Evaluation of an outreach education model over five years: Perception of dental students and their outreach clinical mentors.

INTRODUCTION: The objective was to investigate changes in students' and clinical mentors' perceptions of a model for outreach education over a 5-year period, 2006-2010. MATERIAL AND METHOD: Two cohorts of last-year students of a dental problem-based curriculum and their clinical mentors in the Public Dental Service (PDS) were invited to respond to a questionnaire. In 2006, 85% of 54 students and 72% of their 54 mentors responded; 98% of 40 students and 88% of 41 of the mentors did so in 2010. Participants scored their level of agreement with different statements on a numeric rating scale and gave comments. RESULTS: Dental students and their clinical mentors reported that they shared a consistent and favourable perception of this outreach education model over 5 years. The students reported increased professional confidence and self-reliance. Clinical mentors expressed a transfer of knowledge to their clinics. Differences in scoring were seen between students and mentors for two statements in 2006 and two statements in 2010 (P < 0.05). CONCLUSIONS: The current model for outreach education received favourable and stable ratings over the 5-year period. This model resulted in that students perceived that they became self-reliant, which may facilitate their transition from being a student to becoming a professional. The current model supports exchange and professional development for students, faculty and outreach clinics. This leads us to look at outreach education as an opportunity to form a mutual learning community comprised of the outreach clinics and the dental school.

Presence of Lactobacillus reuteri in saliva coincide with higher salivary IgA in young adults after intake of probiotic lozenges.

The aim of this study was to compare the concentration of salivary immunoglobulin A (IgA) and the selected interleukins (IL)-1ß, IL-6, IL-8 and IL-10 in young individuals with presence and non-presence of Lactobacillus reuteri in saliva after a three-week intervention with probiotic lozenges. The study group consisted of 47 healthy individuals aged 18-32 years with no clinical signs of oral inflammation. In a randomised, double-blind, placebo-controlled, cross-over trial participants ingested two lozenges per day containing two strains of the probiotic bacterium L. reuteri or placebo lozenges. The intervention and wash-out periods were three weeks. Stimulated and unstimulated whole saliva was collected at baseline and immediately after termination of the intervention periods. The samples were analysed for total protein, salivary IgA and selected cytokines. In this extended analysis, data were collected by analysing baseline and follow-up saliva samples related to ingestion of the probiotic lozenges for the presence of L. reuteri through DNA-extraction, PCR-amplification and gel-electrophoresis. At baseline, 27% of the individuals displayed presence of L. reuteri and 42% were positive immediately after the three-week probiotic intervention. Individuals with presence of L. reuteri in saliva had significantly higher (P<0.05) concentrations of salivary IgA and %IgA/protein at the termination of the probiotic intake compared with non-presence. No differences in the cytokine levels were observed. In conclusion, detectable levels of L. reuteri in saliva coincided with higher concentrations of salivary IgA and %IgA/protein in stimulated whole saliva after the three-week daily intake of probiotic lozenges. Our findings suggest that monitoring the presence of probiotic candidates in the oral environment is important to interpret and understand their possible immune-modulating role in maintaining oral health.

The legacy of cariologist Douglas Bratthall, an inspired scientist.

Douglas Bratthall was an inspirational cariologist known for his playful curiosity, thoughtful inquisitiveness, incisive scholarship, and energetic leadership. He became a time, mind, and global traveler who viewed his career path as an exotic safari. This 'Discovery!' report identifies where his era's burning issues have led and how they were shaped by his contributions.

Tramadol-induced oral dryness and pilocarpine treatment: effects on total protein and IgA.

