Search

Background: Chronic kidney disease (CKD) is a progressive disease with an inverse relationship between kidney function and levels of inflammation and oxidative stress. Curcumin and Boswellia serrata have been reported to exert anti-inflammatory effects on the cyclooxygenase and lipoxygenase pathways. Therefore, the purpose of this study was to study the effects of a supplement containing curcumin and B. serrata on eicosanoid derivatives in early stage CKD patients who had not initiated hemodialysis., Methods: Sixteen patients with stage 2 and stage 3 CKD (56.0 ± 16.0 years, 171.4 ± 11.9 cm, 99.3 ± 20.2 kg) were randomized into a treatment group with curcumin and B. serrata or a placebo group. The dependent variables prostaglandin E 2 (PGE 2 ), 5-hydroxyicosatetraenoic acid, 12-hydroxyicosatetraenoic acid, 15-hydroxyicosatetraenoic acid, and 13-hydroxyoctadecadienoic acid were measured both before and after 8 weeks of supplementation. Results were analyzed by using a repeated-measures analysis of covariance for compliance and body-mass index., Results: A significant group effect (p = 0.05), and a trend for Group × Time interaction (p = 0.056) were detected for PGE 2 . No significant differences were observed for any other variables., Conclusions: This is the first article of baseline levels of the dependent variables in early stage CKD, and the first article to show a significant effect of these supplements on PGE 2 in early stage CKD. Further studies are needed to determine whether curcumin and B. serrata may be effective means to reduce inflammation in patients with CKD.

The oxaloacetate acetylhydrolase (OAH, EC 3.7.1.1)-encoding gene Ss-oah1 was cloned and functionally characterized from Sclerotinia sclerotiorum. Ss-oah1 transcript accumulation mirrored oxalic acid (OA) accumulation with neutral pH induction dependent on the pH-responsive transcriptional regulator Ss-Pac1. Unlike previously characterized ultraviolet (UV)-induced oxalate-deficient mutants ('A' mutants) which retain the capacity to accumulate OA, gene deletion Δss-oah1 mutants did not accumulate OA in culture or during plant infection. This defect in OA accumulation was fully restored on reintroduction of the wild-type (WT) Ss-oah1 gene. The Δss-oah1 mutants were also deficient in compound appressorium and sclerotium development and exhibited a severe radial growth defect on medium buffered at neutral pH. On a variety of plant hosts, the Δss-oah1 mutants established very restricted lesions in which the infectious hyphae gradually lost viability. Cytological comparisons of WT and Δss-oah1 infections revealed low and no OA accumulation, respectively, in subcuticular hyphae. Both WT and mutant hyphae exhibited a transient association with viable host epidermal cells at the infection front. In summary, our experimental data establish a critical requirement for OAH activity in S. sclerotiorum OA biogenesis and pathogenesis, but also suggest that factors independent of OA contribute to the establishment of primary lesions., (© 2014 BSPP AND JOHN WILEY & SONS LTD.)

Objectives: To assess whether the use of a graft and/or membrane post-tooth extraction improves healing of the site dimensionally, radiographically, and/or histologically., Materials and Methods: MEDLINE and EMBASE and the Cochrane Central register of controlled trials (CENTRAL) were searched up until August 2011. Randomized controlled trials that included and compared healing post-tooth extraction between a control (no intervention) and a graft and/or membrane (test) were selected., Results: Titles and abstracts of 2,861 papers were screened. A total of 42 papers were selected for full text reading. Nine papers met the eligibility criteria and were selected for further analysis. Because of the varying graft materials used and the different methods of investigation, as well as the variation in follow-up times, a meta-analysis was not possible. The present review found that clinically, there was a range in loss of width in the control sites of 2.46 mm (SD 0.4 mm) to 4.56 mm (SD 0.33 mm) compared to 1.14 mm (SD 0.87 mm) to 2.5 mm (SD 1.2 mm) in the test sites. The range in loss of height in control sites was 0.9 mm (SD 1.6 mm) to 3.6 mm (SD 1.5 mm) compared to a gain of 1.3 mm (SD 2 mm) to a loss of 0.62 mm (SD 0.51 mm) in test sites. Radiographically a range of change in bone height of between 0.51 mm (No SD) to 1.17 mm (SD 1.23 mm) was noted in control sites compared to a change of between 0.02 mm (SD 1.2 mm) and 1 mm (SD 1.4 mm) in test sites., Conclusion: There is limited data regarding the effectiveness of alveolar ridge preservation therapies when compared to the control. Overall the socket intervention therapies did reduce alveolar ridge dimensional changes post-extraction, but were unable to prevent resorption. Histology did demonstrate a large proportion of residual graft material that may account for some of the difference in alveolar ridge dimensions at follow up., (© 2012 Wiley Periodicals, Inc.)

