Comparison between two different local hemostatic methods for dental extractions in patients on dual antiplatelet therapy: a within-person, single-blind, randomized study.

BACKGROUND: Dual antiplatelet therapy (DAPT) provides additional risk reduction of ischemic events compared to aspirin monotherapy, at cost of higher bleeding risk. There are few data comparing new techniques for reducing bleeding after dental extractions in these patients. PURPOSE: This study investigated the effectiveness of the HemCon Dental Dressing (HDD) compared to oxidized cellulose gauze. MATERIALS AND METHODS: This randomized study included 60 patients on DAPT who required at least two dental extractions (120 procedures). Each surgical site was randomized to HDD or oxidized regenerated cellulose gauze as the local hemostatic method. Intra-oral bleeding time was measured immediately after the dental extraction and represents our main endpoint for comparison of both hemostatic agents. Prolonged bleeding, platelet reactivity measured by Multiplate Analyser (ADPtest and ASPItest) and tissue healing comparison after 7 days were also investigated. RESULTS: Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes, P=0.001). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%), P=0.03]. There was poor correlation between platelet reactivity and intra-oral bleeding time. CONCLUSIONS: In patients on DAPT, HDD resulted in a lower intra-oral bleeding time compared to oxidized cellulose gauze after dental extractions. Moreover, HDD also seems to improve healing conditions.

Liver-directed drugs for transthyretin-mediated amyloidosis.

Transthyretin-mediated amyloidosis (ATTR) is a rare, under-recognized, progressively debilitating, fatal disease caused by the aggregation and extracellular deposition of amyloid transthyretin (TTR) fibrils in multiple organs and tissues throughout the body. TTR is predominantly synthesized by the liver and normally circulates as a homotetramer, while misfolded monomers aggregate to form amyloid fibrils. One strategy to treat ATTR amyloidosis is to reduce the amount of TTR produced by the liver using drugs that directly target the TTR mRNA or gene. This narrative review focuses on how TTR gene silencing tools act to reduce TTR production, describing strategies for improved targeted delivery of these agents to hepatocytes where TTR is preferentially expressed. Antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), termed RNA silencers, cause selective degradation of TTR mRNA, while a TTR gene editing tool reduces TTR expression by introducing nonsense mutations into the TTR gene. Two strategies to facilitate tissue-specific delivery of these nucleic acid-based drugs employ endogenous receptors expressed by hepatocytes. Lipid nanoparticles (LNPs) that recruit apolipoprotein E support low-density lipoprotein receptor-mediated uptake of unconjugated siRNA and are now used for CRISPR gene editing tools. Additionally, conjugating N-acetylgalactosamine (GalNAc) moieties to ASOs or siRNAs facilitates receptor-mediated uptake by the asialoglycoprotein receptor. In summary, ATTR is a progressive disease with various clinical manifestations due to TTR aggregation, deposition, and amyloid formation. Receptor-targeted ligands (eg, GalNAc) and nanoparticle encapsulation (eg, LNPs) are technologies to deliver ASOs, siRNAs, and gene editing tools to hepatocytes, the primary location of TTR synthesis.

Dental calculus formation in children and adolescents undergoing hemodialysis.

BACKGROUND: This study aimed to determine whether dental calculus formation is really higher among patients with chronic kidney disease undergoing hemodialysis than among controls. Furthermore, the study evaluated correlations between dental calculus formation and dental plaque, variables that are related to renal disease and/or saliva composition. METHODS: The Renal Group was composed of 30 patients undergoing hemodialysis, whereas the Healthy Group had 30 clinically healthy patients. Stimulated whole saliva and parotid saliva were collected. Salivary flow rate and calcium and phosphate concentrations were determined. In the Renal Group the saliva collection was carried out before and after a hemodialysis session. Patients from both groups received intraoral exams, oral hygiene instructions, and dental scaling. Three months later, the dental calculus was measured by the Volpe-Manhold method to determine the rate of dental calculus formation. RESULTS: The Renal Group presented a higher rate of dental calculus formation (p < 0.01). Correlation was observed between rate of dental calculus formation and whole saliva flow rate in the Renal Group after a hemodialysis session (r = 0.44, p < 0.05). The presence of dental calculus was associated with phosphate concentration in whole saliva from the Renal Group (p < 0.05). CONCLUSION: In conclusion, patients undergoing hemodialysis presented accelerated dental calculus formation, probably due to salivary variables.

