Native Language Spoken as a Risk Marker for Tooth Decay.

OBJECTIVE: The purpose of this study was to assess dmft, the number of decayed, missing (due to caries), and/ or filled primary teeth, of English-speaking and non-English speaking patients of a hospital based pediatric dental clinic under the age of 72 months to determine if native language is a risk marker for tooth decay. STUDY DESIGN: Records from an outpatient dental clinic which met the inclusion criteria were reviewed. Patient demographics and dmft score were recorded, and the patients were separated into three groups by the native language spoken by their parents: English, Spanish and all other languages. RESULTS: A total of 419 charts were assessed: 253 English-speaking, 126 Spanish-speaking, and 40 other native languages. After accounting for patient characteristics, dmft was significantly higher for the other language group than for the English-speaking (p<0.001) and Spanish-speaking groups (p<0.05), however the English-speaking and Spanish-speaking groups were not different from each other (p>0.05). CONCLUSIONS: Those patients under 72 months of age whose parents' native language is not English or Spanish, have the highest risk for increased dmft when compared to English and Spanish speaking patients. Providers should consider taking additional time to educate patients and their parents, in their native language, on the importance of routine dental care and oral hygiene.

Effect of Human Milk and its Components on Streptococcus Mutans Biofilm Formation.

OBJECTIVE: This study investigated the effects of human breast milk and its components on the nutritional aspect of the caries process due to Streptococcus mutans UA159 biofilm formation. STUDY DESIGN: Human breast milk was collected from 11 mothers during 3-9 months postpartum. To test for the effect on biofilm formation, a 16-hour culture of S. mutans was treated with dilutions of human breast milk and several major components of human breast milk, lactose, lactoferrin, IgA, and bovine casein in sterile 96-well flat bottom microtiter plates for 24 hours. The biofilms were fixed, washed, stained with crystal violet, and extracted. Absorbance was measured to evaluate biofilm growth mass. RESULTS: Dilutions 1:10-1:2,560 of the human breast milk samples increased biofilm formation by 1.5-3.8 fold compared to the control. Lactoferrin decreased biofilm formation significantly in all dilutions (average milk concentration of 3 mg/ml). Lactose had no effect at average breast milk concentrations (60 mg/ml) except at its lowest concentration (15 mg/ml) where it was increased. IgA significantly decreased biofilm formation at its highest concentration of 2,400 µg/ml (average milk concentration 600 µg/ml). Casein caused significantly increased biofilm formation at all concentrations tested above the average milk content (2.3 mg/ml). CONCLUSIONS: The results of this study demonstrate an increase in S. mutans biofilm formation by human breast milk 3-9 months post partum. Among its major components, only casein significantly increased biofilm formation among the concentrations analyzed. Lactose had no effect except at 15 mg/ml. Lactoferrin and IgA significantly decreased S. mutans biofilm formation at their highest concentrations. This information expands the current knowledge regarding the nutritional influence of breastfeeding and validates the necessity to begin an oral hygiene regimen once the first tooth erupts.

Antibacterial and physical properties of resin modified glass-ionomers combined with chlorhexidine.

The purpose of this study was to determine the effect on mechanical properties and antimicrobial activity of the addition of chlorhexidine (CHX) to a resin modified glass-ionomer (Photac-fil, ESPE, Norristown, PA, USA). Chlorhexidine diacetate was combined with a resin modified glass-ionomer material at a concentration of 5%. The samples were tested for hardness, tensile strength and erosion at 24 h and 6-week intervals and for elution of CHX and antimicrobial activity weekly for 6 weeks. At 24 h there was no significant difference in hardness between the two groups, but at 6 weeks the resin modified glass-ionomer group was significantly harder than the CHX groups (P < 0.05). The diametral tensile strength test indicated no difference between the control and CHX groups at 24 h or at 6 weeks. The jet erosion test demonstrated significantly less erosion with the CHX group at 24 h but at 6 weeks the CHX group showed significantly more erosion than the control group. The chemical assay data demonstrated a peak elution of CHX at week 1 with residual amounts at weeks 2 and 3. The microbial data demonstrated that the CHX group had a significant reduction in Streptococcus mutans numbers for weeks 1-3, but after week 4 there was no difference between the glass-ionomer with and without CHX. The addition of CHX to resin modified glass-ionomer altered hardness and erosion of the resin-modified glass-ionomer, but because there are no material specifications, it is difficult to determine clinical implications. Chlorhexidine did significantly improve the antimicrobial effect of the glass-ionomer which was consistent with the chemical assay data. The results indicated that the addition of CHX to resin modified glass-ionomer material (Photac-fil) did not seriously degrade the physical properties during the time period tested and that the addition of CHX resulted in a greater reduction in S. mutans when compared with glass-ionomer alone.

