Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review.

Anxiety is an adaptive emotional response to potentially threatening or dangerous situations; moderated by the sympathetic nervous system. Dental anxiety is common and presents before, during or after dental treatment. The physiological response includes an increase in heart rate, blood pressure, respiratory rate, and cardiac output. Consequently, extensive distress leads to avoidance of dental treatment and multiple failed appointments, impacting both oral and general health. Dental anxiety can generate a variety of negative consequences for both the dentist and the patient. Evidence-based strategies are essential for mitigating and relieving anxiety in the dental clinic. Psychotherapeutic behavioural strategies can modify the patient's experience through a minimally invasive approach with nil or negligible side effects, depending on patient characteristics, anxiety level and clinical situations. These therapies involve muscle relaxation, guided imagery, physiological monitoring, utilizing biofeedback, hypnosis, acupuncture, distraction and desensitization. Pharmacological intervention utilizes either relative analgesia (nitrous oxide), conscious intravenous sedation or oral sedation, which can have undesirable side effects, risks and contraindications. These modalities increase the cost and availability of dental treatment.

RIFM fragrance ingredient safety assessment, hydroxycitronellal dimethyl acetal, CAS Registry Number 141-92-4.

Hydroxycitronellal dimethyl acetal was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog hydroxycitronellal diethyl acetal (CAS # 7779-94-4) show that hydroxycitronellal dimethyl acetal is not expected to be genotoxic. The repeated dose, reproductive, and local respiratory toxicity endpoints were evaluated using the TTC for a Cramer Class I material and the exposure to hydroxycitronellal dimethyl acetal is below the TTC (0.03 mg/kg/day, 0.03 mg/kg/day, and 1.4 mg/day, respectively). Data from hydroxycitronellal dimethyl acetal and from read-across material hydroxycitronellal diethyl acetal (CAS # 7779-94-4) show that there are no safety concerns for skin sensitization under the current declared levels of use. The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; hydroxycitronellal dimethyl acetal is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; hydroxycitronellal dimethyl acetal was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, p-tolyl acetate, CAS Registry Number 140-39-6.

The existing information supports the use of this material as described in this safety assessment. p-Tolyl acetate was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog ethyl p-tolyl carbonate (CAS # 22719-81-9) show that p-tolyl acetate is not expected to be genotoxic. Data on read-across materials p-cresol (CAS # 106-44-5) and acetic acid (CAS # 64-19-7) provide a calculated MOE >100 for the repeated dose and reproductive toxicity endpoints. The skin sensitization endpoint was completed using DST for reactive materials (64 µg/cm2); exposure is below the DST. The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; p-tolyl acetate is not expected to be phototoxic/photoallergenic. The local respiratory toxicity endpoint was evaluated using the TTC for a Cramer Class I material, and the exposure to p-tolyl acetate is below the TTC (1.4 mg/day).The environmental endpoints were evaluated; p-tolyl acetate was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, 4-(p-hydroxyphenyl)-2-butanone, CAS Registry Number 5471-51-2.

The existing information supports the use of this material as described in this safety assessment. 4-(p-Hydroxyphenyl)-2-butanone was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data show that 4-(p-hydroxyphenyl)-2-butanone is not genotoxic. Data on 4-(p-hydroxyphenyl)-2-butanone provide a calculated MOE >100 for the repeated dose toxicity endpoint. The developmental and reproductive toxicity and local respiratory toxicity endpoints were evaluated using the TTC for a Cramer Class I material, and the exposure to 4-(p-hydroxyphenyl)-2-butanone is below the TTC (0.03 mg/kg/day and 1.4 mg/day, respectively). Data from 4-(p-hydroxyphenyl)-2-butanone show that there are no safety concerns for skin sensitization under the current declared levels of use. The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; 4-(p-hydroxyphenyl)-2-butanone is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; 4-(p-hydroxyphenyl)-2-butanone was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, isobutyl alcohol, CAS Registry Number 78-83-1.

