6 per cent had been affected by caries. In 60 per cent of the 186 subjects (75 males and 111 females) who had lost premolar teeth in the course of orthodontic treatment, a sound premolar was extracted in preference to a first permanent molar which already had evidence of dental disease. At age 19-20 years, the majority of the first permanent molars were restored and otherwise sound, though a small number which had been restored at age 11-12 years had been lost due to caries.

The effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque, gingivitis and pocketing in adolescents: a longitudinal cohort study.

Reported toothbrushing frequency and the effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque and periodontal disease in a group of 720 adolescents examined at age 11-12 years and again at 15-16 years is presented. At 11-12 years, the mean toothbrushing frequency was 11.5 times per week. By age 15-16 years, it had risen to 13.3 times per week. Children from social class I were less likely to brush once per day or less and more likely to brush twice daily than those from social class V. At both examinations, consistently low negative correlations were seen between reported toothbrushing frequency and the mean scores for buccal and lingual plaque, buccal, mesial and total bleeding. Few significant differences were seen between left- and right-handed toothbrushers at age 11-12 years. These were almost entirely due to differences between the boys. By age 15-16 years, no significant differences existed between the two groups. At both examinations, the boys had higher plaque, bleeding and pocketing scores than did the girls. At 15-16 years of age, all social classes exhibited lower mean total pocketing scores than at age 11-12 years. At 11-12 years of age, the social class differences were mainly contributed by the girls, while at re-examination plaque and bleeding scores for both sexes showed an overall trend to increase from social class I through to social class V. At 11-12 years of age, the boys showed a trend for pocketing to increase from social class I through to social class V. This was absent at 15-16 years of age. The girls showed no such trend at 11-12, but it had emerged by age 15-16. The results again demonstrate the influence of social class and sex rather than toothbrushing frequency and handedness on oral hygiene and gingival health. However, in view of the high number of statistical tests employed, some caution must be exercised in the interpretation of differences significant at the 5 per cent level.

Can tooth brushing damage your health? Effects on oral and dental tissues.

Circumstantial evidence based on anecdote, case reports, epidemiological data and studies in vitro and in situ implicate tooth brushing with toothpaste with tooth wear, gingival recession and dentine hypersensitivity. This review attempts to assess the clinical significance of the potential harm produced by this most common oral hygiene habit. The toothbrush alone appears to have no effect on enamel and very little on dentine. Most toothpaste also has very little effect on enamel and in normal use would not cause significant wear of dentine in a lifetime of use. Wear of enamel and dentine can be dramatically increased if tooth brushing follows an erosive challenge. Gingival recession has a multi-factorial aetiology and certain individuals and specific teeth may be predisposed to trauma from tooth brushing. Tooth brushing is known to cause gingival abrasions but how these relate to gingival recession is not known. The role of toothpaste in gingival abrasion and recession surprisingly has received little if any attention. Gingival recession most commonly exposes dentine and localises sites for dentine hypersensitivity. Some toothpaste products can expose dentinal tubules but erosion is probably the more dominant factor in dentine hypersensitivity. There is no evidence to indicate that electric and manual toothbrushes differ in effects on soft and hard tissues. It is only under, over or abusive use or when combined with erosion that significant harm may be thus caused. In normal use it must be concluded that the benefits of tooth brushing far out-way the potential harm.

Acute idiopathic thrombocytopaenic purpura in childhood: report of a case presenting in general dental practice.

Acute idiopathic thrombocytopaenic purpura is the most common of the thrombocytopaenias of childhood. Clinically it is associated with petechiae, mucocutaneous bleeding and occasionally haemorrhage into tissues. The oral mucosa is frequently involved. This paper describes a case presenting in general dental practice.

A computerised method of monitoring and assessing undergraduate clinical activity.

This article describes the development and use of an electronic data acquisition system for monitoring and assessing the clinical activity of undergraduate dental students. The advantages of such a system over a paper-based one is that it can generate reports quickly and easily, showing the variety of clinical experience gained by the undergraduates and an assessment of the level of skill displayed. It also relieves academic staff of the tedious, repetitive task of collecting and collating data by hand.

Management of conical midline supernumerary teeth in a young child.

The authors report a case of a young patient with conical midline supernumerary teeth. In cases where such supernumeraries are likely to erupt, early surgical intervention, often necessitating the administration of a general anaesthetic, should be avoided if possible. Extraction under local anaesthesia on eruption was preferred for this patient, and resulted in the normal eruption of the permanent central incisors.

A comparison of the nutritional knowledge of dental, dietetic and nutrition students.

Conflicts in dietary messages remain widespread. Such conflicts can have negative effects on the behaviour, motivation and attitudes of individuals. Inconsistencies in dietary advice may be linked to inadequate training of professionals. Literature suggests that the nutrition training of dentists and oral health training of dietitians and nutritionists is limited. This study was designed to provide information on the nutritional knowledge of dental, dietetic and nutrition students and how this conforms to national nutritional guidelines, identifying differences between professional groups and conflicts in undergraduate training. Self-administered questionnaires were completed by 124 dental, dietetic and nutrition students at Cardiff University and the University of Wales Institute, Cardiff (UWIC). Significant inter-group differences (p <0.05) were observed in relation to recommendations concerning the between-mealtime consumption of a wide range of snacks and drinks. Dental students were mainly concerned with oral health problems (for example, acid erosion), while dietetic and nutrition students were mainly concerned with general health problems (for example, obesity). Just over a third of dental students felt that they had received sufficient training in the dietary management of patients. In conclusion, a common risk-factor approach and consistent nutrition guidelines are essential to improve health. In addition, recommendations should be made to incorporate oral health into the training of nutritionists and general health into the training of dentists.