Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study.

PURPOSE: This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM). METHODS: Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively. RESULTS: SEM observation showed that deproteinisation with Papacarie Duo® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness. CONCLUSION: Deproteinisation with Papacarie Duo® gel followed by acid etching contributed to improved etching patterns on HE.

A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques.

OBJECTIVES: To investigate treatment outcomes of different restorative techniques undertaken by dental therapists for primary molar carious lesions in a sample of children in New Zealand primary care. METHODS: This was a randomized controlled trial with children aged 3 to 8 y in New Zealand's Whanganui region. Children meeting inclusion criteria were randomly allocated to treatment with either the Hall technique (HT), in which a stainless-steel crown (SSC) is placed without any carious tissue removal or tooth preparation, or a non-Hall conventional restorative approach (NHT), including tooth preparation with selective carious tissue removal; this included SSC, amalgam, composite, or glass ionomer cement (GIC) restorations. Restorative outcomes after 12 and 24 mo were categorized as success, minor failure, or major failure. RESULTS: Of the 295 eligible children, 149 and 146 were allocated to the HT and NHT groups, respectively, with a total of 570 carious primary molars treated by 13 dental therapists. The participant follow-up rates at 12 and 24 mo were 95% and 91%. SSCs were the most commonly used restoration in the NHT group (60%), followed by GIC (28%). SSCs were the most successful restorations regardless of whether they were placed with the HT or NHT, with success rates of 89% and 92% at 12 mo and 85% and 86% at 24 mo. In the NHT group, the treatment material was a predictor of minor failure at 12 and 24 mo, with significantly more failures with GICs. CONCLUSIONS: SSCs placed by dental therapists are a highly successful restoration for the primary dentition, regardless of whether they are placed with the HT or conventionally. The high failure rate of glass ionomer restorations means that they cannot be recommended for widespread use in New Zealand primary care (Australian New Zealand Clinical Trials Registry, ACTRN12614000844640). KNOWLEDGE TRANSFER STATEMENT: The findings of this study can be used by policy makers and clinicians when deciding on which materials and which approach to use to maximize success and to minimize retreatment rates when providing restorative treatment for carious primary molars in children's primary oral health care. Results also suggest that undertaking research in the primary care setting may enhance translation of new knowledge and techniques into clinicians' hands.

William Henderson (1810-72) and homeopathy in Edinburgh.

William Henderson was appointed professor of general pathology at Edinburgh University and physician-in-ordinary to the ERI. He produced several papers on clinical and pathological aspects of aortic and heart disease and contributed to the differentiation of typhus and typhoid fevers. He became a homeopathist and was at the centre of a controversy surrounding the introduction of homeopathy to Edinburgh in the 1840s. This involved the Faculty of Medicine, the RCPE and medical societies as well as medical personalities, prominent among whom were Professor Sir James Y Simpson, Professor Sir Robert Christison and Professor James Syme. Many Scottish medical graduates were involved in the introduction of homeopathy to the British Isles. Glasgow is one of only four UK cities still to have a homeopathic hospital.

Comprehensive identification of conditionally essential genes in mycobacteria.

An increasing number of microbial genomes have been completely sequenced, and the identified genes are categorized based on their homology to genes of known function. However, the function of a large number of genes cannot be determined on this basis alone. Here, we describe a technique, transposon site hybridization (TraSH), which allows rapid functional characterization by identifying the complete set of genes required for growth under different conditions. TraSH combines high-density insertional mutagenesis with microarray mapping of pools of mutants. We have made large pools of independent transposon mutants in mycobacteria by using a mariner-based transposon and efficient phage transduction. By using TraSH, we have defined the set of genes required for growth of Mycobacterium bovis bacillus Calmette-Guérin on minimal but not rich medium. Genes of both known and unknown functions were identified. Of the genes with known functions, nearly all were involved in amino acid biosynthesis. TraSH is a powerful method for categorizing gene function that should be applicable to a variety of microorganisms.

A prospective study of factors affecting survival of replanted permanent incisors in children.

OBJECTIVE: To examine the factors associated with the onset of resorption in replanted avulsed permanent incisor teeth and to demonstrate their patterns of survival free of resorption. SETTING: Department of Paediatric Dentistry, Belfast. DESIGN: Prospective recording of the timing of the injury and of replantation, the storage media, the degree of root development and contamination, and the completion of root treatment. Clinical and radiographic reviews at 3-month intervals. Root resorption classified as replacement and inflammatory. Logistic regression and survival curves with freedom from resorption as outcomes. RESULTS: In 50 avulsed incisors in children aged 6-16 years the best predictor of overall resorption was total time of dryness, and that for replacement resorption was total extra-oral time. The timing of detection of resorption varied from 102 days to 997 days. CONCLUSION: Both total extra-oral time and time stored dry are important factors for the onset of resorption in replanted avulsed teeth in children.