How did transthyretin amyloid cardiomyopathy progress in patients who took placebo in the study ATTR-ACT? A plain language summary.

WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT?: This plain language summary describes some results of a study called ATTR-ACT. This was the first large study to include people with wild-type and hereditary transthyretin amyloid cardiomyopathy (ATTR-CM for short). ATTR-CM is a type of heart disease that happens when abnormal clumps of protein build up in the heart. This build-up prevents the heart from working properly, causing a condition called heart failure. Wild-type ATTR-CM happens for unknown reasons in some people as they get older. Hereditary ATTR-CM can happen because of changes in people's genes (known as gene variants or mutations). IMPORTANT INFORMATION ABOUT ATTR-ACT: In this study, 441 people with ATTR-CM took either a medicine called tafamidis or a placebo (a capsule that looked like tafamidis but didn't contain any active medicine) by mouth for 30 months, once a day. The researchers' main aim was to find out how tafamidis treatment affected the risk of people dying or being admitted to the hospital for heart problems. They found that tafamidis lowered these risks by about one-third compared with placebo. WHAT ELSE DID RESEARCHERS FIND OUT IN ATTR-ACT?: As described in this summary, after ATTR-ACT was completed, researchers looked back at the results from people who took placebo to learn how ATTR-CM progressed without treatment. The researchers found that about 4 in 10 people with wild-type ATTR-CM who took placebo died and 6 in 10 were admitted to the hospital because of heart problems over 30 months. People who took placebo also could not walk as far at the end of the study as they did at the start because their heart function worsened over time. WHY ARE THESE RESULTS IMPORTANT?: By showing how ATTR-CM affects people's health when they do not take treatment, these results highlight the benefits of early diagnosis and treatment of ATTR-CM. ClinicalTrials.gov NCT number: NCT01994889.

Does the neuromotor abnormality type affect the salivary parameters in individuals with cerebral palsy?

BACKGROUND: Previous studies reported alterations in salivary flow rate and biochemical parameters of saliva in cerebral palsy (CP) individuals; however, none of these considered the type of neuromotor abnormality among CP individuals, thus it remains unclear whether the different anatomical and extended regions of the brain lesions responsible for the neurological damage in CP might include disruption of the regulatory mechanism of saliva secretion as part of the encephalopathy. The aim of this study was to evaluate salivary flow rate, pH and buffer capacity in saliva of individuals with CP, aged 3-16 years, with spastic neuromotor abnormality type and clinical patterns of involvement. METHODS: Sixty-seven individuals with CP spasticity movement disorder, were divided in two groups according to age (3-8- and 9-16-years-old) and compared with 35 sibling volunteers with no neurological damage, divided in two groups according to age (3-8- and 9-16-years-old). Whole saliva was collected under slight suction and pH and buffer capacity were determined using a digital pH meter. Buffer capacity was measured by titration using 0.01N HCL, and flow rate was calculated in ml/min. RESULTS: In both age groups studied, whole saliva flow rate, pH and buffer capacity were significantly lower in the spastic CP group (P<0.05). The clinical patterns of involvement did not influence the studied parameters. CONCLUSION: These findings show that individuals with spastic cerebral palsy present lower salivary flow rate, pH and buffer capacity that can increase the risk of oral disease in this population.

Analysis of the stimulated whole saliva in overweight and obese school children.