Aim: This study developed the Schiff Index into a Cumulative Hypersensitivity Index (CHI) to measure dentine hypersensitivity (DH) severity per subject. It validates this score by investigating if it compares to one comprising a percentage score from all tooth surfaces and as a highest score per subject., Materials and Methods: Overall, 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and oral Schiff Index scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. CHI scores and highest Schiff Index scores were also recorded per subject. Spearman correlation coefficients (p-values) assessed the relationship between CHI scores, Schiff Index percentages and Schiff Index highest per subject., Results: In subjects with a Schiff Index score of 1 or more on at least one tooth surface (indicating DH was present), correlation of the CHI score to the Schiff Index percentage score was 0.982 (p < 0.001). Correlation of the sextant score to the highest Schiff Index score per subject was 0.963, (p < 0.001). DH was more likely on tooth surfaces with gingival recession (p < 0.001) and without bleeding on probing (p < 0.01)., Conclusions: This study has validated a novel CHI score to indicate DH severity per subject and may help guide clinical management., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Chronic kidney disease (CKD) is characterized by a continuous reduction in kidney function, increased inflammation, and reduced antioxidant capacity. The objective of this study was to assess the effects of a herbal supplement on systemic inflammation and antioxidant status in non-dialysis CKD patients. Sixteen patients with CKD (56.0±16.0 yrs, 171.4±11.9 cm, 99.3±20.2 kg) were randomly chosen to receive a herbal supplement composed of Curcuma longa and Boswellia serrata, or placebo. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), glutathione peroxidase (GPx), and serum C-reactive protein (CRP) were measured at baseline and 8 weeks. Baseline data demonstrated elevated inflammation and low antioxidant levels. A significant time effect (p=0.03) and time x compliance interaction effect (p=0.04) were observed for IL-6. No significant differences were observed for any other variables. This study demonstrates that mild and moderate CKD is associated with chronic inflammation and low antioxidant activity. Systemic inflammation and impaired antioxidant status may be greater in CKD populations with multiple comorbidities. Curcumin and Boswellia serrata are safe and tolerable and helped to improve the levels of an inflammatory cytokine.

Objective: To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) at detecting peri-implant bone defects., Materials and Methods: Implants were placed in fresh bovine ribs in osteotomy sites of varying diameter (five with no peri-implant space, five with a 0.35 mm space, five with a 0.675 mm space) and imaged using (i) digital long cone periapical radiographs (LCPAs), (ii) limited volume CBCT using 3D Accuitomo 80(®) and (iii) large volume CBCT using i-CAT Next Generation(®). Images from each were randomly presented to nine examiners on two occasions. Confidence in diagnosing the presence or absence of a peri-implant radiolucency was recorded on a five-point scale. Receiver Operating Characteristic (ROC) analysis and Kappa tests were performed., Results: Digital LCPAs were better at diagnosing a peri-implant bone defect when the peri-implant space was 0.35 mm (P < 0.02). As the peri-implant space increased to 0.675 mm, there was no significant difference in diagnostic accuracy between the three imaging methods. Sensitivity of LCPAs (100) and Accuitomo (97.8) was better than i-CAT (64.4) (P < 0.02). LCPAs and i-CAT had significantly better specificity and positive predictive value than Accuitomo. The negative predictive value of LCPA was significantly better than i-CAT. LCPAs showed better intra-examiner and inter-examiner agreement than CBCT., Conclusion: Within the limitations of this study, LCPAs are a reliable and valid method of detecting circumferential peri-implant bone defects and performed significantly better than CBCT., (© 2012 John Wiley & Sons A/S.)

