Occupational contact urticaria: Australian data.

BACKGROUND: Over the last 30 years there has been increasing recognition of the clinical entity contact urticaria (CU) and the related diagnosis, protein contact dermatitis. However, there are relatively few reports of the occupational relevance of this condition. OBJECTIVES: To describe relevant characteristics of patients diagnosed with occupational CU (OCU) in a tertiary level specialist occupational dermatology clinic in Australia. METHODS: We performed a retrospective analysis of all patients diagnosed with OCU at an occupational dermatology clinic in Melbourne between 1 January 1993 and 31 December 2004. We identified 151 cases of CU diagnosed over the 12-year period. RESULTS: OCU was diagnosed in 8.3% (143 of 1720) of the total number of patients with occupational skin disease. Natural rubber latex accounted for the majority of all cases of OCU. Other common causes were foodstuffs and ammonium persulphate utilized as hairdressing bleach. The most commonly affected sites were the hands, followed by the arms and face. The most frequently affected occupations were healthcare workers, food handlers and hairdressers. All cases of CU in patients with hand symptoms were assessed to be work related. Atopy was a significant risk factor for both latex-related and nonlatex-related OCU. CONCLUSIONS: Radioallergosorbent tests and skin prick testing, including to patients' own food samples, should be part of the routine assessment of patients in high-risk occupations for OCU, particularly if the hands are affected, there is a history of atopy and there is exposure to urticants. We emphasize the importance of both determining the role of occupation in the causation of CU and recognizing all contributory factors in complex cases of occupational contact dermatitis of the hands.

Provisionalization for ceramic laminate veneer restorations: a clinical update.

At the inception of ceramic veneer restorations in the early 1980s, provisional veneer restorations were not customarily placed over teeth which had undergone tooth reduction. During the last several years, provisional veneer restorations have been utilized with increased frequency for a variety of valid reasons. The learning objective of this article is to examine the reasons for the increased utilization of provisional veneer restorations and to describe a selection of the clinical methods employed for direct and indirect fabrication. The indications and contraindications for provisionalization are presented. Four case reports are utilized to describe and illustrate the various clinical circumstances, the provisionalization procedures, the appropriate instruments, and the materials that facilitate the fabrication of aesthetic, functionally sound, and biocompatible provisional restorations.

Smile showcase--redesigning the narrow smile.

This article describes how creative manipulation of tooth dimensions and color can cause a drab, narrow smile to expand by illusion and "come alive." Though many areas of restorative dentistry will be utilized, the unifying element will be the broad application of adhesive dentistry. The case description presented here will help to enhance the ability of the dental practitioner and the laboratory technician to design and produce more aesthetically harmonious, cosmetically appropriate smiles. In addition, it will provide technical guidance in integrating time-honored restorative principles, state-of-the-art dental materials, innovative clinical procedures, and relevant academic research.

Masking severely tetracycline-stained teeth with ceramic laminate veneers.

When the primary restorative objective is the reinstatement of vital natural tooth color, dark tetracycline-stained teeth still represent the ultimate challenge for ceramic laminate veneers. Masking severe stain with opaquing composite resins is a significant advancement; however, the procedure requires additional chairtime, is technique sensitive (to avoid excessive opacity), and involves removal of additional tooth structure. The learning objective of this article is to describe and compare two different methods for masking tetracycline-stained teeth. The article illustrates the natural tooth color derived from ceramic laminate veneers when bonded to opaque composite resins in the maxillary arch, and compares it to a new ceramic veneer formulation in the mandibular arch, which masks the stain, eliminates the need for subopaquing with composite resins, and resembles the qualities of natural tooth color.

Mandibular ceramic veneers: an examination of diverse cases integrating form, function, and aesthetics.

Mandibular anterior ceramic veneers, though used less frequently than maxillary anterior ceramic veneers, are highly useful for certain case conditions. The learning objective of this article is to explore the indications, tooth preparation design, provisionalization considerations, and placement procedures for these conservative aesthetic restorations. In addition, their functional utility, tissue biocompatibility, and variances from maxillary anterior ceramic veneers are discussed by means of several different case reports.

Mandibular ceramic veneers: an examination of complex cases.

