Dental fear/anxiety in Czech preschoolers: relationship to gender, age, location of residence, dental status and previous treatment experience.

AIM: Dental fear/anxiety (DFA) may considerably complicate treatment in paediatric dentistry. This cross-sectional study aimed to assess DFA in Czech preschoolers aged 3-6 years and its relationship to gender, age, location of residence, dental status and previous treatment. METHODS: The study involved 460 children from preschools in four location types selected according to the WHO criteria for oral health surveys. DFA was assessed using the Venham picture test (VPT, score range 0-8) prior to the evaluation of dental status using the dmfs (decayed, missing, filled surface) index. The significance level was set to 5%. CONCLUSION: DFA is common in Czech preschoolers. Higher levels of DFA were found in females, children aged 3-4 years, children from rural areas, children with a higher dmfs index and children who had a tooth extracted.

Applicability of Exposure Reciprocity Law for Fast Polymerization of Restorative Composites Containing Various Photoinitiating Systems.

OBJECTIVES: The exposure reciprocity law (ERL) has been used to calculate the optimal irradiation time of dental composites. This study examined the applicability of ERL for fast polymerization of restorative composites containing various photoinitiating systems using a high-power multi-peak light-emitting diode (LED) lamp. METHODS: Three commercial composites differing in photoinitiating systems were tested: Filtek Ultimate Universal Restorative (FU) with a camphorquinone-amine (CQ-A) photoinitiating system, Tetric EvoCeram (TEC) with CQ-A and (2,4,6-trimethylbenzoyl)phosphine oxide (TPO), and Estelite Σ Quick (ESQ) with CQ and a radical amplified photopolymerization (RAP) initiator. Specimens 2-mm thick were polymerized using a high-power multipeak LED lamp (Valo) at 3 pairs of radiant exposures (referred to as low, moderate, and high) ranging from 15.8-26.7 J/cm2. They were achieved by different combinations of irradiation time (5-20 seconds) and irradiance (1300-2980 mW/cm2) as determined with a calibrated spectrometer. Knoop microhardness was measured 1, 24, and 168 hours after polymerization on specimen top (irradiated) and bottom surfaces to characterize the degree of polymerization. The results were statistically analyzed using a three-way analysis of variance and Tukey's post hoc tests, α = 0.05. RESULTS: Microhardness increased with radiant exposure and except for ESQ, top-surface microhardness was significantly higher than that on bottom surfaces. Combinations of high irradiance and short irradiation time significantly increased the top-surface microhardness of TEC at low and moderate radiant exposures, and the bottom-surface microhardness of FU at a low radiant exposure. In contrast, the microhardness of ESQ on both surfaces at high radiant exposure increased significantly when low irradiance and long irradiation time were used. With all tested composites, bottom-surface microhardness obtained at low radiant exposure was below 80% of the maximum top-surface microhardness, indicating insufficient polymerization. CONCLUSION: Combinations of irradiance and irradiation time had a significant effect on microhardness, which was affected by photoinitiators and the optical properties of composites as well as spectral characteristics of the polymerization lamp. Therefore, ERL cannot be universally applied for the calculation of optimal composite irradiation time. Despite high irradiance, fast polymerization led to insufficient bottom-surface microhardness, suggesting the necessity to also characterize the degree of polymerization on the bottom surfaces of composite increments when assessing the validity of ERL.

Dental composites - a low-dose source of bisphenol A?

Dental composite materials often contain monomers with bisphenol A (BPA) structure in their molecules, e.g. bisphenol-A glycidyl dimethacrylate (Bis-GMA). In this study, it was examined whether dental restorative composites could be a low-dose source of BPA or alternative bisphenols, which are known to have endocrine-disrupting effects. Bis-GMA-containing composites Charisma Classic (CC) and Filtek Ultimate Universal Restorative (FU) and "BPA-free" Charisma Diamond (CD) and Admira Fusion (AF) were examined. Specimens (diameter 6 mm, height 2 mm, n=5) were light-cured from one side for 20 s and stored at 37 °C in methanol which was periodically changed over 130 days to determine the kinetics of BPA release. BPA concentrations were measured using a dansyl chloride derivatization method with liquid chromatography - tandem mass spectrometry detection. The amounts of BPA were expressed in nanograms per gram of composite (ng/g). BPA release from Bis-GMA-containing CC and FU was significantly higher compared to "BPA-free" CD and AF. The highest 1-day release was detected with FU (15.4+/-0.8 ng/g), followed by CC (9.1+/-1.1 ng/g), AF (2.1+/-1.3 ng/g), and CD (1.6+/-0.8 ng/g), and the release gradually decreased over the examined period. Detected values were several orders of magnitude below the tolerable daily intake (4 microg/kg body weight/day). Alternative bisphenols were not detected. BPA was released even from "BPA-free" composites, although in significantly lower amounts than from Bis-GMA-containing composites. Despite incubation in methanol, detected amounts of BPA were substantially lower than current limits suggesting that dental composites should not pose a health risk if adequately polymerized.

