Point-of-care testing has a limited effect on time to clinical decision in primary health care.

OBJECTIVE: To investigate the clinical logistics of laboratory routines at primary health care centres (PHCs). DESIGN AND METHODS: Prospective registration was carried out for each PHC using questionnaires during 2-week intervals between the end of November 2001 and mid-January 2002. The study included 9 PHCs in the county of Ostergötland and 4 in the county of Jönköping, Sweden, with different numbers of blood tests analysed using point-of-care testing (POCT). Data for B-glucose, HbA1c, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone (TSH), T4, cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were collected. Main outcome measures were median time from sampling to available test result (TATa) and median time from sampling to clinical decision (TATd), and the proportion of patients informed of the outcome of the blood test in question during the sampling occasion. RESULTS: A total of 3542 samples were collected. The median TATa showed that B-glucose, ESR and CRP were immediately analysed at all 13 PHCs. For the other tests, TATa varied from immediately to about two days. The median TATd varied from immediately to about a week. When POCT was used, 30% of the patients were informed about the outcome of the test during the sampling occasion. CONCLUSION: POCT has a limited effect on the clinical logistics in PHCs.

Re-osseointegration after treatment of peri-implantitis at different implant surfaces. An experimental study in the dog.

Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.

Osseintegration following treatment of peri-implantitis and replacement of implant components. An experimental study in the dog.

AIM: The aim of the present experiment was to study if the quality of the titanium surface is a decisive factor for osseointegration and re-osseointegration. MATERIAL AND METHODS: 2 Labrador dogs were used. The mandibular 1st molars and all premolars were removed bilaterally. 3 months later, 1 standard fixture and 3, 2-part "test fixtures" were installed in each side of the mandible. The text fixtures consisted of 1 6-mm long apical and 1 4-mm long coronal part connected with an internal screw. After 4 months, abutment connection was performed. 5 months later, a period of experimental peri-implantitis was initiated during which about 50% of the supporting bone tissue was lost. The dogs were later subjected to a treatment that included (i) systemic administration of antibiotics and (ii) surgical debridement of all implant sites. The abutments and the coronal parts of the text fixtures were removed. All parts of the exposed portion of the standard fixtures, the connecting screw and the apical part of the test fixtures were meticulously cleaned by mechanical means. A pristine, coronal fixture part was via the connecting screw attached to the apical fixture part of each text fixture. All fixtures were submerged. 2 weeks later, a fluorochrome was injected intravenously. After 4 months, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis. RESULTS: It was demonstrated that re-osseointegration failed to occur to implant surfaces (standard) exposed to bacterial contamination, but did consistently occur at sites where a pristine implant component was placed in the bone defect following surgical debridement. CONCLUSION: The above findings seem to imply that the quality of the titanium surface is of decisive importance for both osseointegration and re-osseointegration.

Evaluation of "Live for Life", a health promotion programme in the County of Skaraborg, Sweden.

STUDY OBJECTIVE: To evaluate a health promotion programme, combining a population and individual based strategy, in the County of Skaraborg, Sweden, with special attention to outcome. DESIGN: The evaluation was subdivided into structure, process and outcome. The evaluation procedure as a total is described here, but the results presented refer only to outcome. In order to study the potential effect of the individually based health examination, 35 year old subjects who had participated five years previously were in 1994-1996 compared with 35 year old subjects who had not participated before, and compared with their own values five years earlier. The results during 1995-1996 were compared with those of 1989-1990 for corresponding ages in order to study the effect of, particularly, the population based strategy. SETTING: The County of Skaraborg in the south western part of Sweden with about 270 000 inhabitants. In addition to population strategy, involving the total county, men and women aged 30 and 35 years were invited to an individually based examination. MAIN RESULTS: Factors related to body weight increased during the study period, while other factors mostly changed in the direction wanted. As a whole the changes were rather modest. There were favourable changes in lifestyle variables, for example, concerning smoking and dietary habits. CONCLUSIONS: There were beneficial effects from the health promotion programme, but there is a need for continuous improvement of methods of intervention referred to lifestyle.

