Primary prevention of dental erosion by calcium and fluoride: a systematic review.

BACKGROUND: Overviews of the current literature only provide summaries of existing relevant preventive strategies for dental erosion. OBJECTIVES: To perform a systematic review according to the quantitative meta-analysis method of the scientific literature on prevention of dental erosion. The focused question will address primary prevention of dental erosion by calcium and fluoride. MATERIALS AND METHODS: Randomized clinical trials (RCTs) regarding dental erosion prevention. The search included five databases: Embase, Cochrane database of systematic reviews, PubMed (MEDLINE), FDA publication and Berman medical library of the Hebrew University. The search included data in the English language, with effect on preventing dental erosion always presented as mean enamel loss and measured by profilometer. Statistical meta-analysis was performed by StatsDirect program and PEPI statistical software. Fixed- and random-effect models were used to analyse the data. Heterogeneity tests were employed to validate the fixed-effect model assumption. RESULTS: A total of 475 articles on dental erosion prevention were located. A four-stage selection process was employed, and 10 RCT articles were found to be suitable for meta-analysis. CONCLUSIONS: The number of studies on prevention of dental erosion maintaining standards of evidence-based dentistry remains insufficient to reach any definite conclusions. The focused questions of this review cannot be addressed according to the existing literature.

[Community dentistry in practice: four decades of activity among the Ethiopian community].

The immigration absorption of the Ethiopian community poses a great Zionist challenge to the State of Israel. The Department of Community Dentistry established a long and ongoing relationship with this unique population on a variety of levels. We revealed an alarming deterioration of their oral health status since their arrival to Israel. Concurrently, we explored the association between oral health and psychosocial variables among these immigrants. Accordingly, we implemented a holistic community oral health care program (prevention, treatment, dental, medical, social, psychological), with the participation of a multidisciplinary team of Ethiopian born professionals. In addition, as part of the integration process in the Israeli society and workplace, our department educated and trained individuals of this community as dental assistants and dental hygienists in courses held at the Hadassah Medical Organization. We strongly believe that this model of relationship and support should be implemented on a national level.

Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation?

STUDY DESIGN: Controlled experimental human study. OBJECTIVES: To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. SETTING: Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. METHODS: Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T(4)-T(6) paraplegia and 11 patients with C(4)-C(7) tetraplegia. RESULTS: Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. CONCLUSION: Post-prandial IR appears in C(4)-C(7) but not in T(4)-T(6) SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T(4) the mid-thoracic SC is involved in the regulation of glucose and insulin levels.

[Dental practitioners in Israel: past, present and future].

Since 1980 various studies have been published in Israel dealing with dental manpower issues, utilizing several methods such as manpower to population ratio. The dental literature pointed out that dentistry in Israel has an over supply of dentists and that manpower to population ratio is one of the highest in the world 1:770. All studies were based on the information provided by the Ministry of Health which showed that Israel has over 9500 dentists. The Israel Central Bureau of Statistics figures showed a much smaller number which was 5700 active dentists. This enormous gap in between two sources of information, following strict examination of the data revealed that the Bureau of Statistics information is reliable and hence, the real manpower to population ratio in Israel in 2008 was 1:1271. Prediction of manpower is extremely important and the base line information is crucial for future evaluations.

[Dental manpower prediction in Israel for 2017].

A recent study published by the authors indicated that according to the Israeli Central Bureau of Statistics in 2008, Israel had 5800 active dentists, a figure well below the publication by the Ministry of Health. Based on this figure, using the manpower to population ratio method, the following results were obtained: The predicted number of dentist in 2017 would be 6090, based on, the estimated number of Israel: graduates, the estimated number of dentists who would arrive in Israel as immigrants or Israelis who studied abroad, based on an attrition rate of 3% and on the assumption that the number of dentists leaving the country is negligible. Table 2, based on manpower to population ratio, indicates that by 2017, Israel would have 1 dentist per 1400 population, a ratio which is still far above what many countries present, but high for Israel. This might reflect a dramatic change, from employment in public clinics, back to private practices. The results clearly indicate that a shortage of dentists is predicted in the near future and a major brainstorming is urgently required to evaluate these results.