The existing information supports the use of this material as described in this safety assessment. Isobutyl alcohol was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data show that isobutyl alcohol is not genotoxic. Data on isobutyl alcohol provide a calculated MOE >100 for the repeated dose toxicity and reproductive toxicity endpoints. Data from read-across material isoamyl alcohol (CAS # 123-51-3) show that there are no safety concerns for isobutyl alcohol for skin sensitization under the current declared levels of use. The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; isobutyl alcohol is not expected to be phototoxic/photoallergenic. The local respiratory toxicity endpoint was evaluated using the TTC for a Cramer Class I material and the exposure to isobutyl alcohol is below the TTC (1.4 mg/day). The environmental endpoints were evaluated; isobutyl alcohol was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, methyl 2-octynoate, CAS Registry Number 111-12-6.

Methyl 2-octynoate was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data show that methyl 2-octynoate is not genotoxic. Data provided methyl 2-octynoate a NESIL of 110 µg/cm2 for the skin sensitization endpoint. The repeated dose, developmental and reproductive, and local respiratory toxicity endpoints were evaluated using the TTC for a Cramer Class II material, and the exposure to methyl 2-octynoate is below the TTC (0.009 mg/kg/day, 0.009 mg/kg/day, and 0.47 mg/day, respectively). The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; methyl 2-octynoate is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; methyl 2-octynoate was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, methyl ionone (mixture of isomers), CAS registry number 1335-46-2.

Methyl ionone (mixture of isomers) was evaluated for genotoxicity, repeated dose toxicity, developmental and reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from methyl ionone (mixture of isomers) show that the material is not genotoxic and provided a NESIL of 70,000 µg/cm2 for the skin sensitization endpoint. Data provided a calculated MOE >100 for the repeated dose toxicity and developmental toxicity endpoints, and data from read-across material (E)-ß-ionone (CAS # 79-77-6) provided a calculated MOE >100 for the reproductive toxicity endpoint. For the local respiratory endpoint, a calculated MOE >100 was provided by the read-across material ß-ionone (CAS # 14901-07-6). The phototoxicity/photoallergenicity endpoints were evaluated based on data and UV spectra; the material is not phototoxic/photoallergenic. The environmental endpoints were evaluated with data from the target chemical and read-across material α-allylionone (CAS # 79-78-7), and the material was not found to be PBT; its risk quotients, based on current volume of use in Europe and North America (PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, methyl 2-nonenoate, CAS Registry Number 111-79-5.

The existing information supports the use of this material as described in this safety assessment. Methyl 2-nonenoate was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog ethyl trans-2,cis-4-decadienoate (CAS # 3025-30-7) show that methyl 2-nonenoate is not expected to be genotoxic. The repeated dose, reproductive, and local respiratory toxicity endpoints were evaluated using the TTC for a Cramer Class I material, and the exposure to methyl 2-nonenoate is below the TTC (0.03 mg/kg/day, 0.03 mg/kg/day, and 1.4 mg/day, respectively). Data from the target and read-across analog isobutyl-2-butenoate (CAS # 589-66-2) do not indicate the material is a sensitizer. The phototoxicity/photoallergenicity endpoints were evaluated based on data and UV spectra; methyl 2-nonenoate is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; methyl 2-nonenoate was found not to be PBT as per the IFRA Environmental Standards, and its risk quotients, based on its current volume of use in Europe and North America (i.e., PEC/PNEC), are <1.

RIFM fragrance ingredient safety assessment, isobutyl propionate, CAS Registry Number 540-42-1.

The existing information supports the use of this material as described in this safety assessment. Isobutyl propionate was evaluated for genotoxicity, repeated dose toxicity, reproductive toxicity, local respiratory toxicity, phototoxicity/photoallergenicity, skin sensitization, and environmental safety. Data from read-across analog isobutyl acetate (CAS # 110-19-0) show that isobutyl propionate is not expected to be genotoxic. Data from read-across analog isoamyl acetate (CAS # 123-92-2) show that there are no safety concerns for isobutyl propionate for skin sensitization under the current declared levels of use. The repeated dose and reproductive endpoints were evaluated using the TTC for a Cramer Class I material, and the exposure to isobutyl propionate is below the TTC (0.03 mg/kg/day and 0.03 mg/kg/day, respectively). For the local respiratory endpoint, a calculated MOE >100 was provided by read-across analog butyl acetate (CAS # 123-86-4). The phototoxicity/photoallergenicity endpoints were evaluated based on UV spectra; isobutyl propionate is not expected to be phototoxic/photoallergenic. The environmental endpoints were evaluated; isobutyl propionate is not PBT as per the IFRA Environmental Standards. For the risk assessment, isobutyl propionate was not able to be risk screened as there were no reported volumes of use for North America or Europe in the 2015 IFRA Survey.

