Erosive characteristics and fluoride content of cola-type drinks.

AIM: Excessive consumption of carbonated soft drinks is detrimental to general and oral health. This study determined endogenous pH, titratable acidity (TA) and fluoride (F) ion concentration of cola-type drinks available in the UK. Subsidiary aims were to compare: (i) endogenous pH and TA of drinks upon opening (T0) and after 20 minutes (T20); (ii) endogenous pH, TA and F ion concentration of diet vs regular and plastic bottle vs canned drinks. METHODS: Endogenous pH, TA (mls 0.1M NaOH) and F ion (mg/L) of 71 products were measured using a pH meter and F-ISE. A Wilcoxon Signed Ranks Test compared pH and TAs at T0 and T20; a Mann-Whitney U test compared pH, TAs and F ion concentration for; a) regular vs diet drinks; and b) plastic bottle vs canned drinks. RESULTS: Mean (±SD) pH for regular and diet drinks was 2.44 ± 0.12 and 2.83 ± 0.33 respectively (p = 0.001). Mean NaOH (ml) to raise pH to 5.5 and 5.7 was 5.49 ± 0.76 and 6.40 ± 0.78 (regular drinks); 5.17 ± 1.03 and 6.03 ± 1.07 (diet drinks). Diet (p = 0.040) and regular (p = 0.041) drinks had higher TA to pH 5.7 at T0 compared with T20; at T20 regular drinks had higher TA to pH 5.5 (p = 0.026) and pH 5.7 (p = 0.030) than diet drinks. There was no difference in F ion concentration between regular vs diet drinks (p = 0.754) and no significant container effect. CONCLUSION: Erosive characteristics were similar between manufacturers, but higher erosive potentials were evident at T0 compared with 20 minutes later and for regular compared with diet drinks. F ion concentration of drinks was low.

A Compression Kit of a Stocking and Three Superimposed Leggings Is Easy to Don and Dose Adjustable.

BACKGROUND: Forty percent of patients with chronic venous insufficiency (CVI) do not wear their indicated and prescribed compression stockings. Difficulties in donning and a feeling of constraint are the most common reasons for non-adherence. OBJECTIVE: The aim was to develop a compression stocking system that is easy to don and dose adjustable. METHODS: A modular compression stocking kit composed of an understocking and three superimposable leggings (SLLLs) was developed. Substocking pressures (P) at the thinnest part above the ankle (cB level) were 17 mm (understocking) + 15 + 10 + 10 mmHg (3 superimposed leggings; Hatra method). Twenty healthy subjects and 20 patients over 65 years with CVI donned the SLLL compression kit. P was measured in vivo (Picopress method) at the transition of the Achilles tendon to the calf muscle (level cB1) during rest and ankle movements (DSI; dynamic stiffness index) and compared with a strong compression stocking of 40 mmHg (S40). RESULTS: Twenty (20/20) patients aged over 65 with CVI (C4-6) successfully donned the SLLL compression kit without aid, compared with 12 (12/20) who were able to don the S40 without aid (p = .02). In vivo resting P at level cB1 was 34.3 mmHg (SLLL) compared with 37.3 mmHg (S40) (p = .1). The DSI was 16.1 (SLLL) compared with 17.9 (p = .79; S40; CVI group). CONCLUSION: The physical properties of the SLLL compression stocking kit correspond to the characteristics of a strong stocking at rest and exercise (DSI). The donning success rate is excellent (100%). A further potential advantage is that the SLLL leg compression kit is dose adjustable, according to indication or patient tolerance. Wearing comfort over periods of several days and clinical effectiveness need to be investigated in future trials.

Ethanol, ethyl and sodium pyruvate decrease the inflammatory responses of human lung epithelial cells via Akt and NF-κB in vitro but have a low impact on hepatocellular cells.