Effect of postoperative peroxide bleaching on the marginal seal of composite restorations bonded with self-etch adhesives.

The aim of this study was to determine the effect of peroxide bleaching on the marginal seal of composite restorations bonded with several adhesive systems. Combined cylindrical Class V cavities located half in enamel and half in dentin were prepared on the buccal and lingual surfaces of human molars. The cavities were bonded with the self-etch adhesives Clearfil SE-Bond (CLF), Adper Prompt (ADP), and iBond (IBO) and an etch-and-rinse adhesive Gluma Comfort Bond (GLU) and restored with a microhybrid composite Charisma. Experimental groups were treated 25 times for eight hours per day with a peroxide bleaching gel Opalescence PF 20, while the control groups were stored in distilled water for two months and then subjected to a microleakage test using a dye penetration method. Scanning electron microscopy was used to investigate the etching and penetration abilities of the adhesives and morphology of debonded restoration-enamel interfaces after the microleakage tests. Statistical analyses were performed using nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests at p=0.05. The microleakage of all GLU groups was low and not significantly affected by peroxide bleaching. Low microleakage was recorded for CLF control groups, but after bleaching, a small but significant increase in microleakage at the enamel margin indicated its sensitivity to peroxide bleaching. For ADP and IBO control groups, the microleakage at the enamel margins was significantly higher than for GLU and CLF and exceeded that at the dentin margins. Bleaching did not induce any significant changes in the microleakage. Electron microscopy analysis indicated that in our experimental setup, decreased adhesion and mechanical resistance of the ADP- and IBO-enamel interfaces could be more important than the chemical degradation effects induced by the peroxide bleaching gel.

Effect of postoperative peroxide bleaching on the stability of composite to enamel and dentin bonds.

This study investigated the effect of peroxide bleaching gel on the durability of the adhesive bond between composite material, enamel, and dentin created with the etch-and-rinse adhesive Gluma Comfort Bond (GLU) and with the self-etch adhesives Clearfil SE Bond (CLE), Adper Prompt (ADP), and iBond (IBO). The adhesives were applied to flattened enamel and dentin of extracted human molars and built up with a microhybrid composite (Charisma). After 25 eight-hour cycles of bleaching with a 20% carbamide peroxide bleaching gel (Opalescence PF 20), the shear bond strength was measured and compared with one-day and two-month control specimens stored in water. The data were analyzed using nonparametric Mann-Whitney and Kruskal-Wallis statistics (p<0.05). Detailed fractographic analysis was performed using scanning electron microscopy. The bleaching gel significantly decreased the bond strength on both enamel and dentin for the simplified single-step self-etch adhesives ADP and IBO and markedly affected a fracture pattern of ADP specimens at the periphery of their bonded area. The results of our study indicate that the durability of adhesive restorations can be detrimentally influenced by carbamide peroxide bleaching and that different adhesives show varying sensitivity levels to the bleaching gel.

[Central hemiparesis as manifestation of systemic vasculitis]. / Centrální pravostranná hemiparéza jako dominující projev systémové vaskulitidy.

We present a case report of patient with systemic vasculitis with affection of heart, skin, gastrointestinal tract and rare involvement of central nervous system. Diagnosis of systemic vasculitis was based on clinical manifestations, blood hypereosinophilia and brain magnetic resonance imaging. Immunosuppressive therapy led to regression of symptoms including initially present neurologic manifestation.

[Myopathy and mixed hyperlipoproteinemia as the first symptom of systemic AL-amyloidosis]. / Myopatie a smísená hyperlipoproteinemie jako první projev systémové AL-amyloidózy.

