Pregnancy, parity and periodontal disease.

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.

Dental implant use in New Zealand: A 10-year update.

OBJECTIVE: The aim of this study was to explore changes in dentists' promotion and use of implants in New Zealand over the past 10 years. METHODS: A postal survey was conducted of a random sample of 807 New Zealand registered dentists, using a 23-item questionnaire adapted from one used in a similar survey in 2004. RESULTS: The participation rate was 54.3%. In the past 10 years, the percentage of dentists providing an implant service has increased from 49.4% to 68.0%, with an equal proportion of females now providing this service. Single missing teeth (56.9%) and trauma (51.5%) are the most common clinical situations in which implants are provided. Patient enquiries about implants have slightly increased. A need for continuing education, particularly in the area of implant prosthetic procedures, was noted by 76.5%. Despite more proprietary implant systems now being available, the most commonly used system has remained unchanged. Cost is still the primary barrier to implementing implant treatment. CONCLUSIONS: Although dental implant use in New Zealand has increased, it appears that a need exists for continuing education, particularly for implant prosthetic procedures. The perceived expense of treatment continues to hinder optimal utilisation.

Dental implant treatment following trauma: An investigation into the failure to complete Accident Compensation Corporation funded care.

BACKGROUND AND OBJECTIVES: Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment. METHODS: A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique. RESULTS: A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase. CONCLUSIONS: The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for patients.

Periodontopathogen levels following the use of an Er:YAG laser in the treatment of chronic periodontitis.

BACKGROUND: Inflammatory periodontal diseases are initiated by microbial biofilms. The reduction of the biofilm is important in the management of the disease. This study compares periodontopathogen levels following the treatment of chronic periodontitis using Er:YAG laser (ERL) debridement and mechanical scaling and root planing (SRP). METHODS: Using a split-mouth design, two quadrants were randomly allocated for treatment. Two hundred and fifty-two subgingival plaque samples were collected from 21 patients, before treatment (baseline) and at 6 and 12 weeks post-therapy. Multiplex qPCR was used to determine relative levels of Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythensis (Tf), and Aggregatibacter actinomycetemcomitans (Aa). RESULTS: Tf and Pg were significantly reduced post-treatment for both ERL and SRP. ERL treatment resulted in a reduction of Td at 12 weeks. Following SRP treatment Aa was significantly reduced at 12 weeks. No statistically significant difference was seen when treatments were compared at 6 and 12 weeks. CONCLUSIONS: A comparable reduction in the level of the four periodontal pathogens assayed was achieved with Er:YAG laser debridement and mechanical scaling and root planing.

The impact of periodontitis on oral health-related quality of life: a review of the evidence from observational studies.

Modern population based oral health management requires a complete understanding of the impact of disease in order to provide efficient and effective oral health care and guidance. Periodontitis is an important cause of tooth loss and has been shown to be associated with a number of systemic conditions. The impact of oral conditions and disorders on quality of life has been extensively studied. However, the impact of periodontitis on quality of life has received less attention. This review summarizes the literature on the impact of periodontitis on oral health-related quality of life (OHRQoL). Relevant publications were identified after searching the MEDLINE and EMBASE electronic databases. Screening of titles and abstracts and data extraction was conducted. Only observational studies were included in this review. Most of the reviewed studies reported a negative impact of periodontitis on OHRQoL. However, the reporting standards varied across studies. Moreover, most of the studies were conducted in developed countries.

Sea ice microbial production supports Ross Sea benthic communities: influence of a small but stable subsidy.

