Eating disorder professionals' perceptions of oral health knowledge.

OBJECTIVE: The aim of this study was to assess the oral health knowledge among professionals who specialize in treating eating disorders, and identify to what extent their education, and training addresses oral health care delivery, and recommendations for individuals with eating disorders. METHOD: Participants for this study were licensed behavioural and medical providers specializing in eating disorder treatment (n = 107), and recruited through professional eating disorder organizations. Participants completed an anonymous, online questionnaire (33 items) assessing level of oral health-related education, knowledge and treatment recommendations within the participant's respective eating disorder discipline. RESULTS: The majority of respondents (85%) were formally trained in eating disorders, and of those trained, 64.4% were not satisfied with the level of oral health education during formal education, and 19.5% report no oral health education. Respondents consider their knowledge of risk of oral disease for their clients/patients as average or above (84%), and ranked tooth erosion as the greatest reason for oral care (63%) while dry mouth led in the rankings for least significant reason for oral care (33%). Referral for oral care was found to be more common after reports of complication (55%). DISCUSSION: According to these findings, eating disorder professionals regard oral health care for their clients as significant, and may be unaware of associated oral risk factors, current oral care standards and long-term oral effects of disordered eating apart from enamel erosion.

Oral involvement of recessive dystrophic epidermolysis bullosa inversa.

The inversa subtype of autosomal recessive dystrophic epidermolysis bullosa (EBDR-I) is a rare variant characterized by lesions involving primarily the flexural areas of the body. The purpose of this investigation was to characterize the oral manifestations of this unusual dermatologic condition. Ten individuals having EBDR-I were evaluated and compared with an age and sex-matched population of unaffected individuals that served as controls. The diagnosis of EBDR-I was confirmed by skin biopsy that demonstrated tissue separation below the lamina densa and the clinical presentation of blister formation that typically localized to flexural areas. There was clinical variability in the severity and distribution of skin involvement; however, none of the affected individuals demonstrated pronounced digital webbing, severe generalized blistering or growth retardation characteristic of the Hallopeau-Siemens form of EBDR. Oral involvement was seen in all cases with ankyloglossia, loss of tongue papillae and obliteration of the oral vestibule between the lips and gingiva being typical. The oral opening was significantly reduced in older EBDR-I individuals compared with matched controls, confirming that acquired microstomia is a characteristic of EBDR-I. The teeth were not clinically abnormal or malformed and showed no evidence of generalized enamel hypoplasia. Despite this, the prevalence of dental caries in EBDR-I individuals was significantly higher than the control group. The inversa form of EBDR presents with oral findings that are similar but generally milder than those seen in the Hallopeau-Siemens variant of EBDR.

The mesentery as a laminated vascular bed for hepatocyte transplantation.

The small bowel mesentery provides a unique structure of a large vascularized surface area to support hepatocyte transplantation. Cell-seeded polymeric matrices can be juxtaposed in a relatively atraumatic manner between leaves of mesentery such that adequate exchange of nutrients and diffusion of gases can proceed in the interim while neovascularization occurs. Hepatocytes obtained from (RHA) Wistar rats by collagenase perfusion were seeded onto non-woven filamentous sheets of polyglycolic acid 1 x 3 cm in size and 2 mm thickness to a density of 500,000 cells/cm2. Twenty-six recipient Gunn rats (UDP-glucuronyl transferase deficient) underwent laparotomy. Hepatocyte-ladened polymer sheets were placed between leaves of mesentery. Eight sheets were placed per animal and the leaves were approximated, creating a functional implant 1 x 3 x 2 cm. Biopsies between 5-99 days after implantation revealed neovascularization, moderate inflammatory reaction and the presence of viable hepatocytes in 96% (25/26). Immunoperoxidase studies using anti-albumin antibody substantiated hepatocyte specific function in implants. HPLC profiles of bile from Gunn rats transplanted with hepatocytes from congeneic (RHA) rats demonstrated the presence of bilirubin conjugates. There were no conjugation fractions seen in control gunn rats without hepatocyte transplantation. Although total serum bilirubin did not significantly decrease, conjugated bilirubin was identified in 46% (12/26) animals after transplantation with congeneic hepatocytes. We conclude that the mesentery of the small bowel provides a large vascularized surface for cell transplantation. Large numbers of metabolically active hepatocytes can engraft, vascularize, and show function. The mesentery may be a potential bed for clinical hepatocyte transplantation.

The role of zinc in dental amalgams.

Twenty-five AG-Sn alloys containing various additions of Zn were amalgamated and the amalgams tested for physical properties pertinent to dental restoration use. The mercury retained, dimensional change, compressive strength, and creep were all functions of the Zn content.

Early experience with a new ePTFE vascular prosthesis for hemodialysis.

