Fluoride varnishes: should we be using them?

Fluoride varnishes are fast becoming the standard of care as topical fluoride treatments. Fluoride varnishes still await approval from the FDA for use as caries preventive agents. In the meantime, their use for such purposes is considered "off-label." This article highlights the efficacy of fluoride varnishes as caries preventive agents and introduces some of the commercially available fluoride varnishes to the reader. As more clinical trials in the US unravel the efficacy of these agents, there is little doubt that fluoride varnishes will become an integral part of our preventive armamentarium in the battle against dental caries.

Cytoskeletal actin reorganization in neutrophils from patients with localized juvenile periodontitis.

Localized juvenile periodontitis (LJP) is an early-onset periodontal disease associated with a polymorphonuclear neutrophil (PMN) defective migratory response. Kinetics of actin polymerization-depolymerization determine the shape changes occurring in the plasma membrane-associated cytoskeleton and provide the driving force for directed cell migration (chemotaxis). Therefore, we investigated the relation between an abnormality in LJP PMN chemotaxis and an altered reorganization of the actin filament network. PMNs isolated from peripheral blood of LJP patients (n=14) and matching control subjects (n=12) were evaluated for random and directed migration in a Boyden chamber assay, and the kinetics of actin polymerization were studied by flow cytometry. Three groups of LJP patients could be distinguished on the basis of their PMN-chemotactic response compared to their matched control: depressed (n=6), normal (n=4), and elevated (n=4). The abnormal (depressed or elevated) chemotaxis was generally not related to abnormal random migratory response, except for two patients. Since the kinetics of formyl-methionyl-leucyl-phenylalanine-induced F-actin response were highly variable from one subject to another, means were calculated at each timepoint with the values obtained from each group of subjects and compared by a general factorial design analysis. No statistically significant differences were detected between the control group and the LJP patient group. Furthermore, the data did not show a correlation between the kinetics of actin polymerization-depolymerization and the abnormal chemotactic response observed in LJP PMNs. Hence, the chemotaxis defect in LJP PMN appears to be mediated by signaling events that carry their effect independently of an intact cytoskeleton.

Resin-modified glass ionomer cements (RM GICs) implications for use in pediatric dentistry.

The changing face of restorative dentistry has resulted in the introduction of numerous materials. The emphasis on durability, strength, and esthetics led to the introduction of glass ionomer based formulations. The latest entrants into this arena are the resin-based glass ionomer cements. The combined properties of enhanced strength and fluoride release make this material an attractive choice for most restorative procedures. For the pediatric dentist, this material has special value due to its preventive characteristics, ease of placement and esthetics. The amalgam controversy has led practitioners and patients to opt for non-amalgam based restorations. The introduction of "compomers" provides an exciting alternative to amalgam. The purpose of this article is to highlight the properties of these "new age" materials and present a case report on the use of one such commercially available resin/ionomer cement.

Regional odontodysplasia: review of the literature and report of a case.

Regional odontodysplasia is a rare and unique dental developmental anomaly that affects tooth morphogenesis. This case is unusual in that it involved the mandibular dentition. However, in this case the mandible was unilaterally involved. The presence of an abscess in relation to the lower right first permanent molar, in the absence of deep caries or periodontal pathology was an interesting finding. The radiographic appearance of bizarre pulpal morphology with high pulp horns extending to the occlusal surface would provide an open communication between the pulpal tissue and oral cavity. The importance of the first permanent molar as a strategic tooth was recognized and an apexification procedure was performed. The care and treatment of a child with odontodysplasia requires a multidisciplinary approach. In this case the right lower primary cuspid and first primary molar had been extracted previously. The early extraction of these teeth and the subsequent delay in hard tissue formation and eruption of the permanent successors could have resulted in altered growth of the alveolus in this region.

The influence of midazolam and nitrous oxide on respiratory depression in laboratory rats.

Midazolam in combination with nitrous oxide (N2O) is a commonly used sedative approach for pediatric dental patients. Respiratory morbidity and mortality have been reported with midazolam administration, particularly when used in combination with other drugs in the absence of supplemental oxygen. Thus, the purpose of this investigation was to determine the effect of midazolam alone and in combination with N2O on respiration in laboratory rats by measuring arterial blood gas levels. Sixty-four Sprague-Dawley rats, weighing 250-320 g, were assigned to one of eight groups (eight per group). Groups were allocated based upon the dosage of midazolam administered (0, 1.0, 2.0 or 4.0 mg/kg i.p.) and exposure to N2O/02 (50%/50%) or room air. Arterial blood was obtained from a femoral artery catheter and pH, O2, CO2 (mm Hg), and oxygen saturation (%) were determined. Samples were analyzed using a System 1306 pH/Blood Gas Analyzer. Baseline arterial blood gasses were obtained for each animal and at 15-min intervals following midazolam administration throughout the 45-min experiment. Following midazolam administration, animals were placed into a sealed chamber through which flowed either N2O or room air. Group comparisons demonstrated that: 1) arterial CO2 levels increased in midazolam-exposed animals breathing room air, but not in those exposed to N2O (P < 0.05), and 2) as expected, N2O/O2-exposed animals showed an increase in arterial O2 and a %saturation that was not observed in room air groups (P < 0.01). This investigation demonstrated that coadministration of N2O/O to midazolam-exposed animals did not result in hypercarbia, an early indicator of respiratory depression.

Neutrophil function and dysfunction in periodontal disease.

The polymorphonuclear leukocyte or neutrophil is an integral part of the acute inflammatory response. Its function as a protective cell in the pathogenesis of periodontal disease has been studied extensively. Abnormal neutrophil function has been associated (directly or indirectly) with the pathogenesis of early onset periodontal disease. This paper reviews the recent developments in neutrophil function and dysfunction as they relate to periodontal disease progression.