Treatment of Molar-incisor Hypomineralization: A Case Report of 11-year Clinical Follow-up.

The purpose of this case report was to describe an 11-year follow-up of a patient presenting with molar-incisor hypomineralization (MIH) having yellowish and porous permanent incisors and molars. Clinical examination revealed demarcated brown opacities on one upper and one lower central incisor and three first permanent molars. Initially, treatment involved oral hygiene and periodic fluoride varnish application. Subsequently, the occlusal surfaces of the affected molars were restored or sealed with glass ionomer cement. At-home dental bleaching was also performed. Areas of unsatisfactory esthetics on the incisors were replaced by composite resins. This report discussed the patient's needs and expectations, the difficulties of prolonged treatment for patients with MIH, and the restorative protocol involving at-home dental bleaching and composite resins.

Use of fluoridated dentifrices by children in Araçatuba, Brazil: factors affecting brushing habits and amount applied on the brush.

PURPOSE: To evaluate the type and the amount of fluoridated dentifrice applied on children's toothbrushes by parents/guardians according to descriptions typically recommended by scientific societies, as well as to assess the influence of demographic and socioeconomic variables on dentifrice use. METHODS: Parents/guardians of children (0-7 years old; n = 306; convenience sample) attending vaccination centres from Araçatuba (Brazil), answered to a structured questionnaire comprising items related to interviewees' education, child's age, gender, brushing habits and use of fluoridated dentifrice. The amount of toothpaste used by children during toothbrushing was estimated using a portable scale. Similarly, the interviewees were requested to apply dentifrices on toothbrushes according to eight descriptions, ranging from "smear" to "all bristles", following a random sequence. Data were submitted to Mann-Whitney's, Kruskal-Wallis' and Friedman's tests, and Spearman's correlation coefficient (p < 0.05). RESULTS: The type of toothpaste and the amount of product used at home were not affected by the respondents' educational level or family income. However, child's age was significantly correlated with the amount of toothpaste placed on the toothbrush (r = 0.324, p < 0.001). Also, the amount of toothpaste placed on the toothbrush increased according to what would be expected from the descriptions, although wide variations were observed within each description, with large interquartile and overall ranges. CONCLUSION: The amount and the type of dentifrice used by children were influenced by their age, while parents/caregivers' interpretation on verbal instructions regarding appropriate dentifrice quantities varied widely. This reinforces the need for educative measures on the appropriate use by dentifrices by children.

Fluoride concentration and amount of dentifrice influence enamel demineralization in situ.

OBJECTIVES: This study evaluated the effect of conventional (CD, 1100ppm F) and low-fluoride (LFD, 550ppm F) dentifrices, applied in different quantities, on enamel demineralization, and on fluoride (F) concentrations in the dental biofilm formed in situ. METHODS: Five combinations of dentifrices and quantities were tested: placebo (P-F-free) applied on all brush bristles; LFD applied by the transversal technique (0.3g-T1) or on all bristles (0.6g-T2); and CD applied in a pea-sized amount (0.15g-T3) or by the transversal technique (0.3g-T4), in order to produce comparable intensities (F concentration in the dentifrice×amount applied to the brush). Volunteers (n=13, 20-36 years old) wore palatal devices containing 4 bovine enamel blocks, and performed cariogenic challenges (30% sucrose solution) 6×/day, and brushing 3×/day, following a double-blind, cross-over and randomized protocol. On the 8th day, biofilm was collected 5 and 60min after brushing. The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN) and biofilm F concentrations (solid and fluid phases) were determined. Data were analyzed by repeated-measures ANOVA, Student-Newman-Keuls test, and Pearson's correlation coefficient (p<0.05). RESULTS: Significantly lower ΔKHN was observed for treatments with higher intensity (T2 and T4) in comparison with the lower intensity (T1 and T3). A strong correlation was observed between ΔKHN and F concentrations in total biofilm (r=-0.71) and biofilm fluid (r=-0.72) 5min after brushing. CONCLUSIONS: The treatment intensity has a significant influence on the development of caries lesions in situ. CLINICAL SIGNIFICANCE: The intensity of treatment (amount of dentifrice×concentration) during brushing seems to be a more relevant parameter of clinical efficacy than simply observing the F concentration of the product. The use of a small amount of CD significantly reduced the protective effects against enamel demineralization.