Increases in pro-inflammatory cytokine levels and tissue-infiltrating leukocytes have been closely linked to increased systemic and local inflammation, which result in organ injury. Previously, we demonstrated the beneficial and hepatoprotective anti-inflammatory effects of acute ethanol (EtOH) ingestion in an in vivo model of acute inflammation. Due to its undesirable side-effects, however, EtOH does not represent a therapeutic option for treatment of acute inflammation. Therefore, in this study, we compared the effects of acute EtOH exposure with ethyl pyruvate (EtP) as an alternative anti-inflammatory drug in an in vitro model of hepatic and pulmonary inflammation. Human hepatocellular carcinoma cells Huh7 and alveolar epithelial cells A549 were stimulated with either interleukin (IL) IL-1ß (1 ng/ml, 24 h) or tumor necrosis factor (TNF) (10 ng/ml, 4 h), and then treated with EtP (2.5-10 mM), sodium pyruvate (NaP, 10 mM) or EtOH (85-170 mM) for 1 h. IL-6 or IL-8 release from Huh7 or A549 cells, respectively, was measured by an enzyme­linked immunosorbent assay. Neutrophil adhesion to cell monolayers and CD54 expression were also analyzed. Bcl-2 and Bax gene expression was determined by RT-qPCR, and western blot analysis was performed to determine the mechanisms involved. Treating A549 cells with either EtOH or EtP significantly reduced the IL-1ß- or TNF­induced IL-8 release, whereas treating Huh7 cells did not significantly alter IL-6 release. Similarly, neutrophil adhesion to stimulated A549 cells was significantly reduced by EtOH or EtP, whereas for Huh7 cells the tendency for reduced neutrophil adhesion rates by EtOH or EtP was not significant. CD54 expression was noticeably reduced in A549 cells, but this was not the case in Huh7 cells after treatment. The Bax/Bcl-2 ratio was dose­dependently decreased by EtOH and by high-dose EtP in A549 cells, indicating a reduction in apoptosis, whereas this effect was not observed in Huh7 cells. The underlying mechanisms involve reduced phosphorylation of Akt and nuclear factor-κB (NF-κB) p65. We noted that as with EtP, EtOH reduced the inflammatory response in lung epithelial cells under acute inflammatory conditions. However, due to the low impact which EtP and EtOH had on the hepatocellular cells, our data suggest that both substances exerted different effects depending on the cellular entity. The possible underlying mechanisms involved the downregulation of Akt and the transcription factor NF-κB, but further research on this subject is required.

Estimation of daily dietary fluoride intake: 3-d food diary v. 2-d duplicate plate.

The 3-d food diary method (3-d FD) or the 2-d duplicate plate (2-d DP) method have been used to measure dietary fluoride (F) intake by many studies. This study aimed to compare daily dietary F intake (DDFI) estimated by the 3-d FD and 2-d DP methods at group and individual levels. Dietary data for sixty-one healthy children aged 4-6 years were collected using 3-d FD and 2-d DP methods with a 1-week gap between each collection. Food diary data were analysed for F using the Weighed Intake Analysis Software Package, whereas duplicate diets were analysed by an acid diffusion method using an F ion-selective electrode. Paired t test and linear regression were used to compare dietary data at the group and individual levels, respectively. At the group level, mean DDFI was 0·025 (sd 0·016) and 0·028 (sd 0·013) mg/kg body weight (bw) per d estimated by 3-d FD and 2-d DP, respectively. No statistically significant difference (P=0·10) was observed in estimated DDFI by each method at the group level. At an individual level, the agreement in estimating F intake (mg/kg bw per d) using the 3-d FD method compared with the 2-d DP method was within ±0·011 (95 % CI 0·009, 0·013) mg/kg bw per d. At the group level, DDFI data obtained by either the 2-d DP method or the 3-d FD method can be replaced. At an individual level, the typical error and the narrow margin between optimal and excessive F intake suggested that the DDFI data obtained by one method cannot replace the dietary data estimated from the other method.

Decreased inflammatory responses of human lung epithelial cells after ethanol exposure are mimicked by ethyl pyruvate.

BACKGROUND AND PURPOSE: Leukocyte migration into alveolar space plays a critical role in pulmonary inflammation resulting in lung injury. Acute ethanol (EtOH) exposure exerts anti-inflammatory effects. The clinical use of EtOH is critical due to its side effects. Here, we compared effects of EtOH and ethyl pyruvate (EtP) on neutrophil adhesion and activation of cultured alveolar epithelial cells (A549). EXPERIMENTAL APPROACH: Time course and dose-dependent release of interleukin- (IL-) 6 and IL-8 from A549 were measured after pretreatment of A549 with EtP (2.5-10 mM), sodium pyruvate (NaP, 10 mM), or EtOH (85-170 mM), and subsequent lipopolysaccharide or IL-1beta stimulation. Neutrophil adhesion to pretreated and stimulated A549 monolayers and CD54 surface expression were determined. KEY RESULTS: Treating A549 with EtOH or EtP reduced substantially the cytokine-induced release of IL-8 and IL-6. EtOH and EtP (but not NaP) reduced the adhesion of neutrophils to monolayers in a dose- and time-dependent fashion. CD54 expression on A549 decreased after EtOH or EtP treatment before IL-1beta stimulation. CONCLUSIONS AND IMPLICATIONS: EtP reduces secretory and adhesive potential of lung epithelial cells under inflammatory conditions. These findings suggest EtP as a potential treatment alternative that mimics the anti-inflammatory effects of EtOH in early inflammatory response in lungs.