Pilocarpine induces a profuse flow of saliva, and it may re-establish saliva production in cases of drug-induced oral dryness. The aim of the study (a sub-study to the previous trial investigating the pilocarpine fluid effects in individuals suffering from drug-induced dry mouth) was to search for saliva quality changes induced by the treatments. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol to induce oral dryness. Secretion rate was measured before and after tramadol, and then after pilocarpine, placebo, or no treatment. All saliva was analyzed for its protein and IgA content in the pilocarpine (n=15) and placebo groups (n=12). At baseline, the flow of saliva was 0.47±0.05ml/min, the protein output 0.17±0.2mg/min and the IgA output 0.022±0.002mg/min. After tramadol treatment (50mg 3×/day over two days), the flow was reduced by 64%, protein output by 52% and the IgA output by 38%. While placebo treatment did not affect any of the variables, the flow was 120%, the protein output 193% and the IgA output 83% of the baseline characteristics after pilocarpine treatment (5mg). Thus, the pilocarpine-induced increase in the flow rate in the state of tramadol-induced oral dryness results in saliva with a well preserved protein concentration but with a decrease in IgA concentration. However, compared to baseline, there was neither a decrease in output nor in concentration of IgA.

Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmö.

The aim of this study was to determine attitudes of final-year dental students in Cardiff, Cork and Malmö towards tooth whitening. Following receipt of ethical approval, pre-piloted questionnaires were distributed to final-year dental students in Cork, Cardiff, and Malmö as close as possible to graduation. The questionnaire sought information relating to various opinions and attitudes towards the use of bleaching techniques including safety of bleaching, confidence in the provision of bleaching, recommendations to patients, teaching received, awareness of restrictions on the use of bleaching products and management of simulated clinical scenarios. Eighty three per cent (n = 116) of questionnaires were returned. Cork dental students had the most didactic teaching (2-h vital, 1-h non-vital bleaching) compared to Cardiff or Malmö students (0 h each). More Cork students regarded bleaching as safe (76%, n = 28) than Cardiff (70%, n = 32) or Malmö (36%, n = 12) students. More than 50% of Cork students feel they know enough about bleaching to provide it in practice, significantly more than Cardiff (< 25%) or Malmö (< 25%) students. The majority of students would provide vital bleaching after qualification (100% (n = 37) Cork; 82% (n = 27) Malmö; 76% (n = 35) Cardiff). In simulated clinical scenarios, more Cork students would propose bleaching treatments (89%n = 33) than Malmö (64%n = 21) or Cardiff (48%n= 22) students. Variations exist in the attitudes and approaches of three European dental schools towards bleaching. Dental students need to be best prepared to meet the needs of their future patients.

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth.

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.

In vitro fluoride release and the antibacterial effect of glass ionomers containing chlorhexidine gluconate.

Fluoride release from glass-ionomers (GI) may be important for the prevention of secondary caries. The addition of chlorhexidine gluconate (CHX) to glass-ionomer cement (3%) adds an effect that enables it to be used as a varnish for the temporary coating of surfaces at risk for caries. This study investigated the fluoride release pattern and antibacterial effect of such a material. Glassionomer luting cement powder (Aqua-Cem) was mixed with water, 10% CHX or 10% CHX with 11% tartaric acid (TA), respectively, to test specimens (6 X 1.5 mm). After setting, the specimens were immersed in 10 ml deionized water and transferred to new vials after various intervals over a period of two months. The antibacterial effect towards mutans streptococci was assessed using agar diffusion. The fluoride release was measured after two hours and after shifting the specimens to new vials 10 times during the two-month period. The mean total fluoride release was 69.02, 50.64 and 48.56 microg/cm2 from each specimen in the GI, GI-CHX and the GI-CHX-TA groups, respectively. For two-hour old specimens, the mean inhibition zone was 0, 50, 36 mm2 in the GI, GI-CHX and GI-CHX-TA groups, respectively, and, after two months, 45 mm2 in the GI-CHX group and 19 mm2 in the GI-CHX-TA group. It can be concluded that the addition of CHX and CHX-TA adds antibacterial properties to GI and the release of fluoride is decreased.

Mucins MUC5B and MUC7 in minor salivary gland secretion of children and adults.