Quality improvement in primary health care using computerised journal, exemplified by a smoking cessation programme for diabetic patients.

OBJECTIVE: To study the possibility of using the computerised journal for quality improvement in diabetes care. DESIGN: The computerised journal was used to reach all diabetic smokers aged 30-75 years and to invite them to a structured smoking cessation programme. The follow-up time was 18 months. SETTING: Habo, a Swedish community with 9600 inhabitants, with one primary health care centre. SUBJECTS: 147 subjects, aged 30-75 years, were registered with the diagnosis of diabetes mellitus in the computerised journal at the primary health care centre. Altogetber 25 of these patients were registered as smokers in the journal. All of them were invited to a smoking cessation group. RESULTS: Information about smoking habits in the journal was available for all but 11%. After 18 months' follow-up, 9 of the 14 patients (64%) who started in the smoking cessation group had become non-smokers. Of those 11 subjects who did not attend the group, 6 had stopped smoking during the follow-up time in spite of not participating in the structured programme. CONCLUSION: The computerised journal is a useful tool for quality improvement, giving the opportunity for directed preventive efforts on selected patient groups.

Marginal bone level around implants assessed in digital and film radiographs: in vivo study in the dog.

BACKGROUND: One of the objectives of postoperative radiographic examinations of implants is to evaluate the marginal bone height and its changes over time. PURPOSE: The purpose of this study was to assess the influence of digital image processing on measurements of the marginal bone level around implants. MATERIAL AND METHODS: Implants in beagle dogs, used to study the development of peri-implantitis and subsequent healing following treatment, were monitored with conventional radiography and a digital image plate system. Five observers measured the distance between a reference point and the bone level. Measurements in conventional radiographs were made with the use of an x-ray viewer (2x) and a magnifying lens (7x). For the digital images, the system's built-in measuring function was used together with five image processing techniques: edge enhancement (matrixes set on 5 and 25), inverted grey scale, single color highlight, and color intensity mapping together with the brightness and contrast control. From the time of maximum breakdown and the end of the experiment, histologic values were available. RESULTS: Differences between techniques and observers increased toward the end of the healing period. Measurements made at maximum breakdown did not differ significantly from the histologic value. Measurements made after healing all methods, except that using edge enhancement and a 25 x 25 kernel, differed significantly from the histologic value by underestimating the bone level. CONCLUSIONS: Measurements of bone level around implants from digital radiographs are as accurate and precise as those from film images. In particular cases, the use of specific image processing algorithms may improve both accuracy and precision. After healing, the histologic specimens showed an incomplete bone fill in the crater with a remaining thin layer of connective tissue in contact with the fixture, and in such situations, the morphology of the bone will give a more complicated diagnostic task.

Resolution of peri-implantitis following treatment. An experimental study in the dog.

The aim of the present experiment was i) to study the effect of anti-microbial therapy of experimentally induced peri-implantitis lesions and ii) to assess features of bone regrowth following treatment. Four beagle dogs were used. Three titanium fixtures (Brånemark System) were installed in each quadrant of the mandible (premolars previously extracted). Abutment connection was performed 5 months later and ligature induced breakdown was initiated. The ligatures were removed when approximately 50% of the initial bone support was lost. A 3-week antibiotic regimen (amoxicillin and metronidazole) was initiated 1 month later. Two days after the start of the antibiotic administration, the experimental implant sites were exposed to local therapy. The abutments were removed and the exposed fixture surfaces were treated with an abrasive (pumice) administered via a rotating brush (left side) or cleaned with cotton pellets soaked in saline (right side). Cover screws were attached to the fixtures and the implants were submerged. Fluorochromes were injected intravenously 2 weeks, 4 weeks and 12 weeks after surgery. The animals were killed 7 months after surgery and block biopsies of each implant site were dissected and prepared for histological analysis. The findings of the examinations disclosed that the inflammatory lesion was resolved and new bone formation had occurred in the previous defect following antimicrobial and local therapy. The amount of "re-osseointegration" that had taken place, however, was small. Indeed, at all experimental implant sites, a thin connective tissue capsule was found to separate the implant surface from the newly formed bone.