The fluoride contents of commercially-available soya milks in the UK.

BACKGROUND: In some parts of the world, soya milks are found to be a significant source of fluoride (F). Among western commercial markets, although there has been a sustained increase in soya milk products available for purchase, there are limited data on their F content. OBJECTIVE: To determine the F content of soya milk products available in the UK market including fresh and ultra-high temperature products in addition to sweetened and unsweetened soya milks. MATERIALS AND METHODS: Fifty-two traditional and UK-produced soya milk samples commercially available in northeast England were analysed to determine their F concentration using a modified hexamethyldisiloxane-facilitated diffusion method with a F-ion-selective electrode coupled to a potentiometer. RESULTS: The median F concentration of all products was 0.293 µg/ml ranging from 0.015 µg/ml to 0.964 µg/ml. The median F concentration of ultra-high temperature (UHT) (n = 42) milks was 0.272 µg/ml lower than 0.321 µg/ml obtained for fresh (n = 10) soya milks. Organic soya milks contained less F compared with non-organic for sweetened and unsweetened categories. CONCLUSION: Commercially available soya milks in the UK do not pose an increased risk for dental fluorosis development. Further research is necessary into the manufacturing process of soya milks, which may influence the overall F content of the end product.

Urinary fluoride excretion in 6- to 7-year-olds ingesting milk containing 0.5 or 0.9 mg fluoride.

Effectiveness of 0.5 mg fluoride (F) milk ingestion in preventing caries has been termed only 'moderate'. In this 3-arm partial cross-over intervention, 32 children aged 6-7 years in a non-F area were recruited and urinary F excretion (UFE) measured before and after ingestion of 0.5 or 0.9 mg F milk. Maintaining customary dietary and oral hygiene habits, children underwent a 2-week 'wash-in' with non-F milk, providing a 24-hour urine sample on day 4 of non-F (baseline) and F milk ingestion containing either (i) 0.5 mg or (ii) 0.9 mg F (intervention). A comparative group of thirteen 6- to 7-year-olds living in fluoridated areas provided a 24-hour urine sample on day 4 of daily non-F milk ingestion, following a 2-week non-F milk wash-in. Valid urine samples were analysed for F and UFE estimated from corrected 24-hour urine volume and F concentration. For the 24 test children providing 2 valid urine samples, mean (95% CI) change in corrected 24-hour UFE was 0.130 (0.049, 0.211) and 0.153 (0.062, 0.245) mg/day for 0.5 mg (p < 0.007) and 0.9 mg F (p < 0.001) groups, respectively. Post-intervention, mean (SD) corrected 24-hour UFE was 0.437 (0.153) mg/day and 0.420 (0.188) mg/day for the 0.5 and 0.9 mg F groups, respectively, which were lower than the WHO provisional standards (0.48-0.60 mg F/day). F milk consumption significantly increased UFE; however, the F content of 0.5 and 0.9 mg F milk may be too low to achieve WHO provisional UFE standards concomitant with optimal F exposure in children aged ≥6 years.

Fractional urinary fluoride excretion of 6-7-year-old children attending schools in low-fluoride and naturally fluoridated areas in the UK.

F is an important trace element for bones and teeth. The protective effect of F against dental caries is well established. Urine is the prime vehicle for the excretion of F from the body; however, the relationship between F intake and excretion is complex: the derived fractional urinary F excretion (FUFE) aids understanding of this in different age groups. The present study aimed to investigate the relationships between (1) total daily F intake (TDFI) and daily urinary F excretion (DUFE), and (2) TDFI and FUFE in 6-7-year-olds, recruited in low-F and naturally fluoridated (natural-F) areas in north-east England. TDFI from diet and toothbrushing and DUFE were assessed through F analysis of duplicate dietary plate, toothbrushing expectorate and urine samples using a F-ion-selective electrode. FUFE was calculated as the ratio between DUFE and TDFI. Pearson's correlation and regression analysis were used to investigate the relationship between TDFI and FUFE. A group of thirty-three children completed the study; twenty-one receiving low-F water (0·30 mg F/l) and twelve receiving natural-F water (1·06 mg F/l) at school. The mean TDFI was 0·076 (SD 0·038) and 0·038 (SD 0·027) mg/kg per d for the natural-F and low-F groups, respectively. The mean DUFE was 0·017 (SD 0·007) and 0·012 (SD 0·006) mg/kg per d for the natural-F and low-F groups, respectively. FUFE was lower in the natural-F group (30 %) compared with the low-F group (40 %). Pearson's correlation coefficient for (1) TDFI and DUFE was +0·22 (P= 0·22) and for (2) TDFI and FUFE was − 0·63 (P< 0·001). In conclusion, there was no correlation between TDFI and DUFE. However, there was a statistically significant negative correlation between FUFE and TDFI.