Low uric acid levels in serum of patients with ALS: further evidence for oxidative stress?

BACKGROUND: The exact cause of amyotrophic lateral sclerosis (ALS) is unknown. Oxidative stress is one of the factors implicated in the etiology of ALS as well as in that of other neurodegenerative diseases. Uric acid is an important natural antioxidant that may reduce oxidative stress. The objective of this study was to prospectively determine the serum uric acid levels in ALS patients and allegedly healthy individuals and to correlate those values with measures of ALS disease progression among the patients. METHODS: The ALS patients and well-matched controls underwent blood tests for serum uric acid levels which were then correlated with the patients' disability status, as expressed by the ALS Functional Rating Scale (ALSFRS-R). RESULTS: Eighty-six ALS patients and 86 well-matched controls participated. The ALS patients' mean+/-SD uric acid level was significantly lower (4.78+/-1.3 mg/dl) than that of the controls (5.76+/-1.26 mg/dl) (p<0.0001). The findings were similar for a second examination performed after an interval of at least 6 months. There was a correlation between the relative decrease of serum uric acid levels among patients (the difference between the patients' level and the controls' level) and the rate of disease progression (ALSFRS-R decline) (p<0.0001, r=0.624). CONCLUSIONS: ALS patients had lower serum uric acid levels than healthy individuals. The decreased uric acid levels were correlated to the rate of disease progression (ALSFRS-R decline), further demonstrating the possible role of oxidative stress in the induction and propagation of the disease.

Cold pressor test in tetraplegia and paraplegia suggests an independent role of the thoracic spinal cord in the hemodynamic responses to cold.

BACKGROUND: Cold application to the hand (CAH) is associated in healthy people with increase in heart rate (HR) and blood pressure (BP). OBJECTIVE: To study hemodynamic responses to CAH in humans following spinal cord injuries of various levels, and examine the effect of spinal cord integrity on the cold pressor response. DESIGN: An experimental controlled study. SETTING: The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS: Thirteen healthy subjects, 10 patients with traumatic T(4-6) paraplegia and 11 patients with traumatic C(4-7) tetraplegia. MAIN OUTCOME MEASURES: HR, BP, HR and BP spectral components (low frequency, LF; high frequency, HF; LF/HF), cerebral blood flow velocity (CBFV) and cerebrovascular resistance index (CVRi). METHODS: The outcome measures of the three subject groups monitored for HR, BP and CBFV were compared from 5 min before to 5 min after 40-150 s of CAH. The recorded signals were digitized online and analyzed offline in both the time and frequency domains. RESULTS: During CAH, HR and CVRi increased significantly in all subject groups (P<0.001), and BP in control subjects and in the tetraplegia group (P<0.01). BP increase was not statistically significant in paraplegia, and CBFV, HR LF, HR HF and BP LF did not change significantly during CAH in any group. CONCLUSIONS: The CAH effect in tetraplegia and the suppressed BP increase in paraplegia, supported by the other findings, suggest a contribution of an independent thoracic spinal mechanism to the cold pressor response.

Modified cold pressor test by cold application to the foot after spinal cord injury: suggestion of hemodynamic control by the spinal cord.

OBJECTIVE: Study hemodynamic responses to cold application to the foot (CAF) to explore the autonomic cardiovascular control by the spinal cord. DESIGN: Controlled experimental study. Hemodynamic variables were measured or calculated for 13 healthy subjects, 10 patients with traumatic T4-T6 paraplegia, and 11 patients with traumatic C4-C7 tetraplegia. Subjects were continuously monitored for heart rate (HR), blood pressure (BP), and cerebral blood-flow velocity (CBFV) from 5 mins before to 5 mins after 40-120 secs of CAF by ice water foot immersion. The recorded signals were digitized online and analyzed offline in the time and frequency domains. RESULTS: During CAF, HR increased in the control group but decreased in patients (P < 0.001). BP increased significantly in the control and tetraplegia groups (P < 0.001) and nonsignificantly in the paraplegia group. HR and BP spectral components (LF, HF, LF/HF) did not change significantly. CBFV increased significantly in the patient groups (P < 0.05) but not in the control subjects. The cerebrovascular resistance increased significantly in the control and tetraplegia groups (P < 0.001), but not in the paraplegia group. CONCLUSIONS: The findings support the presence of hemodynamic autonomic control by the spinal cord and show that responses to CAF can be used to assess its integrity.