Objectives: To assess effects of dehydration on tooth colour. To investigate any change in tooth colour resulting from dehydration and the time required for any change to return to baseline., Methods: 20 subjects with intact maxillary central incisors were recruited. In each case one incisor was randomly assigned as test tooth with the other acting as control. Spectrophotometric shade of the test teeth was assessed before dehydration and after rubber dam isolation every 10min for 30min. Test teeth were allowed to rehydrate and measurements taken every 10min for 30min. Data was collected in CIE L*a*b* colour coordinates. A panel of 10 examiners assessed before and after dehydration digital images of the control and test teeth. The panel judged whether central incisors were of same or different shade and which tooth was lighter if a difference was detected., Results: All colour coordinates showed significant differences between baseline versus 10, 30min of dehydration and 30min of rehydration (p<0.02) except L* after 30min rehydration. The panel found test and control teeth to be of same shade before and of different shade after dehydration (p<0.001). Test teeth were significantly lighter after dehydration (p<0.005)., Conclusion: A significant change in shade of teeth when dehydrated was detected by both instrumental and visual assessment. Teeth became lighter and perceivable colour change had not returned to baseline shade within 30min of rehydration. Therefore shade matching procedures should be carried out before the teeth are exposed to dehydration., Clinical Significance: As most dental procedures lead to dehydration of teeth which can alter their shade and may lead to errors in shade matching. To avoid unacceptable mismatch of colour between natural teeth and dental restoration it is important that the shade matching procedure is carried out at the beginning of the appointment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Human and equine outbreaks caused by eastern equine encephalomyelitis virus (EEEV) typically occur in North America adjacent to coastal wetlands associated with the presence of Culiseta melanura (Coquillet) mosquitoes. Eastern equine encephalomyelitis (EEE) is an emerging disease in Tennessee, as the first records of equine disease began in 2002. In 2006 we trapped and tested mosquitoes for EEEV at hardwood swamps in western Tennessee that were at the epicenter of a multi-equine outbreak in fall of 2005. Additionally, the Tennessee Valley Authority tested mosquito pools collected in Tennessee swamps from 2000 to 2007 for the presence of arboviruses. Two pools of EEEV positive Culex erraticus (Dyer and Knab) mosquitoes were found (one each in 2003 and 2004) in a county adjacent to where the 2005 outbreak occurred. In 2008, another EEE outbreak involving multiple horses occurred in West Tennessee. A brain specimen was collected from a horse during this outbreak and the first isolate of EEEV from Tennessee was obtained. In total, 74,531 mosquitoes collected from 2000 to 2008 were tested via polymerase chain reaction and VecTest for EEEV. The traditional enzootic vector, Cs. melanura, was found in low numbers at all collection sites. Cx. erraticus, however, was consistently found in high numbers and was the only mosquito species in which EEEV was detected. We suggest that EEE transmission may be maintained by Cx. erraticus in a nontraditional cycle. We discuss the importance of a nontraditional cycle from the perspective of EEEV adaptation and emergence.

