Is silver diammine fluoride effective in arresting dental caries in cavitated primary molars?

CLINICAL QUESTION: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dental caries in cavitated caries lesions in primary molars. DATA SOURCES: A systematic search was carried out in PubMed, Scopus, and Embase. Furthermore, cross-referencing was performed using the references lists of full-text articles and grey literature was also retrieved for eligible studies. Two independent reviewers were responsible for study selection and data extraction. STUDY SELECTION: Randomized and non-randomized clinical studies that evaluated the caries arrest rate of SDF compared to no treatment or any other type of non-invasive or minimally-invasive treatment were included. Only publications in the English, Italian and French language and with a minimum follow-up of 6 months were considered for study eligibility. DATA EXTRACTION AND SYNTHESIS: The characteristics of the included studies-age, sex, type of study, sample size, caries at baseline, setting, operator, blinding, intervention, outcomes and assessment of any confounders-were extracted from the included papers. The quality assessment was carried out using the Cochrane risk of bias tool. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. RESULTS: A total of nine publications were included for qualitative review and five of them were included in the meta-analysis. Around half of lesions that received annual or biannual application SDF ≥ 38% were arrested. CONCLUSIONS: SDF 38% application was found to be effective in arresting dental caries progression in cavitated primary molars.

[Child-friendly restorations of primary molars using the Hall technique]. / Kindvriendelijke restauraties van tijdelijke molaren met de Hall-techniek.

Minimally invasive dentistry is being used increasingly often, especially in paediatric dentistry. It involves replacing traditional 'drilling and filling' with treatment modalities that are tissue-saving and minimally burdensome to the patient. One of these techniques for treating carious dentine lesions is the Hall technique. A stainless-steel crown is cemented onto the primary molar without the use of anaesthesia or any form of preparation. The molar is 'sealed' under the crown and this stops the carious process in the cavity. Usually, the procedure requires 2 sessions. The Hall technique is well tolerated by children and provides the primary molar with a durable restoration. Together with this technique, the patient is also guided in an individual prevention process. The survival rates of Hall crowns are very high.

Self-perceived oral health and orofacial aesthetics of cleft patients.

PURPOSE: To evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls. METHODS: 420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient's perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile-Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls. RESULTS: CL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group. CONCLUSION: This study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.

Phase I and pharmacodynamic study of high-dose NGR-hTNF in patients with refractory solid tumours.

BACKGROUND: NGR-hTNF exploits the peptide asparagine-glycine-arginine (NGR) for selectively targeting tumour necrosis factor (TNF) to CD13-overexpressing tumour vessels. Maximum-tolerated dose (MTD) of NGR-hTNF was previously established at 45 µg m(-2) as 1-h infusion, with dose-limiting toxicity being grade 3 infusion-related reactions. We explored further dose escalation by slowing infusion rate (2-h) and using premedication (paracetamol). METHODS: Four patients entered each of 12 dose levels (n=48; 60-325 µg m(-2)). Pharmacokinetics, soluble TNF receptors (sTNF-R1/sTNF-R2), and volume transfer constant (K(trans)) by dynamic imaging (dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)) were assessed pre- and post-treatment. RESULTS: Common related toxicity included grade 1/2 chills (58%). Maximum-tolerated dose was not reached. Both C(max) (P<0.0001) and area under the plasma concentration-time curve (P=0.0001) increased proportionally with dose. Post-treatment levels of sTNF-R2 peaked significantly higher than sTNF-R1 (P<0.0001). Changes in sTNF-Rs, however, did not differ across dose levels, suggesting a plateau effect in shedding kinetics. As best response, 12/41 evaluable patients (29%) had stable disease. By DCE-MRI, 28/37 assessed patients (76%) had reduced post-treatment K(trans) values (P<0.0001), which inversely correlated with NGR-hTNF C(max) (P=0.03) and baseline K(trans) values (P<0.0001). Lower sTNF-R2 levels and greater K(trans) decreases after first cycle were associated with improved survival. CONCLUSION: asparagine-glycine-arginine-hTNF can be safely escalated at doses higher than MTD and induces low receptors shedding and early antivascular effects.

