"Setting the scene in early childhood" - an MID approach for life.

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

Caries experience of children with cardiac conditions attending the Royal Children's Hospital of Melbourne.

BACKGROUND: Poor oral health in children with cardiac conditions can have negative effects on quality of life and increased risk of infective endocarditis. The aim of this study was to investigate the caries experience in children with cardiac conditions attending the Royal Children's Hospital, Melbourne. METHODS: Medical and dental records of 428 children aged <12 years were examined. Cardiac and other medical diagnoses, decayed, missing and filled surfaces/teeth were recorded and analysed. Children referred for reasons other than caries management (NRCM) was analysed separately to address confounding of referral reason on caries experience. RESULTS: Mean age of overall study population was 4.9 (SD 2.4) years, caries prevalence 52.1%, mean dmft 3.65 (SD 4.8), mean dmfs 6.19 (SD 11.3), enamel defects prevalence 29.2%. Mean age of NRCM group was 4.6 (SD 2.4) years, caries prevalence 37.5%, mean dmft 2.37 (SD 4.2), mean dmfs 4.22 (SD 9.4), enamel defects prevalence 23.0%. Untreated carious lesions accounted for 89.9% of caries experience. Caries experience was associated with low socio-economic status, absence of comorbidity and enamel defect presence. CONCLUSIONS: High disease levels were observed. Age, socio-economic status and enamel defects were associated with caries experience, not severity of cardiac diagnoses. Early referral for dental care and improved access should be facilitated.

Effects of replacing pork backfat with emulsified vegetable oil on fatty acid composition and quality of UK-style sausages.

Rapeseed and sunflower oil were used to replace pork backfat in UK-style sausages by incorporating the oils as pre-formed emulsions. Replacing the pork backfat emulsion with rapeseed emulsion at total fat content of about 12%, reduced total saturated fatty acid (SFA) composition from 38% to 14% (4.5 to 1.8 g/100 g), increased monounsaturated fatty acid (MUFA) composition from 45% to 59% and increased polyunsaturated fatty acid (PUFA) composition from 15% to 25%. Partial replacement of pork backfat with rapeseed at a fat content of about 20% reduced SFA from 38% to 24% (7.2 to 4.8 g/100 g). There were no significant differences in eating quality and overall liking other than slight differences in the attributes 'firmness' and 'particle size'. Improvement in the fatty acid composition was achieved without adversely affecting colour shelf life or lipid oxidation. The study suggests that a substantial reduction in SFA can be achieved by incorporating 'healthy' oils in UK-style sausages without adversely affecting eating quality or shelf life.

The application of caries risk assessment in minimum intervention dentistry.

Caries risk assessment forms the cornerstone for the successful application of a minimum intervention dentistry philosophy in the management of dental caries. Patients, particularly those with evidence of active dental caries at baseline, require a caries risk assessment to identify those risk factors that will most likely contribute to the progression of the carious disease process. Once identified, these factors should be eliminated or at least moderated to ensure the disease progression is stabilized before conservative and rehabilitative dental procedures are undertaken. Each individual will present with a slightly different caries risk profile and the principles of a patient centred approach to manage each case should be applied to the individual diagnostic and treatment planning phases of dental care. Current chairside technologies such as caries susceptibility and activity tests can be utilized to provide baseline and follow-up data to assist the dental practitioner in this task. However, clinician intuition or 'gut feeling' has been found to be a better prognostic indicator for future dental caries experience than present caries prediction instruments in most cases. As caries risk data are accumulated and refined at a population, community and individual level, the sensitivity and specificity of the caries risk assessment modelling will improve as will the positive predictive power of the final statistical model algorithm. It is likely that online caries predictive tools will be available for general dental practitioners in the not too distant future to help clinicians formulate accurate caries risk profiles for their patients.

Effects of low protein diets on pigs with a lean genotype. 1. Carcass composition measured by dissection and muscle fatty acid composition.

Pigs with a lean genotype were fed diets differing in protein and amino acid contents between 40 and 115 kg live weight. A high protein control regime (C) was compared with one supplying 11% less total protein but the same essential amino acid levels (LP1) and one supplying 16% less protein but lower amino acid levels (LP2). Regime LP2 produced fatter pigs in terms of subcutaneous, intermuscular and intramuscular fat (IMF), the latter measured in longissimus and semimembranosus muscles. The percentage of linoleic acid was lowest and that of oleic acid highest in IMF from LP2 pigs (11.57 and 34.59% respectively in longissimus). Pigs in regime LP1 had more longissimus IMF than C but similar semimembranosus IMF although both muscles had lower percentages of linoleic acid in LP1 than C, suggesting a tendency towards greater fat deposition in LP1. The high IMF content in LP2 produced the most tender, juicy steaks.

Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders.

Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.

Caries experience in preschool children referred for specialist dental care in hospital.

