Self-perceived oral health and orofacial aesthetics of cleft patients.

PURPOSE: To evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls. METHODS: 420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient's perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile-Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls. RESULTS: CL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group. CONCLUSION: This study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.

Evaluation and recommendations of the oral health, oral function, and orofacial aesthetics-related measures of the ICHOM Standard Set for Cleft Lip and Palate.

This study was performed to evaluate the efficacy of outcome measures for the orofacial domain included in the International Consortium for Health Outcomes Measurement Standard Set for Cleft Lip and Palate (ICHOM-SCS). In this multicentre study involving two cleft centres, suggestions to optimize the type and timing of outcome measures were made based on data and clinical experience. Patient-reported outcome measures (PROMs) (CLEFT-Q Jaw, Teeth, Eating/Drinking; Child Oral Health Impact Profile-Oral Symptoms Scale (COHIP-OSS)) and clinical outcome measures (caries experience and dental occlusion) data were collected retrospectively for age 5, 8, 10, 12, 19, and 22 years. The data were categorized by cleft type and analysed within and between age groups using Spearman correlation, the distribution of responses per item, a two-sample test for equality of proportions, and effect plots. Most correlations between PROMs and clinical outcome measures were weak (r < 0.5), suggesting PROMs and clinical outcome measures complement each other. The COHIP-OSS and CLEFT-Q Eating/Drinking barely detected problems in any patient category and are no longer recommended. A suitable alternative appears complex to find; outcomes of this study and the recent literature doubt an added value. Similar problems were found in the CLEFT-Q Jaw at time-point 12 years. Therefore, time-points 15 and 17 years are currently suggested.

[Caries in cleft patients: aetiology, prevalence, prevention, and treatment]. / Cariës bij schisispatiënten: oorzaak, prevalentie, preventie en behandeling.

The caries prevalence in patients with cleft lip and/or palate is higher in both the deciduous and permanent dentition, compared to non-cleft patients. Inadequate oral hygiene is one of the main causes. Additional, individualized advice concerning diet and oral hygiene, such as the additional advice of the Ivoren Kruis (Dutch association of dental hygienists), is of great importance. During curative treatment, attention should be paid to any dental anxiety and possible reduced compliance.

Parents' satisfaction on dental care of Dutch children with Autism Spectrum Disorder.

PURPOSE: To assess if Dutch children with Autism Spectrum Disorder (ASD) regularly visit a dentist and to evaluate parent's satisfaction on the care provided. METHODS: Parents of ASD children (2-18 years) were invited to fill out a survey. The survey consisted of questions regarding ASD severity, frequency of dental visits, history of dental pain, type of dental practice and parents' satisfaction. Results were analysed using Chi square and Mann-Whitney U tests (α = 5%). RESULTS: Of the 246 returned questionnaires, 19 were excluded (incomplete or unconfirmed ASD diagnosis). All children visited a dentist at least once and 5% of them had their last visit more than 12 months ago. According to parents, 15% of the children did not receive the needed care when they had toothache and 21% of the parents were unsatisfied with the current dental care provided. No difference was found between satisfied and unsatisfied parents in type of dental practice visited (p > 0.05). The children of unsatisfied parents reported more often pain during the last year (p = 0.013) and had a more severe type of ASD (p = 0.016). CONCLUSIONS: The majority of Dutch ASD children investigated regularly visit a dentist and 21% of the parents is unsatisfied with the dental care provided.

Biomimetic Remineralization of Carious Lesions by Self-Assembling Peptide.

Caries is the most common disease in the world. Great efforts have been undertaken for prevention and to identify a regenerative treatment solution for dental caries. Self-assembling ß-sheet forming peptides have previously shown to form 3-dimensional fiber networks supporting tissue regeneration. In particular, the self-assembling peptide P11-4 has shown potential in the treatment and prevention of dental caries. It has previously been shown that application of monomeric P11-4 solution to early carious lesions can increase net mineral gain by forming de novo hydroxyapatite crystals. The hypothesis for the mode of action was that monomeric self-assembling peptide P11-4 diffuses into the subsurface lesion body and assembles therein into higher order fibrils, facilitating mineralization of the subsurface volume by mimicking the natural biomineralization of the tooth enamel, and it remains within the lesion body as a scaffold built-in by the newly formed hydroxyapatite. The aim of the present study was to investigate the mechanism of action of the self-assembling peptide P11-4 supporting mineralization of carious enamel. By various analytical methods, it could be shown that the self-assembling peptide P11-4 diffuses into the subsurface lesion, assembles into higher formed aggregates throughout the whole volume of the lesion, and supports nucleation of de novo hydroxyapatite nanocrystals and consequently results in increased mineral density within the subsurface carious lesion. The results showed that the application of self-assembling peptide P11-4 can facilitate the subsurface regeneration of the enamel lesion by supporting de novo mineralization in a similar mode of action as has been shown for the natural formation of dental enamel.