Cardiovascular risk during early adult life. Risk markers among participants in "Live for Life" health promotion programme in Sweden.

STUDY OBJECTIVE: To study differences in cardiovascular lifestyle risk factors and biological risk markers in early adult life, with special attention to age and sex differences. Lifestyle cardiovascular risk factors included dietary habits, physical inactivity, smoking, alcohol habits, psychosocial strain, and mental stress. Biological risk markers included anthropometric variables, arterial blood pressure, and serum cholesterol concentration. DESIGN: A combined individual and community based preventive programme, including health examinations. SETTING: All communities in the County of Skaraborg in south western Sweden. PARTICIPANTS: Altogether 12,982 men and women aged 30 or 35 years who underwent health examinations over seven years. MAIN RESULTS: In both sexes, biological risk markers studied were worse in 35 year old subjects than in 30 year olds. Furthermore, a larger proportion of men aged 35 years were smokers and were physically inactive compared with 30 year old men. However, dietary habits were better in both sexes in the upper age group. At both ages there were also significant differences between men and women. Women, compared with men, had better dietary habits and lower alcohol consumption but smoked more and experienced greater mental stress and psychosocial strain. All biological risk markers were worse in men than in women at both ages studied. During the observation period, some improvement of the health profile of the participants was observed, indicating a beneficial effect of the intervention programme. CONCLUSIONS: The results indicate that the risk of cardiovascular disease, as assessed from studying lifestyle and biological risk markers, increases early in life, suggesting that preventive measures should start early.

A secondary ion mass spectroscopic study of the elemental composition pattern in rat incisor dental enamel during different stages of ameloblast differentiation.

In most earlier studies on the elemental composition pattern of dental enamel, a picture is presented which describes a limited region. In this study, estimates of the incorporation of some critical elements into enamel were correlated with the differentiation stages of the ameloblasts through out the whole tooth. Elemental analyses of rat incisor dental enamel during the secretory, transitional and maturation phases were performed using two different modes of secondary ion mass spectrometry (SIMS). The results were presented as ion images and three-dimensional spatial resolution graphs. In the elemental images of 23Na, 26CN, 35Cl and 39K, counts were detected during the secretory and maturation phases of amelogenesis. Variations were interpreted as resulting from secretion of elements during the secretory phase and resorption during the maturation phase. In line scans the ion yield from enamel during different stages of differentiation of the ameloblasts was analysed. The elements investigated were 12C, 19F, 23Na, 31P, 39K and 77CaCl. As seen in the images, most elements exhibited a higher ion yield during the earlier stages of secretion, and lower yields during the maturation-phase resorption. Cl, together with P, increased during the phases of maturation. In the most apical portions of the teeth, corresponding to a presecretory phase, an inverse pattern was seen for most of the elements. If the surface yield was high at the onset of the secretory phase, the presecretory yields were lower, and vice versa.

The effect of antimicrobial therapy on periimplantitis lesions. An experimental study in the dog.

The objective of the present study was to evaluate the effect of systemic antibiotics and local debridement in the treatment of experimentally induced periimplantitis lesions. 5 Labrador dogs, and about 1-year old, were included in the study. In order to establish bilateral recipient sites for implants the mandibular right and left 1st molars, 4th and 3rd premolars were removed. 6 titanium fixtures (Brånemark System Nobelpharma AB, Göteborg, Sweden) were installed and standard abutments were connected 3 months after fixture installation. Cotton floss ligatures were placed in a submarginal position around the neck of the abutments and the animals were placed on a diet which allowed plaque accumulation. After 6-8 weeks, when the tissue destruction amounted to about 20% of the fixture length, the ligatures were removed. 1 month after ligature removal, an antibiotic regimen (amoxicillin and metronidazole) was initiated and maintained for 3 weeks. In the left side of the mandible, buccal and lingual mucoperiosteal flaps were elevated, the granulation tissue within the bone craters adjacent to the implants was curetted, and the abutments were removed. The exposed outer surface, the internal part of the fixtures, as well as the abutments were treated with a detergent, delmopinol. The cleaned abutments were autoclaved, and connected to the clean fixtures. The mucoperiosteal flaps were replaced to their original position, adapted to the abutments and sutured. A careful plaque control program was initiated for the left jaw quadrants. In the right side of the mandible no local treatment was given to the fixtures and the abutments following ligature removal. Furthermore, no plaque control was provided to the implant segments in the right jaws. After 4 months of healing block biopsies including one implant with adjacent hard and soft tissue were harvested and prepared for light microscopy. It was observed that systemic antimicrobial therapy, combined with implant cleaning, curettage of the bone defect and regular plaque control resulted in (i) resolution of the periimplantitis lesion, (ii) a significant recession of the marginal periimplant mucosa, and (iii) a minor additional apical shift of the base of the bone defect. In the untreated sites the plaque associated infiltrate remained and was in several sites examined in contact with the adjacent bone tissue.