OBJECTIVE: To determine if some stimulated whole saliva parameters are influenced by an increase of Body Mass Index. METHODS: Controlled cross-sectional study involving 90 school children of both genders between 7 and 10 years of age, from Bragança Paulista - SP. Three groups were formed: overweight, obese and control. Body Mass Index and diet intake by the Food Register method were evaluated. The salivary pH, flow rate, buffer capacity, protein, phosphate, calcium, fluoride, total and free sialic acid, and peroxidase activity were determined. RESULTS: The overweight and obese groups showed greater energy and lipid intake (P< 0.001) than the control group. There was no difference in the saliva flow rate between groups, however only the control group showed a mean value considered normal. In the overweight and obese groups a decrease in both the concentration of phosphate (P< 0.001) and peroxidase activity (P<0.001) was observed. In the obese group an increase in the concentrations of free sialic acid (P= 0.004) and protein (P= 0.003) occurred. CONCLUSION: Overweight and obese children show alterations in the concentrations of phosphate, free sialic acid and proteins, and in the peroxidase activity that are favorable conditions for dental caries.

Alteration of Ca(2+)-ATPase activity in the homogenate, plasma membrane and microsomes of the salivary glands of streptozotocin-induced diabetic rats.

Diabetes has been implicated in the dryness of the mouth, loss of taste sensation, sialosis, and other disorders of the oral cavity, by impairment of the salivary glands. The aim of the present study was to examine the plasma membrane, microsomal, and homogenate Ca(2+)-ATPase activity in the rat submandibular and parotid salivary glands of streptozotocin-induced diabetes. We have also examined the influence of the acidosis state on this parameter. Diabetes was induced by an intraperitoneal injection of streptozotocin and acidosis was induced by daily injection of NH(4)Cl. At 15 and 30 days after diabetes induction, the animals were euthanized and the submandibular and parotid salivary glands were removed and analyzed. Ca(2+)-ATPase (total, independent, and dependent) was determined in the homogenate, microsomal, and plasma membranes of the salivary glands of diabetic and control rats. Calcium concentration was also determined in the glands and showed to be higher in the diabetic animals. Ca(2+)-ATPase activity was found to be reduced in all cell fractions studied in the diabetic animals compared with control. Similar results were obtained for the submandibular salivary glands of acidotic animals; however in the parotid salivary glands it was found an increase in the enzyme activity.

Dye-enhanced laser fluorescence detection of caries lesions around brackets.

The aim was to evaluate the performance of DIAGNOdent [laser fluorescence(LF) and LFpen] devices enhanced by fluorescent dye in detecting mineral loss around brackets and comparing the inhibitory effect of bonding material on artificial demineralization, and to verify whether LF methods show the same trends of mineral loss. Brackets were bonded to premolar halves with Fuji Ortho LC, Transbond XT, and Ortho Glass LC cements (n = 15). The teeth were soaked in demineralizing solution (pH = 4.8) for 16 days. Mineral loss was calculated by atomic emission spectrometry, and lesions were measured with LF devices with dye [tetrakis N-methylpyridyl porphyrin (TMPyP)]. Groups were compared with regard to LF readings and mineral loss, and performance of caries detection was calculated. Higher mineral loss and LF-TMPyP values occurred in the resin group. LFpen-TMPyP readings were significantly higher in the demineralized groups. Correlation was observed between mineral loss and LF measurements. LF methods are capable of identifying lower demineralization around brackets bonded with resin-modified glass ionomer cements.

Saliva flow rate, buffer capacity, and pH of autistic individuals.