Fluoride gel supplemented with sodium hexametaphosphate reduces enamel erosive wear in situ.

OBJECTIVE: This study evaluated the effect of fluoride gels, supplemented or not with sodium hexametaphosphate (HMP), on enamel erosive wear in situ. METHODS: Twelve healthy volunteers wore palatal appliances containing four bovine enamel discs. Subjects were randomly allocated into four experimental phases (double-blind, crossover protocol) according to the gels: Placebo (no fluoride or HMP), 1% NaF, 2% NaF, and 1% NaF+9% HMP. Enamel discs were selected after polishing and surface hardness analysis, and treated only once with the respective gels prior to each experimental phase. Erosion (ERO) was performed by extra-oral immersion of the appliance in 0.05M citric acid, pH 3.2 (four times/day, five minutes each, 5 days). Additional abrasion (ERO+ABR) was produced on only two discs by toothbrushing with fluoridated dentifrice after ERO (four times/day, 30s, 5 days). The specimens were submitted to profilometry and hardness analysis. The results were analyzed by two-way ANOVA and the Student-Newman-Keuls test (p<0.05). RESULTS: The 1% NaF+9% HMP gel promoted significantly lower enamel wear for ERO compared to the other groups, being statistically lower than 1% NaF and Placebo for ERO+ABR. Similarly, the lowest values of integrated lesion area were found for 1% NaF+9% HMP and 2% NaF, respectively, for ERO and ERO+ABR. CONCLUSION: The addition of HMP to the 1% NaF gel promoted greater protective effect against ERO and ERO+ABR compared to the 1% NaF gel, achieving similar protective levels to those seen for the 2% NaF gel. CLINICAL SIGNIFICANCE: Gel containing 1% NaF+9% HMP showed a high anti-erosive potential, being a safer alternative when compared to a conventional 2% NaF gel.

Analysis of anticaries potential of pit and fissures sealants containing amorphous calcium phosphate using synchrotron microtomography.

The aim of this study was to analyze the anticaries potential of pit and fissure sealants containing amorphous calcium phosphate (ACP) by synchrotron microtomography. Bovine enamel blocks (4×4 mm; n=50) were selected through surface hardness (Knoop) analysis. Slabs were obtained through cross-sections taken 1 mm from the border of the enamel. Five indentations, spaced 100 µm apart, were made 300 µm from the border. Ten specimens were prepared for each tested material (Ultraseal XT plus TM, Aegis, Embrace, Vitremer and Experimental Sealant). The materials were randomly attached to the sectioned surfaces of the enamel blocks and fixed with sticky wax. The specimens were submitted to pH cycling. After that, the surface hardness (SH1) was determined, and the blocks were submitted to synchrotron microcomputed tomography analysis to calculate the mineral concentration (ΔgHAp cm(-3)) at different areas of the enamel. The comparison between the SH1 and ΔgHAp cm(-3) showed a correlation for all groups (r=0.840; p<0.001). The fluoride groups presented positive values of ΔgHAp cm(-3), indicating a mineral gain that was observed mainly in the outer part of the enamel. The ACP showed mineral loss in the outer enamel compared with fluoride groups, although it inhibited the demineralization in the deeper areas of enamel. The combination of two remineralizing agents (fluoride and ACP) was highly effective in preventing demineralization.

Effect of fluoride gels supplemented with sodium trimetaphosphate on enamel erosion and abrasion: in vitro study.