Comparison of electrosurgical and formocresol pulpotomy procedures in children.

OBJECTIVES: Although previous studies have examined the electrosurgical pulpotomy technique for primary teeth, no well-controlled, clinical human trials have been published. The purpose of this study was to prospectively compare electrosurgical pulpotomies vs. formocresol pulpotomies in human vital primary molar teeth. DESIGN: Fifty children were randomly divided into two groups, 25 receiving an electrosurgical pulpotomy and 25 receiving a formocresol pulpotomy. RESULTS: After at least 5 months postoperative observation time, the clinical and radiographic success rates for the electrosurgical groups were 96 and 84%, respectively; and for the formocresol group, 100 and 92%, respectively. CONCLUSION: There were no statistically significant differences between the success rates for the two groups at the P < 0.05 level as tested by Fisher's exact test. This study failed to demonstrate a difference in the success rate between the electrosurgical and formocresol pulpotomy techniques.

Interaction of GABA and excitatory amino acids in the basolateral amygdala: role in cardiovascular regulation.

Activation of the amygdala in rats produces cardiovascular changes that include increases in heart rate and arterial pressure as well as behavioral changes characteristic of emotional arousal. The objective of the present study was to examine the interaction of GABA and excitatory amino acid (EAA) receptors in the basolateral amygdala (BLA) in regulating cardiovascular function. Microinjection of the GABAA receptor antagonist bicuculline methiodide (BMI) or the E A A receptor agonists NMDA or AMPA into the same region of the BLA of conscious rats produced dose-related increases in heart rate and arterial pressure. Injection of the nonselective EAA receptor antagonist kynurenic acid into the BLA prevented or reversed the cardiovascular changes caused by local injection of BMI or the noncompetitive GABA antagonist picrotoxin. Conversely, local pretreatment with the glutamate reuptake inhibitor L-trans-pyrrolidine-2,4-dicarboxylic acid enhanced the effects of intra-amygdalar injection of BMI. The cardiovascular effects of BMI were also attenuated by injection of either the NMDA antagonist 3-(2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP) or the AMPA receptor antagonist 1,2,3,4-tetrahydro-6-nitro-2, 3-dioxo-benzo[f]quinoxaline-7-sulfonamide (NBQX). When these two EAA receptor antagonists were combined, their ability to suppress BMI-induced tachycardic and pressor responses was additive. These findings indicate that the cardiovascular effects caused by blockade of GABAergic inhibition in the BLA of the rat are dependent on activation of local NMDA and AMPA receptors.

Early environmental influences can attenuate the blood pressure response to acute stress in borderline hypertensive rats.

The objective of this experiment was to test the hypothesis that early environmental influences could affect cardiovascular reactivity to acute stress in borderline hypertensive rats. This study utilized a cross-fostering paradigm in which borderline hypertensive rat (BHR) pups were reared by their natural spontaneously hypertensive rat (SHR) mothers, by an adoptive SHR dam, or by an adoptive Wistar-Kyoto female. Several maternal behavior measures were taken throughout weaning. Cardiovascular responses to acute stress were measured in adult BHR offspring. SHR dams spent significantly more time engaged in arched, as contrasted with passive, nursing behaviors throughout the preweaning period. Although strain of dam had no effect on resting blood pressure or heart rate, BHR reared by WKY dams had a greatly reduced blood pressure response to acute stress compared with BHR raised by either natural or adoptive SHR dams. These results suggest that the expression of cardiovascular characteristics in the BHR can be modified by early environmental influences and support the hypothesis that the expression of the hypertensive phenotype in the BHR is dependent upon information that is conveyed both genetically and environmentally.