[Autism-friendly dental care]. / Autismevriendelijke tandheelkundige zorg.

Autism Spectrum Disorder (ASD) occurs in approximately 1% of the Dutch population. Among the group of patients with this disorder, there is a substantial diversity regarding skills, intelligence and treatability. However, there are also common characteristics; people with ASD often have difficulty with social interaction, communication, and exhibit typical patterns of behaviour. Therefore, problems may arise in the various areas of development, such as language development and responding to sensory stimuli. Dental practitioners will also be confronted with individuals with ASD. Care can be significantly improved, considering that negative experiences and dental anxiety are widespread at this time.

Homologous adoptive cutaneous anaphylaxis (HoACA)--a method which detects IgG antibody in the mouse at the cellular level.

We describe a new method, homologous adoptive cutaneous anaphylaxis (HoACA). HoACA will detect IgG at the cellular level if mice are immunized in such a manner that no IgE is synthesized. HoACA could be utilized for the same purposes as a previously described method, heterologous adoptive cutaneous anaphylaxis (HACA). HACA detects IgE at the cellular level and has been used primarily to study the establishment of tolerance. It has also been used for localizing the site of IgE formation and for determining the effect of drugs on IgE formation.

Enhanced IgE and IgG anti-melittin antibody formation induced by heparin-Melittin complexes in mice.

It is known that heparin which is strongly anionic will precipitate in vitro with cationic proteins such as melittin, the principal constituent of bee venom. Our experiments indicate that mice immunized with complexes of melittin and heparin produced greater amounts of IgE and IgG antibody (to this protein) than did mice immunized with melittin alone. It is possible that heparin released from mast cells following a bee sting could complex with melittin and enhance the allergenic properties of this molecule.

Antigenic, adjuvant and permeability enhancing properties of melittin in mice.

Melittin, a mast cell lytic agent which comprises 50% of the protein content of bee venom, may be responsible for some of the severe reactions produced by bee stings in allergic and non-allergic individuals. We therefore investigated some of the biologic properties of this molecule in mice and found that repeated intradermal injections of melittin without adjuvant induced IgE formation in mice. In addition, melittin as well as another surfactant, saponin, were potent adjuvants for IgE formation in mice when mixed with ovalbumin (Ov). Titres of 1280 and 2560 to ovalbumin were produced in CBA mice after two injections of melittin and Ov or saponin and Ov. Melittin was also shown to have an enhancing effect on the vascular permeability induced by an antigen antibody interaction in mouse skin. Evan's blue dye was injected intravenously into ovalbumin-sensitized mice which had been injected intradermally with ovalbumin alone, melittin alone or a mixture of melittin and ovalbumin. The amount of local extravasation of dye was significantly greater in the area injected with the melittin and ovalbumin mixture than the amount of dye obtained from the skin site injected with melittin alone plus that extracted from the site injected with ovalbumin alone.

Reduction of contact sensitivity reactions to oxazolone in mite-infested mice.

Oxazolone-sensitized mite-infested (SWR-M) and mite-free (SWR-J) mice were challenged with oxazolone on the skin of the neck and shoulder. The migration of radioactively labeled cells to the site of contact sensitivity reaction to oxazolone was significantly less in SWR-M than in SWR-J mice. Serum obtained from SWR-M mice suppressed the extravasation of cells into the skin site of SWR-J mice challenged with oxazolone. The decrease in cellular influx in SWR-M mice occurred in areas of mite infestation (skin of neck and shoulder) as well as in areas not infested with mites (the ears). SWR-M mice also gave evidence of enhanced vascular permeability. A possible role for histamine in the inhibition of contact sensitivity in mite-infested mice is discussed.