Are parents of high caries risk Dutch children motivated to brush their children's teeth? An assessment using the health action process approach questionnaire.

PURPOSE: To assess the social cognitive constructs of the Health Action Process Approach (HAPA) of parents of high caries risk children to be treated under intravenous sedation (IVS) or with behavioural guidance techniques (BGT), and to assess the changes in these constructs for each treatment group after treatment. DESIGN: In this cohort study, 160 children aged 3-10 years were allocated by their paediatric dentist to either IVS (77.4%) or BGT. Their parents filled out a HAPA questionnaire, before (T1, n = 160), immediately (T2, n = 108) and three months (T3, n = 71) after their children's dental rehabilitation. RESULTS: Before treatment, all parents had high scores on all social cognitive constructs. There were no differences in mean HAPA scores between the treatment groups (p > 0.05). After treatment, mean scores changed in both groups. In the BGT group, action self-efficacy changed from 3.64 (T1) to 3.36(T2) (p = 0.027) and to 3.13 (T3) (p = 0.021) and coping self-efficacy changed from 3.63 (T1) to 3.23 (T2) (p = 0.015). In the IVS group, action planning changed from 3.25 (T1) to 3.05(T3) (p = 0.036) and action control changed from 2.58 (T1) to 2.82 (T2) (p = 0.012) and to 2.87 (T3) (p = 0.006). CONCLUSIONS: High scores on social cognitive constructs of parents of children referred to a paediatric dentist showed that they seem to be motivated to brush their children's teeth, irrespective of the treatment group. Small changes were observed in the HAPA constructs, however, these are not considered clinically relevant.

A retrospective clinical study on the resin infiltration of proximal caries lesions: the operator's effect.

PURPOSE: This retrospective university-based study investigated the effect of operators' training and previous experience on the success of resin infiltration (RI) in arresting proximal non-cavitated caries lesions in primary and permanent teeth. METHODS: Information was collected regarding RI of proximal non-cavitated caries lesions in primary and permanent teeth with a follow-up period up to 32 months. Factors investigated were: operators' clinical experience and training, patient's age, tooth, arch, mouth-side, surface treated, tooth separation, and baseline lesion depth. Kaplan-Meier survival and Cox regression analysis with shared frailty were used (α = 5%). RESULTS: A total of 130 proximal surfaces treated on 115 teeth of 43 children (11 ± 4.4 years) were evaluated. Survival of RI was 46% up to 32 months. Lesions treated by non-trained dentists were more likely-to-present progression than those performed by non-trained dental students under supervision (HR 2.41, 95% CI: 1.00-5.80); conversely, no difference was found between non-trained dental students under supervision and trained dentists (HR 0.52, 95% CI: 0.16-1.70). Additionally, dentin lesions were 59% more-likely-to-present progression than enamel lesions (HR 0.41, 95% CI: 0.17-0.99). CONCLUSION: The operator's experience and training could influence the success of RI on proximal non-cavitated caries lesions and it should be taken into consideration when choosing this treatment modality.

Parents' satisfaction on dental care of Dutch children with Autism Spectrum Disorder.

PURPOSE: To assess if Dutch children with Autism Spectrum Disorder (ASD) regularly visit a dentist and to evaluate parent's satisfaction on the care provided. METHODS: Parents of ASD children (2-18 years) were invited to fill out a survey. The survey consisted of questions regarding ASD severity, frequency of dental visits, history of dental pain, type of dental practice and parents' satisfaction. Results were analysed using Chi square and Mann-Whitney U tests (α = 5%). RESULTS: Of the 246 returned questionnaires, 19 were excluded (incomplete or unconfirmed ASD diagnosis). All children visited a dentist at least once and 5% of them had their last visit more than 12 months ago. According to parents, 15% of the children did not receive the needed care when they had toothache and 21% of the parents were unsatisfied with the current dental care provided. No difference was found between satisfied and unsatisfied parents in type of dental practice visited (p > 0.05). The children of unsatisfied parents reported more often pain during the last year (p = 0.013) and had a more severe type of ASD (p = 0.016). CONCLUSIONS: The majority of Dutch ASD children investigated regularly visit a dentist and 21% of the parents is unsatisfied with the dental care provided.