OBJECTIVE: The study was designed to investigate the relative amount of MUC5B and MUC7 in minor salivary glands in children and adults, in order to test the hypothesis that secretion of salivary mucins changes between childhood and adulthood. METHODS: Ninety individuals in the age-groups 3-year-olds, 14-year-olds, and young adults 20-25 year-olds were recruited. Sialopapers were applied on the labial and the buccal mucosa and then placed in the Periotron 8,000 (Proflow ) for calculation of the amount of saliva. The assessment of MUC5B and MUC7 was carried out in an ELISA using the LUM5B-2 and the LUM7-1 antiserum, respectively. RESULTS: MUC5B and MUC7 were detected in the labial minor gland saliva in all age groups. In buccal gland saliva, only a few individuals in each age group showed detectable amounts of the mucins. In the labial area, a significantly lower level of MUC7 was noted in 3-year-olds compared with adults. CONCLUSION: The results indicate a site-dependent difference in minor gland mucin secretion and an age-related difference in the labial gland secretion of MUC7.

Low salivary IgA activity to cell-surface antigens of mutans streptococci related to HLA-DRB1*04.

BACKGROUND/AIMS: Mutans streptococci are found in almost all individuals, though there are large differences in colonization levels between individuals. These differences are not readily explained, though several factors are believed to influence the colonization. One factor is the immune response to mutans streptococci, mainly provided by salivary immunoglobulin A (IgA). In a previous study, differences in salivary IgA reactions to oral streptococci were observed between human leukocyte antigen (HLA)-DR4-positive and DR4-negative individuals. A lower salivary IgA activity to Streptococcus mutans in particular was most pronounced for two DR4 subgroups, DRB1*0401 and *0404. The main purpose of this study was to further investigate, in a larger study group, the salivary IgA activity to antigens of three oral streptococci in relation to different HLA-DRB1*04 alleles. METHODS: Stimulated saliva was collected from 58 HLA-DRB1*04-positive individuals. Whole cell antigen extracts from S. mutans, Streptococcus sobrinus and Streptococcus parasanguis and the streptococcal antigen (SA) I/II were separated in SDS-PAGE, transblotted and detected with diluted saliva (Western blot), and analyzed in a computer program. All distinct immunoblot bands over 100 kDa were recorded and compared in relation to DRB1*04. RESULTS: The immunoblots revealed lower salivary IgA reactions to S. mutans, S. sobrinus and SA I/II, but not to S. parasanguis, for the DRB1*0401- and *0404-positive individuals compared to other DRB1*04 types. For the *0401 subgroup there was a significant association with a lower IgA response to S. mutans. CONCLUSION: The results confirm earlier observations and may also support previous demonstrated association between colonization by mutans streptococci and the serologically defined HLA-DR4.

Oral pilocarpine for treatment of opioid-induced oral dryness in healthy adults.

Pilocarpine induces a profuse flow of saliva when administered orally, but effects on drug-induced oral dryness have not been examined. The aim of this trial was to investigate if pilocarpine increases production of saliva in individuals suffering from dry mouth due to treatment with opioids. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol (50 mg t.d.s.) to induce oral dryness, and were thereafter assigned to one of three groups. Secretion rate of saliva was measured before and after tramadol, and after the oral administration of pilocarpine (5 mg), placebo, or no treatment. Baseline characteristics did not differ among the groups (mean +/- SEM: 0.37 +/- 0.06 mL/min), and tramadol lowered the secretion at the same level in all groups (0.15 +/- 0.02 mL/min). Pilocarpine increased the flow above that observed with placebo (0.66 +/- 0.19 vs. 0.15 +/- 0.02 mL/min). Thus, pilocarpine re-establishes the flow of saliva in the state of tramadol-induced oral dryness.

Salivary IgA reactions to cell-surface antigens of oral streptococci.