The objective of the study was to evaluate saliva flow rate, buffer capacity, pH levels, and dental caries experience (DCE) in autistic individuals, comparing the results with a control group (CG). The study was performed on 25 noninstitutionalized autistic boys, divided in two groups. G1 composed of ten children, ages 3-8. G2 composed of 15 adolescents ages 9-13. The CG was composed of 25 healthy boys, randomly selected and also divided in two groups: CG3 composed of 14 children ages 4-8, and CG4 composed of 11 adolescents ages 9-14. Whole saliva was collected under slight suction, and pH and buffer capacity were determined using a digital pHmeter. Buffer capacity was measured by titration using 0.01 N HCl, and the flow rate expressed in ml/min, and the DCE was expressed by decayed, missing, and filled teeth (permanent dentition [DMFT] and primary dentition [dmft]). Data were plotted and submitted to nonparametric (Kruskal-Wallis) and parametric (Student's t test) statistical tests with a significance level less than 0.05. When comparing G1 and CG3, groups did not differ in flow rate, pH levels, buffer capacity, or DMFT. Groups G2 and CG4 differ significantly in pH (p = 0.007) and pHi = 7.0 (p = 0.001), with lower scores for G2. In autistic individuals aged 3-8 and 9-13, medicated or not, there was no significant statistical difference in flow rate, pH, and buffer capacity. The comparison of DCE among autistic children and CG children with deciduous (dmft) and mixed/permanent decayed, missing, and filled teeth (DMFT) did not show statistical difference (p = 0.743). Data suggest that autistic individuals have neither a higher flow rate nor a better buffer capacity. Similar DCE was observed in both groups studied.

Laser as a therapy for dry mouth symptoms in a patient with Sjögren's syndrome: a case report.

This clinical case study reports on dry mouth symptoms in a patient with Sjögren's syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.

Laser fluorescence device does not perform well in detection of early caries lesions in primary teeth: an in vitro study.

PURPOSE: To evaluate if using the laser fluorescence (LF) device improves the detection of early or more advanced occlusal caries lesions in primary teeth. MATERIALS AND METHODS: A total of 181 occlusal sites in primary teeth were assessed by one examiner using DIAGNOdent. The same examiner and a second examiner evaluated 72 of the sites again to assess intra- and inter-examiner reproducibility. After histological validation, lesions were divided at three thresholds according to the lesion depth: outer half of the enamel (D1), inner half of the enamel (D2) and dentine (D3). The sensitivity, specificity, accuracy and area under ROC curve were calculated for cut-off points for the sample considering the aforementioned thresholds. The parameters were compared using chi-square test and by comparison between unpaired ROC curves. RESULTS: The overall LF performance was better at dentine threshold than at enamel threshold. The higher specificity was found at D3 and D2, and higher accuracy at D3 (P < 0.001). The intra- and inter-examiner agreements were classified as good or excellent for all thresholds. CONCLUSIONS: The LF device performs better at the dentine threshold than at the enamel threshold. This method does not perform well in detecting initial enamel caries lesions.

Study of the buffering capacity, pH and salivary flow rate in type 2 well-controlled and poorly controlled diabetic patients.

PURPOSE: This study measured the flow rate, pH and buffering capacity of saliva from well- and poorly metabolically controlled Type 2 diabetic patients in three cities of the southern part of Brazil, compared with healthy individuals from the same cities. MATERIALS AND METHODS: Whole saliva was collected by mechanical stimulation and buffering capacity and glucose level were measured. Blood was collected after 12 hours fasting and glucose and glycosylated haemoglobin concentrations were determined. The data were analysed by one-way ANOVA and Student-Newman-Keuls (alpha= 0.05). RESULTS: The flow rate was lower in the Type 2 diabetic patients, regardless of whether they were well or poorly metabolically controlled, compared with healthy individuals (p < 0.05). Salivary glucose concentration was higher in both diabetic patient groups, i.e. well and poorly metabolically controlled, than in the control (p < 0.05). CONCLUSION: The metabolic control of hyperglycaemia was not sufficient to improve the salivary flow rate or the salivary glucose concentration.

Comparison of electrolyte concentrations in whole saliva of individuals with and without cerebral palsy.