Coordination of Eu3+ Activators in ZnAlEu Layered Double Hydroxides Intercalated by Isophthalate and Nitrilotriacetate.

Luminescent layered double hydroxides (LDH) intercalated by isophthalate (ISO) and nitrilotriacetate (NTA) have been synthesized and characterized by powder X-ray diffraction (PXRD), extended X-ray absorption fine structure (EXAFS), elemental analysis (ICP-OES and CHN), and photoluminescence spectroscopy. While PXRD shows the successful formation of ZnAlEu LDHs, EXAFS reveals that the Eu activators are hosted in the hydroxide layers with an eightfold, oxygen-rich coordination, distinct from the sixfold coordination expected for the octahedral sites of metal cations in LDHs. This kind of coordination should locally distort the brucite-like layers. Additionally, the intercalation of ISO and NTA in the LDHs is shown to change the coordination environment around Eu compared to nitrate-intercalated ZnAlEu LDHs, which suggests that these anions directly interact with the Eu centers and/or strongly affect their coordination geometry. Finally, from the photoluminescence results, analyzed based on the Judd-Ofelt theory, it is determined that Eu is most likely in an environment with no inversion symmetry.

Bonding effectiveness of different adhesion approaches to unground versus ground primary tooth enamel.

AIM: This study aims to evaluate the bonding effectiveness of self-etch and etch-and-rinse adhesive systems in on intact and ground primary tooth enamel. STUDY DESIGN: Sixty primary incisors were divided into 6 groups according to the adhesive system (etch-and-rinse - Adper Single Bond 2 - SB, 2 steps self-etch -Clearfil SE Bond - SE, and 1 step self-etch - One Up Bond F Plus OBF) and to the substrate (ground or intact enamel): G1-SB/intact enamel; G2-SE/intact enamel; G3- OBF/intact enamel; G4-SB/ground enamel; G5- SE/ground enamel and G6-OBF/ground enamel. METHODS: Microshear bond test specimens were prepared with microhybrid composite and after 24h of water storage the microshear test was performed. STATISTICS: Data were submitted to statistical analysis using two-way ANOVA and Tukey's tests (p<0.05). RESULTS: Comparing the enamel characteristics (ground or intact) only when SE was used a statistically significant difference was found, as G2 (21.12+/-4.52) was statistically lower than G5 (33.29+/-5.44). Among the intact enamel groups, SB (26.11+/-7.56) was statistically superior to SE (21.12+/-4.52) and OBF (17.01+/-3.96). However, when comparisons were made among groups of ground enamel, SE (33.29+/-5.44) was significantly higher than SB (26.35+/-8.18) and OBF (17.52+/-3.46). CONCLUSION: The two-step self-etch adhesive system is a reliable alternative to etch and rinse adhesive systems on both ground and intact primary enamel.

Transoral surgical removal of a giant fibrolipoma of the esophagus: case report.

An esophageal mass of more than 20 cm in length was diagnosed in a patient who presented with persistent dysphagia. Diagnosis of an endo-esophageal tumour was made by barium swallow; esophagoscopy confirmed the presence of a capsulated pink endo-esophageal mass. MRI confirmed the presence of a large capsulated mass within the esophagus, that appeared to be adipose tissue; a small stalk originating at the level of the upper esophageal sphincter was described and the polyp extended down to the gastroesophageal junction. Demonstration of the site and length of the stalk allowed a transoral removal of the mass, performed through a Weerda diverticuloscope (Karl Storz Endoskopie Gmbh, Tuttlingen Germany), a technique that has never been described before. Histology confirmed the mass as a fibrolipoma. The authors discuss both the role of MRI in diagnosis and treatment planning and the technique of transoral excision.