Diversity in guilds of primary producers enhances temporal stability in provision of organic matter to consumers. In the Antarctic ecosystem, where temporal variability in phytoplankton production is high, sea ice contains a diatom and microbial community (SIMCO) that represents a pool of organic matter that is seasonally more consistent, although of relatively small magnitude. The fate of organic material produced by SIMCO in Antarctica is largely unknown but may represent an important link between sea ice dynamics and secondary production in nearshore food webs. We used whole tissue and compound-specific stable isotope analysis of consumers to test whether the sea ice microbial community is an important source of organic matter supporting nearshore communities in the Ross Sea. We found distinct gradients in delta13C and delta15N of SIMCO corresponding to differences in inorganic carbon and nitrogen acquisition among sites with different sea ice extent and persistence. Mass balance analysis of a suite of consumers demonstrated large fluxes of SIMCO into the nearshore food web, ranging from 5% to 100% of organic matter supplied to benthic species, and 0-10% of organic matter to upper water column or pelagic inhabitants. A delta13C analysis of nine fatty acids including two key biomarkers for diatoms, eicosapentaenoic acid (EPA, 20:5omega3), and docosahexaenoic acid (DHA, 22:6omega3), confirmed these patterns. We observed clear patterns in delta13C of fatty acids that are enriched in 13C for species that acquire a large fraction of their nutrition from SIMCO. These data demonstrate the key role of SIMCO in ecosystem functioning in Antarctica and strong linkages between sea ice extent and nearshore secondary productivity. While SIMCO provides a stabilizing subsidy of organic matter, changes to sea ice coverage associated with climate change would directly affect secondary production and stability of benthic food webs in Antarctica.

Bacterial localization and viability assessment in human ex vivo dentinal tubules by fluorescence confocal laser scanning microscopy.

AIM: To develop a convenient method for the localization and quantification of live and dead bacteria in human ex vivo mineralized dentinal tubules. METHODOLOGY: The roots from human single-rooted teeth (n = 12) were infected with Enterococcus faecalis V583 and either treated with calcium hydroxide paste or left untreated; six control roots were uninoculated and untreated. Following further incubation, roots were stained with fluorescent DNA-binding reagents, washed thoroughly, sectioned and examined by confocal laser scanning microscopy. Computer-assisted determinations of fluorescence (bacterial viability) were compared statistically. RESULTS: Bacteria were distributed in the tubules throughout the length of the roots but tubule penetration distance was slightly reduced in the apical sections. There was no significant difference in bacterial tubule penetration between roots from different teeth and small standard deviations indicated reproducibility appropriate for experimental application. Following treatment with calcium hydroxide paste, live and dead bacteria were readily distinguishable by contrasting green and red fluorescence. Bacterial viability determinations amongst roots treated in the same way were not significantly different, and the small standard deviation is commensurate with experimental application. CONCLUSIONS: Fluorescent viability staining is a convenient, accurate and reproducible method for localizing and quantifying live and dead bacteria in human ex vivo mineralized dentinal tubules.

A system of calibrating microtomography for use in caries research.

Desktop microcomputed tomography (micro-CT) offers a non-invasive 3-dimensional analysis of structures and their physical properties. To date, the use of micro-CT has mostly involved qualitative observations, with the extent of quantitative analysis relying on automated internal calibration by the micro-CT control software. However, the value of such calibration is limited by machine drift. For an accurate quantitative use of micro-CT, it is recognized that external means of calibration are needed. A novel system of calibration standards, also known as 'phantoms', is presented. A range of low mineral concentration phantoms involving triethylene glycol dimethacrylate/glycerolate dimethacrylate resin mixed with commercial pure hydroxyapatite (HAP), from 0.07 to 1.05 g/cm(3), was fabricated. Sintered HAP was impregnated with the same resin, producing phantoms with medium-level mineral concentrations up to 1.90 g/cm(3). These phantoms were easy to create, proved accurate and stable with repeated use, and were found to mimic the composite nature of dental enamel and dentine structures under investigation.

The attitudes of New Zealand dentists and dental hygienists towards toothbrushes and toothbrushing.

The purpose of this study was to survey the attitudes of dentists and dental hygienists who practise in New Zealand, with respect to their personal habits, and the recommendations they give to their patients about toothbrush use. A questionnaire was mailed to 800 dentists and 74 dental hygienists with a response rate of 58% and 66% respectively. The results indicate that 76.6% of dentists and 89.1% of dental hygienists recommend toothbrush replacement every two to three months to their patients and generally follow this recommendation themselves. Both groups feel patients should replace their toothbrushes more often than they currently do and the majority tell their patients when to replace brushes. Dentists and dental hygienists have identified bristles that "no longer remove plaque" and "bent, splayed bristles" as the two most important indicators of when a new toothbrush is needed. Soft, compact head brushes are most often recommended by both groups. Most offices give toothbrushing instruction and distribute complimentary brushes. Dentists most often assume this task, but when a hygienist is employed, this duty is typically their responsibility. Oral B and Colgate toothbrushes are the brands most often recommended by both dentist and dental hygienists.