The effect of sleep on conscious sedation: a follow-up study.

This study evaluated the effect of preoperative sleep on the success of conscious sedation. Seventy-six children, from 18 to 61 months of age, participated in this study. Sixty-two children received chloral hydrate (50-60 mg/kg) and hydroxyzine (15-35 mg) and 14 children received intramuscular meperidine hydrochloride (2.2 mg/kg). Parents were asked to complete a questionnaire which asked several questions about their child's activity the previous day, and their bedtime. The operator ranked the sedations on a scale of 1 to 4, with 1 being good and 4 being poor. The results were statistically evaluated using the Wilcoxon Rank sum test. The children that received a normal amount or greater amount of sleep preoperatively did not show any significantly higher degree of success (p < 0.26) with their sedation appointment. The parents' perception of their child's tiredness did demonstrate borderline (p < 0.08) significance. Children greater than 36 months of age had a significantly higher (p < 0.03) degree of successful sedations. The results of this study demonstrated that there was no clear correlation between the child's preoperative sleep and the outcome of the sedation, but that a tired child may increase the likelihood of a poor sedation. In addition, the child's age at the time of the sedation may affect the outcome of the sedation.

Intraoperative hypothermia associated with lower extremity tourniquet deflation.

STUDY OBJECTIVE: To determine the rapidity and extent of core temperature decrease following release of a lower extremity pneumatic tourniquet. DESIGN: Prospective study. SETTING: Inpatient surgery in a university trauma center. PATIENTS: 11 ASA status I and II adults undergoing unilateral lower extremity fracture fixation in which a tourniquet was used, with general anesthesia. INTERVENTIONS: Temperature was measured in the esophagus before and after lower extremity tourniquet release. MEASUREMENTS AND MAIN RESULTS: Tourniquet times ranged from 41 to 129 minutes (mean 98.5 +/- 9.1 minutes). Following tourniquet deflation core temperature decreased in all patients, with a maximal decline at 10 minutes, the termination of measurements, although trending downward. Esophageal temperature decreased an average of 0.46 degree C +/- 0.2 degree C at 5 minutes, and 0.67 degree C +/- 0.2 degree C at 10 minutes following tourniquet release, respectively. Temperature changes were significant (p = 0.0001) at both time intervals. CONCLUSION: Core temperature drops significantly immediately following release of the tourniquet at the esophageal temperature monitoring site. This decrease is the result of cooling of systemic blood reperfusing the hypothermic limb, and mixing of cool, "washed out" blood with the systemic circulation. As the consequences of hypothermia are well-known, we recommend core temperature monitoring in all patients having lower extremity tourniquet placed during general anesthesia, as well as vigilant monitoring for prolonged effects of anesthetics in the postoperative period.

Clonazepam for the treatment of lancinating phantom limb pain.

OBJECTIVE: To propose clonazepam for use in the empiric treatment of shooting/shocking phantom limb pain. SETTING: Outpatient pain clinic associated with a university hospital. PATIENTS: Two patients with phantom limb pain after total hip disarticulation. INTERVENTIONS: Treatment with clonazepam. RESULTS AND CONCLUSIONS: Clonazepam provided effective relief for > 6 months in two patients with shooting/shocking phantom limb pain. Although clonazepam therapy is not new, it appears to have been omitted from current pain texts and journals as a treatment option for phantom limb pain.

Managing patients who have seizure disorders: dental and medical issues.

Some dental professionals may have concerns about treating patients who have seizure disorders. The authors contend that increased knowledge about seizures and how to manage them may make dental professionals more comfortable. This article reviews the various seizure types, discusses commonly used anticonvulsants and their side effects and outlines some special concerns dentists may have in providing care to these patients.