OBJECTIVE: To analyze sodium, potassium, calcium, phosphorus, and magnesium concentrations in whole saliva of adolescents with cerebral palsy (CP) and compare them with those of normal individuals. METHOD AND MATERIALS: Thirty-six adolescents with CP aged 12.0 +/- 1.8 years were compared with 36 healthy age-matched individuals. Saliva was collected under slight suction. Electrolyte concentrations were determined by inductively coupled argon plasma with atomic emission spectrometry. RESULTS: Significant differences were observed with matched and unmatched flow rates. Sodium concentrations were significantly decreased, whereas potassium levels were significantly increased in the CP group. No statistically significant differences were observed regarding phosphorus, magnesium, and calcium concentrations between adolescents with CP and controls. CONCLUSION: Our results suggest that there is an alteration in the sodium and potassium concentration in whole saliva of individuals with CP.

The influence of valproic acid on salivary pH in children with cerebral palsy.

The purpose of this open-label, crossover study was to measure salivary pH after the oral administration of distilled water, a 10% sucrose solution, and valproic acid to a population of 10 children with cerebral palsy. Salivary pH was measured just prior to giving the solutions and then every five minutes for 60 minutes. The critical pH was defined at 5.5, below which dental demineralization occurs. In this population, valproic acid decreased salivary pH to below the critical pH for an extended period of time (mean = 4.32 at 20 minutes) when compared to mean salivary pH after administration of distilled water (7.11 at 20 minutes) and a 10% sucrose solution (5.96 at 20 minutes). Recovery from this low pH to above the critical level did not occur until after 50 minutes and furthermore did not recover to baseline, neutral levels, for the duration of this study (60 minutes). Our results suggest that children with cerebral palsy, a population with a tendency toward reduced salivary function, have a compromised ability to buffer the oral administration of an exogenous acid. This can result in an increased susceptibility to demineralization and caries of the teeth.

Salivary parameters in infants aged 12 to 60 months with Down syndrome.

The purpose of this study was to measure certain components in whole saliva from children with Down syndrome aged 12 months to 60 months. Twenty children with Down syndrome were compared with 18 children without Down syndrome. Whole saliva was collected under slight suction and the salivary pH was measured with a portable pH meter soon after collection. Electrolyte concentrations were determined by inductively coupled argon plasma with atomic emission spectrometry. Sialic acid was determined by thiobarbituric acid assay. Amylase was assayed measuring the maltose produced by the breakdown of starch and peroxidase with ortho-dianisidine. No statistically significant differences were observed in sialic acid, calcium, phosphorus and magnesium concentrations between the group with Down syndrome and the control group. Protein and sodium concentration were higher in the group with Down syndrome compared to the control group. On the other hand, the flow rate, pH, amylase and peroxidase activities and potassium concentration were lower in those with Down syndrome compared to those children in the control group.

Ability of laser fluorescence device associated with fluorescent dyes in detecting and quantifying early smooth surface caries lesions.

A laser fluorescence (LF) device is a portable tool, but it does not measure minor mineral changes. Our in vitro study aim is to propose the association of an LF with two fluorescent dyes and to evaluate the performance in detecting and quantifying early demineralization. Artificial caries lesions are created in 40 primary canine teeth using a demineralizing solution (pH=4.8) for 12, 24, 48, and 96 h. LF measurements are performed with DIAGNOdent after demineralization in these samples and in 20 sound primary teeth. Measurements with LF with 0.2-mM tetrakis(N-methylpyridyl)porphyrin (LF TMPyP) and with 4-mM protoporphyrin IX (LF PPIX) are made. The amount of calcium loss is determined by atomic emission spectrometry. A correlation between LF and LF with dyes and mineral loss and receiver operating characteristics analysis are performed, as well as comparisons of sensitivity, specificity, and accuracy values. Significant correlation is obtained with LF TMPyP and mineral loss of lesions demineralized for 24, 48, and 96 h. Better performance is achieved with LF TMPyP for all parameters than with LF alone. LF PPIX does not present good results. In conclusion, LF TMPyP provides good performance in detecting and quantifying very early enamel caries lesions.