Guided bone regeneration in the treatment of periimplantitis.

The objective of the present experiment was to study the soft and hard tissue healing following treatment of experimentally induced periimplantitis. 5 labrador dogs about 1-year old were used. The mandibular right and left 1st molars, 4th and 3rd premolars were removed, titanium fixtures (Brånemark System) were installed, and standard abutments were connected in a 2nd stage procedure. After 3 months experimental periimplantitis was induced by the placement of cotton floss ligatures in a submarginal position. 6 weeks later the ligatures were removed. 1 month after ligature removal, an antibiotic regimen was initiated. During a 3-week period, each dog was given tablets of amoxicillin and metronidazole. In the left side of the mandible, buccal and lingual mucoperiosteal flaps were elevated and granulation tissue within the bone craters curetted. The abutments were removed. The exposed outer surfaces and the internal part of the fixtures were carefully cleaned with a detergent (delmopinol HC1). An e-PTFE membrane was placed over each fixture and adjusted to cover the bone crater. New cover screws were fitted through the membranes to the cleaned fixtures. The implants were submerged and the flaps sutured. In the right side of the mandible no local treatment was performed. The dogs were sacrificed after 4 months and biopsies prepared for histological examination. The findings indicated that treatment of a periimplantitis lesion, including comprehensive systemic antimicrobial therapy and cleaning of submerged implants resulted in (i) the elimination of the inflammatory process in the periimplant tissues and (ii) the establishment of a dense connective tissue capsule in direct contact with the previously exposed surface of the implant system. It was also observed that (iii) new bone was frequently laid down on the pristine cover screws.

Results from an intervention programme dealing with cardiovascular risk factors. Experiences from a study of men aged 33-42 in Habo, Sweden.

OBJECTIVE: To evaluate the long-term effect of a health examination and intervention programme in a Swedish community. DESIGN: A health examination was carried out with the purpose of improving cardiovascular risk factors. A health profile was created as an educational tool, by means of which a nurse discussed the results of the health examination with the participants. Follow-up studies were carried out after 1 year and after 3-6 years. PARTICIPANTS: All men aged 33-42 living in a Swedish community (Habo) were invited to the health examination. Altogether 652 participated, corresponding to a participation rate of 86.1%. MAIN RESULTS: In the 1-year follow-up study, improvement with respect to cardiovascular risk factors was seen in a high-risk group (n = 161) for systolic blood pressure and lifestyle factors such as alcohol consumption, smoking, mental stress, mental health, and for the sum of risk points according to the health profile. Corresponding improvement was not seen in other men of similar age in the same community who had not participated in the health survey. In the 3-6 year follow-up only minor improvements remained, mainly for blood pressure and sum of risk points. CONCLUSION: Even if the results are rather promising in the short run, it seems urgent to make the methods for improving cardiovascular risk factors better, especially with regard to long-term results.

Bacterial colonization on internal surfaces of Brånemark system implant components.