IgE antibody response to mite antigens in mite infested mice.

Mice infested at birth with the mouse mite Myocoptes musculinus developed positive skin tests to mite antigens at the age of 5 weeks. Serum IgE antibodies directed against mite antigens were first detected at 6 weeks of age and high levels of IgE were present as long as 1 year later. Similar kinetics of IgE formation were observed in mice infected as adults. Mast cell degranulation by mite extract was demonstrated in connective tissue obtained from the skin of mite infested mice.

Suppression of IgE antibody formation in mice: requirement for T-T lymphocyte interaction.

Norman SWR mice injected with syngeneic spleen cells from ovalbumin (Ov)-primed mice were unable to make IgE anti-Ov antibodies when challenged with alum-pertussis-Ov. Immune T lymphocytes were shown to be responsible for the inhibitory effects of adoptively transferred spleen cells. Treatment of recipient mice with mild x-irradiation or with cyclophosphamide 2 or 3 days before cell transfer resulted in abrogation of the suppressor effect of immune cells. The injection of T lymphocytes into x-irradiated milce restored the suppressive effect of immune cells. It thus appears that immune T cells provide the stimulus for activation of suppressor T cells of the host. Although the generation of suppression is antigen-specific, the expression of suppression appears to be nonspecific.

Suppressor T cells for IgE and IgG in Peyer's patches of mice made tolerant by the oral administration of ovalbumin.

A single oral dose of ovalbumin (Ov) resulted in inhibition of IgE formation in mice subsequently immunized i.p. with Al(OH)3-Ov. Repeated feeding of Ov (on alternate days for 2 weeks) induced the formation of detectable suppressor cells in Peyer's patches and spleen. Suppression was demonstrated by the ability of adoptively transferred Peyer's patch or splenic lymphocytes from Ov-fed tolerant mice to inhibit IgE formation in Ov-immunized syngeneic recipients. Suppressor cells could be induced by feeding mice as little as 100 microgram of Ov on alternate days for 2 weeks. Suppression was specific and Peyer's patch lymphocytes were shown to be more effective suppressors than splenic lymphocytes.

Inhibition of IgE production of mice by non-specific suppressor T cells.

SWR adult normal splenic T lymphocytes injected into irradiated syngeneic mice along with immune spleen cells can suppress IgE formation by the immune cells. Spleen cells from 1- or 3-week-old mice, however, are not effective in abrogating IgE synthesis. The T lymphocytes which are induced to become suppressors for IgE are hydrocortisone-resistant and anti-thymocyte serum-sensitive. Normal SJL mice, a poor reagin-producing strain, do not appear to have more suppressor cells or cells which are more easily stimulated to become suppressor cells than a good reagin-producing strain (SWR).

Enhanced reaginic antibody formation to ovalbumin in mice given repeated injections of concanavalin A.

Mice injected with 4 weekly doses of concanavalin A arabinogalactan complex (Con A-AG) give a secondary type of IgE response when they encounter ovalbumin (Ov) for the first time. The IgE-enhancing effect of Con A-AG immunization applies to Ov but not to various other antigens. However, no cross-reaction appears to exist at the humoral level between Con A and Ov. The apparent priming of mice to Ov by Con A can be adoptively transferred to syngeneic irradiated recipients by spleen cells.

The suppressive effect of the interferon on the ability of mouse spleen cells synthesizing IgE to sensitize rat skin for heterologous adoptive cutaneous anaphylaxis.

Mouse spleen cells which are synthesizing IgE can sensitize rat skin for HACA. When such cells are treated with mouse interferon, their ability to sensitize rat skin is reduced or completely inhibited. Two hundred PRD50 units of interferon reduced HACA reactions by more than 50%; 600 units gave complete inhibition. Interferon may act by inhibiting IgE synthesis and/or release.

The use of 3H serotonin release from mast cells of the mouse as an assay for mediator liberation.

The release of 3H 5-HT from murine mast cells is shown to be a simple reproducible method for studying the activation of such cells by various agents. 3H-serotonin was taken up by peritoneal cell suspensions in vitro and was released by antigen, Concanavalin A, Forssman antiserum, anti-mouse immunoglobulin, or a polypeptide antibiotic, Cinnamycin.