Patients with non-Sjögren's sicca report poorer general and oral health-related quality of life than patients with Sjögren's syndrome: a cross-sectional study.

Understanding the impact of the disease on quality of life is crucial in patient management. In this cross-sectional study, general and oral health-related quality of life questionnaires, and thorough examinations of oral and ocular dryness were performed in age- and sex-matched patients with primary Sjögren's syndrome (pSS group), non-Sjögren's syndrome sicca (non-SS group) and healthy controls. General and oral health-related quality of life were investigated with the 36-Item Short Form Health Survey and the 14-Item Oral Health Impact Profile questionnaires, respectively. Subjective symptoms of xerostomia and ocular dryness were recorded using the Summated Xerostomia Inventory and Ocular Surface Disease Index, respectively. Clinical examinations included evaluation of clinical oral dryness scores, candida counts, unstimulated and stimulated saliva secretory rates, tear osmolarity, tear film break-up time, Schirmer I test and ocular surface staining. Both patient groups had pronounced signs and symptoms of xerostomia and ocular dryness. Even though the non-SS patients had less severe clinical signs than the pSS patients, they demonstrated much poorer general and oral health-related quality of life. In conclusion, non-SS patients require more attention in order to improve their quality of life.

Polymer coated liposomes for dental drug delivery--interactions with parotid saliva and dental enamel.

The interactions between pectin coated liposomes and parotid saliva and dental enamel were studied to investigate their potential to mimic the protective biofilm formed naturally on tooth surfaces. Different pectin coated liposomes with respect to pectin type (LM-, HM- and AM-pectin) and concentration (0.05% and 0.2%) were prepared. Interactions between the pectin coated liposomes and parotid saliva were studied by turbidimetry and imaging by atomic force microscopy. The liposomes were adsorbed to hydroxyapatite (HA) and human dental enamel using phosphate buffer and parotid saliva as adsorption media. A continuous flow was imposed on the enamel surfaces for various time intervals to examine their retention on the dental enamel. The results were compared to uncoated, charged liposomes. No aggregation tendencies for the pectin coated liposomes and parotid saliva were revealed. This makes them promising as drug delivery systems to be used in the oral cavity. In phosphate buffer the adsorption to HA of pectin coated liposomes was significantly lower than the negative liposomes. The difference diminished in parotid saliva. Positive liposomes adsorbed better to the dental enamel than the pectin coated liposomes. However, when subjected to flow for 1h, no significant differences in the retention levels on the enamel were found between the formulations. For all formulations, more than 40% of the liposomes still remained on the enamel surfaces. At time point 20 min the retention of HM-pectin coated and positive liposomes were significantly higher. It was concluded that pectin coated liposomes can adsorb to HA as well as to the dental enamel. Their ability to retain on the enamel surfaces promotes the concept of using them as protective structures for the teeth.

Quantitative and qualitative analyses of human salivary micelle-like globules.

In the present study we examined the protein proportion and amino acid profile of the salivary micelle-like globules (SMGs) of human whole saliva and parotid saliva (HWS, HPS). Saliva and SMG samples from each subject (clarified HWS and HPS from 6 subjects, and unclarified HWS from 3 subjects) were analysed for amino acids using standard acid hydrolysis procedures. HPS, clarified HWS and the respective supernatant samples (remaining after removal of the SMGs) were also measured for protein using the micro-Kjeldahl method. SMGs from clarified and unclarified HWS made up 4.7% and 19.7%, respectively, of the total salivary protein based on amino acid analyses. With the micro-Kjeldahl method SMGs from clarified HWS made up 7.3% of the total saliva protein. SMGs isolated from HPS were found in only small amounts. The amino acid profile for the SMGs was strikingly similar to that known for the 2-h pellicle, and differed significantly from HWS or HPS. The results support previous morphological studies indicating that the SMGs represent a major component of the newly formed pellicle.