The indications for mandibular anterior ceramic veneers, tooth preparation design, provisionalization considerations, and placement procedures were presented in a previous article by the author. The functional utility, tissue biocompatibility, and dissimilarities of mandibular veneers, in comparison to maxillary anterior ceramic veneers, were explored, along with indications and contraindications for this form of treatment. This article demonstrates the aesthetic range of these restorations in the context of more complex cases. The learning objective of this article is to illustrate the viability of mandibular ceramic veneers in realigning teeth nonorthodontically, while sustaining the biologic health of the periodontium, stability of the occlusion, and aesthetic parameters of each case. The importance of wax mock-ups is outlined for visualization of the final result, as well as the evaluation of root proximity to avoid subgingival ledging of the teeth and subsequent periodontal disease. Orthodontics and other methods for the correction of anterior crowding are discussed.

An immediate-extraction anterior single-tooth replacement utilizing a fiber-reinforced dual-component bridge.

Replacement of a single anterior tooth is an extremely challenging procedure. Numerous objective and subjective factors must be evaluated by the interdisciplinary team in the determination of the appropriate restorative method. This article reviews the restorative options and describes an emerging treatment modality--the fiber-reinforced dual-component bridge--as the option selected in a case requiring an immediate extraction of the maxillary right central incisor. The pertinent technology, indications, contraindications, and current clinical technique of dual-component nonmetallic prostheses are examined.

Material safety data sheets and allergic contact dermatitis: a misleading case.

A 33-year-old welder had previously been identified with an allergy to epoxy resin. When the cause of his recurrent skin eruption was being investigated, it was found that the putty he was using at work contained epoxy resin, which was not listed on the material safety data sheet.

Eosinophilic cellulitis case report: treatment options.

Eosinophilic cellulitis in a 56 year old woman is described. The patient responded well to oral prednisolone, but attempts to withdraw the corticosteroid resulted in relapses. Remission was achieved with a combination of dapsone, antihistamine and alternate-day prednisolone.

Release of renin from glomeruli isolated from rat kidney.

1. Glomeruli free from renal tubules and cell debris were isolated in large numbers from rat kidney cortex by a rapid, simple process of graded sieving on stainless steel meshes. 2. Glomeruli were viable, had fragments of the arterioles attached and contained renin. 3. Glomeruli, when incubated, released renin into the medium. Using a super-fusion technique this was shown to be time dependent until a basal secretion level was achieved. 4. Release of renin was directly proportional to the number of glomeruli and could be stimulated by isoprenaline, adrenaline and noradrenaline in order of the potency of their action on beta-adrenoreceptors. 5. Isolated glomeruli were therefore established as a useful model system for studying the release of renin by direct influences on the juxtaglomerular cells where haemodynamic, tubular and extrarenal influences are removed.

Squamous cell carcinoma of the skin. Accuracy of clinical diagnosis and outcome of follow-up in Australia.

The accuracy of the clinical diagnosis of 1292 non-melanotic skin tumours that were submitted to a private pathology service in 1980-1981 was determined. The clinical diagnosis that was written on the pathology slip which was submitted with the tumour was correlated with the histological diagnosis and the type of medical practitioner submitting the lesion. The clinical diagnosis was most accurate in the case of basal cell carcinoma; dermatologists most often reached this diagnosis correctly. For squamous cell carcinoma, although most frequently the lesions were diagnosed correctly clinically by dermatologists, their clinical diagnosis was confirmed in only 51% of cases. On average, 36% of squamous cell carcinomas were diagnosed clinically as basal cell carcinomas. The clinical course of 299 patients with a total of 305 squamous cell carcinomas that were selected from the squamous cell carcinomas that were submitted in 1980-1981 was traced. Four tumours (1.6%) which occurred in sun-exposed areas of the body metastasized, and 18 (7.5%) recurred locally. We conclude that those non-melanotic skin tumours which have the most potential to metastasize (squamous cell carcinomas) are those which are most poorly diagnosed clinically. It is recommended that patients with non-melanotic skin cancers should undergo biopsy as a routine to confirm the clinical diagnosis. Those who have a squamous cell carcinoma removed should be followed up for at least two years after the initial treatment.

Skin reactions to sunscreens.

Sunscreen reactions are said not to be uncommon. A population referred to a patch testing clinic was evaluated for reactions to sunscreen by questionnaire initially and then, if relevant, by patch testing to sunscreen products and their components. Irritant reactions were more common than allergic contact dermatitis. Allergic reactions to sunscreens were less common than to non-sunscreen chemicals present in sunscreen products.