Physiologically relevant screening of polyphenol-rich commercial preparations for bioactivity in vascular endothelial cells and application to healthy volunteers: A viable workflow and a cautionary tale.

This study describes the screening of 13 commercially-available plant extracts for pharmacological activity modulating vascular function using an endothelial cell model. A French maritime pine bark extract (FMPBE) was found to have the greatest effect upon nitric oxide availability in control (181% ± 36% of untreated cells) and dysfunctional cells (132% ± 8% of untreated control cells). In healthy volunteers, the FMPBE increased plasma nitrite concentrations 8 h post-consumption compared to baseline (baseline corrected median 1.71 ± 0.38 (25% IQR) and 4.76 (75% IQR) µM, p < 0.05). This was followed by a placebo-controlled, healthy volunteer study, which showed no effects on plasma nitrite. It was confirmed that different batches of extract had been used in the healthy volunteer studies, and this second batch lacked bioactivity, assessed using the in vitro model. No difference in plasma catechin levels was seen at 8 h following supplementation between the studies (252 ± 194 nM versus 50 ± 64 nM, p > 0.05), however HPLC-UV fingerprinting showed that the new batch had a 5-15% in major constituents (including procyanidins A2, B1 and B2) compared to the original batch. This research describes a robust mechanism for screening bioactive extracts for vascular effects. It also highlights batch variability as a significant limitation when using complex extracts for pharmacological activity, and suggests the use of in vitro systems as a tool to identify this problem in future studies.

Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition.

BACKGROUND: The aim of this study was to evaluate the effect of fluoride varnish on enamel caries progression in the primary dentition. METHODS: One hundred forty-two children in Head Start schools (3 to 5 years old) were randomized into the varnish and control groups. Children in the varnish group received fluoride varnish (Duraphat, Colgate-Palmolive Co.) at baseline and after four months, and children in the control group received no professional fluoride applications. Two calibrated examiners performed the examinations at baseline and at nine months. RESULTS: At nine months, the authors found that in the control group, 37.8 percent of active enamel lesions on occlusal, buccal and lingual surfaces became inactive, 3.6 percent progressed and 36.9 percent did not change. In the varnish group, 81.2 percent became inactive, 2.4 percent progressed and 8.2 percent did not change. The difference between the groups was statistically significant (P < .0001). The mean decayed surfaces, or ds, value in the varnish group was significantly lower after nine months than it was at baseline (P < .0001). When enamel lesions were included in the data analysis (along with dentinal lesions), the decayed with initial enamel lesions, missing and filled surfaces, or dEmfs, values; decayed with initial enamel lesions, missing and filled teeth, or dEmft, values; and decayed surfaces with initial enamel lesions, or dEs, values were significantly lower in the varnish group after nine months than they were at baseline (P < .0001). CONCLUSIONS: These results suggest that fluoride varnish applications may be an effective measure in reversing active pit-and-fissure enamel lesions in the primary dentition. CLINICAL IMPLICATIONS: Fluoride varnishes are safe, easy to apply and well-accepted by patients. This study shows that fluoride varnish may offer an efficient, nonsurgical alternative for the treatment of decay in children.

Acceptance of the xylitol chewing gum regimen by preschool children and teachers in a Head Start program: a pilot study.

PURPOSE: This pilot study evaluated the acceptance and compliance of a xylitol chewing gum regimen by both children and classroom teachers in a Head Start program. METHODS: Thirty-five children chewed 100% xylitol gum (XyliFresh 100%, Leaf, Inc., 500 Field Dr., Lake Forest, IL 60045 U.S.A.) three times a day over a three week period. Children's acceptance was evaluated using a picture selection test. Teachers' acceptance was evaluated using a questionnaire. The children's and teachers' compliance was evaluated using a daily checklist that was completed by each teacher. RESULTS: Positive ratings were given for xylitol gum chewing (94%) and for taste (86%). Children's acceptance and compliance for chewing was excellent. Children chewed the gum at designated times and none of the children swallowed the gum. Teachers' acceptance of the chewing program was low. Three out of five participating teachers thought the gum chewing disturbed the classroom routine and four were not willing to participate in the program next year. Teachers' compliance was good and they followed by instructions during a three-week period. CONCLUSIONS: This study supports the suggestion that chewing xylitol gum is well accepted by children. Collaboration and education is essential to motivate teachers to adopt and supervise school-based prevention programs.