The aim of the present study was to examine the microbiota on the internal surface of the components of 28 Brånemark implants in 10 partially edentulous patients who had been treated with 1 fixed partial prostheses each. The prostheses had been in function for 1 to 8 years. The fixed prostheses were checked for mobility and removed. The abutment screws were loosened and classified as stable, easily removed or loose. Then, bacterial samples were obtained from the various internal surfaces of the implant system. Estimation and identification of the most predominant species was performed on the blood agar plates. Identification was based on Gram reaction, oxygen sensitivity and biochemical tests. Internal surfaces of different components of the Brånemark implants, after varying periods of function in the oral cavity, consistently harboured a heterogeneous and primarily anaerobic microbiota. The individual samples showed a great variation. No relation could be seen between type and length of abutment, abutment stability, bone loss and type and number of microorganisms found in the samples. The flora consisted mainly of facultative and anaerobic streptococci, Gram-positive anaerobic rods such as Propionibacterium, Eubacterium and Actinomyces species and Gram-negative anaerobic rods including Fusobacterium, Prevotella and Porphyromonas species. There are reasons to suggest that this presence of bacteria is the result of (i) a contamination of the fixture and abutment components during the 1st and/or 2nd stage of implant installation and/or (ii) a transmission of microorganisms from the oral environment during function subsequent to bridge installation.

Interrelation between risk factors for cardiovascular disease in men aged 33-42. A study from Habo in Skaraborg County, Sweden.

OBJECTIVES: The main purpose was to study associations between different risk factors for coronary heart disease in order to find out whether such associations already exist during the fourth decade of life. SETTING: A study carried out by the primary healthcare staff in the community of Habo in Skaraborg County in south-western Sweden. SUBJECTS: All men living in Habo aged 33-42 years who were willing to participate in the study--in total 652 men (participation rate 86%). MAIN OUTCOME MEASURES: Risk factors for coronary heart disease considered as markers of lifestyle: body-mass index as a measure of general obesity, waist-to-hip circumference ratio as a measure of central obesity, arterial blood pressure, serum cholesterol concentration and serum triglyceride concentration. RESULTS: There were statistically significant correlations between all the factors analysed including anthropometric data, blood pressure and serum lipids. CONCLUSIONS: The results indicate associations between different risk factors at an early age and emphasises the need for a multifactorial view on risk as early as at the ages which were the focus of this study.

Different types of inflammatory reactions in peri-implant soft tissues.

The aim of the present study was to analyze some features of the peri-implant mucosa at sites in the dog model which had been exposed to plaque accumulation for periods up to 9 months. The experiment was carried out in 5 labrador dogs. The mandibular right and left 2nd, 3rd and 4th premolars (2P2, 3P3, 4P4) and the 1st molars (1M1) were extracted. Following a 3-month healing period, 3 titanium fixtures (Nobelpharma AB, Göteborg, Sweden) were installed in the edentulous premolar/molar regions. Abutment connection was performed 3 months later and a meticulous plaque control period of 3 months was initiated. A clinical examination was performed at the end of this preparatory period and a main study period of 9 months continued. During this period, the plaque control regimen was maintained in the mesial and central (left: L1, 2 and right: R1, 2) implant segments, whereas plaque was allowed to accumulate on the distal implants, i.e.. L3 and R3. At the end of the main study period, i.e., 12 months after abutment connection, the clinical examination was repeated, the animals perfused and biopsies obtained. Semi-thin sections were produced for histometric and morphometric analyses. The peri-implant mucosa at implant sites exposed to daily and comprehensive plaque control at biopsy was clinically noninflamed and the connective tissue lateral to a junctional epithelium was devoid of accumulations of inflammatory cells.(ABSTRACT TRUNCATED AT 250 WORDS)

A study of men aged 33-42 in Habo, Sweden with special reference to cardiovascular risk factors. Design, health profile and characteristics of participants and non-participants.

An intervention study of men living in the Community of Habo in southwestern Sweden has been carried out. All men aged 33-42 and living in the community were invited. Altogether 652 men participated. The study included a questionnaire, an interview made by a nurse, anthropometric measurements, blood pressure measurements, measurements of respiratory function and work performance capacity, and blood sampling for chemical analyses. The participation rate was high, 86.1%, after one mail invitation even considering the fact that two reminders were sent. Most of the non-participants had recently been in contact with the health care organisation, either because they were high-consumers of health care, or because they had attended a health examination at work. A health profile was worked out comprising 11 different potential risk factors for coronary heart disease. This health profile turned out to be a useful educational tool when discussing the results of the examination with the participants. Risk points were given according to certain predetermined criteria. The distribution of risk factors was similar in the different ages studied. Most of the participants had at least one risk factor as defined, but many of them had two or more risk factors.