RIFM fragrance ingredient safety assessment, propanal diethyl acetal, CAS registry number 4744-08-5.

There are insufficient toxicity data on the target material propanal diethyl acetal (CAS # 4744-08-5). Hence, in silico evaluation was conducted to determine read-across analogs for this material. Based on structural similarity, reactivity, metabolism data, physical-chemical properties, and expert judgment, analogs acetal (CAS # 105-57-7) and butane, 1,1'-[methylenebis(oxy)]bis- (CAS # 2568-90-3) were identified as read-across materials with sufficient data for toxicological evaluation of genotoxicity.

Associations of obesity with triglycerides and C-reactive protein are attenuated in adults with high red blood cell eicosapentaenoic and docosahexaenoic acids.

BACKGROUND: N-3 fatty acids are associated with favorable, and obesity with unfavorable, concentrations of chronic disease risk biomarkers. OBJECTIVE: We examined whether high eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid intakes, measured as percentages of total red blood cell (RBC) fatty acids, modify associations of obesity with chronic disease risk biomarkers. METHODS: In a cross-sectional study of 330 Yup'ik Eskimos, generalized additive models (GAM) and linear and quadratic regression models were used to examine associations of BMI with biomarkers across RBC EPA and DHA categories. RESULTS: Median (5th-95th percentile) RBC EPA and DHA were 2.6% (0.5-5.9%) and 7.3% (3.3-8.9%), respectively. In regression models, associations of BMI with triglycerides, glucose, insulin, C-reactive protein (CRP) and leptin differed significantly by RBC EPA and DHA. The GAM confirmed regression results for triglycerides and CRP: at low RBC EPA and RBC DHA, the predicted increases in triglycerides and CRP concentrations associated with a BMI increase from 25 to 35 were 99.5±45.3 mg/dl (106%) and 137.8±71.0 mg/dl (156%), respectively, for triglycerides and 1.2±0.7 mg/l (61%) and 0.8±1.0 mg/l (35%), respectively, for CRP. At high RBC EPA and RBC DHA, these predicted increases were 13.9±8.1 mg/dl (23%) and 12.0±12.3 mg/dl (18%), respectively, for triglycerides and 0.5±0.5 mg/l (50%) and -0.5±0.6 mg/l (-34%), respectively, for CRP. CONCLUSIONS: In this population, high RBC EPA and DHA were associated with attenuated dyslipidemia and low-grade systemic inflammation among overweight and obese persons. This may help inform recommendations for n-3 fatty acid intakes in the reduction of obesity-related disease risk.

Use of a commercial probiotic supplement in meat goats.

Sixty-three Boer crossbred goats were used in 5 separate experiments (Exp. 1 to 5) to evaluate the effects of a commercial probiotic supplement on growth performance (Exp. 1 to 4), diet digestibility (Exp. 5), carcass traits (Exp. 3), and fecal bacterial populations (Exp. 4). Goats were either fed a commercially pelleted concentrate diet and supplemented with a commercial probiotic (PRO) that had shown anecdotal positive effects on goat growth and performance according to local goat producers, or they remained as controls. The dose of PRO used was within the labeled dose for sheep for all studies. For Exp. 1, goat BW and feed intake were measured and G:F was calculated every 7 d for 56 d. For Exp. 2 to 4, BW and feed intake were measured and G:F was calculated every 14 d. The first day of supplementation was considered d 0. Carcass traits were also collected at slaughter on d 57 for Exp. 3, and fecal samples were collected every 14 d for microbial culture for Exp. 4. For Exp. 5, which was a digestibility trial that lasted for 10 d, animals were placed in metabolic pens for collection of feces and orts. Growth performance of goats was not affected by probiotic supplementation, with the exception of performance in Exp. 2, in which ADG and G:F were improved (P < 0.03) in PRO goats compared with control goats on d 56 only (treatment x day interaction; P < 0.05), averaging 0.21 +/- 0.02 kg/d for PRO goats and 0.11 +/- 0.02 kg/d for control goats for ADG and 0.17 +/- 0.02 for PRO goats and 0.10 +/- 0.02 for control goats for G:F. Carcass weights and weights of fabricated cuts (shoulder, loin, leg, rack, shank, and total parts) as well as carcass length, leg circumference, loin eye area, and backfat were not influenced by PRO supplementation. Apparent digestibilities of OM, DM, NDF, ADF, CP, and GE (on a DM basis) were similar for the PRO and control treatments. Fecal culture analysis of Escherichia coli and coliforms, Lactobacillus, and Bifidobacterium populations were not influenced by the PRO treatment. Overall, although the PRO treatment affected goat ADG and G:F in Exp. 2, no PRO treatment effects were noted on growth performance for Exp. 1, 3, and 4. Furthermore, the PRO treatment did not affect diet digestibility, carcass traits, or fecal microbial populations in goats. In conclusion, no consistent benefits were noted from supplementing healthy, growing meat goats with PRO.