Effect of enteral nutritional products differing in carbohydrate and fat on indices of carbohydrate and lipid metabolism in patients with NIDDM.

Non-insulin dependent diabetes mellitus (NIDDM) is associated with chronic hyperglycemia, which increases the risk of developing microvascular and macrovascular complications. Elevated triglyceride (TG) and VLDL cholesterol levels and low levels of HDL cholesterol have also been frequently reported in NIDDM patients. A diet high in complex carbohydrate and low in fat is typically recommended for management of NIDDM, however, this has recently been challenged by scientific reports of the benefits of dietary intakes high in monounsaturated fat. Thirty-two individuals with NIDDM were randomized to receive either Ensure with Fibre (30% fat) or a high monounsaturated fatty acid product, Glucerna (50% fat). These products were consumed for 28 days at > 80% of daily energy intake. Post-treatment, dietary compliance was verified by a higher plasma TG 18:1 n-9 (p < 0.001) in the Glucerna group and a higher plasma TG 18:2 n-6 (p < 0.001) in the Ensure with Fibre group. The postprandial rise in blood glucose levels, determined by fingerprick samples, was significantly lower (p < 0.01) in the Glucerna group. Trends of clinical interest were greater mean decreases in the Glucerna group compared to the Ensure with Fibre group in: fructosamine, 9.13 umol/L vs 0.14 umol/L; glucose, 1.61 mmol/L vs 0.63 mmol/L; and insulin, 46.0 pmol/L vs 12.6 pmol/L; respectively. However, overall, fasting plasma glucose, fructosamine, TG and cholesterol levels were not significantly different between groups. Thus, in these patients, the high monounsaturated fat diet and the standard diet were similar with regard to usual indicators of carbohydrate and lipid metabolism. A high monounsaturated fat diet appears to pose no risk to lipoprotein metabolism in NIDDM patients.

A comparison of stereological and computer-assisted histomorphometric analysis as tools for histological quantification in regenerative studies.

This study was designed to compare computer-assisted histomorphometric analysis (CAHA) and stereology (STER) as measurement tools for evaluating the repair response during periodontal wound healing. Thirty-six histological sections derived from 4 surgically created defects in the furcation of mandibular second premolars of sheep were measured by each technique to determine the furcation area and volume, and the percentage of new bone formation at 7 wk postoperatively. Slides were viewed in random order with the source unknown to the examiner (JL). One section from each of the 4 specimens was flagged for triplicate measurement by each technique. Intraexaminer error was determined to be low as the coefficient of variation in each of the 2 techniques was between 1% and 4%. A consistently higher percentage of bone was identified using stereology. The coefficient of agreement was plotted to determine how closely these 2 techniques were matched in their respective estimations of bone fill in a furcation defect. This analysis revealed statistical bias between the 2-techniques and a low degree of agreement between them. This study demonstrates that the 2 techniques are not interchangeable. It also emphasizes that the reader must be cautious when comparing results from studies in which different systems of measurement and analysis have been used. Stereology was determined to be the measurement tool of choice due to its high degree of reproducibility, ease of use and efficient use of time.

Autologous bone marrow transplantation versus chemotherapy in relapsed/refractory non-Hodgkin's lymphoma: estimates of long-term survival from the recent literature.

Long-term survival following chemotherapy or autologous bone marrow transplantation in adults with relapsed/refractory non-Hodgkin's lymphoma was evaluated. English language articles published from January 1, 1988 to September 1, 1993 were obtained from a broad-based MEDLINE search retrieving 3,854 citations regarding therapy for lymphomas. Citations were evaluated using both computer-based evaluation and manual review. Articles were included if they addressed the disease of interest (non-Hodgkin's lymphoma, Working Formulation D-H), the population of interest (adults with either relapsed or refractory disease), and the therapies of interest (chemotherapy or autologous bone marrow transplantation). Articles were excluded if they did not provide convincing information on long-term survival (as evidenced by either survival analysis or individual patient data) or if they reported a small number of patients (N < 15). No randomized trials of the two therapies were found. Nine case series were found reporting on 444 eligible patients receiving chemotherapy; eight were found reporting on 256 patients undergoing autologous marrow transplantation. After weighting by sample size, the mean 3-year survival rate was 25% (95% CI, 20-30%) following chemotherapy and 40% (95% CI, 33-47%) following marrow transplantation. The reporting of potentially relevant prognostic factors was inconsistent among articles. Despite our comprehensive synthesis and evaluation of currently available data, the survival advantage of marrow transplantation in relapsed/refractory non-Hodgkin's lymphoma that we report must be viewed as tentative, given the limitations of the case series data. In addition, establishing the comparability of patients treated with these therapies is made more difficult by the inconsistent reporting of potentially relevant prognostic factors. The results of an international randomized trial of these two therapies is forthcoming and may address some of these shortcomings.