Hemodynamic effects of liquid food ingestion in mid-thoracic paraplegia: is supine postprandial hypotension related to thoracic spinal cord damage?

BACKGROUND: Postprandial hypotension (PPH) appears in various conditions with autonomic failure and was symptomatic in a patient with thoracic paraplegia, but was not remarkable in patients with tetraplegia. OBJECTIVE: To determine whether the pathology causing PPH may include a thoracic but not a cervical spinal cord lesion (SCL). DESIGN: An experimental controlled study. SETTING: The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS: Thirteen healthy subjects, 10 patients with traumatic T(4)-T(6) paraplegia, and 11 patients with traumatic C(4)-C(7) tetraplegia. MAIN OUTCOME MEASURES: Heart rate (HR), blood pressure (BP), HR and BP spectral components (LF, HF, LF/HF), cerebral blood flow velocity (CBFV), and cerebrovascular resistance index (CVRi). METHODS: The effects of a standard liquid meal on the outcome measures were compared between the three subject groups monitored for HR, BP, and CBFV, from 55 min before to 45 min after the start of the meal. The recorded signals were digitized online and analyzed off-line in the time and frequency domains. RESULTS: After meal, BP decreased only in the paraplegia group (P<0.01), HR increased more prominently in this group (P<0.01), CVRi tended to decrease only in the paraplegia group, CBFV did not change significantly in any group, and HR LF/HF increased (P<0.001) in all groups but tended to increase more in paraplegia. CONCLUSIONS: Patients with mid-thoracic SCL may develop PPH. The pathology causing PPH can include a thoracic but not a cervical SCL. The normal hemodynamic reaction to liquid meal ingestion is mediated through the mid-thoracic spinal cord. The sympathovagal balance increases after food ingestion, more prominently in patients with PPH, and cerebrovascular resistance changes during PPH may help maintain the cerebral circulation.

Wide-range C-reactive protein efficacy in acute ischemic stroke patients.

OBJECTIVE: To compare the recently introduced wide-range C-reactive protein (wr-CRP) with the widely used high-sensitivity Behring Dade method (hs-CRP) in acute stroke/transient ischemic attack (TIA) patients. MATERIALS AND METHODS: A total of 119 consecutive patients admitted to a tertiary medical center with acute ischemic stroke/TIA were included in the study. Venous blood was obtained for both assays during the first 24 h, 3-5 days, as well as 3-6 months thereafter. RESULTS: A highly significant correlation (r=0.994, P<0.0001) was found between the two methods even when analyzed at three different time points. In addition, a similar correlation was noted between these two assays and other commonly used biomarkers, including white blood cell count, Westergren's sedimentation rate and quantitative fibrinogen. CONCLUSION: Real-time, on-line and low-cost wr-CRP assay is a reasonable alternative to the Behring Dade hs-CRP method in acute stroke/TIA patients.

[Community aspects of geriatric dentistry--a literature review: 1975-2000].