Background: Healthcare providers are a primary source of information on preventive health issues for patients. Further research related to physical activity (PA) promotion in the primary care setting is needed., Objective: To explore the feasibility of a physician and community PA intervention using a pedometer for: increasing PA levels among inactive patients; enhancing relationships between physicians and community PA partners; and influencing the PA promotion habits of physicians., Methods: A 6-week PA intervention was delivered to 152 inactive patients who were recruited in physician waiting rooms, counselled by their physicians, provided with a pedometer and referred to a community action site (CAS) at their local recreation centre for further support. PA was measured at baseline and follow-up using the International Physical Activity Questionnaire. Follow-up interviews were conducted with physicians and recreation representatives on the challenges and benefits associated with the intervention., Results: Study patients significantly increased their PA (103% change in MET min/week). Physicians and recreation professionals were highly satisfied with the intervention and partnership. There were challenges to ongoing communication. Physicians reported increased awareness of the pedometer and community resources as supports for PA., Conclusion: A pedometer-based PA intervention delivered by physicians in partnership with a community PA stakeholder is feasible and warrants further research. Long-term maintenance of this intervention would require resources for pedometers, and ongoing contact and communication between the physicians and CAS to ensure availability of community supports.

Background: The effect of smoking on soft tissues after periodontal treatment has been extensively studied. However, little focus has been placed on the impact of smoking on bone regeneration after treatment. The aim of this review is to systematically assess the effect of smoking on bone regeneration after periodontal treatment., Methods: A protocol was established and studies were sourced from five electronic databases. Screening, data abstraction, and quality assessment was conducted by two review authors. Prospective and retrospective clinical studies assessing bone regeneration in smokers and non-smokers after periodontal therapy were selected. In addition, arms of clinical trials comparing different interventions that reported results separately for smokers and non-smokers were also included. Primary outcome measures were based on clinical and/or radiographic indicators of bone regeneration after periodontal therapy. The review and meta-analysis followed many of the recommendations outlined in the preferred reporting items for systematic reviews and meta-analyses statement., Results: Six of 10 studies included in this review concluded that smoking negatively influenced bone regeneration. A meta-analysis of a subgroup of three studies demonstrated that smoking resulted in significantly less bone gain (P = 0.03) as measured by a change in the probing bone level after the treatment of intrabony defects with guided tissue regeneration. The meta-analysis showed a standardized mean difference of -2.05 (95% confidence interval: -2.64 to -1.47) using the random-effects model., Conclusions: Smoking has a negative effect on bone regeneration after periodontal treatment. Patients should be advised that their smoking habit may result in poorer bone regeneration after periodontal treatment.

The effect of loading on microleakage and microtensile bond strength of MOD composite restorations bonded with either self-etching or etch-and-rinse adhesive was investigated. MOD cavities were prepared in 28 extracted molar teeth. 14 teeth were bonded with a one-step self-etching adhesive (G-Bond) and 14 with an etch-and-rinse adhesive (Optibond Solo Plus) then restored with resin composite. For each adhesive, 7 teeth were loaded and 7 unloaded (controls). Loading was achieved with an axial force of 80 N at 2.5 cycles/s for 250,000 cycles. All the teeth were stored in 0.25% rhodamine solution for 24 h and sectioned in a bucco-lingual direction at the proximal boxes to examine microleakage then further sliced mesiodistally into beams for the μTBS test. Failure modes were determined using confocal and scanning electron microscopy. ANOVA assessed the effect of loading on microleakage and bond strength. After loading, restorations bonded with G-Bond exhibited significantly greater dye penetration compared to Optibond Solo Plus at both the axial walls and cavity floor. On the other hand, loading significantly reduced the μTBS of Optibond Solo Plus, whereas it had no significant effect on the μTBS of G-Bond.

Objective: To evaluate the use of a single Astra Tech implant to support a two-unit cantilever fixed dental prosthesis., Materials and Method: Twenty-nine subjects with an edentulous space (at least equivalent to two bicuspid units) in the premolar/molar segments of the maxilla or mandible with opposing natural teeth or a fixed/removable prosthesis were treated. They were provided with either a 4 or 5.0 mm diameter fixture MT OsseoSpeed. Prostheses were constructed using a cast-to abutment as a one-piece unit with porcelain fused to precious metal to allow direct screw retention., Results: Subjects expressed a high satisfaction with treatment, including appearance and function. The most important complication was abutment screw loosening. It occurred as a single episode in four subjects and in another six subjects the loosening was recurrent. Bone levels were stable and there were no significant differences in radiographic bone height between cantilever and non-cantilever sides of the implant at any time point., Conclusion: Single implants can be successfully used to support two-unit cantilever FDPs in the premolar region. A common factor could not be identified in relation to abutment screw loosening., (© 2011 John Wiley & Sons A/S.)