Systemic AL-amyloidosis is a disorder brought about by the over-production and deposition of fragments of light immunoglobulin chains in tissues, the consequence of which is their functional impairment. The most often affected are the kidneys, the heart, the gastro-intestinal tract and the nervous system. We describe the case of a 57-year-old patient in whom a rare disorder of the striated muscle (am yloid myopathy) was present, as the first clinical indication of systemic AL-amyloidosis. The main symptoms were muscle weakness and an increase in laboratory signs of muscle lesion. The patient was monitored for several years and treated with a diagnosis of primary idiopathic polymyositis (the likely diagnosis according to the diagnostic criteria of Bohan and Peter). Only after some years did hepatomegaly appear with elevated liver transaminases and a diagnosis of systemic AL-amyloidosis was established on the basis of a liver biopsy. By additional staining of striated muscle preparations with a dye for amyloid (in accordance with Maldyk) amyloid myopathy was confirmed. In addition to muscle affection, mixed hyperlipoproteinemia was present from the beginning. This was probably the first indication ofamyloidosis. The case description points out the justified inclusion of systemic AL-amyloidosis in differential diagnosis of muscle weakness and signs of muscle lesion. Amyloidosis must be considered if in addition to myopathy there is also present a problem with any organ which can typically be affected by amyloidosis.

[Cognitive dysfunction in patients with systemic lupus erythemathosus with or without antiphospholipid antibodies]. / Kognitivní dysfunkce u pacientu se systémovým lupus erythematodes a antifosfolipidovými protilátkami.

INTRODUCTION: Impairment of cognitive functions is one of the neuropsychiatric symptoms of systemic lupus erythemathosus (SLE), the association of which with secondary antiphospholipid syndrome is often mentioned in the literature on the subject. Ethiology has not yet been fully clarified. PATIENTS AND METHODS: The aim of the study was to compare the "mini-mental state examination" (MMSE) outcomes in SLE patients with and without antiphospholipid antibodies (APA). RESULTS: Probands producing APA presented with significantly worse results in MMSE when compared to patients without these antibodies. There was no difference between patients with antisphospholipid syndrome and those with APA only. DISCUSSION AND CONCLUSION: Our study supports the notion that association of SLE with APA (not only with antiphospholipid syndrome) aggravates the deterioration of cognitive functions. MMSE test should not be omitted in the follow-up of SLE patients.

[Gout and diabetes]. / Dna a diabetes.

Gout is the most frequent cause of acute arthritis in men over 40 years of age. In the recent years, gout incidence has been increasing in developed countries probably due to dietary changes, alcohol consumption, ageing of population and also application of high-risk medications. Hyperuricemia is one of the symptoms of hyperinsulinism and metabolic syndrome. The level of uricemia correlates with the degree of insulin resistance. Correlation of uric acid levels and the risk of coronary and cerebral accidents were reported both in diabetic and non-diabetic population. It has not been explained satisfactorily whether this is the direct result of hyperuricemia or concurrently present symptom of metabolic syndrome. The study describes symptomatology of clinical signs of gout and discusses about appropriate therapeutic approach in each stage of the disease. New therapeutic possibilities that are still in the stage of clinical studies are mentioned. Also, we focus on alternative dietary recommendations for hyperuricemia and gout patients. The reason of changes in dietary regime is the effort to alleviate the signs of metabolic syndrome. The study emphasises the practical significance of screening of metabolic syndrome signs during examination of gout patients so that appropriate targeted therapeutic intervention could be performed. On the contrary, increased risk of gout-induced movement disorders should be taken into account in patients with diagnosed insulin resistance.

[Retinopathy in dermatomyositis]. / Retinopatie pri dermatomyozitide.

The authors describe a patient with acute onset dermatomyositis, "probable", according to criteria of Bohan and Peter, as well as the development of the disease in the course of 21 months. A special feature was the decline of visual acuity (practically to the level of blindness). The cause was severe retinopathy with dominance of macular oedema, "cotton wool" spots and haemorrhages, as apparent from photographs of the fundus and findings obtained by fluorescein angiography. The problem of initial treatment was resistance to megadoses of glucocorticoid (i.v. pulses). A favourable change occurred only after i.v. administration of polyvalent immunoglobulin in a total dose of 600 mg/kg body weight. Then the authors observed the unique phenomenon of regression of retinal oedema incl. the macula, of the haemorrhages and "cotton wool" spots. Consistent with it vision off the right eye improved to 1.0 and the left eye to 0.66 in the course of 11 months. Stabilized retinal neovascularizations persist. On account of the latter the authors treated the retina by laser panretinocoagulation.

[Long-term study of diffuse connective tissue disease after methylprednisolone pulsed therapy]. / Dlouhodobé sledování difúzních nemocí pojiva po pulzní lécbe metylprednizolonem.