The world's population is in transition, but there is an inevitable move in all societies towards an aging population. There is an agreement that the ability of the geriatric population to adjust to the "third age" depends on the will of the society and the community to provide services and to support this vulnerable and dependent population. The preponderance of oral health issues and their impact upon general health and quality of life have prompted a variety of geriatric related efforts over the last 20 years. Predoctoral and postdoctoral education and training efforts have been initiated, geriatric research agendas have started to yield important findings, and a few service programs have marginally helped improve dental care access for the geriatric population. Past discoveries have enabled large portions of the world's population to enjoy far better oral health than their forebears a century ago. Although different patterns of dental needs emerge throughout the world, the "silent epidemic" of oral diseases is affecting the most vulnerable parts of the population: the poor children, the elderly and many members of racial and ethnic minority groups. The review of the literature of community aspects of geriatric dentistry in the past twenty-five years will be introduced in two articles. The first article summarizes the important issues of demography, oral health condition, changes in attitude towards oral health of the geriatric population, oral health services given in geriatric institutions and mobile dentistry. The issues of law and ethics, development of public and community oral health programs for the geriatric population and plans as well as trends for the future will be discussed in the second article. Setting goals and presenting data are steps in the right direction but are not enough; the success will be measured by the ability to make things happen. The continuing anticipated growth of the geriatric population will, hopefully, be translated into a rising political power and to fruitful and practical health outcomes.

[Community aspects of geriatric dentistry--a literature review: 1975 - 2000].

The world's population is in transition, but there is an inevitable move in all societies towards an aging population. There is an agreement that the ability of the geriatric population to adjust to the "third age" depends on the will of the society and the community to provide services and to support this vulnerable and dependent population. The preponderance of oral health issues and their impact upon general health and quality of life have prompted a variety of geriatric related efforts over the last 20 years. Predoctoral and postdoctoral education and training efforts have been initiated, geriatric research agendas have started to yield important findings, and a few service programs have marginally helped improve dental care access for the geriatric population. Past discoveries have enabled large portions of the world's population to enjoy far better oral health than their forebears a century ago. Although different patterns of dental needs emerge throughout the world, the" silent epidemic" of oral diseases is affecting the most vulnerable parts of the population: the poor children, the elderly and many members of racial and ethnic minority groups. The review of the literature of community aspects of geriatric dentistry in the past twenty five years will be introduced in two articles. The first article summarizes the important issues of demography, oral health condition, changes in attitude towards oral health of the geriatric population, oral health services given in geriatric institutions and mobile dentistry. The issues of law and ethics, development of public and community oral health programs for the geriatric population and plans as well as trends for the future will be discussed in the second article. Setting goals and presenting data are steps in the right direction but are not enough; the success will be measured by the ability to make things happen. The continuing anticipated growth of the geriatric population will, hopefully, be translated into a rising political power and to fruitful and practical health outcomes.

[A new gel for topical use in treating severe periodontal disease--clinical observations].

Within the framework of the efforts to find non-invasive treatment methods for severe periodontitis, a topical gel was developed by an Israeli research group. The aim of the current study is to present clinical observations and X-ray measurements of alveolar bone changes following an 8 week, self-care periodontal treatment in two groups of patients with severe periodontitis. All 31 patients who participated in the study showed an improvement of the periodontal condition as expressed in all the indexes examined. The observation findings testify to the fact that through self-care using a topical gel, significant results were achieved: decrease in probing depth, decrease in bleeding, significant improvement in teeth mobility and in level of the alveolar bone height and its density. These clinical findings raise interesting research questions and hint at the potential for regeneration of supportive periodontal tissues in cases of severe periodontitis, currently achieved only through surgical means. In order to obtain more accurate data regarding the treatment potential of this gel, it is important to conduct additional controlled clinical trials on different populations and also to try and determine how it works.

Lack of plasma norepinephrine cyclicity, increased estradiol during the follicular phase, and of progesterone and gonadotrophins at ovulation in women with premenstrual syndrome.

In healthy women, plasma norepinephrine (NE) has a cycle with the highest levels occurring at ovulation and early luteal phase. We examined plasma NE cyclicity in premenstrual syndrome (PMS) patients as compared to controls, its relation to estradiol (E(2)), progesterone (P), luteinizing hormone and follicle-stimulating hormone, and the correlation of these parameters with the PMS symptoms. Lack of NE cyclicity was observed in PMS patients. In controls, peak NE levels occurred at ovulation and early luteal phase. In PMS, serum E(2) was higher during the follicular phase, while P and gonadotrophins were higher especially at ovulation and the luteal phase. In the late luteal phase, E(2) levels were lower in PMS patients than in controls. A negative correlation was observed between the area under the curve for E(2) in the luteal phase and PMS somatic and mental scores. Plasma NE showed a negative correlation with abrupt mood swings, impatience, nervousness, tiredness, weakness, apathy, and headache. These data suggest that lack of NE cyclicity characterizes PMS, some symptoms being related to low E(2) levels during the late luteal phase and decreased noradrenergic activity at ovulation and the luteal phase.