Ophiopogon root (Radix Ophiopogonis) prevents ultra-structural damage by SO2 in an epithelial injury model for studies of mucociliary transport.

We studied the action of the herb, Ophiopogon root (OR) in a epithelial injury model, hypothesizing that it may have beneficial effects on mucociliary transport following injury to the palate induced by sodium metabisulphite (MB) which releases SO(2) on contact with water. OR (extract from 1g of root/ml)-incubated palates and non-incubated palates were compared to assess the effect of MB on mucociliary clearance on the bull frog palate. MB 10(-1) M, acutely increased mucociliary clearance time (MCT) by 254.5 +/- 57.3% in untreated and 243.3 +/- 98.5% in OR-incubated palates, (over all significance assessed by one-way ANOVA, F = 12.82, p < 0.001, df = 8,54 for MB and F = 10.56, p < 0.001, df = 8,54 for OR). MCT returned to normal during recovery in OR-treated palates following MB. In untreated palates, MCT did not return to control values during a similar recovery period. ANOVA comparing MCTs in the recovery period in untreated vs OR-treated palates was significantly different (F = 2.92, p < 0.03, df = 5,36). SEM images of epithelial tissue, analyzed by morphometry, showed a 25 +/- 12% loss of ciliated cells in untreated palates and little or no damage to cilia in OR-treated palates. Intact groups of ciliated cells were found in SEM micrographs of mucus from MB-treated palates. We conclude that the loss of cilia or ciliated cells prevented full recovery of MCT after MB in untreated palates. In OR-incubated palates, mucociliary transport was completely restored within 20 min after topical application of MB, possibly through a protective action on the extra-cellular matrix.

The increasing prevalence of childhood sickle-cell disease in Ireland.

BACKGROUND: Ireland has been relatively free of sickle-cell disease (SCD) and a care policy for the disease has not been established. AIM: To determine the prevalence of childhood SCD in Ireland and to predict requirements for a comprehensive care and assessment programme. METHODS: We retrospectively analysed the data of children with SCD presenting with sickle-cell crisis to one institution from January 1999 to April 2001. We also determined the nature and severity of the presenting haemoglobinopathy phenotype. RESULTS: Ninety-two patients with haemoglobinopathy have been registered with the Paediatric Haematology Service. The majority are from Nigeria with a smaller number from Angola and the Congo. Sixty have sickle-cell trait, 23 SCD, four haemoglobin SC disease and two haemoglobin E (HbE). There have been 32 sickle-cell crises. The majority were haemolytic or splenic sequestration events with a smaller number of aplastic and vaso-occlusive events and one osteomyelitis. CONCLUSION: The increasing number of children presenting with SCD as a result of the increasing refugee numbers requires a comprehensive care approach similar to that required for paediatric haemophilia to ensure optimum care.

The acute physiological and mood effects of tea and coffee: the role of caffeine level.

