Rapid and highly sensitive electrochemical determination of alkaline phosphatase using a composite tyrosinase biosensor.

The use of an amperometric graphite-Teflon composite tyrosinase biosensor for the rapid monitoring of alkaline phosphatase (ALP), with no need of an incubation step and using phenyl phosphate as the substrate, is reported. Phenol generated by the action of ALP is monitored at the tyrosinase composite electrode through the electrochemical reduction of the o-quinone produced to catechol, which produces a cycle between the tyrosinase substrate and the electroactive product, giving rise to the amplification of the biosensor response and to the sensitive detection of ALP. The current was measured at -0.10 V 5 min after the addition of ALP. As a compromise between high ALP activity and high sensitivity for the detection of phenol, a pH of 8.5 was chosen. The substrate concentration was also optimized. A linear calibration plot was obtained for ALP between 2.0 x 10(-13) and 2.5 x 10(-11), with a detection limit of 6.7 x 10(-14) M. Different types of milk were analyzed with good results, using an extremely simple and rapid procedure.

Changing oral care needs in the United States: the continuing need for oral medicine.

OBJECTIVE: The purpose of this article is to provide oral care providers evidence of oral conditions and medical compromise that is impacting the oral health and oral health needs of the public. DESIGN: Data were analyzed based on current epidemiologic data, derived in large part from the Health and Nutrition Examination Surveys, the National Center for Health Statistics, National Health Interview Survey Series 1994-1997; American Cancer Society, National Cancer Institute Surveillance Examination and End Results data base, Morbidity and Mortality Weekly Reports, peer-reviewed publications, and surveys of oral medicine-related disorders. RESULTS: Millions of Americans have medical conditions that complicate their oral health care. Oral health problems associated with age, medical health and treatment, and institutional setting are increasing. Chronic orofacial pain, persistent oral soft tissue lesions, and salivary gland and chemosensory disorders are common problems of modern society. CONCLUSIONS: Evidence suggests that the next decade will bring a significantly increased demand for diagnosis and management of patients with oral conditions and patients with oral manifestations of systemic conditions, and an increase in general oral care needs of patients who are medically compromised. These increasing demands should be reflected in dental education and continuing education.

The hypotrichosis-generating shorn (shn) mutation maps to distal chromosome 7 in the Norway rat.

We have recently identified an autosomal recessive mutation in the Norway rat that generates an almost complete absence of normal hair. Here we describe a multilocus backcross analysis that was used to map this mutation, named shorn (gene symbol shn), to the distal end of rat chromosome 7. Although this region in rat carries no previously mapped similar mutations, the homologous genomic regions in mouse and human contain several potential homologues and candidate genes.

Need and Demand for Oral Medicine Services in 1996. A report prepared by the Subcommittee on Need and Demand for Oral Medicine Services, a subcommittee of the Specialty Recognition Committee, American Academy of Oral Medicine.

The need and demand for oral medicine services in the United States and Canada was determined by a prospective survey of American Academy of Oral Medicine practitioners who attended the Academy's 1996 annual meeting. Of the 50 surveys returned from 149 eligible registrants, it was determined that, on the average, oral medicine practitioner respondents practiced 2.3 days per week and treated 8.7 patients per day; this amounts to more than 40,000 patient-care visits per year. Almost 90% of patients were treated because of medically compromising conditions, oral mucocutaneous disease, or chronic orofacial pain. Most of the care (52%) was provided in non-university settings. Most treatment involved the comprehensive evaluation of complex oral problems (36.7%), the prescription of medications (24.2%), or comprehensive dental treatment (21.8%) for patients with severe and life-threatening medical conditions. These results suggest that oral medicine services are needed and that demand for these services is high.

Antibacterial prophylaxis.

Bacteremias of dental origin have been implicated as sources of infection in specific cardiac conditions, diabetes, neutropenia, kidney disease, splenectomy, and patients with prosthetic joints. This article reviews the relative risks of dental bacteremias in these patients, discusses the merits of various regimens, and presents current prophylactic antibiotic recommendations.

Bacterial contamination of dental radiographic film.

Three types of paper-covered and one type of plastic-covered Kodak dental film were used to determine if bacteria could penetrate the coverings and contaminate the inner film. Films from each group were immersed for 30 or 120 seconds in high concentrations of known bacterial suspensions with or without 10% sterilized calf serum added to the incubation media. The plastic-covered film effectively excluded all bacteria, whereas the paper-covered film showed contamination with all organisms even at 30 seconds. Increasing the viscosity of the incubation medium with calf serum decreased the level of contamination.

What you don't see can hurt you.

Although AVMs are quite rare, at least two generalizations can be drawn from this case. First, don't rush into treatment. Time spent in the initial diagnosis and treatment planning is time well spent. Carefully evaluate the signs and symptoms, develop a good initial differential diagnosis, and if the facts just don't fit, expand your differential diagnosis. Second, take advantage of continuing education courses in oral diagnosis, oral pathology and oral medicine. This is certainly the best way to keep current, increase your diagnostic knowledge and expand your differential diagnoses. Finally, I hope this case presentation makes clear that what you don't suspect, you seldom see, and what you don't see can hurt you and your patients.