It has been suggested that the use of alcohol-containing mouthrinses could lead to the presence of acetaldehyde in saliva. In this cross-over study, salivary acetaldehyde levels and microbial profiles were determined before and after rinsing with ethanol-containing mouthrinses with essential oils (EO) and cetyl pyridinium chloride (CPC) as the active ingredients, and with 21.6% ethanol and water controls. After rinsing with all ethanol-containing rinses, acetaldehyde was detected in saliva after 30 s but declined to low levels after 5 min. The highest peak levels were seen with the ethanol control (median = 82.9 μM at 2 min) and were significantly higher than those seen at the same time after rinsing with the EO rinse (43.1 μM). There was no correlation between microbial counts or plaque scores and acetaldehyde levels, although dividing the subjects on the basis of a peak acetaldehyde salivary concentration of > 90.8 μM after the ethanol rinse revealed that the high responders were highly significantly more likely to harbour salivary yeasts than were the low responders. Rinsing with ethanol-containing mouthrinses causes a rapid, but transient, increase in salivary acetaldehyde levels., (© 2011 Eur J Oral Sci.)

Objective: To evaluate the effect of resin coating and occlusal loading on microleakage of class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic restorations., Material and Methods: Molars were prepared for an mesio-occlusal-distal (MOD) inlay and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement). After 24 h of water storage, the restored teeth in each group were divided into two subgroups: unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM) was used for evaluation of microleakage. The locations of the measurements were assigned to the cavity walls and floor., Results: Loading did not have a significant effect on microleakage in either the resin-coated or non-coated group. Resin coating significantly reduced microleakage regardless of loading. The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation also revealed that microleakage at the enamel surface was minimal regardless of resin coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated dentin showed decreased leakage., Conclusions: Resin coating with a combination of a dentin-bonding system and a flowable resin composite may be indicated prior to impression-taking when restoring teeth with CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

The diverse health needs of patients presenting to emergency department (EDs) are such that precise handovers between staff are critical to ensure all aspects of care are communicated. The handover process in an ED in south western Sydney, Australia, did not always achieve this, so a new approach, in which handovers tak place next to patients, has been developed. This article outlines the background to the change, describes the new system and reports the results of its audit.

Background: A number of studies have suggested that implant failure and associated bone loss is greater in subjects with a history of periodontitis., Purpose: To evaluate the risk for marginal bone loss around implants and implant failure in subjects with a history of periodontitis compared with periodontally healthy subjects in studies with a minimum 3-year follow-up., Data Sources: The MEDLINE, EMBASE, and PubMed databases and relevant journals were searched up to July 1, 2008, with restriction to English language., Review Methods: Prospective and retrospective longitudinal observational clinical studies comparing periodontal/peri-implant variables among subjects with periodontitis and subjects who were periodontally healthy were included. Screening of studies, quality assessment, and data extraction were conducted independently and in duplicate. Clarification of missing and unclear information was not sought. Outcome measures were: implant survival/failure, peri-implant parameters, changes in radiographic marginal bone level, probing pocket depth, and gingival index., Results: Seventeen potential studies were identified and six studies were accepted comparing patients with periodontitis and periodontally healthy patients treated with implants. Five studies were eligible for meta-analysis of implant survival and four studies were eligible for meta-analysis of bone loss around implants. The odds ratio for implant survival was significantly in favor of periodontally healthy patients (3.02, 95% confidence intervals 1.12-8.15). A random effects model showed more marginal bone loss in periodontitis subjects compared with periodontally healthy subjects (standard mean difference 0.61, 95% confidence interval 0.14-1.09)., Conclusions: Within the limitations of the heterogenous studies available, a moderate level of evidence indicates that periodontitis subjects were at significantly higher risk for implant failure and greater marginal bone loss as compared with periodontally healthy subjects. Prospective observational studies with subject-based designs are recommended.