OBJECTIVE: This in vitro study aims to evaluate the effect of low fluoride (F) gel associate sodium trimetaphosphate (TMP) on erosion with or without abrasion. DESIGN: Enamel blocks (4 mm × 4 mm) selected through surface hardness (SH) is divided into five groups (n=12): gel without F and TMP (placebo), gel containing 4500 ppm F (4500), gel containing 4500 ppm F plus TMP5% (4500 TMP5%), gel containing 9000 ppm F (9000), and gel containing 12,300 ppm F (acid gel). Those groups were additionally subdivided into conditions of erosion (Ero) and of erosion plus abrasion (Ero/Abra). The blocks have undergone a single application of gel on the first day of the study. The erosion challenge was produced by Sprite Zero for five minutes four times a day and abrasion was carried out by machine brushing for 15s. After the challenges, the surface hardness (%SH), wear and cross-sectional hardness (ΔKHN) were analyzed. The data were analyzed using a 2-way ANOVA test followed by a Student-Newman-Keuls (p<0.05). RESULTS: Lower values of %SH, wear and ΔKHN were observed for erosion challenge (p<0.001). The %SH was lower in groups treated with fluoride gels, differing in the placebo (p<0.05). With addition of TMP to the gel 4500, enamel wear was lower when compared with another groups (p<0.05). CONCLUSION: In vitro conditions, the 4500 5%TMP gel showed greatest effect against erosion and erosion/abrasion.

Early Carotid Atherosclerosis and Hepatic Lipase-514 C/T Polymorphism: A Study in Hyperalphalipoproteinemic Individuals / Aterosclerosis carotídea subclínica y el polimorfsmo HL-514 C/T de la lipasa hepática: un estudio en individuos hiperalfalipoproteinémicos

Objective: Hepatic lipase (HL) is involved in the metabolism of several lipoproteins and has a key role in reverse cholesterol transport and atherosclerosis. The aim of this study was to evaluate the effects of HL -514C/T polymorphism on sub-clinical and established carotid atherosclerotic in hyperalphalipoproteinemic and control individuals. Methods: One hundred and sixty nine asymptomatic individuals (aged 47 ± 16 years), 71 hyperalphalipopro-teinemic (Hyper-A, HDL-C = 68mg/dL) and 98 controls (CTL, HDL-C< 68mg/dL) were selected by clinical and laboratory evaluations. Lipids and lipoproteins were measured by enzymatic methods. HL activity was measured in post-heparin plasma by a radiometric assay and HL-514C/T genotypes were analyzed by PCR. Carotid intima-media thickness (cIMT) was measured by Doppler ultrasonography. Results: No differences in HL -514C/T genotype frequencies were observed between the groups. HL -514C/T polymorphism did not contribute to variations in cIMT or atherosclerotic lesion frequencies in Hyper-A and controls. Furthermore, no interactions between HL-514C/T polymorphism and cIMT or atherosclerotic lesions were found. Conclusions: In hyperalphalipoproteinemic individuals the -514C/T polymorphism is not associated with significant variations in HDL-Cholesterol concentrations. Besides, it has no repercussions on carotid atherosclerosis, although hepatic lipase activity is significantly reduced. No financial conflicts of interest exist.