BACKGROUND: An expanded polytetrafluoroethylene (ePTFE) graft for hemodialysis designed for immediate cannulation was tested. The graft contains a cannulation segment consisting of a stretch ePTFE base tube surrounded by flat and round ePTFE fibers that are secured by a thin, perforated ePTFE cover. This study reports our early experience with this new vascular prosthesis. PATIENTS AND METHODS: Between June 1994 and March 1995, 48 arteriovenous grafts were implanted in 47 patients for whom autogenous fistula construction was impossible. Mean patient age was 57 years (range 37 to 85), 86% of the patients were black, and 60% were men. Twenty-two (46%) grafts were in the forearm, 19 (39%) in the upper arm, and 7 (15%) in the groin. Unassisted and assisted patency rates were calculated by the Kaplan-Meier method. The times of first hemodialysis relative to implantation and the times to hemostasis after first decannulation were recorded. Explanted grafts were histologically evaluated with hematoxylin and eosin and Gram's stains. RESULTS: The unassisted and assisted 6-month patency rate were 42% and 73%, respectively. Five of the first 10 graft were lost to management and technical errors, after which the respective patency rates were 56% and 82%. Eleven of 22 thrombosed grafts were salvaged, 9 with urokinase thrombolysis and 2 with surgical thrombectomy. Twenty-eight grafts were cannulated within 7 days. The time to hemostasis was usually 2 to 4 minutes and always less than 15 minutes. Histologic analysis of a graft explanted at 40 days showed good fibrous incorporation and capillary ingrowth between the cover and round fibers. CONCLUSIONS: This new ePTFE vascular prosthesis can be safely cannulated immediately after implantation, avoiding the morbidity of temporary central venous catheter hemodialysis. After an initial period of familiarization, patency similar to that of other ePTFE arteriovenous grafts was achieved. For patients requiring urgent hemodialysis, this graft is an ideal alternative that allows immediate, safe cannulation.

Development defects of enamel in humans with hereditary epidermolysis bullosa.

Developmental defects of enamel are often reported as a feature of the more severe forms of epidermolysis bullosa (EB). The purpose of this investigation was to determine the prevalence and character of enamel defects in each of the major hereditary EB types. Clinical evaluations were made on 237 individuals representing all of the major EB types and 58 unaffected individuals. All EB cases were categorized by phenotype, mode of inheritance and skin biopsy. The frequency of individuals having developmental enamel defects ranged from 8.6% in recessive dystrophic EB to 100% in junctional EB; 27.5% of the control population had these defects. Generalized hypoplasia characterized by either severe pitting and/or thin enamel was seen in all junctional EB cases but not in any other EB type. There was a tendency for the severe Herlitz form of junctional EB to have thin enamel while non-Herlitz junctional EB cases had less severe pitting and generally no reduction in enamel thickness. The prevalence of individuals with hypoplastic enamel bands was greater in the EB population (9.7%) than controls (1.9%). Thus individuals with simplex and dominant dystrophic EB typically have enamel defects that are similar in frequency and distribution to those of unaffected individuals. Developmental defects of enamel are a consistent feature of junctional EB, although the clinical expression is highly variable.

The effect of the cooling rate of dental alloys on their amalgamation properties.

Silver-tin alloys of various compositions (60-80 atomic % Ag) have been prepared from the melt using cooling rates from about 50 degrees C/hr to about 10(6) degrees C/sec. Structural differences due to the different cooling rates were shown by metallographic and x-ray diffraction techniques. From each composition and cooling rate, powders were then prepared and amalgamated. The amalgams were tested for Hg content, dimensional change during setting, and tensile strength. Changes in cooling rates had some effect on the relative amounts of phases present but primarily affected the grain sizes. In general, the faster the cooling rate, the smaller the grain size; the smaller the grain size, the faster and more uniform the amalgamation; the more uniform the amalgamation, the stronger the amalgam. Storage of the alloy powders at room temperatures slowed their amalgamation rates, destroyed their uniformity,and resulted in weaker amalgams. However, no phase changes were observed by x-ray diffraction in the freshly comminuted alloys after aging at room temperature for two months.

Progress in splat-cooling of dental alloys.

Improved techniques in preparing and sizing dental alloy powders containing Ag, Sn, and Cu have led to amalgams with higher strengths and less spread in dimensional change but very poor shelf life. Since maximum strengths occurred for amalgams containing about 15% more Sn than previously reported, and consequently presumably more of the weak gamma2 phase, the higher strengths are difficult to understand. The poor shelf life may be explained by oxidation of the highly reactive splat-cooled alloy or possibly by the existence of highly reactive metastable phases which transform fairly rapidly to the less reactive equilibrium ones.

Salivary function of persons with hereditary epidermolysis bullosa.

Oral alterations of the hard and/or soft tissues are commonly associated with the different types of epidermolysis bullosa (EB). The relationship of oral soft and hard tissue changes to the disease mechanisms in different EB types remains to be elucidated. The purpose of this investigation was to evaluate selected aspects of salivary function in a healthy control population and in persons affected with different types of EB. Sixty-one patients with EB, representing all the major types of EB, and 36 unaffected persons were examined to measure their stimulated salivary flow rates and salivary levels of IgA, albumin, and total protein. Our results show that none of the types of EB demonstrated a decreased salivary flow rate. However, patients with recessive dystrophic EB had significantly elevated salivary IgA, albumin, and total protein levels. The increased IgA level seen in this form of EB appears most likely to be related to the high prevalence of oral blistering rather than the result of altered mucosal immune function. Despite severe cutaneous and extracutaneous involvement associated with inherited EB, we found no evidence to support the hypothesis of abnormal salivary function or mucosal immunity in this disease. Taken together, these findings suggest that the rampant dental caries seen in the severe forms of EB are likely attributable to nonsalivary factors such as enamel involvement, soft tissue alterations, and/or diet. Alternatively, there may be mucosal immunity or salivary enzyme alterations that influence oral disease in these patients, but these were not evaluated in this investigation.

Splat-cooled alloys in the Ag-Sn-Cu system.

Strength, dimensional change during setting, and corrosion resistance have been measured for amalgams prepared from splat-cooled alloys of different compositions in the Ag-Sn-Cu system. The amalgam with optimum values of these properties was made from the alloy containing 60 at. % Ag, 25 at. % Sn, and 15 at.% Cu. Tensile strengths for amalgams from this alloy were about 8000 psi, dimensional change during setting near zero, and corrosion resistance was good. X-Ray diffraction showed that the gamma1 and gamma2 phases had essentially disappeared after about 24 hr. At the latter time Cu6Sn5 was present.