[Optimal fluoride level in drinking water and public health].

Water fluoridation is a safe, efficient, and well-proven way of preventing dental decay in the community. In countries such as Israel, where dental care is not covered by the national insurance law, this has an important role in reducing social inequalities in health care. For toddlers and children, water fluoridation is the only way of promoting dental health without a need for regular visits to dental clinics, and without regard to parent awareness and motivation. The other methods of fluoride supplementation do not succeed in reaching the level of safety and cost-efficiency of water fluoridation, and their use is successful only among upper socio-economic classes. Water fluoridation has been defined by the US CDC as one of the main achievements in health care during the 20th century. In spite of the legal difficulties raised by various activist groups, the use of water fluoridation is growing steadily among developed as well as third world countries. The Israeli bylaw of national water fluoridation that is in effect will enable the safe improvement of the overall dental health status of the population at an extremely low cost.

[Is there a need for an additional dental school in Israel? 2002 status and future forecasting].

Dental manpower planning is constantly in discussion throughout the world. Current data indicates a transition from oversupply reports 10 to 20 years ago to a present undersupply of dentists with a forecast for further shortage in the near future. The dental profession in Israel has gone through deep and extreme changes since the late 80'. Dentists are now at the "bottom of the barrel" and many abandoned the profession after long and demanding years of education. The future of the academic dental institutions is also unclear. In spite of the current unrealistic present, we are witnessing some processes that might change the status of the dental profession in Israel in the near future. Among these are the changing roll of female dentists in the profession, increasing age of practicing dentists, obligatory state licensing exams, less immigration of dentists and the natural growth of the population. Together with the expected increase of demand for dental care, a decrease in the number of dentists in Israel will result in a balanced dental manpower in 2011. Therefore, the necessity of establishing a third dental school in Israel was brought to discussion. Dental schools are responsible not only for students qualification as caregivers, but also for enrichment of practicing dentists with updated data, and qualifying specialist dentists in the various fields of the profession. At the present, there is no justification for establishing a third dental school in Israel. Nevertheless, it is obligatory to maintain and strengthen the two existing dental schools in spite of the needed high costs. Only in this way the profession will continue to enjoy a nation high quality professional and academic dental manpower. The continuous qualification of specialists will be maintained and an open "path" will be available for future manpower enlargement. Hastiness and rashness, which ended in national shortage of dentists in other countries, should be avoided in Israel.

[Quality assurance in dentistry--past, present and future].

Quality assurance involves the cycle of quality assessment, formal identification of problems, developing a strategy for resolving problems and implementation of changes. Historically, the term "first do not harm" can be considered as the first step in quality assurance. Patients' high expectations from the outcomes of dental treatment, new technology and cost containment changed the perspectives completely. We are facing a new era of an increasing demand for patients' involvement as well as an increasing demand for accountability of the members of the profession. The article describes the development of the issue of quality assurance during the last thirty years and highlights the difficulties encountered by the profession in adjusting the changes due to lack of education, experience, knowledge and absence of a definition for accepted criteria for action. Developing criteria for appropriateness of dental treatment, developing mechanisms for assessing the art of care, development of large data bases and development of consumers' surveys are some of the leading suggestions for future action. The responsibility for quality and quality assurance lies in the hands of the dental profession. Organized dentistry possesses a social and ethical commitment for the society, as well as professional obligation for the members of the profession. Although cost containment gave rise to the issue of quality, quality assurance should not be measured in financial terms, but in terms of accepting responsibility and working for continuous improvement. Steps in the right direction will, hopefully, lead to a better and more efficient utilization of the available resources and will increase the trust of the public in the profession of dentistry. Therefore, organized dentistry should not leave this important issue to be dealt by non-dental professions or commercial organizations.