Oral glucose tolerance and its relationship to overweight and other cardiovascular risk factors in men aged 33-42. A study in the community of Habo, Sweden.

OBJECTIVE: To study the prevalence of family history of diabetes, overweight, and glucose intolerance in a defined general population, and the associations between these variables and others involved in the so-called metabolic syndrome (blood pressure, obesity, serum lipids). DESIGN: An oral glucose tolerance test (OGTT) was done on all participants in a population study who reported a family history of diabetes or had a body mass index (BMI) > or = 27. SETTING AND PARTICIPANTS: A population study of men aged 33-42 was carried out at Habo in southwestern Sweden (participation rate 86.1%). An OGTT was done on 170 men who fulfilled the criteria stated above. RESULTS: Overweight was a risk factor for impaired glucose tolerance and was more strongly associated with this state than was a family history of diabetes. Glucose intolerance was also associated with increased blood glucose concentration during the OGTT and with other metabolic disturbances such as increased serum lipids, increased blood pressure, and physical inactivity. CONCLUSIONS: The combination of overweight and impaired glucose tolerance is already common at a rather young age in men and is often combined with impairment of arterial blood pressure and serum lipids. The results indicate that it is urgent to start preventive measures early in life.

Dental injuries, temporomandibular disorders, and caries in wrestlers.

The aim of this study was to examine the prevalence of dental injuries, temporomandibular disorders (TMD), and dental caries in a group of champion wrestlers. Twenty-six male wrestlers, with a mean age of 23 yr, and an age-matched control group participated in the study. A questionnaire was used with questions on trauma, frequency of headache, intensity of practicing sports, use of sugar-containing "sports drinks", use of mouth guards, and previous TMD problems. Four bitewing radiographs were taken in all subjects. In addition, three intraoral apical radiographs of maxillary and mandibular frontal regions were taken in the wrestlers. The number of existing teeth, dental caries, amount and type of restorations, and dental injuries were recorded. Examination of the stomatognathic system comprised bilateral palpation of the masseter and temporal muscles and temporomandibular joints, and evaluation of the mandibular movements. None of the subjects had drunk sports drinks or worn mouth protectors regularly. The wrestlers had more frequent and severe dental injuries localized to the frontal region of the maxilla than the controls. No statistical differences were found in the prevalence of caries or TMD between the groups.

Salivary fluoride clearance after a single intake of fluoride tablets and chewing gums in children, adults, and dry mouth patients.

The aim of the present investigation was to compare the clearance pattern in saliva and the salivary stimulating effect of a new fluoride (F) chewing gum (Fluorette) with three other F products used in Scandinavia for many years for caries prevention. Concentration of F was determined in whole saliva in three groups of subjects: 1) children, 10-12 yr of age (n = 20), 2) adults (n = 20), and 3) dry mouth patients (n = 15), after a single intake of the two tablets, Dentan and Fludent, and the two chewing gums, Fluomin and Fluorette, all containing 0.25 mg F as NaF. Sucking was allowed until the tablets had been completely dissolved in the mouth. The chewing gums were used for 15 min. Saliva samples were collected from subjects expectorating 0.3-0.5 ml at nine different time intervals up to 45 min after the intake. There were some significant differences in the maximum F concentration, the area under the salivary fluoride concentration curve (AUC) when plotted against time, and the salivary stimulating effect among the four products, but as a whole they were small and probably of minor clinical importance. Among the various groups, the dry mouth patients showed the highest salivary F concentration. Thus, the main conclusion from this study is that the F tablets and chewing gums studied, including the new product Fluorette, had approximately the same clearance pattern in saliva and the same salivary stimulating effect. However, there were great variations among the different subjects.