Inflammatory and replacement resorption in reimplanted permanent incisor teeth: a study of the characteristics of 84 teeth.

Avulsion is a serious injury which can cause damage to some or all of the dental and surrounding tissues. This study examined the profiles of teeth showing inflammatory resorption, in terms of time prior to reimplantation, contamination, pulp extirpation time and period of splinting and compared them to teeth without resorption. There were a total of 71 children in the present study (mean age 9.8 years, range 6-16 years) with a total of 84 reimplanted teeth. Inflammatory resorption was present in 22 teeth. There was a significant relationship between the presence of inflammatory resorption and the time the teeth were dry prior to reimplantation, with a lesser effect for total delay time. There were slightly later pulp extirpation times for teeth with inflammatory resorption, with median delays of 16 and 11 days respectively and increased inflammatory resorption in teeth extirpated at 20 days or later. Replacement resorption was present in 40 teeth. There was a significantly longer splinting time in teeth with replacement resorption and more resorption in teeth splinted for longer than 10 days. It was concluded that pulp extirpation time was not critical unless the delay exceeded 20 days and that splinting time should not exceed 10 days.

The protein translocation apparatus contributes to determining the topology of an integral membrane protein in Escherichia coli.

The assembly of integral membrane proteins is determined by features of these proteins and the protein translocation apparatus. We used alkaline phosphatase fusions to the membrane protein MalF to investigate the role of the protein translocation machinery in the arrangement of proteins in the cytoplasmic membrane of Escherichia coli. In particular, we studied the effects of prlA mutations on membrane protein topology. These mutations lie in the secY gene, which encodes a core component of the protein translocation apparatus. We find that the topology of some of the fusion proteins is changed and, in one case, is completely inverted in prlA mutants. We discuss the mechanism of prlA-mediated export and the role of the protein translocation apparatus in contributing to membrane protein topology.

A computer software package to facilitate clinical audit of outpatient paediatric dentistry.

This paper reports the development and function of a computer program for clinical audit of outpatients in hospital paediatric dentistry in the United Kingdom. The project was one of several national audit projects supported by the Faculty of Dental Surgery, Royal College of Surgeons of England, and funded by the Department of Health. The software is designed to record data utilizing a nationally-agreed minimum set of codes for dental diagnosis, treatment and medical complications, together with patient demographic details pertaining to source of referral, age and sex of patient, and area of residence. A significant component of the software is a flexible report generator which allows data to be analysed using any combination of the above criteria. Audit of activity in hospital dentistry is desirable to enable comparisons to be made between groups of patients and treatments related to diagnosis. This provides the information necessary to enable improvements in clinical practice whilst also assisting the development of both local and national clinical guidelines. Use of this software package will enable such comparisons to be made not only within one hospital but also between different hospital and regions in the United Kingdom.

Candida infection of a persistent palatal ulcer in a 20-month-old child.

A 20 month-old infant presented with a painless, persistent lesion on the hard palate which had been present for 6 months. The lesion was aggressive in appearance, approximately 2 cm in diameter with raised, rolled edges, and there was what appeared to be granulation tissue present together with some necrotic slough in its base. It was considered to represent a traumatized area with superimposed secondary Candida infection. A direct smear of the lesion was positive for Candida. Antifungal therapy, and an attempt to avoid further irritation by advising the mother not to give the child a feeding bottle whenever possible, resulted in complete healing of the lesion. There has been no recurrence in 2 years.

Recent advances in the management of patients with haemophilia and other bleeding disorders.

Much attention has been focused recently on barriers to dental care, particularly for patients with disabilities, from the perspective of the patient and the dental team. Treatment of patients with haemorrhagic disorders may cause a certain amount of anxiety in dental staff. The authors of this paper aim to reduce this anxiety by clarifying confusion between the haemorrhagic disorders and making recommendations concerning the dental care of such patients.

Plasma thiamin pyrophosphate and erythrocyte transketolase in chronic alcoholism.

Thiamin status in patients with an alcohol problem was studied before and after intramuscular thiamin hydrochloride. Results for erythrocyte transketolase activity and plasma thiamin pyrophosphate are compared. Plasma thiamin pyrophosphate values for healthy human subjects are reported for the first time. Advantages of plasma thiamin pyrophosphate in the assessment of thiamin status of patients are discussed.

The nutritional status of patients with an alcohol problem.

73 patients with an alcohol problem seen in a hospital medical unit over a two year period were examined specifically for signs suggestive of nutritional deficiency and of organ or system damage due to alcohol. A seven day dietary recall was carried out on most of them. Clinical signs of nutritional deficiency were relatively uncommon but nine patients had Wernicke-Korsakoff syndrome and ten had peripheral neuropathy. Thiamine was present in less than recommended amounts in 81.5% of the diets. Vitamin D and vitamin C were the next most common dietary deficiencies. 66.1% were deficient in energy intake and about a third of patients derived more than 40% of their energy from alcohol.