Cultivating critical thinking in the clinical learning environment.

The dental education knowledge base suggests a lack of understanding and research about how to teach critical thinking skills in the clinical learning environment. The acquisition of critical thinking skills is essential to the development of future practitioners, yet difficult to measure quantitatively. This study used qualitative research methods to assess the frequency and nature of teaching critical thinking skills in the University of Florida College of Dentistry predoctoral student clinics. Thirteen faculty and forty-four students in six clinics (oral diagnosis/treatment planning, endodontics, periodontology, operative dentistry, prosthodontics, and emergency care/oral surgery) were observed by an independent evaluator. Critical thinking skills were infrequently taught, and teacher-dominated instruction predominated. The findings underscore the need for thoughtful curriculum planning prior to predoctoral clinical instruction and periodic appraisal of clinical instruction. Suggestions for improving critical thinking in the clinical learning environment are presented.

Oral health status of Russian children with unilateral cleft lip and palate.

OBJECTIVE: To evaluate the oral and dental health of Russian children who underwent Frolova primary palatoplasty. DESIGN: Eighty-nine children (62 boys and 27 girls; age range, 5 to 9 years) who had undergone repair of unilateral cleft lip and palate were included in this oral/dental evaluation. Factors such as stage of dentition; oral hygiene; carious, missing and restored teeth; and occlusion were recorded. RESULTS: Twenty-six of the 89 patients presented with a palatal fistula. Oral hygiene of patients without a palatal fistula was significantly better than that of patients with a fistula (p < .01). Forty-five percent of patients had eight or more decayed teeth. Significantly more patients with palatal fistulae had class II soft tissue facial profiles than those without palatal fistulae. Anterior crossbites were found in 48% of patients, unilateral posterior crossbites in 58%, and bilateral posterior crossbites in 12%. CONCLUSIONS: The high percentage of poor oral hygiene and dental caries found in this group of patients is likely due to the general unavailability of dental hygiene products and the high cost of these products when available. In addition, it seems there is limited understanding by parents of the importance of dental hygiene and appropriate diet in preventing dental disease.

Myers-Briggs Type Indicator and dental school performance.

The Myers-Briggs Type Indicator (MBTI) was administered to 256 dental students, representing four classes, at the University of Florida College of Dentistry. The results of this psychological instrument were then correlated with overall dental school performance based on results from the National Dental Board Examinations Part I and II (NB-I, NB-II), yearly class rank, and specific academic difficulties as measured by the Student Performance Evaluation Committee. Introverted students were found to display a significantly increased performance on NB-I (p = .038) and NB-II (p = .044). They were also found, however, to demonstrate a progressively lower class rank over the four-year period than extroverted students and were more likely to experience major academic difficulties as well. Judging and sensing individuals were found to earn a higher class rank over the four-year period than perceiving and intuitive students, respectively. Perceiving students were found to exhibit major difficulties or were placed on probation more often than judging individuals. These results may prove useful in counseling students to recognize potential problems before they commence their dental education or to anticipate and address specific weaknesses during the course of their education.

Risk factors associated with acute dental pain in children.