Baby bottle tooth decay: a concern for all mothers.

Health care professionals often inappropriately separate dental health from other health functions. Baby bottle tooth decay (BBTD) should be a concern for all professionals who work with expectant or new mothers and very young children. Research indicates that even though many mothers are aware of the etiology of the condition, they continue to allow prolonged nursing with milk or liquids other than water. Nurses can help promote good oral health for children by educating and training expectant and new mothers, children, and others who work with mothers and children in preventing BBTD.

Central amygdaloid lesions attenuate cardiovascular responses to acute stress in rats with borderline hypertension.

The present study tested the hypothesis that lesions of the central nucleus of the amygdala (CeA) would reduce the cardiovascular responses to acute stress in a rodent model that is genetically predisposed toward hypertension. Male borderline hypertensive rats (BHR) were given bilateral electrolytic lesions directed to destroy the CeA or were subjected to a sham procedure. Direct measurements of blood pressure and heart rate were recorded during rest, during 10 min of acute stress, and for 10 min following stress. Analysis of the data revealed that BHR with CeA lesions had a significant attenuation of the stress-induced pressor response compared to sham-operated subjects. Behavioral measures taken in an open field chamber before and after lesions revealed no differences in numbers of squares crossed or rearings. These results suggest that the CeA is an important neural structure in mediating cardiovascular responses to acute stress in a model susceptible to environmentally induced hypertension.

The effect of sleep on conscious sedation.

This study evaluated the effect of preoperative sleep on the success of conscious sedation. Thirty healthy children between the ages of 18 and 61 months of age were utilized in this study. The children all received chloral hydrate (50-60 mg/kg) and hydroxyzine (15-25 mg) and nitrous oxide (30-50%). Parents were asked to complete a questionnaire which asked several questions about their child's activity the previous day, their diet, and questions that related to their bedtime. The operator ranked the sedations on a scale from 1 to 4 with 1 being good and 4 being poor. The results were then statistically evaluated using the non-parametric Mann-Whitney and Kruskal-Walls tests. The children that received a normal amount of sleep or greater amount of sleep preoperatively had a borderline (P = .06) higher degree of successful sedation. There was no correlation between the child's bedtime (early, normal, late) and the success of sedation. The parent's perception of their child's tiredness could not be correlated with the success of the sedation. The children greater than 36 months of age had a significantly (P = .02) higher degree of successful sedations. The results suggest that a well rested child may experience a more pleasant dental sedation while under chloral hydrate and hydroxyzine conscious sedation and that the child's age at the time of the sedation may affect the outcome of the sedation.

Vascular responsiveness in the unstressed borderline hypertensive rat.

This study compares vascular responses of unstressed borderline hypertensive rats (BHR) to age-matched Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). Rings of thoracic aorta were mounted for isometric force determinations in tissue baths. Cumulative additions of phenylephrine (PE) or serotonin (5-HT) produced contractile responses in BHR aorta that were less than WKY but greater than SHR. Removing the endothelium increased force development to both agonists, with BHR showing the greatest increase. Based on EC50 determinations, no differences in PE sensitivity existed between groups, although in response to 5-HT, rings from SHR were significantly more sensitive than WKY. While the sensitivity of all rings increased with denuding, BHR showed a greater relative increase in sensitivity than WKY or SHR (intact EC50 divided by denuded EC50) to both PE and 5-HT. This suggests that there may be greater endothelium-derived relaxation in BHR than in WKY or SHR. In rings precontracted with 1 microM PE, the cumulative addition of acetylcholine resulted in greater relaxation in BHR than in SHR and WKY preparations. Thus, rings from unstressed BHR, which have only slightly higher blood pressures than WKY rats, demonstrate greater endothelium-mediated relaxation than WKY or SHR. Increased endothelium-derived relaxation may represent a possible mechanism for masking hypertension in BHR that is compromised as a result of exposure to a chronic stress paradigm.