A comparison of the signs of temporomandibular joint dysfunction and occlusal discrepancies in a symptom-free population of men and women.

To date, there has been no conclusive explanation for the predominance of female patients with temporomandibular joint (TMJ) dysfunction. The purpose of this study was to survey a normal population without symptoms for the presence of certain putative signs of TMJ dysfunction in association with certain signs of occlusal discrepancy and to determine the presence of any gender variation. The subjects (217 men and 217 women) were examined for the presence of three putative signs of TMJ dysfunction: limited mandibular opening (under 37 mm), deviation on opening, and joint sounds. The subjects were also examined for the presence of four signs of occlusal discrepancy: an anterior slide from centric relation (CR) to centric occlusion (CO), lateral slide from CR to CO, nonworking occlusal contacts, and working disclusive contacts distal to the canines. CR is the mandibular position at which the condyles are in their most superior position on the posterior aspect of the articular tubercles. CO is the mandibular position at which the mandibular and maxillary teeth are in maximum intercuspation. There were no significant differences in the prevalence of the putative signs of TMJ dysfunction and occlusal discrepancy between men and women. It was concluded that factors other than the presence of these signs of TMJ dysfunction and occlusal discrepancy are responsible for the high predominance of female patients with TMJ dysfunction.

Glossodynia in patients with nutritional deficiencies.

Various types of nutritional deficiencies can produce glossodynia and associated signs of inflammation. Changes such as swelling of the tongue, papillary atrophy, and surface ulceration are possible in most of the deficiency states. To further complicate the clinical picture, the patient commonly will suffer from multiple nutritional deficiencies [29]. Therefore, it is not advisable to diagnose a specific nutritional deficiency on clinical impression alone. To establish iron, folate, or vitamin-B12 deficiency, a hematologic screening that includes complete blood count, red-cell, serum iron, B12, and folate levels should be performed [30]. Although they are rarely required, specific tests for suspected niacin, pyridoxine, and riboflavin deficiency are available. Although glossodynia related to nutritional deficiency is statistically uncommon, it is easily curable with replacement therapy. Identification of a vitamin deficiency through early oral symptoms can forestall development of serious and irreversible systemic and neurologic damage.

The role of the dentist in diagnosing infection in the AIDS patient.

A case report of an AIDS patient afflicted with disseminated histoplasmosis is presented. Characteristic granulomatous-appearing lesions on the tongue were observed during the patient's initial workup, but the patient became unavailable for a scheduled biopsy. Consequently, the diagnosis of a histoplasmosis infection was established only after the performance of several time-consuming, stressful, and, at times, invasive diagnostic procedures. It is proposed that early histologic evaluation of the suspicious oral lesions would have resulted in the diagnosis, thus making more extensive diagnostic testing unnecessary. This case illustrates the need for the dentist to pursue an aggressive approach in evaluating oral lesions in the AIDS patient.

Metastatic adenocarcinoma of the colon presenting as periradicular periodontal disease: a case report.

Metastases to the jaws account for only 1% of all malignant tumors of the oral cavity. Consequently the diagnosis of metastasis to the mandible requires a high degree of clinical suspicion and the use of a systematic diagnostic approach. In this case report a patient sought treatment for what appeared clinically and radiographically as periradicular periodontal disease. However, because the patient had a medical history of adenocarcinoma of the colon 5 years previously, metastasis to the jaws was included in the differential diagnosis. Metastasis to the jaws may resemble periodontal disease or many of the other benign and malignant conditions that affect the jaws, thus making the correct radiographic diagnosis difficult. Ultimately, histologic evaluation is essential to make a definitive diagnosis.

Arteriovenous malformation of the mandible: report of case.

Arteriovenous malformations are rare, but, considering the life-threatening consequences of these lesions, they must constantly be considered in a differential diagnosis. The management of this patient from the initial symptoms emphasizes the need for a methodical approach to oral diagnosis using the fundamental techniques of inspection, auscultation, and palpation, as well as the more recent techniques of laboratory and radiographic evaluation.

The patient with chronic renal failure who is undergoing dialysis or renal transplantation: another consideration for antimicrobial prophylaxis.

A patient with chronic renal failure who is undergoing dialysis or renal transplantation is susceptible to a number of infections. Transient, usually asymptomatic bacteremias occur in a wide variety of dental manipulations, particularly those involving the mucous membranes. Certain bacteremias may cause serious complications in these already compromised patients. Therefore, antimicrobial prophylaxis is essential when these patients undergo bacteremia-causing dental procedures.

Early aggressive cemento-ossifying fibroma: a diagnostic and treatment dilemma.

A case involving a 22-year-old male patient with early aggressive cemento-ossifying fibroma in the mandible is discussed. The historical difficulty in categorizing fibro-osseous lesions is reviewed, and the importance of clinical, radiographic, and surgical findings to the ultimate diagnosis and correct treatment of these lesions is emphasized.