[The influence of socio-demographic and psychological variables on the level of satisfaction of geriatric patients from dental care].

UNLABELLED: The increasing geriatric population poses unique treatment challenges for the dental practice. Satisfaction from dental treatment is considered to be an important issue that influences the attitude and cooperation of the geriatric patient. It is associated with the quality of treatment and with different variables, such as physical, emotional, social and financial. The objectives of the present study were to perform a preliminary characterization of a group of geriatric patients and to identify possible factors that might be associated with their level of satisfaction from dental treatment. MATERIAL AND METHODS: Fifty-one geriatric patients (20 males and 31 females) participated in the study. They were given a questionnaire which included 41 items regarding: socio-demographic variables, social activity, self image, level of apprehension, locus of control and level of satisfaction from dental care. RESULTS: Twenty-two patients reported a high level of satisfaction from dental treatment and twenty-nine reported a low level of satisfaction. No significant association was found between the degree of satisfaction from dental treatment and the examined variables of social activity, self-image and level of apprehension. Good doctor-patient relationships--"the art of care", is considered to have an important impact on the level of satisfaction, especially among the geriatric patients. CONCLUSION: Therefore, it is suggested that these relationships might determine the level of satisfaction of the geriatric patient from dental treatment.

[The fight over water fluoridation in Israel].

Water fluoridation in Israel was initially introduced on a municipal level in 1981. Legislation in favor of national water fluoridation was approved in 1998. Over the last year an increasing campaign against the fluoridation project has become more and more evident. The material published by the opponents to fluoridation, distributed in pamphlets, daily journals and mass media resources, illustrate as in the USA, an endless and unrestrained "duel" between opponents and supporters of fluoridation. In Israel, in contrast to the USA, referenda are unprecedented, therefore, the political "battle field" is transferred to the municipal authorities and the Knesset. The pivotal component of the Israeli opponents to fluoridation regards the public's health and safety. Unscientific publications appear regularly in the daily journals and electronic mass media with no reference of supporting studies ever mentioned. The inevitable question addressed in this article is what are the best ways of action to be taken by the supporters of fluoridation is Israel. The main and most important mode of action against this campaign is, undoubtedly, continuous persuasion. Nevertheless, the continuous daily struggle of the supporters must be in a world-wide frame and be adjusted to the different target groups of the public. An effective confrontation should include nation-wide available publications (internet, daily papers and multimedia) with special emphasis on the important subjects (e.g. evidence based care, significance of toxic doses and the value of social justice), in a format comprehensible to the public and its leaders. The American experience helps us to understand that the opposition to water fluoridation will not diminished but, on the contrary, is expected to strengthen. We must look forward with no illusions and establish ways of action and cooperation by learning from past experience and from that of our collaborators. This will serve as the basis for the ongoing frank and persuasive efforts, derived from a deep and honest belief in the justice of our way.

High levels of catecholamines in human semen: a preliminary study.

The objective of this study was to determine the seminal concentrations of four different catecholamines and their association with semen quality. Seminal concentrations of adrenaline, noradrenaline, 3,4-dihydroxy-phenylalanine (DOPA), and 3,4-dihydroxy-phenyl acetic acid (DOPAC) were determined in 13 healthy volunteers, using high-performance liquid chromatography with an electrochemical detector. In addition, semen analysis was performed. Noradrenaline and DOPA were present in all specimens with a concentration of 15 181+/- 2951 pg ml(-1) and 4023 +/- 429 pg ml(-1) (mean +/- SE), respectively. These concentrations are respectively 19 times (range: 3-44) and twice (range: 1-3) as high as the maximal normal concentration in plasma. Adrenaline was present in 10 and DOPAC in seven of 13 specimens. No correlation was found between the concentration of any of the catecholamines evaluated and semen characteristics. In conclusion, noradrenaline and DOPA are present in human semen at concentrations that are much higher than maximal normal values in plasma. Adrenaline and DOPAC were also found in some of the samples. The concentrations of catecholamines in semen are not associated with semen quality.