BACKGROUND: In the immunoblot technique, using whole bacteria cell extracts as antigens, both intra- and extracellular antigens are detected, which gives a large number of immunoglobulin A (IgA) reactions (immunoblot bands) when incubated with saliva. It is important to distinguish which immunoblot bands represent bacterial cell-surface antigens, since these antigens could be involved in adhesion mechanisms and be available for blocking in vivo. METHODS: Bacterial extracts of Streptococcus mutans, Streptococcus sobrinus, Streptococcus parasanguis and the streptococcal antigen I/II were separated using SDS-PAGE. The antigens were detected with saliva in Western blot. Untreated saliva and saliva in which cell-surface reactive IgA had been absorbed with whole bacteria cells were analyzed. RESULTS: Approximately half the number of the bands were absent for saliva absorbed with homologous cells, compared to untreated saliva. The absorption pattern was almost identical for S. mutans and S. sobrinus but not for S. parasanguis. Salivary IgA reactive against streptococcal antigen I/II was absorbed by S. mutans cells, to a lesser extent by S. sobrinus cells, and not at all by S. parasanguis cells. CONCLUSION: It is likely that the bands that were absent after absorption represented cell-surface antigens. For S. mutans and S. sobrinus, these bands were probably the streptococcal antigen I/II.

Platelet storage solution improves the in vitro function of preserved platelet concentrate.

BACKGROUND AND OBJECTIVES: Stored platelets develop biochemical lesions, manifest as depressed haemostatic function, clot retraction and wound healing. ViaCyte trade mark, a proprietary experimental preservative solution (comprising D-ribose, D-glucose, Hanks solution, Hepes solution, bovine serum albumin, tic anticoagulant peptide and sterile water), was tested in comparison with the presently accepted storage solution, citrate-dextrose-phosphate-plasma (CDP-P), to evaluate its ability to preserve platelet function during storage. MATERIALS AND METHODS: Platelets stored in ViaCyte and platelets suspended in CDP-P were transferred to polypropylene tubes with PL732 covers and analysed for adenine nucleotide levels (ATP molecules), in vitro agonist-mediated P-selectin expression and aggregation. RESULTS: After 5 days of storage at room temperature, 12.2% of platelets stored in ViaCyte exhibited P-selectin expression at rest, and 64.2% exhibited P-selectin expression upon activation with thrombin challenge, an increase of 52%. Platelets stored in CDP-P exhibited 44.4% P-selectin expression at rest, suggesting significant activation during storage, and thrombin stimulation resulted in P-selectin expression of 47.9%, an increase of only 2.5% (P< or =0.002, untreated vs. treated). ViaCyte also maintained ATP levels throughout the storage period, while these levels became depressed in platelets stored in CDP-P (P< or =0.02, untreated vs. treated). Storing platelets in the experimental preservative solution maintained their ability to aggregate, while control platelets lost their ability to aggregate in response to agonist. CONCLUSIONS: ViaCyte appears to protect platelets during storage, reflected by a low level of induced lesions. Platelets stored in ViaCyte maintain energy levels at their resting state, which preserves their ability to aggregate and secrete granule contents, and ensures the availability of additional platelets for activation upon in vitro challenge.

Proceedings for the 5th Asia-Pacific Conference on Disaster Medicine: creating an agenda for action.