BACKGROUND: Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. METHODS: A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. RESULTS: Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). CONCLUSIONS: The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

A reduced protein diet induces stearoyl-CoA desaturase protein expression in pig muscle but not in subcutaneous adipose tissue: relationship with intramuscular lipid formation.

A reduced protein diet (RPD) is known to increase the level of intramuscular lipid in pig meat with a smaller effect on the amount of subcutaneous adipose tissue. This might be due to tissue-specific activation of the expression of lipogenic enzymes by the RPD. The present study investigated the effect of a RPD, containing palm kernel oil, soyabean oil or palm oil on the activity and expression of one of the major lipogenic enzymes, stearoyl-CoA desaturase (SCD) and on the level of total lipids and the fatty acid composition of muscle and subcutaneous adipose tissue in pigs. The RPD significantly increased SCD protein expression and activity in muscle but not in subcutaneous adipose tissue. The level of MUFA and total fatty acids in muscle was also elevated when the RPD was fed, with only small changes in subcutaneous adipose tissue. A positive significant correlation between SCD protein expression and total fatty acids in muscle was found. The results suggest that an increase in intramuscular but not subcutaneous adipose tissue fatty acids under the influence of a RPD is related to tissue-specific activation of SCD expression. It is suggested that the SCD isoform spectra in pig subcutaneous adipose tissue and muscle might be different.

Manipulation of the n-3 polyunsaturated fatty acid content of muscle and adipose tissue in lambs.

Fifty Suffolk-crossbred wether lambs, with an initial live weight of 29 +/- 2.1 kg, were allocated to one of five concentrate-based diets formulated to have a similar fatty acid content (60 g/kg DM), but containing either linseed oil (high in 18:3n-3); fish oil (high in 20:5n-3 and 22:6n-3); protected linseed and soybean (PLS; high in 18:2n-6 and 18:3n-3); fish oil and marine algae (fish/algae; high in 20:5n-3 and 22:6n-3); or PLS and algae (PLS/algae; high in 18:3n-3 and 22:6n-3). Lambs were slaughtered when they reached 40 kg. Growth performance and intake were similar (P > 0.35) among treatments. By contrast, gain:feed was higher (P < 0.05) in lambs fed the fish oil compared with the linseed oil or PLS/algae diets. Total fatty acid concentration (mg/100 g) in the neutral lipid of the longissimus muscle was not affected by treatment (P > 0.87) but was least (P < 0.05) in the phospholipid fraction in lambs fed the linseed oil diet. Lambs fed either diet containing marine algae contained the highest (P < 0.05) percentage of 22:6n-3 in the phospholipid (mean of 5.2%), 2.8-fold higher than in sheep fed the fish oil diet. In lambs fed the fish/algae diet, the percentage of 20:5n-3 was highest (P < 0.05), contributing some 8.7, 0.8, and 0.5% of the total fatty acids in the muscle phospholipid, neutral lipids, and adipose tissue, respectively. The percentage of 18:3n-3 in the phospholipid fraction of the LM was highest (P < 0.05) in lambs fed the linseed oil diet (6.9%), a value double that of sheep fed the PLS diet. By contrast, lambs fed the PLS diet had twice the percentage of 18:3n-3 in the muscle neutral lipids (3.8%) than those offered the linseed oil diet, and 5.5-fold greater than lambs fed the fish/algae treatment (P < 0.05), an effect that was similar in the adipose tissue. The percentage of 18:2n-6 was highest (P < 0.05) in lambs fed the PLS diet, where it contributed 33.7, 10.1, and 11.2% in the muscle phospholipid, neutral lipids, and adipose tissue, respectively. The highest (P < 0.05) muscle PUFA-to-saturated fatty acid (P:S) ratio was obtained in lambs fed the PLS diet (0.57), followed by the PLS/algae diet (0.46), and those fed the fish oil or linseed oil diets had the lowest ratios (0.19 and 0.26, respectively). The favorable P:S ratio of lambs fed the PLS/algae diet, in conjunction with the increased levels of 20:5n-3 and 22:6n-3, enhanced the nutritional qualities of lamb to more closely resemble what is recommended for the human diet.

Social and behavioural determinants of early childhood caries.

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Dental caries experience of preschool children from the North Brisbane region.

BACKGROUND: To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. METHODS: A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. RESULTS: Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). CONCLUSIONS: Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Submandibular gland aplasia and progressive dental caries: a case report.

When severe caries occurs in mandibular permanent incisor teeth, the clinician should consider the possibility of associated submandibular gland aplasia or salivary hypofunction. Early diagnosis of submandibular gland disease is essential, as operative problems involving restoration of mandibular incisor teeth are considerable. Furthermore, progressive severe dental caries can present a dilemma for the clinician in affected individuals, despite intensive preventive and restorative therapy. A case report describing severe progressive dental caries and enamel demineralization of the permanent mandibular incisor teeth in a young girl is presented. Further investigation revealed absence of functional bilateral submandibular salivary glands contributing to the rapid breakdown of the teeth despite intensive preventive measures.