On the rôle of human salivary micelle-like globules in bacterial agglutination.

The hypothesis to be tested in this in vitro study was that the salivary micelle-like globules (SMGs) have a rôle in the agglutination of some oral bacteria. An attempt to determine the mechanisms for the interactions involved was also carried out. 4 laboratory and 4 native streptococci strains were tested. Human whole (HWS) and parotid (HPS) saliva was collected from 4 subjects, and SMGs were isolated from both salivas, and agglutination was recorded in the various bacterial suspensions over time. HPS, HWS and SMGs isolated from HPS and HWS caused typical agglutination patterns for the mutans strains. Salivary supernatants (without SMGs) caused a much delayed or no agglutination. Electron microscopy showed SMG-like structures on the surface of the agglutinated bacteria. Addition of pyrophosphate to HPS prevented agglutination, whereas guanidine HCl prevented normal agglutination of a sanguis strain, and urea had no obvious effect. Together, these results indicate that the SMGs are important in the agglutination of streptococci, and that both calcium-dependent, electrostatic and hydrophobic interactions may be involved.

Fractionation of salivary micelle-like structures by gel chromatography.

Globular structures have been demonstrated in human parotid saliva by transmission electron microscopy and photon correlation spectroscopy. The aim of this study was to fractionate these salivary globular structures for analytical and preparative purposes using a gel-filtration material capable of separating spherical particles up to 300-400 nm in diameter. Freshly obtained parotid saliva was applied to a Sephacryl S-1000 column. Peak fractions were collected and prepared for transmission electron microscopy (TEM) or for amino acid analysis. Bovine milk was included as the casein micelles by TEM appear to be similar to the salivary aggregates and their elution profiles are known. The salivary globular structures were eluted in one major peak. TEM of negatively stained samples from the peak fractions demonstrated globular protein aggregates consistent with the salivary structures in parotid saliva. Amino acid analysis showed characteristic amino acid profiles with unusual high levels of proline, 40-45%. The casein micelles were eluted in one major peak and separated from the whey proteins. This study indicates that the salivary globular structures can be isolated by gel chromatography. The amino acid analysis indicates that proline-rich proteins may be an important fraction of the salivary globular structures.

Zeta potentials of human enamel and hydroxyapatite as measured by the Coulter DELSA 440.

The zeta potential of human enamel is of physiological importance for interactions between enamel surfaces and the surrounding aqueous medium of saliva. The zeta potentials of both enamel and hydroxyapatite (HA) have been examined previously by various techniques. In this study, we examined the zeta potential of human enamel and HA using the Coulter DELSA 440, which, by a laser, makes independent Doppler shift measurements of moving particles in an electric field at 4 different angles, providing advantages over previous techniques. The enamel and HA particles were suspended directly in different phosphate buffers, or first incubated for 2 hrs in parotid (PS) or whole saliva (HWS) and then suspended in the same buffers. The enamel and HA particles exhibited an overall net surface potential of -15 to -30 mV, depending on the buffer content. Incubation in PS and HWS gave less negative potentials of -8 to -14 mV. In our previous studies, the salivary micelle-like structures (SMSs), seen in TEM of parotid saliva, were observed to have a zeta potential of -9 mV (Rykke et al., 1996). The zeta potential determinations in this study support the concept of an adsorption of mostly SMSs to the enamel surfaces, with a change of the zeta potential of the enamel and HA toward that of the SMSs.

Rate of pellicle formation in vivo.