Objetivo: La Lipasa Hepática (HL) está implicada en el metabolismo de las lipoproteínas distintas y desempeña un papel en el transporte inverso del colesterol y la aterosclerosis. El objetivo de este estudio fue evaluar los efectos del polimorfismo HL-514 C/T en la aterosclerosis carotídea subclínica en los individuos e hiperalfalipoproteinémicos y controles establecidos. Métodos: Ciento sesenta y nueve sujetos asintomáticos (edad 47 ± 16 años), 71 hiperalfalipoproteinémicos (Hyper-A, HDL-C = 68mg/dL) y 98 controles (CTL, HDL-C <68mg/dL) fueron seleccionados por evaluaciones clínicas y de laboratorio. Lípidos y lipoproteínas se midieron por métodos enzimáticos. La actividad de la HL se midió en plasma después de la heparina por el método radiométrico, y los genotipos HL-514C/T se analizaron por PCR. El Grosor íntimo-medial carotídeo (cIMT) se midió mediante ecografía. Resultados: No hubo diferencias en las frecuencias de los genotipos HL-514 C/T se observó entre los grupos. Polimorfismo HL-514 C/T no ha contribuido a los cambios en cIMT o la frecuencia de las lesiones ateroscleróticas en Hyper-A y los controles. Por otra parte, no hay interacción entre el polimorfismo HL-514 C/T y cIMT ni fueron halladas lesiones ateroscleróticas. Conclusiones: El polimorfismo HL -514 C/T no está asociado con cambios significativos en el colesterol HDL en hiperalfalipoproteinémicos particulares y no tiene efecto en la arteriosclerosis carotídea a pesar de que la actividad de la HL ha sido reducida significativamente. Los autores declaran no poseer conflictos de interés.

Early Carotid Atherosclerosis and Hepatic Lipase-514 C/T Polymorphism: A Study in Hyperalphalipoproteinemic Individuals / Aterosclerosis carotídea subclínica y el polimorfsmo HL-514 C/T de la lipasa hepática: un estudio en individuos hiperalfalipoproteinémicos

Objective: Hepatic lipase (HL) is involved in the metabolism of several lipoproteins and has a key role in reverse cholesterol transport and atherosclerosis. The aim of this study was to evaluate the effects of HL -514C/T polymorphism on sub-clinical and established carotid atherosclerotic in hyperalphalipoproteinemic and control individuals. Methods: One hundred and sixty nine asymptomatic individuals (aged 47 ± 16 years), 71 hyperalphalipopro-teinemic (Hyper-A, HDL-C = 68mg/dL) and 98 controls (CTL, HDL-C< 68mg/dL) were selected by clinical and laboratory evaluations. Lipids and lipoproteins were measured by enzymatic methods. HL activity was measured in post-heparin plasma by a radiometric assay and HL-514C/T genotypes were analyzed by PCR. Carotid intima-media thickness (cIMT) was measured by Doppler ultrasonography. Results: No differences in HL -514C/T genotype frequencies were observed between the groups. HL -514C/T polymorphism did not contribute to variations in cIMT or atherosclerotic lesion frequencies in Hyper-A and controls. Furthermore, no interactions between HL-514C/T polymorphism and cIMT or atherosclerotic lesions were found. Conclusions: In hyperalphalipoproteinemic individuals the -514C/T polymorphism is not associated with significant variations in HDL-Cholesterol concentrations. Besides, it has no repercussions on carotid atherosclerosis, although hepatic lipase activity is significantly reduced. No financial conflicts of interest exist.(AU)

Objetivo: La Lipasa Hepática (HL) está implicada en el metabolismo de las lipoproteínas distintas y desempeña un papel en el transporte inverso del colesterol y la aterosclerosis. El objetivo de este estudio fue evaluar los efectos del polimorfismo HL-514 C/T en la aterosclerosis carotídea subclínica en los individuos e hiperalfalipoproteinémicos y controles establecidos. Métodos: Ciento sesenta y nueve sujetos asintomáticos (edad 47 ± 16 años), 71 hiperalfalipoproteinémicos (Hyper-A, HDL-C = 68mg/dL) y 98 controles (CTL, HDL-C <68mg/dL) fueron seleccionados por evaluaciones clínicas y de laboratorio. Lípidos y lipoproteínas se midieron por métodos enzimáticos. La actividad de la HL se midió en plasma después de la heparina por el método radiométrico, y los genotipos HL-514C/T se analizaron por PCR. El Grosor íntimo-medial carotídeo (cIMT) se midió mediante ecografía. Resultados: No hubo diferencias en las frecuencias de los genotipos HL-514 C/T se observó entre los grupos. Polimorfismo HL-514 C/T no ha contribuido a los cambios en cIMT o la frecuencia de las lesiones ateroscleróticas en Hyper-A y los controles. Por otra parte, no hay interacción entre el polimorfismo HL-514 C/T y cIMT ni fueron halladas lesiones ateroscleróticas. Conclusiones: El polimorfismo HL -514 C/T no está asociado con cambios significativos en el colesterol HDL en hiperalfalipoproteinémicos particulares y no tiene efecto en la arteriosclerosis carotídea a pesar de que la actividad de la HL ha sido reducida significativamente. Los autores declaran no poseer conflictos de interés.(AU)

