Occupational exposure to airborne proteolytic enzymes and lifestyle risk factors for dental erosion--a cross-sectional study.

This study examined the hypothesis that occupational exposure to airborne proteolytic enzymes is associated with dental erosions on the facial surfaces of exposed teeth. Individuals (n = 425) working at a pharmaceutical and biotechnological enterprise (Novozymes A/S) were examined; their mean age was 35 years (range = 18-67 years) and 143 (34%) were women. Two hundred and two of these individuals were newly employed by the company. Occupational exposure was assessed from questionnaire and workplace information. For practical analytical purposes, individuals were categorized as either previously exposed to proteolytic enzymes or not. Information on relevant lifestyle factors and medical history was obtained from a questionnaire. The main effect measure was facial erosion, but lingual erosion indices and the presence of Class V restorations were also considered. The validity of these measures was shown to be very high. Adjusted for potential confounders, there was no association between history of occupational exposure to proteolytic enzymes and prevalent facial or lingual erosion. With respect to prevalence of Class V restorations, the association was significant. The present study did not support directly our primary hypothesis that occupational exposure to airborne proteolytic enzymes is associated with dental erosions on the facial surfaces of exposed teeth. However, the results indicate that exposure to proteolytic enzymes may lead to pronounced tooth substance loss, demanding treatment.

A clinical index for evaluating and monitoring dental erosion.

This study describes a new fine-scaled system for classifying initial and advanced dental erosions. The system includes the use of study casts of the teeth in an epoxy resin with an accurate surface reproduction. The severity of erosion on each tooth surface is scored according to six grades of severity. In addition, the presence of a Class V restoration and dental erosion on the same surface increases the erosion score, as it is assumed that the need for restorative treatment can be caused by the erosion. A high inter-examiner agreement was found when the present scoring system was used by two examiners on the same sample. With this prerequisite it is proposed that an index value for facial, oral, incisal/occlusal and cervical surfaces is calculated as the mean value of scores for the respective surfaces. The index values represent the severity of tooth substance loss in various locations of the oral cavity and are furthermore suitable for data analysis. The system is thereby well-suited for determining etiologic factors and monitoring the progression of erosion over time.

Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings.

Treatment of patients who attribute their environmental illness to mercury from amalgam fillings is largely experimental. On the Symptom Check List, overall distress, and somatization, obsessive-compulsive, depression, and anxiety symptom dimensions, were increased in 50 consecutive patients examined, and Eysenck Personality Questionnaire scores suggested less extroversion and increased degree of emotional liability. Succimer (meso-2, 3-dimercaptosuccinic acid) was given at a daily dose of 30 mg/kg for five days in a double-blind, randomized placebo-controlled trial. Urinary excretion of mercury and lead was considerably increased in the patients who received the chelator. Immediately after the treatment and 5 to 6 weeks later, most distress dimensions had improved considerably, but there was no difference between the succimer and placebo groups. These findings suggest that some patients with environmental illness may substantially benefit from placebo.

Change in surface hardness of BisGMA/TEGDMA polymer due to enzymatic action.

The surface microhardness of specimens made of a BisGMA/TEGDMA polymer was measured before and during treatment for 60 days with phosphate buffer or phosphate-buffered esterase solution with an activity corresponding to the mean hydrolase activity of human saliva. The hardness of the buffer-treated specimens was unchanged during the incubation period, while that of the esterase-treated specimens decreased gradually. After about five days of treatment, no further change in hardness was observed for up to 60 days. Based on the difference in the calculated hardness of the specimens as a function of the applied load during measurement, it was estimated that the mean microhardness of the outermost surface layer of the esterase-treated specimens was diminished by about 15%, compared with that of the buffer-treated specimens. From these results, it was concluded that the wear resistance of a BisGMA/TEGDMA polymer is most likely diminished by hydrolases in saliva.

Effect of human saliva on surface degradation of composite resins.

The amount of methacrylic acid produced by incubation of the dimethacrylate ester TEGDMA in human whole saliva was measured. The conversion rate of TEGDMA was determined in stimulated saliva from dental students and in unstimulated saliva from both dental students and patients. The differences in mean conversion rate measured in the three groups were not statistically significant (P = 0.346). The mean conversion rate +/- SD for all saliva samples was 4.54 +/- 3.24 mumol MAA/L.h. The surface of BISGMA/TEGDMA-polymer specimens treated with porcine liver esterase in activities equivalent to those found in human saliva exhibited a lower Wallace microhardness than the surface of untreated specimens. Polymer specimens incubated in human saliva exhibited a similar reduction in the microhardness. The results demonstrated that enzymes in human saliva are capable of softening the surface of dimethacrylate polymers presumably by inducing a hydrolysis of methacrylate ester bonds. The mechanical removal of a surface layer softened by hydrolases will expose a new surface layer to enzymatic attack. The enzymatic softening may thus contribute to the in vivo wear of composite restorations.

[Screening for bacteriuria in the laboratory: autotrak, test strips and microscopic examination compared with culture]. / Screening for bakteriuri i laboratoriet: autotrak, teststrimler og mikroskopi sammenlignet med dyrkning.

A prospective investigation was undertaken to compare quantitative culture of 739 samples of urine in a microbiological laboratory with the screening methods: phase contrast microscopy examination, test strip examinations for nitrite and leukocyte esterase (Multistix-2, Ames) and "Autotrak" (automatic quantitating of the bacterial content in fluids: BBT instruments). The three screening methods were, by and large, of equal value as regards true positive diagnostic frequency (0.48-0.55) and true negative diagnostic frequency (0.92). The methods were also equally rapid but microscopy examination was by far the cheapest (0.15 Danish crowns per test as compared with 1.75 for test strips and 3.10 for "Autotrak"). In addition, microscopic examination has the further advantage, although this of lesser value where cocci are concerned, of being capable of differentiating the morphology of the bacteria and their motility. It is noted that test strips have a false negative rate of approximately 13%.

Gingival and alveolar bone reaction to marginal fit of subgingival crown margins.

Interproximal subgingival marginal discrepancies of full coverage restorations were compared with adjacent crevicular fluid flow and percentage radiographic periodontal bone loss. A total of 88 patients with 116 premolar crowns were evaluated. Patients were selected at random from student treatment records, Institute of Dental Prosthetics, Royal Dental College, Copenhagen, Denmark. Crevicular fluid collected on filter paper strips from the interproximal area was stained with 0.2% ninhydrin solution and the length of the area measured. Marginal fit was determined by measuring the marginal excess or deficit recorded in a polyether impression. The amount of bone around each crowned tooth was measured on five times magnified prints of radiographs. Percentage bone loss was calculated by dividing the distance from the alveolar crest to the most coronal level at which the periodontal space retained its normal width by the distance from the alveolar crest to the root apex. Correlating marginal fit with crevicular fluid within gingival index scores showed r = 0.32 (G.I.1) and r = 0.42 (G.I.2). Fit vs percentage bone loss showed r = 0.68 and r = 0.59, respectively (P less than or equal to 0.001). Differentiation was further made within the 0.0-0.2 mm range discrepancy by categorizing the data in four groups. Comparing fit relative to crevicular fluid and bone loss, most of these groups were significantly different when analyzed statistically using the Mann-Whitney U-Test. Small defects less than or equal to 0.050 mm were associated with significantly less fluid flow and bone loss than defects exceeding this value.