A practice guideline and decision aid for blood transfusion.

An attempt was made to reduce exposure of patients to blood products by using a point-of-ordering decision support system and strict adherence to a practice guideline, by observing physician behavior in the multidisciplinary intensive-care unit (ICU) of a tertiary-care medical center. Hemoglobin (Hg) level at the time of transfusion, total units of red blood cells (RBCs) per admission, units per patient per ICU day, fraction of patients receiving no transfusions, and incidence of single-unit transfusions covering 628 patients were measured. In Phase 1, RBC transfusion behavior was observed without intervention. In Phase 2, a special order form for RBCs that suggested a transfusion threshold of 8.6 g/dL of Hg was introduced. In Phase 3, the suggested threshold was lowered to 7.0 g/dL and required all transfusions that did not meet the new guideline to be prospectively reviewed by a transfusion medicine physician. The Hg level at transfusion fell from 8.5 g/dL to 8.2 g/dL (p = 0.008). The use of single-unit transfusions fell from 32 percent to 17 percent (p = 0.001), but there was no change in the number of patients receiving any blood, the total units per admission, or units per patient per day. In this setting, a practice guideline with a point-of-decision support system did not influence blood usage. Intermediate outcomes (such as the level of anemia at transfusion or compliance to a guideline) should not substitute for

Decreased birth weight and attainment of postnatal catch-up growth in offspring of rats exposed to cigarette smoke during gestation.

Pregnant rats were exposed to cigarette smoke daily for a 2-hour period throughout gestation and the body weights of offspring were monitored for 5 weeks postnatally. The average birth weight of the cigarette smoke exposed pups was significantly smaller compared to both pair-fed and ad libitum control groups. However, the body weights of the pups exposed to smoke were no longer significantly different from those in the pair-fed and ad libitum control groups at weeks 1 and 2 after birth, respectively. This study indicates that fetal growth retardation caused by exposure to cigarette smoke during pregnancy does not persist after birth.

Interactive effects of alcohol and diabetes during pregnancy on the rat fetus.

To determine the effect of maternal diabetes and alcohol intake, separately and in combination, on fetal growth and development, pregnant rats were divided into four groups: diabetic (D), diabetic plus alcohol (DA), control (C), and control plus alcohol (CA). Diabetes was induced by administration of streptozotocin before mating and alcohol was administered by gavage (2 g/kg body weight/day) on days 6-11 of gestation. Both diabetic groups (D and DA) had significantly lower weight gain during pregnancy compared to the controls (C and CA), despite the fact that the former consumed more food and water. Alcohol treatment resulted in reduced water and food intake and lower weight gain in the diabetic rats (DA), but not in the non-diabetic rats (CA), compared to their respective controls (D and C). On day 21 of gestation fetal body weights were significantly less and placental weights were significantly greater in the diabetic groups (D and DA) compared with the non-diabetic groups (C and CA). Differences in fetal and placental weights between rats exposed and not exposed to alcohol (C vs. CA and D vs. DA) were not significant. The number of fetuses with external malformations was significantly greater in the litters of alcohol exposed diabetic (DA) than non-alcohol exposed (D) animals. No external or skeletal malformations were observed in fetuses of non-diabetic rats regardless of whether or not they received alcohol (C or CA). The skeletal development of fetuses of diabetic rats, judged by the number and size of ossification centers on day 21 of gestation, was retarded when compared with fetuses of non-diabetic rats. Alcohol further retarded skeletal development of fetuses of diabetic animals (DA vs. D), but not of fetuses of non-diabetic rats (CA vs. C). It is concluded that maternal alcohol administration potentiates the effects of maternal diabetes on the incidence of fetal malformations and the retardation of skeletal development.