The acquired enamel pellicle is thought to be the result of a selective adsorption of salivary proteins and to be involved in the protection of the enamel surfaces. The chemical composition of the 2-h acquired enamel pellicle is fairly well established. However, the rate of formation and the amino acid composition of the initially formed enamel pellicle have been little investigated. The aim of this study was therefore to examine the rate of pellicle formation and the amino acid composition of the initially formed enamel pellicle. Samples of human enamel surfaces were carried in the mouth for various periods of time (2.5 min to 10 h). Rate of pellicle formation was indicated as a function of oral exposure time and the time necessary to remove the proteinaceous film from the surfaces by argon ion sputtering. The chemical composition of the initially acquired pellicle was examined by amino acid analyses of pellicle material collected in vivo from enamel surfaces 15 min and 1 h after pumicing, respectively. The pellicle reached an initial thickness in about 2-3 min, at which level it stayed for about 30 min. The thickness of the acquired pellicle then increased to about three times the initial thickness and stayed at that level for the rest of the experimental period (10 h). Amino acid analyses of pellicle material collected after 15 min and after 1 h were different in that the amino acid profiles of the 15-min pellicle only contained traces of proline and arginine. It may be argued that the pellicle formation proceeds in two stages owing to the adsorption of protein aggregates and that the chemical compositions of the pellicles of the two stages differ.

Dental materials for posterior restorations.

Assessment of the quality of dental restorations by the Ryge system is described. Generally, the quality of dental restorations is shown to be dependent on the technique sensitivity of the restorative material as well as the skill and experience of the dentist. Concerning biocompatibility, adverse reactions related to amalgam restorations are unlikely or scarce, due to small amounts of released mercury. Resin based restorative materials contain a large number of organic compounds and, as such, the toxic and allergenic potentials are unknown. Gold and ceramics turn out to be the most biotolerable dental materials. Based on studies on longevity, data indicate that the median age of amalgam restorations is 10-12 years, of gold castings 13-14 years and more, and of composite restorations 4 years. Data on longevity of ceramic restorations are sparse. Secondary caries appears to be the most frequent cause for replacement of the different restorations, followed by marginal degradation. Secondary caries account for more failures among the resin based restorations than among amalgam. Reviewing the literature, it appears that amalgam is the best and most economic dental material for routine posterior restorations with reasonable durability. Gold is recommended for complex restorations. Resin based composites may be limited to small restorations where cosmetics is the main aspect, as wear and recurrent caries are main problems. Ceramic restorations comprise aesthetic restorations with excellent biocompatibility, however, data on longevity and marginal adaptation are not encouraging.

Amino acid composition of acquired enamel pellicle collected in vivo after 2 hours and after 24 hours.

The adsorption of salivary proteins to dental enamel during pellicle formation has been shown to be a specific process and dependent on the chemical composition of the surfaces. Most studies on the amino acid composition of the acquired enamel pellicle have, however, been performed on the "2-h-pellicle" under controlled experimental conditions. This may have eliminated some natural factors involved in pellicle formation. The aim of the present study was to investigate the effect of extended time of formation and diet on the pellicle formation. Pellicle material was collected from the same subject after 2 and after 24 h when food and beverages were avoided, and after 24 h with the intake of a normal diet. The collected pellicle materials were hydrolyzed and amino acid analyzed. The results showed that pellicle material collected after 24 h and fasting had a chemical composition similar to the "2-h-pellicle", whereas pellicle material collected after 24 h and a normal diet was different, indicating a dietary contribution to pellicle formation or a bacterial degradation of the pellicle.

Chemical analysis and scanning electron microscopy of acquired pellicle formed in vivo on stannous fluoride treated enamel.

Stannous fluoride (SnF2) has been shown to be an effective caries preventive agent. After topical treatment of enamel surfaces, two reaction products have been demonstrated to precipitate on the surfaces, a larger type of globules, probably a calcium fluoride like product, and a smaller type of globules, probably a tin phosphate. The aim of the present study was to examine the amino acid composition and the formation of the acquired pellicle on SnF2-treated enamel in vivo. The chemical composition was examined by amino acid analysis of pellicle material collected in vivo from SnF2-treated enamel surfaces. Pellicle formation was examined by scanning electron microscopy on SnF2-treated enamel fragments carried in the mouth for 2 h. The results showed that pellicle material was formed in abundant amounts and covered the globular surfaces following the SnF2 treatment. The chemical analyses showed amino acid profiles with high content of acidic and neutral amino acids. The profiles were different from known amino acid profiles obtained from analyses of pellicle material collected from untreated enamel surfaces.