Disaster medicine has come to the forefront and has become the focus of interest not only in the medical community, but also in the eyes of the public. The 5th APCDM was convened in Vancouver, Canada, 27-30 September 2000. It brought together over 300 delegates from 32 countries to share their experiences and thoughts regarding disaster events and how to effectively manage them. The conference was devoted to the task of establishing priorities and creating an Agenda for Action. From the discussions, key actions required were defined: COMMUNICATIONS: (1) Identify existing regional telehealth groups and gather lessons to be learned from them; (2) Form a telehealth advisory group to work with regional groups to compile telehealth initiatives, identify international protocols in telehealth already in existence, and solicit feedback before setting international standards; and (3) Increase corporate partnerships in the fields of telehealth and telecommunications, and invite corporations to send delegates to future APCDM meetings. This should be an initiative of the APCDM, the World Association of Disaster and Emergency Medicine (WADEM), or the European Society of Emergency Medicine. EDUCATION AND RESEARCH: (1) Formalize education in disaster medicine and management. The World Health Organization and WADEM should take a leadership role; (2) WADEM is requested to hold a conference with a focus on qualitative research; (3) WHO is requested to continue the provision of international research teams, but to advocate for the development of national disaster research infrastructure; (4) Make research findings and reports available on web sites of such organizations as WHO and PAHO; (5) Develop the translation of research for community utilization. The WHO and PAHO are organizations that are requested to consider this action; and (6) WADEM/APCDM are requested to focus future conferences on applied research. INFORMATION AND DATA: (1) Create an "Information and Data Clearinghouse on Disaster Management" to collect, collate, and disseminate information; (2) Collect data using standardized tools, such as CAR or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness and establish mechanisms for addressing the obstacles to preparedness; and (4) WADEM is requested to develop a web site providing a resource list of interdisciplinary institutions and response activities, organized by country, topic, and research interests. Links to other pertinent web sites should be provided. INTERDISCIPLINARY DEVELOPMENT: (1) Focus on the interdisciplinary nature of disaster response through more conferences encompassing grassroots efforts and through WADEM publications; (2) Develop and apply a standardized template of Needs Assessment for use by multidisciplinary teams. Team Needs Assessment is essential to determine the following: (a) Local response and international assistance required; (b) Appropriate command system; and (c) Psychosocial impact and support necessary. PSYCHOSOCIAL ASPECTS: (1) Incorporate relief for caregivers into action plans. This should include prime family members who also are caregivers; and (2) Implement measures that give survivors control over the recovery process. RESPONSE MANAGEMENT: (1) Define relationships and roles between governments, military and security personnel, non-governmental organizations (NGOs), and civic groups. Use an international legal framework and liability to reinforce accountability of disaster responders; (2) Establish a more sophisticated use of the media during disasters; (3) Establish standards in key areas. WADEM is requested to write "White Papers" on standards for the following areas: (a) management, (b) health/public health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4) Establish task forces to anticipate and resolve issues around evolving and emerging disasters (e.g., chemical and biological terrorism, landmines, emerging infectious diseases). WADEM was again identified as the vehicle for promoting this action. The responsibility of the next meeting of the Asia-Pacific Conference on Disaster Medicine will be to measure progress made in these areas by assessing how well these collective decisions have been implemented.

Platelet glass bead retention predicts bleeding after cardiac surgery.

OBJECTIVE: To determine if the platelet glass bead retention assay can predict bleeding after cardiac surgery. DESIGN: Prospective, observational study. SETTING: Large, tertiary care, academic medical center. PARTICIPANTS: Forty-three adult patients scheduled to undergo elective cardiac surgery employing cardiopulmonary bypass (CPB). MEASUREMENTS AND MAIN RESULTS: Whole blood samples were observed for platelet count, prothrombin time, and platelet (glass bead) retention assay. The platelet retention and prothrombin times were independent univariant and multivariant predictors of bleeding after CPB (r = 0.554, p = 0.0002 and r = 0.655, p = 0.00001). CONCLUSION: The platelet glass bead retention assay measures dynamic platelet function and is sensitive to the CPB-induced adhesion and aggregation defect and correlates with postoperative blood loss. Modification of this platelet function assay used with the prothrombin time may provide a simple and effective diagnostic approach to bleeding after CPB.

HLA-DR4 and salivary immunoglobulin A reactions to oral streptococci.

