Global Burden of Sugar-Related Dental Diseases in 168 Countries and Corresponding Health Care Costs.

Oral diseases such as dental caries, edentulism (tooth loss), periodontal disease (PD), and oral cancer currently constitute an increased major public health burden across the globe, with significant differences between countries. One of the main drivers of caries, edentulism, and PD is the excessive intake of sugars. Here, we aimed to quantify the global sugar-related dental health and cost burden in the year 2010. This study used a health-econometrical model to calculate the disease burden as well as the direct and indirect costs attributable to the intake of free sugars (mono- and disaccharides [MDS]). To this end, several databases from the Institute for Health Metrics and Evaluation (IHME), Organisation for Economic Co-operation and Development (OECD), Food and Agriculture Organization (FAO), and World Bank were used. In total, the corresponding disease burden in 168 countries and economic burden in 31 OECD countries were quantified. In 2010, the consumption of MDS was associated with a global dental disease burden of 4.1 million disability-adjusted life years (DALYs; 95% uncertainty interval [UI]: 2.1 to 7.4 million DALYs), with 2.7 million DALYs from MDS-related caries and 1.4 million DALYs from PD. In terms of economic costs, MDS-related dental diseases were associated with a global financial burden of 172 billion US dollars (USD; 95% UI: 91 to 295 billion USD), the largest share of which (151 billion USD) was incurred in OECD countries. Overall, 26.3% (95% UI: 13.3% to 47.5%) of the total global oral disease burden was attributed to the consumption of MDS. The present study emphasizes the need to further address the role of free sugars in oral health and nutrition policy. Although the largest share of the economic burden was accounted for by OECD countries, emerging economies should address this challenge early on in national public health policies if they are to avoid disease and the prospect of increased cost burdens.

[Problem-based learning (POL) in environmental medicine]. / Problemorientiertes Lernen (POL) in der Umweltmedizin.

"Environmental medicine" is a new sub-discipline in the spectrum of medical specialization in Germany. The Berlin Academy of Occupational Medicine and Health Protection, now a branch of the Berlin Chamber of Physicians, developed a 200-lesson curriculum for physicians who want to specialize in this field. Coincidentally during the initial courses, the attendants were already highly qualified ("Facharzt"-level) and experts in various occupational fields, and hence the composition of the classes was highly heterogeneous on the levels of practical experience as well as theoretical knowledge. The Academy therefore decided to change the teaching method to Problem-Oriented Learning (POL). This required training tutors for small learning groups, supervision for these tutors and supplying adequate teaching materials and a stimulating environment for the student. The "Arbeitsgruppe Reformstudiengang Medizin" (Medicine Curriculum Reform Project) at the Berlin Humboldt University as well as the Dutch Rijksuniversiteit Limburg in Maastricht helped in the process of conceptualization. Participants worked in groups of up to 8 persons under non-directive tutors. A new "case" was presented every day, and the students developed individual learning goals according to the Seven Steps-method, which were then researched individually and with the help of outside experts. The findings were reported back and discussed in the group. Initially there was irritation, but after two or three days participants got used to not being lectured. Instead of being passive recipients of expert knowledge they felt that the POL method of learning enhanced their competence to act independently.

Sensitivity ofLemna bioassay interacts with stock-culture period.

The effect of stock-culture period on the sensitivity of theLemna bioassay to four different phenolic substances was evaluated in this study. The sensitivity of the bioassay interacted with the stock-culture period of either 11, 14, or 18 days. After a seven-day testp-hydroxybenzoic acid (HBA), vanillic acid (VA),trans-cinnamic acid (CA), and ferulic acid (FA) with a concentration of 0.05 mM significantly reduced the number of fronds and the dry weight compared with the untreated control when the stock-culture period had been exactly 14 days. The sensitivity after the shorter (11 days) or longer (18 days) stock-culture period was reduced, and the differences in the dry weight to the untreated control were not significant after a stock culture period of 18 days. The two higher concentrations (0.1 and 0.25 mM) showed stronger inhibition. A comparison of the inhibition at 0.05 mM revealed that the stock-culture period affected the relative toxicity of the four phenolic substances. Since the pH increased in the stock-culture flasks during the 18-day period from 6.25 to 7.9, we hypothesize that differences in theLemna assay can be at least partly attributed to a pH effect, possibly in combination with a relative nutrient deficiency. We recommend a standardization of the stock-culture period to 14 days to improve the sensitivity of theLemna bioassay.

Biologically active secondary metabolites of barley. IV. Hordenine production by different barley lines.

Forty-three lines of barley, including ancestral (wild), landraces, Middle Eastern lines, and modern cultivars, were grown under two different sets of environmental conditions. Hordenine production in barley roots was determined at the one-leaf stage by HPLC analysis and, in two lines only, over a period of 35 days. Forty-two of the 43 lines produced significant amounts of hordenine, although there was no variation among groups. Middle Eastern lines had the highest production with 327 µg/g on a dry weight basis. Production was, however, determined more by environmental conditions during growth than by genetic factors. Hordenine production was up to seven times higher in plants grown under lower light intensities.

[6 dentin adhesive products subjected to controls in vitro]. / Six produits adhésifs dentinaires soumis au contrôle in vitro.

The aim of this in vitro study was to assess of the biocompatibility of 6 adhesive dental products (Cavalite, Dual Cement, Fuji Type II, Gluma, Ketac Bond, Scotch Bond) using cell cultures of human pulps and a standardized method. It was thus possible to improve the scale of biological activity proposed by Regad et al., (1989). The specific behaviour of the cells in the contact and adjacent zones has been added to the assessment of the cellular reactions of the whole culture. These criteria allowed the clear differentiation of the toxicity and the biocompatibility of the products. The following estimations were made: Gluma and Fuji Type II "toxic", Cavalite "acceptable", Scotch Bond "not significant", Ketac bond and Dual Cement "acceptable" and "not significant" with a "toxic" tendency.

[Substitute model of an in-vitro biological trials. I. Standardized method using human pulp cells]. / Modèle substitutif d'essai biologique in vitro. I. Méthode normalisée à l'aide de cellules pulpaires humaines.

To ascertain the biocompatibility of dental materials, an in vitro biological test using cultures of human pulp cells was designed as an alternative to the in vivo method using human teeth. The cells were cultured from fresh explants of pulp germs and the 4th generation of cells (P4) was shown to be very similar to the controls. The comparison between the results of the in vitro cell cultures (obtained by rating the cells' growth and the histomorphology) and those of the controls (histologic rating of the pulpal response) indicated that the developed cell culture method was suitable for the preliminary evaluation of pulpal protective materials.

[Substitute model for in-vitro biological testing. II. Quantitative evaluation of the biocompatibility of dental products]. / Modèle substitutif d'essai biologique in vitro. II. Evaluation quantitative de la biocompatibilité des produits dentaires.

A biological model for evaluating pulpo-dentinal capping materials is described. The model uses cultures of human pulp cells which are explanted to form cell monolayers. Four products already tested in vivo on teeth subsequently extracted for orthodontic reasons were laid directly over these cultures and observed after 7, 14, 21 and 28 days, corresponded to the in vivo test periods. The growth and morphology of the cells were similar for both test systems, indicating comparability between the two biological models as well as the validity of the developed in vitro method. A preliminary scale of biological activity is proposed which could be useful for preliminary screening of materials.