Pulsed i.v. treatment with methylprednisolone (MP) infusions à 1 g 3-5 times on alternate days was administered in 22 diffuse connective tissue diseases: 13X systemic lupus erythematosus (SLE), 1X Sharp's syndrome and 8X polymyositis/dermatomyositis (PM/DM). In all instances active disease was involved with serious organ manifestations; 17 patients had no aimed treatment so far, in 5 previous treatment had failed. A total of 101 pulsed MP was administered. Initial MP treatment was always successful. The patients were then followed up during oral maintenance treatment for 3-60 months (mean 27 months) in a stage of persistent, inconstant or partial remission. In six patients treatment was repeated 8X after reactivation. The response was always favourable and did not differ from that to initial MP treatment, except for one female patient who died from progression of PM/DM (one female patient died from the sequels of oncological disease associated with SLE).

[A 5-year study of cardiac involvement in polymyositis/dermatomyositis]. / Petiletá studie postizení srdce u polymyositidy/dermatomyositidy.

Improvement of the diagnosis and new therapeutic opportunities revealed a number of organ affections also in patients with polymyositis and dermatomyositis. One of the prognostically important organ manifestations is affection of the heart. The prospective investigation comprises 15 patients with a confirmed diagnosis of polymyositis (10) or dermatomyositis (5). The investigation, using a number of non-invasive method (ECG, echocardiography, systolic time intervals, 99mTc pyrophosphate scan of the heart muscle), proved in the course of the 60-month investigation an increase of pathological findings from 40% at the onset (6/15) to 6 from 11 surviving patients (three died), i.e. a total of 64.3% of the group. Investigation of the fate of patients with signs of myocardial damage during the active stage of the disease (positive myocardial scan) indicates that in these patients also other signs of cardiac damage develop more frequently and that the general prognosis is more unfavourable. The authors consider therefore cardiac damage in the active stage of the disease a reason for intensive treatment.

[Immunologic examination of the blood in the differential diagnosis of acute gouty arthritis and rheumatoid arthritis]. / Imunologická vysetrení v séru v diferenciální diagnostice akutní dnavé artritidy a revmatoidní artritidy.

In 16 patients with acute gouty arthritis, 30 IgM RF seropositive cases of rheumatoid arthritis (RA) and 20 IgM RF seronegative cases of RA the values of 14 indicators of antibody and natural immunity were assessed in serum. The assembled data were evaluated by step-wise discrimination analysis. This made it possible to select consecutively signs important for the differentiation of acute gouty arthritis from IgM RF seropositive RA (immunocomplexes, beta-2 microglobulin, C3) and for its differentiation from IgM RF seronegative RA (IgE, C3, transferrin, free SH groups). Thus obtained classification functions make it possible to classify correctly, random subjects with a probability of 76.7-93.7%.

[Immunologic examination of the synovial fluid in the differential diagnosis of knee joint inflammations. Computer analysis of 275 patients]. / Imunologická vysetrení v synoviální tekutine v diferencní diagnóze zánetu kolenního kloubu. Pocítacová analýza u 275 nemocných.

In the synovial fluid of the knee joint 15 immunological indicators were assessed in 275 patients divided into three groups according to the following diagnoses: rheumatoid arthritis, gonarthritis and synovitis after a blunt injury. The assembled data were evaluated by a stepwise discrimination analysis. This made it possible to select eventually in the compared groups eight characteristics with a differentiating value: IgE, immunocomplexes, beta-2 microglobulin, C3, CRP, alpha-2 macroglobulin, LF-test--reciprocal titre, LF-test--square of reciprocal titre. The classification functions of these characteristics make the correct classification of a random patient with a probability of 78.8-92% possible.

[Clinical importance of changes in antibody immunity in gout]. / Klinický význam zmen protilátkové imunity u dny.

In 77 patients with gout (16 with acute attacks and 61 during an attack-free period), in 30 healthy subjects, 30 patients with IgM RF serum positive rheumatoid arthritis (RA) and 20 cases of IgM RF serum negative RA the authors examined serum values of 10 parameters of antibody immunity: IgA, IgG, IgM, IgD, IgE, beta-2 microglobulin (beta-2 MG), immunocomplexes (IK), IgM RF/LFT, IgM/RF/HAT and ANA/IF. Data obtained by quantitative analyses were processed by stepwise discrimination with the consecutive selection of characteristics significant for the differentiation of the investigated groups and by assessment of classification functions which make it possible to classify individuals selected at random. The authors consider the following particularly important from the clinical aspect: acute gouty attack--IgM RF serum positive RA (IK and beta-2 MG), attack-free stage of gout--healthy subjects (IgA, IgG, IgM, IgD, IK, IgE). IgM RF were detected in 5/77 patients with gout, ANA/IF not in a single patient.