Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis : Six new cases and a literature review.

BACKGROUND: There are increasing data suggesting the involvement of the immune system in narcolepsy. The co-occurrence of narcolepsy with other autoimmune disorders (including multiple sclerosis, MS) is rare. PATIENTS AND METHODS: International multicenter sleep center survey and literature review on narcolepsy with (NC) and without (NwC) cataplexy. RESULTS: A total of 26 patients (pts), 6 in the survey and 20 in the literature were found. Two different types of association were identified: (1) Symptomatic type (5 pts): MS preceding the onset of narcolepsy, which was always without cataplexy (NwC); sleep onset REM episodes (SOREM) and hypocretin deficiency were observed in some, and lesions in the hypothalamus in all patients. (2) Coexisting type (18 pts): MS preceding or following the appearance of NC with SOREM, hypocretin deficiency but no lesions in the hypothalamus. A positive effect of steroids, immunoglobulins or natalizumab on narcolepsy symptoms was observed in four patients. DISCUSSION: Narcolepsy and MS are rarely associated. In addition to NwC secondary to hypothalamic demyelination, some patients present a coexistence of MS with NC without detectable hypothalamic lesions. The rarity of reports on this association probably reflects underrecognition. The elucidation of underlying genetic and immune mechanisms needs further studies.

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentition’s subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Composite materials: composition, properties and clinical applications. A literature review.

Various composite materials are available today for direct restorative techniques. The most well-known materials are the hybrid composites. This technology, based on methacrylates and different types of filler coupled with silanes, has been continuously improved. Disadvantages such as polymerisation shrinkage, bacterial adhesion and side effects due to monomer release still remain. The aim of material development is to eliminate or at least reduce these negative factors by adapting the individual components of the material. With ormocers, the methacrylate has been partially replaced by an inorganic network. According to recent studies, the biocompatibility was not improved in all cases. The development of compomer was an attempt to combine the positive properties of glassionomers with composite technology. This has only partially succeeded, because the fluoride release is low. In an in-situ study, a caries protective effect could be shown at least in the first days following filling placement with concurrent extra-oral demineralisation. By replacing the chain-monomers in the composite matrix by ring-shaped molecules, a new approach to reduce polymerisation shrinkage was investigated. A new group of materials, the siloranes, has been developed. Siloranes are hydrophobic and need to be bonded to the dental hard tissue using a special adhesive system. Long-term clinical studies are still needed to prove the superiority of this new group of materials over modern hybrid composites.