Clinical virology in children.

Virology has become an increasingly important field of medicine in the past decade. Many infectious diseases that were once of unknown etiology can now be linked to the specific viral pathogen. New methods for diagnosing and treating viral diseases are being developed. In addition, antiviral therapy or prophylaxis is available for many of these viral illnesses. This article reviews the basic medical aspects of some viral infections. Human parvovirus B19 causes erythema infectiosum, with the classic "slapped-cheek" rash. Human herpesvirus type 6 is thought to be the cause of roseola infantum, characterized by the familiar macular/maculopapular rash on the trunk and arms. Varicella-zoster virus infection results in chickenpox, which in the future may be prevented by a vaccine. Herpes simplex virus-1 causes up to 90 percent of oral and labial herpes infections. Congenital cytomegalovirus infection results in birth defects. Epstein-Barr virus is the primary cause of mononucleosis. Human papillomavirus causes laryngeal and genital warts. Respiratory syncytial virus is the major cause of lower respiratory tract disease in children. Rotavirus is the common agent in childhood diarrhea.

Studies of vanadyl sulfate as a glucose-lowering agent in STZ-diabetic rats.

To study the effect of vanadium (V) intake on blood glucose lowering, tissue V concentrations, glutathione reductase (GR) activity, and plasma trace metal concentrations, streptozotocin(STZ)-diabetic rats were treated with vanadyl sulfate (VS) (0.5-1.2 g/l in the drinking water) for up to 12 weeks. Kidney and plasma V concentrations were positively correlated with V intake. Kidney GR activities were not affected by VS treatment nor were plasma cobalt, molybdenum, manganese or lithium concentrations. Individual V intakes were dependent upon severity of diabetes, with more hyperglycemic rats consuming greater quantities of VS solution. A diminished effect on glucose lowering of VS above 1 g/l was noted.

Self-reported medical problems of adult female survivors of childhood sexual abuse.

BACKGROUND: Childhood sexual abuse has been established as an antecedent to specific psychological disorders in adulthood. Only recently have researchers begun to consider the effects of this early trauma on subsequent physical health status. The current study sought to explore the relationship between a history of childhood sexual abuse in female adults and subsequent self-reported medical complaints. METHODS: This consecutive sample study used a questionnaire to distinguish subjects with a sexual abuse history and those without such a history. Subjects were female patients over 18 years of age at a primary care health center. RESULTS: Twenty-six percent of the 523 subjects who completed the entire questionnaire acknowledged a history of sexual abuse in childhood. This percentage is consistent with estimates for the population at large. The abused group reported more problems in respiratory, gastrointestinal, musculoskeletal, neurological, and gynecological functions. Statistically significant discriminating variables for those who had been abused were (1) total medical complaints reported, (2) previous mental health treatment, and (3) age of first sexual intercourse. Among the abused group, only 5.1% had ever disclosed information about their sexual abuse experiences to a physician. CONCLUSIONS: At least one in four women are survivors of childhood sexual abuse. These women rarely spontaneously reveal this history to a physician, yet they are more likely than nonabused patients to report multisystemic medical complaints. To avoid misdiagnosis and misuse of medical services, physicians should routinely obtain a thorough sexual history, particularly when the patient has multisystem complaints.

Pulsed phytoplankton supply to the rocky subtidal zone: influence of internal waves.

Hydrographic measurements indicate that the thermocline and the phytoplankton-rich chlorophyll maximum layer are vertically displaced over a rocky pinnacle in the central Gulf of Maine by internal waves with maximum amplitudes of 27 m. Such predictable downwelling events are linked to rapid, 2- to 3-fold increases in chlorophyll a, an indicator of phytoplankton concentration, in pulses of warm water recorded 4 cm above the bottom (29-m depth). The 1.5-5.6 degrees C temperature fluctuations had an average period of 10.6 min and were generated on both ebb and flood tides. Local lee waves and the arrival of solitons propagated from Georges Bank are hypothesized to explain the timing of the internal waves. Because internal waves and chlorophyll maxima are pervasive features of stratified temperate seas, this mechanism of food coupling should be common in other rocky subtidal habitats.