The purpose of this study was to relate several variables (age, sex, race, number of extractions performed, dental arch, tooth position, mobility, root length, osseous resorptive defects, soft tissue inflammation, and history of preexisting pain) to the prevalence of parental report of pain in their children between forty-eight hours before (preexisting pain) and seven hours after extraction of their primary teeth (postextraction pain). Sixty-two children, ages two to ten years, were studied. The results indicated that there was no relationship between preexisting pain and the report of postextraction pain. There was a trend for females, primary molars, and presence of osseous resorptive defects to be associated with preexisting dental pain Root length (complete root formation) and presence of adjacent soft tissue inflammation were statistically significant for preexisting pain. Chronologic age was the only variable studied that was associated with postextraction pain in these children. Although the existence of pain is difficult to assess in children, the results of this study may be useful in a clinician's decision-making process as to the need for prescribed analgesics following extraction of primary teeth.

Pediatric dentists' attitudes regarding parental presence during dental procedures.

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).

Comparison of preoperative ibuprofen, acetaminophen, and placebo administration on the parental report of postextraction pain in children.

Previous investigations demonstrated that administering a preoperative analgesic can reduce postextraction pain in adults. Studies also have shown that ibuprofen was superior in alleviating postextraction pain when compared with acetaminophen. The purpose of this study was to compare the efficacy of the preoperative administration of ibuprofen, acetaminophen, and placebo in reducing postextraction pain in children. Sixty children, aged 2-10 years, requiring primary teeth extractions, were selected to participate in the study. Patients were assigned in a blind, random fashion to one of the three pretreatment drug groups. Parental report of their child's pain and use of analgesics during the immediate 7-hr postoperative period was elicited by telephone the day after the extraction procedure. Thirty-five percent of the patients were reported by their parents to experience postextraction pain. Of those patients, 52% received postoperative analgesics for pain relief (18% of the total). Although there was a trend toward reduced postextraction pain reported by the parents, the preoperative administration of neither analgesic was found to be statistically superior by chi-square analysis to placebo administration.

Variables influencing hemoglobin oxygen desaturation in children during routine restorative dentistry.

Pulse oximetry to monitor oxygen saturation during pediatric dental sedations has revolutionized the early detection of hypoxemia. Previous sedation studies confirmed the occurrence of hemoglobin oxygen desaturation when sedative agents are administered in conjunction with nitrous oxide. The purpose of this study was to monitor the hemoglobin oxygen saturation levels of nonmedicated pediatric patients during routine restorative procedures to study the effect of nitrous oxide, chronologic age, tonsil size, and lidocaine dose. Two identical pulse oximeters and probes were attached to a patient's right and left feet to validate the occurrence of oxygen desaturations. The results revealed that 20.3% of the patients demonstrated at least one occurrence of oxygen desaturation during the routine dental procedure. Administration of nitrous oxide had no effect on the prevalence of oxygen desaturation. Although chronologic age, tonsil size, and lidocaine dose did not exert a statistically significant influence when analyzed independently, when combined they were related statistically (P < 0.0001) to the occurrence of oxygen desaturation as defined by the parameters of the study. These data suggest that some of the oxygen desaturations recorded during routine restorative appointments may result from probe error and a combination of patient-related variables.

The efficacy of preoperative analgesic administration for postoperative pain management of pediatric dental patients.

Appropriate pain-management strategies for children receiving dental care continue to be poorly delineated. Recent studies have demonstrated the benefit of preoperative analgesic administration upon alteration of the postoperative pain experience in adults. It is the purpose of this study to assess the efficacy of preoperative administration of acetaminophen on the prevalence of postoperative pain-related behaviors and the frequency of postoperative analgesic use in 4- to 10-year-old children following various dental procedures. The results indicate a high prevalence of postoperative pain, independent of the type of dental procedure performed and the preoperative administration of acetaminophen. There is a trend toward reduced postoperative pain in the acetaminophen pretreatment groups. A greater sample size, with more reliable pain-assessment methods, may help to further elucidate the efficacy of preoperative analgesic administration in children. The clinician should be alerted to the potential for pain-related behaviors to occur following routine pediatric dental care.

A survey of local anesthetic usage in pediatric patients by Florida dentists.