A study of the influence of mouth-breathing in some parameters of unstimulated and stimulated whole saliva of adolescents.

OBJECTIVE: The aim of this study was to analyze some standard parameters of the unstimulated and stimulated whole saliva of mouth-breathers and a control group to determine if these variables present any difference in mouth-breathers compared to control group, since these parameters of saliva can influence the oral health. METHODS: Saliva samples were collected from 61 adolescents aged 10-19 years; 30 were mouth-breathers and 31 were nose-breathers. The unstimulated salivary specimen was collected, followed by collection of the stimulated saliva. Soon after collecting the salivary sample, the flow rate and buffering capacity were determined. The samples were then stored at -80 degrees C until analysis was performed. The analysis consisted of the determination of protein content and total, free and bound sialic acid levels. RESULTS: No statistically significant difference was observed in the flow rate, buffering capacity, protein content, total and bound sialic acid levels of unstimulated and stimulated saliva, nor in the free sialic acid of stimulated saliva. However, the levels of free sialic acid of the unstimulated saliva were significantly higher in the mouth-breather compared to the control group. CONCLUSIONS: Since a higher level of free sialic acid is indicative of an increase in the number of bacteria in saliva, our findings suggest that mouth-breathers retain more bacteria in oral tissues.

Salivary analysis of patients with chronic renal failure undergoing hemodialysis.

This study evaluated the flow rate and composition of whole saliva in patients with chronic renal failure undergoing hemodialysis. In the group on dialysis (RG) (n = 15), saliva was collected just prior to hemodialysis CT1) and at completion (T2), while in the healthy subjects (HG)(n = 15) saliva was collected at the same time of day as the pre-dialysis. Saliva samples were analyzed by inductively coupled argon plasma with atomic emission spectrometry. Significant differences were found in the flow rate, potassium, magnesium and phosphorus concentrations at the RG-T1 and HG (p < 0.05). Sodium concentration at RG-T1 and RG-T2 were higher than HG (p < 0.05). Total protein concentration was higher at RG-T1 than at the other two analyses. Salivary peroxidase activity at RG-T1 and RG-T2 was lower than at HG. Our findings suggest that in patients with chronic renal failure, the saliva is altered. Hemodialysis, however, seems to help control saliva composition and flow rate.

The influence of PVC seal wrap and probe tips autoclaving on the in vitro performance of laser fluorescence device in occlusal caries in primary teeth.

The goal of this study was to evaluate the influence of a PVC Seal Wrap as barrier protection and the influence of autoclaving on the in vitro performance of a laser fluorescence device in detecting occlusal caries lesions in primary teeth. The clinical significance of the experiment is to create a protocol to avoid the possibility of underestimating caries in clinical setting.

Electrolyte concentrations in saliva of children aged 6-10 years with Down syndrome.

STUDY DESIGN: In this study sodium, potassium, calcium, phosphorus, zinc, and magnesium ion concentration was analyzed in stimulated whole saliva in 22 children with Down syndrome aged 6 to 10 years. These children were compared with 21 healthy children of the same age. Stimulated saliva was collected by chewing a piece of parafilm for 10 minutes. The pH was measured with a portable pH meter after collection. Electrolyte concentrations were determined by inductively coupled argon plasma with atomic emission spectrometry. RESULTS: No statistically significant differences were observed in phosphorus, zinc, magnesium, and calcium concentration between the children with Down syndrome and the control children. The sodium concentration showed about 66.8% higher value in the Down syndrome than in the control group. On the other hand the flow rate and potassium concentration were lower in the Down syndrome than in the control group. CONCLUSION: Our results suggest that there is alteration in the metabolism of the duct and/or acinar cells of salivary glands of Down syndrome children.