Compliance with school F-milk and non-F milk intake in 3 to 4 and 6 to 7-year-old children.

BACKGROUND: Fluoridated (F) milk schemes are employed in six countries to reduce dental caries in children. To maximise their benefits considerable uptake is required. Measuring compliance and understanding contributing factors is important in evaluating the effectiveness of schemes since it can be unclear whether reported sub-optimal fluoride (F) intakes, measured through urinary F excretion, are due to sub-optimal F contents of milks or lack of compliance with consumption. OBJECTIVES: To determine compliance with milk consumption for children receiving non-F or F milk (containing 0.5 or 0.9 mgF per 189 ml carton) and rationalise the use of compliance data for clinical observational or intervention studies involving F milk schemes. RESEARCH DESIGN: Partially randomised, partial cross-over study. PARTICIPANTS: 50 children aged 3-4 and 6-7y consuming non-F (n=50) and F milk (0.5 mgF; n=15 children; 0.9mg F; n=16 children) at school. RESULTS: Mean compliance for both non-F and F milk was > or =90% in each of the groups studied and showed no statistically significant difference for children using both milks. The 95% central range of proportions of milk consumed for groups of individuals was wider for 0.9mgF milk (25% to 100%) than for 0.5 mgF milk (81% to 100%) although the greatest range of variation in compliance for within individual observations was seen for non-F milk consumption and in older children. CONCLUSION: Assessment of compliance with consumption should be included when dental efficacy of F milk consumption is being investigated or evaluated to quantify F exposure from milk. This is important, particularly if a change in the F dose of F milk might be under consideration.

Effect of rinsing with mouthwashes after brushing with a fluoridated toothpaste on salivary fluoride concentration.

The aim of the study was to determine whether rinsing with a mouthwash after brushing with a fluoridated toothpaste affected oral fluoride (F) retention and clearance compared with an oral hygiene regime without mouthwash. In this supervised, single-blind study, 3 regimes were compared: (A) brushing for 1 min with 1 g of 1,450 microg F/g NaF toothpaste followed by rinsing for 5 s with 10 ml water; (B) as A but followed by rinsing for 30 s with 20 ml of 100 mg F/l NaF mouthwash, and (C) as B but rinsing for 30 s with a non-fluoridated mouthwash. Twenty-three adults applied each treatment once in a randomised order, separated by 1-week washout periods, and used a non-fluoridated toothpaste at home prior to and during the study. Whole saliva samples (2 ml), collected before each treatment commenced and 10, 20, 30, 60, 90 and 120 min afterwards, were subsequently analysed for fluoride by ion-specific electrode. The mean (SD) back-transformed log (area under salivary F clearance curve) values were: A = 2.36 (+3.37, -1.39), B = 2.54 (+2.72, -1.31) and C = 1.19 (+1.10, -0.57) mmol F/l x min, respectively. The values for regimes A and B were statistically significantly greater than that for regime C (p < 0.001; paired t test). These findings suggest that use of a non-F mouthwash after toothbrushing with a F toothpaste may reduce the anticaries protection provided by toothbrushing with a F toothpaste alone. The use of a mouthwash with at least 100 mg F/l should minimise this risk.

The amino bisphosphonate ibandronate prevents calciphylaxis in the rat at doses that inhibit bone resorption.

The present experiments were carried out to test the hypothesis that there is a common underlying biochemical mechanism that accounts for the different kinds of soft tissue calcification observed in animals that are treated with toxic doses of vitamin D. In previous studies we showed that lethal doses of vitamin D cause extensive calcification of arteries, lungs, kidneys, and cartilage, and that doses of the amino bisphosphonate ibandronate that inhibit bone resorption completely inhibit each of these soft tissue calcifications and prevent death. In the present experiments we have examined the effect of ibandronate on an entirely different type of calcification, the calciphylaxis induced by administration of a challenger to rats previously treated with sub-lethal doses of vitamin D. These studies show that ibandronate doses that inhibit bone resorption completely inhibit artery calcification as well as, in the same rat, the calciphylactic responses to either subcutaneous injection of 300 mg FeCl3 or intrascapular epilation. Since the vitamin D-treated animals had dramatically increased levels of bone resorption, and concurrent treatment with ibandronate normalized resorption, these results support the hypothesis that soft tissue calcifications in the vitamin D-treated rat may be linked to bone resorption. The ability of ibandronate to inhibit all vitamin D-associated calcifications in the rat cannot be explained by an effect of ibandronate on serum calcium, since serum calcium remained 30% above control levels in the vitamin D-treated animals that also received ibandronate.