In vitro evaluation of the effect of mouth rinse with trimetaphosphate on enamel demineralization.

OBJECTIVE: The aim of this study was to investigate the effectiveness of sodium trimetaphosphate (TMP) addition to mouth rinses to inhibit enamel demineralization. DESIGN: Bovine enamel blocks (n = 88) were selected by surface hardness and divided into eight treatment groups (n = 11 per group): placebo, 100 or 225 µg F/ml; the rinses with 100 µg F/ml had differing TMP concentrations (range 0-0.6%). The blocks were subjected to pH cycling for 5 days and treated twice a day with mouth rinses. After that, surface and cross-sectional hardness as well as fluoride in enamel were measured. RESULTS: The groups containing both 100 µg F/ml and 0.4% TMP inhibited demineralization most effectively (p < 0.001). This formulation yielded lower values of lesion areas than the formulations containing 100 or 225 µg F/ml but no TMP. The addition of 0.4% TMP increased the fluoride in enamel. CONCLUSION: It is possible to improve the effectiveness of a mouth rinse with 100 µg F/ml by addition of TMP, this being superior in inhibiting enamel demineralization compared with mouth rinses containing 225 µg F/ml.

Effect of rinsing with water immediately after neutral gel and foam fluoride topical application on enamel remineralization: An in situ study.

OBJECTIVE: The aim of this study was to evaluate, in situ, the effect of rinsing with water immediately after neutral fluoride foam application (Foam) or fluoride gel application (Gel). DESIGN: Ten volunteers wore acrylic palatal appliances containing 4 enamel blocks selected by surface hardness with artificial caries. Five experimental regimes of 3 days each were set according to treatment: placebo; Gel and Foam followed by no rinsing or consuming of liquids or solids for the next 30min; Gel and Foam followed by immediately washing with water jet. After each phase, surface hardness was again measured for analysis of mineral gain, evaluated through percentage of surface hardness recovery (%SHR) and integrated loss of subsurface hardness (ΔKHN). The concentration of loosely bound fluoride (CaF2) and firmly bound fluoride (FA-like) formed and retained were also determined. RESULTS: Fluoride treatments produced greater remineralization (%SHR and ΔKHN) compared to placebo group (p<0.05). There was no difference in the ability to promote remineralization and in the concentration of fluoride formed and retained, in each analysis, between Gel and Foam (p>0.05). CONCLUSION: The data suggest that rinsing with water immediately after topical application does not seem to have an influence on the ability of fluoride to promote remineralization.

A rich chemokine environment strongly enhances leukocyte migration and activities.

The migration of leukocytes in immune surveillance and inflammation is largely determined by their response to chemokines. While the chemokine specificities and expression patterns of chemokine receptors are well defined, it is still a matter of debate how leukocytes integrate the messages provided by different chemokines that are concomitantly produced in physiologic or pathologic situations in vivo. We present evidence for a novel regulatory mechanism of leukocyte trafficking. Our data are consistent with a mode of action where CC-chemokine receptor 7 (CCR7) agonists and unrelated, nonagonist chemokines first form a heteromeric complex, in the presence of which the triggering of CCR7 can occur at a much lower agonist concentration. The increase is synergistic and can be evoked by many but not all chemokines. Chemokine-induced synergism might provide an amplification system in "chemokine-rich" tissues, rendering leukocytes more competent to respond to migratory cues.