The objective of this study was to determine the effect of caffeine level in tea and coffee on acute physiological responses and mood. Randomised full crossover design in subjects after overnight caffeine abstention was studied. In study 1 (n = 17) the caffeine level was manipulated naturalistically by preparing tea and coffee at different strengths (1 or 2 cups equivalent). Caffeine levels were 37.5 and 75 mg in tea, 75 and 150 mg in coffee, with water and no-drink controls. In study 2 (n = 15) caffeine level alone was manipulated (water, decaffeinated tea, plus 0, 25, 50, 100, and 200 mg caffeine). Beverage volume and temperature (55 degrees C) were constant. SBP, DBP, heart rate, skin temperature, skin conductance, and mood were monitored over each 3-h study session. In study 1, tea and coffee produced mild autonomic stimulation and an elevation in mood. There were no effects of tea vs. coffee or caffeine dose, despite a fourfold variation in the latter. Increasing beverage strength was associated with greater increases in DBP and energetic arousal. In study 2, caffeinated beverages increased SBP, DBP, and skin conductance and lowered heart rate and skin temperature compared to water. Significant dose-response relationships to caffeine were seen only for SBP, heart rate, and skin temperature. There were significant effects of caffeine on energetic arousal but no consistent dose-response effects. Caffeinated beverages acutely stimulate the autonomic nervous system and increase alertness. Although caffeine can exert dose-dependent effects on a number of acute autonomic responses, caffeine level is not an important factor. Factors besides caffeine may contribute to these acute effects.

Treatment of psoroptic mange with reference to epidemiology and history.

Treatment methods in the last century involved the use of substances such as sulphur, mercury, hellebore, arsenic, nicotine and others, applied in various ways. The advent of dips in 1843 signalled an advance. However, the biology of the mite, Psoroptes ovis, the epidemiology of sheep scab and the lack of persistence of the acaricides necessitated repeated laborious treatments to ensure success. In 1947 this changed with the use of organo chlorines (OCs) which had up to 3 months residual activity. The use of OCs led to the eradication of psoroptic mange of sheep in USA. Organo phosphates (OPs) were introduced in the late fifties and synthetic pyrethroids (SPs) in the early seventies. In 1985, due to sheep tissue residues, lindane (OC) was withdrawn from the market and this greatly reduced the capacity for effective sheep scab control. Before the arrival of the endectocidal avermectin, ivermectin in 1978 and its successful use as an acaricide in 1992, control of psoroptic mange was limited to plunge dipping. In 1994 moxidectin, a milbemycin, was found to be effective and to have the added benefit of at least 4 weeks persistent activity. Another avermectin doramectin was shown, in 1995, to successfully treat scab and recently an ivermectin bolus has been introduced which has a 100 days' activity and is fully therapeutic and prophylactic. Strict attention to detail in the use of injectable products is essential in order to achieve satisfactory results. Work is progressing on the use insect growth regulators (IGRs) and also on naturally occurring substances such as linalool, neem and lavender oil. At the CVRL Dublin, promising results have been achieved with neem and some IGRs. Other areas of interest are allemones, synergists, microclimate manipulation, sheep breed resistance and vaccines. Successful control depends on epidemiological knowledge, accurate diagnostic techniques, intimate knowledge of the mite's life cycle, its behaviour on and off the host, its macro and molecular biology, the nature of the pathogenesis of the disease, sheep husbandry practices, nutritional and environmental factors; also farmer awareness and attitudes. The variable responses of sheep to the mite, the unpredictable incubation period, course, manifestations and outcome make this an intriguing and perplexing disease. Ways to overcome these problems and to achieve possible eradication are discussed.

Nimodipine for treatment of idiopathic epilepsy in dogs.

OBJECTIVE: To evaluate efficacy and safety of the calcium channel antagonist nimodipine in dogs with idiopathic epilepsy. DESIGN: Prospective clinical trial. ANIMALS: 10 dogs with idiopathic epilepsy. Dogs were included if seizures were inadequately controlled despite treatment with barbiturates and serum phenobarbital concentrations were > 25 micrograms/ml, if dogs had intolerable adverse effects when treated with barbiturates, or if dogs had mild, inadequately treated seizures. PROCEDURES: Dogs were treated with nimodipine (2.5 mg/kg [1.1 mg/lb] of body weight, PO, q 12 h), and other medications were slowly withdrawn. Dogs were monitored for seizure frequency and severity as well as any adverse effects to the medication. RESULTS: Few adverse effects were reported. Seizure control, however, was generally inadequate. All but 2 dogs were withdrawn from the study because of poor seizure control. Plasma nimodipine concentrations were low, with a mean peak concentration of 105.3 ng/ml. CLINICAL IMPLICATIONS: Nimodipine was not successful in controlling seizures in dogs used in this study.