The aim of this study was to describe and compare salivary immunoglobulin A (IgA) antibody reactions to extracts of strains of three oral streptococci in human leukocyte antigen (HLA)-DR4-positive and -DR4-negative subjects. Whole paraffin-stimulated saliva samples were collected from 27 apparently healthy subjects. Previous HLA typing showed that 20 subjects were DR4 positive and 7 were DR4 negative. HLA-DRB1*04 subtyping was performed among the DR4-positive subjects. Whole-cell antigen extracts from Streptococcus mutans (KPSK 2), Streptococcus sobrinus (OMZ 65) and Streptococcus parasanguis (Nt 62) were separated in SDS-PAGE. The antigens were immunoblotted with diluted saliva (Western blot), scanned and analyzed in a computer system. All immunoblot bands were recorded in DR4-positive and DR4-negative saliva pools, and bands with an optical density >or=0.1 were selected for analysis in individual salivas. The DR4-negative subjects in general had more immunoblot bands and more distinct bands than did the DR4-positive subjects. A higher concentration of total IgA in saliva was correlated with more bands, especially to antigens separated from S. mutans. When the number of bands was calculated per IgA unit, significant differences were observed between DR4-positive and DR4-negative salivas. This was particularly seen for S. mutans and S. parasanguis. As the number of bands was analyzed in relation to DR4 subgroups, DRB1*04, there was a lower salivary IgA activity to S. mutans in the DRB1*0401 and *0404. The variable level of correlation previously demonstrated for S. mutans colonisation and serologically defined DR4 positive subjects might be explained by the heterogeneity in this group, and the relation should be sought on a subgroup level.

The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy.

To compare the efficacy of immunoglobulin replacement therapy given intravenously versus subcutaneously to prevent infections in patients with primary antibody deficiency syndromes, an international, multicenter, open label, crossover study was designed. Forty patients were randomized to receive either subcutaneous or intravenous immunoglobulin replacement therapy for 1 year. In the second year, patients were switched to the alternative treatment, enabling patients to act as their own controls. Equivalent doses were given by both routes. Ethical approval was obtained from the review boards of the hospitals in which the patients were seen and written consent obtained from each patient. Patients with a primary antibody deficiency syndrome, either common variable immunodeficiency or IgG subclass deficiency or specific antibody deficiency, who required immunoglobulin replacement therapy were included in the study. Patients were excluded if they had significant thrombocytopenia (defined as platelets less than 50 x 10(9)/liter), had high levels of anti-IgA antibodies (defined as greater than 1:8192), or had severe adverse reactions to a blood product within the last 2 years. The primary end point was the number of infections and their severity (moderate and major) during the two treatment periods. Secondary end points were adverse reactions, length of infections, days lost from school or work due to infections, and acceptability of treatment regimens to the patients. Based on the assumption that it was difficult to prove equivalence of therapies statistically in crossover studies, an arbitrary number of 40 patients was selected on the basis that this might be achievable in 2 years. There are no significant differences in efficacy or adverse reaction rates between immunoglobulin replacement therapy given subcutaneously or intravenously.

Transient reduction of mutans streptococci on tooth surfaces using a chlorhexidine-containing glass ionomer cement varnish.

Chlorhexidine (CHX) has been incorporated in polymer-based varnishes to reduce mutans streptococci (ms) by the sustained release of CHX. Such varnishes often adhere well to teeth initially but are easily peeled off. To be effective, repeated application is necessary. Glass ionomer (GI) cements interacts with tooth minerals to form a stronger bond, and the inherent brittleness of the cement makes it difficult to remove in large fragments. The fluoride content may also reduce demineralisation. The aim of this study was to observe whether ms could be reduced interproximally and in saliva by a single application of a GI cement containing 3.3% CHX gluconate (CHX-GI). After professional tooth cleaning and a mouth rinse for 2 min with 0.2% CHX, the teeth of six subjects were coated with CHX-GI cement. An additional six subjects were treated with a GI cement that did not contain CHX, and seven subjects received professional tooth cleaning only. Ms samples were taken interproximally with the tooth pick method before and after treatment. Interproximal levels were classified according to the number of colony-forming units (c.f.u.) found: 0, 1-20, 21-100, and > 100. Saliva ms were sampled with the Strip Mutans method. After four weeks, the interproximal levels of ms had decreased only in the CHX-GI group (p < 0.05). In this group 9 of 14 highly colonised sites (> 100 c.f.u.) remained reduced throughout this period. In the GI and the untreated group a slight increase of ms interproximally was seen after one week. The interproximal ms scores in all groups approached baseline levels after 8 weeks. There were no significant differences in saliva ms levels between the groups during the test period. GI cement may be a possible vehicle for CHX in reducing ms interproximally.

Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries. A multi-centre study.

The aim of the study was to evaluate the clinical efficacy and safety of a new method (Carisolvtrade mark) for chemo-mechanical removal of caries. At four centres, 137 consecutive patients (64 females and 73 males aged 3-85 years, mean 35) entered a prospective, controlled, randomised open study. One primary caries lesion with distinct dentine involvement was selected per patient. A total of 116 lesions in permanent and 21 in deciduous teeth were selected. Caries was removed with traditional drilling or the new method. Gel was applied onto the carious dentine and the softened caries gently removed with specially designed hand instruments. New gel was applied and the procedure was repeated until no more debris could be removed and the surface was hard as judged by clinical criteria (probing and visual inspection). An independent examiner judged the cavity being caries-free or not, using clinical criteria. One hundred and thirteen patients were randomised for gel treatment and 24 for drilling. Three patients selected for drilling did not complete the treatment. Total caries removal was achieved in 106 cases with gel and in 19 with drilling. The reasons for incomplete caries removal were step-by-step excavation in 5 cases, unsuccessful caries removal in 1 case for each treatment, while 2 cases refused inspection. Mean (+/- SD) time for caries removal was 10.4 (+/-6.1) min with the gel method and 4.4 (+/-2.2) min with drilling. Mean volume of gel used was 0.4 (+/-0.2) ml. Eighty-two of 107 patients perceived that the new method caused less discomfort compared to drilling. Dentine caries was effectively removed using the Carisolv method without any adverse reactions.

Fissure penetration and antibacterial effect in vitro of a glass ionomer cement containing chlorhexidine gluconate.

Chlorhexidine has been incorporated in different varnishes to provide a slow release system on the tooth surface in order to reduce mutans streptococci. To provide an alternative vehicle for chlorhexidine with better adhesion properties compared to resin-based varnishes, glass ionomer cement (GI) has been suggested. However, one disadvantage for glass ionomers is a longer setting time compared to the resin-based varnishes. The aim with this study was to compare the fissure penetration and antibacterial characteristics of a glass-ionomer cement (GI) with a GI containing chlorhexidine gluconate (GI-CHX), and GI-CHX with added tataric acid (GI-CHX-TA) to reduce its setting time. Antibacterial properties against mutans streptococci were assessed by agar diffusion. GI, GI-CHX and GI-CHX-TA were applied with a microbrush on the occlusal surfaces of 4, 4 and 6 extracted molars respectively. After setting of cements, sections were ground with 1 mm intervals and photographed. The fissure penetration and adaptation of the cements were scored excellent, acceptable or unacceptable under blind conditions according to a standard. Seventy percent scored excellent with GI-CHX-TA (n = 54) compared with 40% with GI-CHX (n = 48) and 38% with GI (n = 40), (p < 0.05). GI-CHX and GI-CHX-TA had significant better antibacterial properties compared to GI or GI with added tataric acid only.

HLA-DR4 and number of mutans streptococci in saliva among dental students and staff.

Our aim was to corroborate previous findings that HLA-DR4 carriers are characterized by higher levels of mutans streptococci in saliva than are individuals expressing other HLA-DR types. Of 68 subjects (dental students, staff, and faculty) who were sampled for salivary counts of mutants streptococci, 13 subjects with the lowest counts of mutans streptococci and 15 subjects with the highest counts were selected for HLA-typing. Of the 13 who expressed HLA-DR4, 8 were heavily colonized by mutants streptococci. Although a trend towards a relationship was found between HLA-DR4 carriage and high levels of mutans streptococci, it was not statistically significant. In this selected population, knowledge of how to minimize the risk of caries and mutans streptococci level may have influenced the results.