Effect of two organic phosphonates on protein adsorption in vitro and on pellicle formation in vivo.

Organic phosphonates have been introduced in dentifrices to reduce the formation of dental calculus. They may conceivably act as calcium sequestrants or crystal growth inhibitors, interfering directly with the calcium ions on the hydroxyapatite (HA) and enamel surfaces. The aim of the present study was to examine the effect of two organic phosphonates on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo. The effect on protein adsorption in vitro was studied by adsorption of albumin to either untreated or phosphonate treated HA powder. Ion exchange chromatography was also performed with columns with untreated and phosphonate treated HA as bed materials and with linear gradients of either phosphate or phosphonates. The effect on pellicle formation in vivo was studied by scanning electron microscopy on untreated and phosphonate treated enamel fragments which had been carried in the mouth to acquire pellicle materials. The present study showed that phosphonate-treated HA took up less protein. The adsorbed protein was, furthermore, less firmly bound to phosphonate treated hydroxyapatite. Phosphonate-treated enamel fragments carried in the mouth also exhibited a slower rate of pellicle formation as compared to the untreated enamel fragments.

Effect of silicone oil on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo.

Silicone oil has been introduced in a dentifrice for smokers because of its effect as a polishing agent. Silicone oils are hydrophobic in character and have low surface tensions and good wetting properties. Due to the low surface tension, silicone oils may spread readily on solid surfaces and cover them with a thin, water-repellent film. Introduced via dentifrices silicone oil may thus well be able to adsorb to enamel surfaces and to interfere with surface characteristics such as protein adsorption. The aim of the present study was to examine the effect of silicone oil on protein adsorption to hydroxyapatite (HA) in vitro and on pellicle formation in vivo. The effect on protein adsorption to HA in vitro was studied by adsorption of albumin to either untreated or silicone oil treated HA powders. Ion exchange chromatography was also used with either untreated or silicone oil treated HA as bed materials. The effect on pellicle formation in vivo was studied using enamel fragments carried in the mouth to acquire pellicle material. The chemical composition of the acquired pellicle was studied by collection and chemical analysis of pellicle material formed on enamel surfaces in vivo. The study showed that silicone oil treated HA took up less protein and that the adsorbed protein was bound to hydroxyapatite by a different mechanism as compared to untreated controls. The results indicated that hydrophobic interactions could be involved in binding of proteins to silicone oil treated hydroxyapatite. Silicone oil treated enamel fragments carried in the mouth showed a slower rate of pellicle formation as compared to untreated fragments. The amino acid composition of the acquired pellicle collected in vivo from silicone oil treated enamel surfaces was also different from pellicle material collected from untreated enamel.

Desorption of acquired enamel pellicle in vivo by pyrophosphate.

Soluble pyrophosphate (PP) has been introduced in dentifrices to inhibit the formation of dental calculus. The mechanism of inhibition is probably an adsorption of the pyrophosphate ions to the Ca-sites on the enamel surfaces and a blocking of the active sites for crystal growth. It has been shown in a recently published study that PP reduced the protein adsorption to hydroxyapatite (HA) in vitro and also inhibited the pellicle formation in vivo. The aim of the present study was to examine the desorption potential of pyrophosphate on the acquired enamel pellicle in vivo. Enamel fragments were carried in the mouth to collect pellicle material and some of the enamel surfaces were then treated with PP. Pellicle formation was examined by SEM of the enamel surfaces. The results showed that pyrophosphate desorbed the acquired enamel pellicle effectively. The clinical consequences of this effect is unknown, but it could possibly explain some aspects of hypersensitivity of teeth observed in some individuals using dentifrices containing PP.