The Hall Technique 10 years on: Questions and answers.

It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Landscape structure in the Pirapó, Paranapanema 3 and 4 Hydrographic Unit, in the state of Paraná, Brazil.

The aim of this study is to characterize the Pirapó, Paranapanema 3 and 4 Hydrographic Unit, emphasizing its physical attributes and processes of use and occupation, responsible for the structure of the current landscape and the state of its water resources. The recognition of the landscape's spatial structure in the hydrographic unit and its drainage basins was obtained by integrated analysis of the main elements that compose it: geology, landforms (hypsometric and slope), soils, climate and land use. Analysis revealed that within each drainage basin several variations in the spatial structure of the landscape occur which produce an internal compartmentalization. Each compartment is defined by its own geo-ecological structure, physiognomic standards and dynamics, reflected in its potentialities and vulnerabilities and in the conditions of water resources in the wake of occupation and use over time.

Water quality monitoring of the Pirapó River watershed, Paraná, Brazil.

This study aimed to evaluate the water quality of the Pirapó River watershed in Paraná, Brazil, and identify the critical pollution sites throughout the drainage basin. The water quality was monitored during the period from January 2011 to December 2012. Nine points distributed throughout the main channel of the Pirapó River were sampled for a total of 17 samplings. The water quality was evaluated based on the determination of 14 physical, chemical and microbiological parameters. Analysis of the variables monitored in the Pirapó River watershed using factor analysis/principal components analysis (FA/PCA) indicated the formation of three distinct groups of parameters: water temperature (Twater), dissolved oxygen (DO) and a group composed of total suspended solids (TSS), turbidity and nitrite (NO2⁻). The parameters Twater and DO exhibited a relationship with the seasonality, and the TSS, turbidity, and NO2⁻ levels were correlated with surface runoff caused by rainfall events. Principal component analysis (PCA) of the sampling points enabled the selection of the 10 most important variables from among the 14 evaluated parameters. The results showed that the nitrate (NO3⁻), NO2⁻, TSS, turbidity and total phosphorous (TP) levels were related to the soil type, and the parameters DO, electrical conductivity (EC), ammoniacal nitrogen (N-NH3) and thermotolerant coliforms (TC) were related to organic matter pollution, with the P5 sampling site being the most critical site. The ordination diagram of the sampling points as a function of the PCA indicated a reduction from 9 to 5 sampling points, indicating the potential for decreasing the costs associated with monitoring.

Ultrasound guided versus direct vein puncture in central venous port placement.

INTRODUCTION: This study will report our experience on positioning of totally implanted venous catheter system (port-a-cath) as compared to ultrasound guidance versus blind technique. MATERIALS AND METHODS: From July 1996 to November 1999 in the vascular suite of the Europen Institute of Oncology, 427 port-a-cath were implanted in patients with neoplastic disease. All devices were implanted through the subclavian vein. 198 with ultrasound guided puncture and 229 following anatomical landmarks. All patients underwent a close and specific clinical and instrumental follow-up to evaluate possible complications. RESULTS: Use of Ultrasound (US) in subclavian vein catheterization has reduced the number of puncture attempts, with a better patient complicance, allowing a faster procedure and reducing peri-procedural complications. Ultrasound technique has shown reduction in early complications. In fact in our experience we had no pneumothorax events by using ultrasound guidance, versus 11 events with blind technique. US has shown no reduction in late complications: 3 thrombosis versus 6 thrombosis with US guidance, and 3 fractured and embolized catheter versus 2 cases. Fibrin-cuff percentage was the same in the two groups with only 1 case, as the dislocation of the catheter tip in the jugular vein with 2 cases in both groups. Moreover US let us to avoid the arterial puncture and to perform a more peripheral puncture of the subclavian vein, reducing the risk of 'pinch-off' phenomenon and of haematoma, with no cases reported under US guidance versus 1 case respectively in direct vein puncture. CONCLUSIONS: US guided puncture of subclavian vein for the implantation of venous catheter system is faster by reducing procedure time, it is easier for the operator and safer for the patient than blind technique by exposing anatomical structures. Morevover US guidance reduces early complications and limits costs.

Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn's disease.

BACKGROUND: Studies comparing magnetic resonance enterography (MRE) and computerized tomography enterography (CTE) for Crohn's disease (CD) are scarce. METHODS: The aim of this study was to prospectively compare the sensitivity, specificity, and accuracy of abdominal MRE and CTE to assess disease activity and complications (fistulas, strictures) in ileocolonic CD. A total of 44 patients (23 male; 21 female; mean age 44) with ileocolonic CD underwent both MR and CT in a short time interval (mean 5 days). A 16-slice CT with intravenous contrast and an MRI with oral and paramagnetic intravenous contrast were performed. Ileocolonoscopy was used as the reference standard. Sensitivity values of CT and MR for detection of extraenteric signs of disease were compared with the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards. RESULTS: No significant differences in sensitivity, specificity, and accuracy were observed between MRE and CTE regarding the following parameters at the patient level: localization of CD (P = 1.0), bowel wall thickening (P = 1.0), bowel wall enhancement (P = 1.0), enteroenteric fistulas (P = 0.08), detection of abdominal nodes (P = 1.0), and perivisceral fat enhancement (P = 0.31). MR was significantly superior compared to CT in detecting strictures (P = 0.04). Per segment analysis showed that MRE was significantly superior to CTE in detecting ileal wall enhancement (P = 0.02). CONCLUSIONS: MR and CT are equally accurate to assess disease activity and bowel damage in CD. MR may be superior to CT in detecting intestinal strictures and ileal wall enhancement. MR may represent an alternative technique to CT in assessing ileocolonic CD.

Landscape structure in the Pirapó, Paranapanema 3 and 4 Hydrographic Unit, in the state of Paraná, Brazil

The aim of this study is to characterize the Pirapó, Paranapanema 3 and 4 Hydrographic Unit, emphasizing its physical attributes and processes of use and occupation, responsible for the structure of the current landscape and the state of its water resources. The recognition of the landscapes spatial structure in the hydrographic unit and its drainage basins was obtained by integrated analysis of the main elements that compose it: geology, landforms (hypsometric and slope), soils, climate and land use. Analysis revealed that within each drainage basin several variations in the spatial structure of the landscape occur which produce an internal compartmentalization. Each compartment is defined by its own geo-ecological structure, physiognomic standards and dynamics, reflected in its potentialities and vulnerabilities and in the conditions of water resources in the wake of occupation and use over time.

Resumo O objetivo deste trabalho é caracterizar a Unidade Hidrográfica do Pirapó, Paranapanema 3 e 4, ressaltando os seus atributos físicos e os processos de uso e ocupação, responsáveis pela estrutura da paisagem atual e pelo estado dos seus recursos hídricos. O reconhecimento da estrutura espacial da paisagem na unidade hidrográfica e nas suas bacias foi obtido por meio da análise integrada dos principais elementos que a compõe: geologia, relevo, solos, clima e uso da terra. A análise mostrou que no interior de cada bacia hidrográfica ocorrem variações na estrutura espacial da paisagem que produzem uma compartimentação interna. Cada compartimento se define por uma estrutura geoecológica, padrões fisionômicos e dinâmicos próprios o que se reflete nas suas potencialidades e vulnerabilidades e nas condições dos seus recursos hídricos, em face das formas de ocupação e uso ao longo do tempo.