A native soluble form of CTLA-4.

CTLA-4 is an immunoregulatory receptor expressed on the surface of activated T and B lymphocytes. The counterreceptors for CTLA-4 are the B7 family molecules. We describe alternatively spliced mRNAs expressed in hematolymphoid tissues of humans, mice, and rats that lack the transmembrane domain coded by exon 3 of the CTLA-4 gene. These alternate transcripts were detected by RT-PCR in B cells and resting T cells of both the CD4 and the CD8 phenotype. Activation of human blood mononuclear cells with PHA or anti-CD3 + anti-CD28 monoclonal antibodies appears to effect a decrease in the amount of the alternative transcript relative to the full-length transcript. Recombinant sCTLA-4 is a B7-binding protein and has immunomodulatory effects as measured by inhibition of the mixed leukocyte response. Human serum contains immunoreactive material consistent with a native soluble form of CTLA-4.

Long-term patient adherence to antiretroviral therapy.

OBJECTIVE: To measure patient adherence to antiretroviral therapy over a two-year period and to identify factors impacting adherence. METHODS: In a regional HIV treatment center, 100 consecutive patients starting any new antiretroviral agent were enrolled in this study, which consisted of a one-year retrospective data review and a one-year prospective component. The tools used for evaluating adherence were the monthly prescription refill data and a patient questionnaire. Data analyzed included overall adherence, adherence to individual antiretrovirals, and change in adherence over time, as well as factors reported as influencing adherence. RESULTS: Greater than 80% adherence in taking prescribed doses was seen in 75% of patients during the retrospective phase of the study; adherence increased to 84% in the prospective phase. Throughout the prospective phase of the study, monthly median adherence rates were 98-100%. Suboptimal adherence secondary to pill fatigue or number of daily pills did not occur. Reported nonadherence to dietary restrictions varied among drugs. The primary cause given for poor adherence was difficulty remembering followed by inconvenient dosing schedule and difficulty scheduling administration times around meals. At least one adherence tool was used by 61% of patients. A diagnosis of AIDS was associated with lower adherence in our patient population (p = 0.039); substance abuse and psychiatric history had no influence. CONCLUSIONS: Adherence to antiretroviral treatment regimens did not diminish over the two years studied. Several patients with poor adherence were identified, emphasizing the importance of addressing this issue both prior to and throughout treatment. A personalized approach by healthcare providers can optimize patient adherence to antiretroviral therapy by providing careful drug selection in addition to routine follow-up and the provision of information, feedback, and reminder systems.

Cutting edge: a soluble form of CTLA-4 in patients with autoimmune thyroid disease.

We have recently identified a novel transcript of the CTLA-4 gene that may represent a native soluble form of CTLA-4 (sCTLA-4). To determine whether sCTLA-4 was expressed in humans, we applied a sensitive enzyme immunoassay on serum from patients with autoimmune thyroid disease (ATD). Eleven of 20 patients with ATD had circulating levels of sCTLA-4 ranging from 28 to 78 ng/ml, whereas only 1 of 30 apparently healthy volunteers had a level greater than 4 ng/ml. sCTLA-4 immunoreactivity was inhibited by its binding to B7.1, suggesting that sCTLA-4 is a functional receptor. Immunoprecipitation analysis of serum from patients with ATD revealed a polypeptide consistent with the predicted size of sCTLA-4. We conclude that a native soluble form of CTLA-4 is derived from an alternate transcript of the CTLA-4 gene, and its level in plasma is elevated among a population of patients with ATD.

Early childhood caries--a new name for an old problem.

Early childhood caries (ECC) is one the most prevalent diseases of infants and toddlers from low income, immigrant and ethnic minority backgrounds. Yet, scant research and health care resources have been allocated to allow a better understanding this disease process. Since rampant dental caries in young children cannot be exclusively blamed on known risk factors such as poor oral hygiene and diet control, other models for disease initiation and progression need to be explored. Furthermore, evidence-based recommendations are critical for dissemination of consistent and effective preventive strategies to health care providers and government agencies. To accomplish this objective, organizations concerned with children's health issues need to seek additional resources to meet this challenge and overcome this inequity.

Separate but equal? A system comparison study of MEDLINE's controlled vocabulary MeSH.

This study tested the effect of controlled vocabulary search feature implementation on two online systems. Specifically, the study examined retrieval rates using four unique controlled vocabulary search features (explode, major descriptor, descriptor, subheadings). Each search feature was applied to nine search queries obtained from a medical reference librarian. The same queries were searched in the complete MEDLINE file on the Dialog and Ovid systems. The unique records, i.e., those records retrieved in only one of the two systems, were identified and analyzed. Dialog produced equal or more records than Ovid in nearly 20% of the queries. The study demonstrated that users need to be aware of system-specific designs that may require differing input strategies across different systems for the same unique controlled vocabulary search features. The paper concludes by making recommendations and suggestions for future research.