Effect of sodium lauryl sulfate on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo.

Sodium lauryl sulfate (SLS) is widely used as a synthetic detergent in dentifrices. It has been shown to have high affinity for hydroxyapatite (HA), and the binding mechanism has been proposed to be electrostatic, involving the negative sulfate terminals of the SLS and the calcium sites on the HA. The binding of SLS to HA may thus well interfere with the protein adsorption to HA. The aim of the present study was to examine the effect of SLS on protein adsorption in vitro and on pellicle formation in vivo. The effect on protein adsorption was studied using ion exchange chromatography. The effect on pellicle formation was studied using enamel fragments carried in the mouth. The study showed that SLS-treated HA adsorbed less protein than untreated HA. Protein adsorbed to SLS-treated HA was more firmly bound to HA as compared to untreated HA. SLS-treated enamel fragments carried in the mouth showed a slower rate of pellicle formation than non-treated enamel.

Interindividual and longitudinal studies of amino acid composition of pellicle collected in vivo.

The formation of the acquired enamel pellicle is due to the adsorption of salivary proteins to the enamel surface. This adsorption is assumed to be specific and is dependent on the chemical characteristics of the surface. The aim of the present study was to investigate the consistency of the chemical composition of the acquired pellicle collected in vivo. Inter- and intraindividual differences in the chemical composition of pellicle material were examined during 2 yr in three different individuals. The amino acid profiles obtained from pellicle analyses were compared to hydrolyzed whole saliva collected at the same time as the pellicle material. The results showed that the amino acid composition of pellicle was consistent both between and within the individuals. The amino acid profiles obtained from the analyses of the saliva samples were different from the pellicle profiles, illustrating the selective nature of pellicle formation. This supports the contention that the adsorption of salivary proteins to dental enamel is a very specific process.

Protein adsorption to hydroxyapatite and to calcium fluoride in vitro and amino acid analyses of pellicle formed on normal enamel and on calcium-fluoride-covered enamel in vivo.

Fluoride treatment of enamel has been reported to result in the formation of a layer of a CaF2-like material on the enamel surface. Protein adsorption to enamel is a specific process dependent on the nature of the surface, and little is known about protein adsorption to CaF2. Albumin and lysozyme were adsorbed to hydroxyapatite (HA) and CaF2 powder in vitro, and protein adsorption patterns constructed. In vivo pellicle was collected from three volunteers from fluoride-treated enamel and from normal enamel, and the amino acid compositions analyzed separately. The results showed that CaF2 took up small amounts of proteins as compared with HA. When the CaF2 was pretreated with a phosphate buffer, pH 6.8, the protein adsorption increased markedly. The amino acid analyses showed no major differences in the amino acid compositions between pellicle collected from CaF2-covered enamel and pellicle collected from normal enamel. This lack of difference is presumably due to the adsorption of phosphate ions to the CaF2 crystals and hence changed surface properties.

Effect of pyrophosphate on protein adsorption to hydroxyapatite in vitro and on pellicle formation in vivo.

This study showed that pyrophosphate (PP) desorbed an acidic protein (albumin) from hydroxyapatite (HA) more effectively than phosphate and that HA pretreated with PP took up markedly less protein than untreated HA. The protein which adsorbed to PP-treated HA was more loosely bound than that adsorbed to untreated HA. In vivo experiments showed that pellicle formed more slowly on PP-treated etched enamel than on untreated controls. The possible clinical implications of these findings are discussed.

A clinical and scanning electron microscopic study of a new restorative material for use in posterior teeth.

Eighty-two restorations with a new posterior restorative material showed good wear resistance on the occlusal surfaces after 2 years of service. The loss of substance averaged 30-50 micron, which is below the clinically detectable level. Inferior contact points were frequently registered, reflecting the problems with inadequate matrix systems. Clinically relevant problems were all related to the quality of the contact area.