Local anesthetic toxicity in the child dental patient is a concern of the dental profession. A survey of 117 Florida dentists was conducted to determine their local anesthetic practices in treating children. Results indicated that a fifth of the respondents might use local anesthetic levels that could cause potential CNS toxicity in the smaller and younger children they treat. It is the responsibility of the dental profession to recognize the differences in treating this group of patients, and the serious consequences that might occur when maximum recommended levels of local anesthetic are exceeded.

The effects of various dental procedures and patient behaviors upon nitrous oxide scavenger effectiveness.

This prospective study of 36 children, ages 44-93 months, receiving nitrous oxide-oxygen under standardized conditions during routine dental procedures was conducted to determine what influence eight selected dental procedures and three patient behaviors had on ambient nitrous oxide (N2O) levels in the dentist's breathing zone. Half the children received nitrous oxide-oxygen via a scavenging nasal mask. An infrared spectrophotometer analyzed the ambient N2O level continuously throughout the procedure and the time-weighted average (TWA) for consecutive 15-sec intervals was recorded by a microprocessor. A video camera was used to synchronize the coded dental procedures and patient behaviors to the TWA ambient N2O levels recorded. The results demonstrated that scavenging significantly reduced the dentist's exposure to ambient N2O (P less than 0.05, nonscavenged mean = 284.7 ppm; scavenged mean = 36.6 ppm), but the mean TWA N2O concentration remained significantly higher, P less than 0.05, than the 25-ppm level recommended by the National Institute for Occupational Safety and Health (NIOSH). Supplemental oral evacuation was the only dental procedure capable of reducing ambient N2O to below NIOSH's recommendation when scavenging was employed. The administration of local anesthesia consistently created a significant increase in ambient N2O levels. Patient behaviors of talking, crying, and movement also resulted in significant increases from baseline ambient N2O levels.

Humoral immune response to active root resorption with a murine model.

A depression in autoantibody titers to tooth root antigens has been shown to coincide with active root resorption in the dog. Since a murine model would facilitate immunologic studies of root resorption because of the availability of syngeneic and immunodeficient strains, the objectives of this study were to develop a quantitative mouse model for root resorption and to determine if a similar drop in tooth root autoantibodies coincides with active root resorption in this species. Uniform areas of necrosis were created in the periodontal ligaments of lower incisors of 36 male Swiss albino mice by inserting a cryoprobe through a skin incision (-80 degrees C; 5 minutes). Contralateral incisors served as controls. At 0, 3, 5, 7, 10, 14, and 21 days; six mice were killed, and blood and incisors were collected. Relative surface areas of root resorption were quantified with micrographs taken at a standardized position, tilt, and magnification with a scanning electron microscope. Serum autoantibody titers were determined with an enzyme-linked immune sorbent assay with antigen prepared from a 5 mol/L guanidine-HCl-EDTA (pH 5.0) extract of incisor roots that were harvested from syngeneic mice. ANOVA and the paired Student t test were used to compare data at the various time points. No root resorption was evident on control teeth. Localized lesions on treated teeth were found to be of significant size between 7 and 14 days (p less than 0.05), but most of these erupted into the mouth by 21 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical effectiveness of 1 and 2% lidocaine in young pediatric dental patients.

Clinical effectiveness of the double-blind administration of 1 and 2% lidocaine solutions was evaluated for restorative and surgical procedures on primary molars of children 4.5 to 10.5 years old. This effectiveness was measured by changes in the child's heart rate, the child's self report of pain, and the operator's assessment of the anesthesia's effectiveness. Although the incidence of anesthetic failure was higher for the 1% solution (31.3%) than for the 2% solution (11.1%), no statistically significant difference between the solutions was found. During the performance of pulpotomies and extractions, a higher failure rate was recorded for the 1% solution (62.5%) than for the 2% solution (28.6%), but these differences were not statistically significant. For minor restorative procedures, the 1% solution was equally successful in achieving anesthesia. The results suggested that 1% lidocaine should be used when multiple minor procedures are performed and potential toxicity in the young dental patient is a concern.