Objective: To assess the accuracy of measuring the cortical bone thickness adjacent to dental implants using two cone beam computed tomography (CBCT) systems., Material and Methods: Ten 4 x 11 mm Astra Tech implants were placed at varying distances from the cortical bone in two prepared bovine ribs. Both ribs were scanned in a reproducible position using two different CBCT scanners. Ten examiners each carried out four measurements on all 10 implants using the two CBCT systems: vertical distance between the top of the implant and the alveolar crest (IT-AC), and thickness of the cortical bone from the outer surface of the implant threads at 3, 6 and 9 mm from the top of the implant. Ground sections were prepared and bone thickness was measured using a light microscope and a graticule to give a gold standard (GS) measurement., Results: The examiner's measurements were significantly different between CBCT systems for the vertical and thickness dimensions (P<0.001) while measuring the cortical bone thickness between 0.3 and 3.7 mm. Within that range, i-CAT NG measurements were consistently underestimated in comparison with the GS. Accuitomo 3D60 FPD measurements closely approximated the GS, except when cortical bone thickness was <0.8 mm. The mean percentage errors from the GS at 3, 6 and 9 mm measurement levels were 68%, 28% and 18%, respectively, for i-CAT NG and 23%, 5% and 6%, respectively, for Accuitomo 3D60 FPD., Conclusions: Within the limitations of this study, it was concluded that i-CAT NG (voxel size 0.3) may not produce sufficient resolution of the thin cortical bone adjacent to dental implants and, therefore, the measurements may not be accurate; whereas, Accuitomo 3D60 FPD (voxel size 0.125) may produce better resolution and more accurate measurement of the thin bone.

In 2006, 2,817 blood-fed mosquitoes were collected from the site of a 2005 eastern equine encephalitis outbreak in Chester County, TN. Using a polymerase chain reaction-based assay, 264 vertebrate hosts were identified from seven mosquito species. Culex erraticus and Cx. nigripalpus fed on a diversity of mammalian, avian, and reptilian hosts, whereas Anopheles quadrimaculatus and An. punctipennis were predominantly mammalophagic. Overall, 27% of Cx. nigripalpus, 16% of Cx. erraticus, and 7% of An. quadrimaculatus blood meals were acquired from avian hosts. No avian-derived blood meals were identified from An. punctipennis. The house finch, Carolina wren, and mourning dove were the most commonly identified avian host species. By incorporating this study with flight range, vector competence, and virus field isolation data, we assessed certain aspects of the enzootic and epizootic vectorial capacity of the mosquito species present at this outbreak site.

This study investigated the effect of resin coating and occlusal loading on adhesion and microleakage of all-ceramic crowns. Molars were prepared for an all-ceramic crown and were divided into two groups: non-coated (control) and resin-coated with Clearfil Tri-S Bond. Crowns were fabricated using CEREC 3 and cemented using Clearfil Esthetic Cement. After 24 h of storage in water, the restored teeth in each group were divided into two subgroups: unloaded, or loaded while stored in water. Mechanical loading was achieved with an axial force of 80 N at 2.5 cycles s(-1) for 250,000 cycles. After immersion in Rhodamine B, the specimens were sectioned and processed for microleakage evaluation by confocal microscopy, which was followed by further sectioning for microtensile bond testing. Loading had no significant effect on microleakage in either the resin-coated or non-resin-coated groups. Resin coating did not reduce the microleakage at the dentine interface but increased the microleakage at the enamel interface. All the beams fractured during slicing when non-coated and loaded. The bond strengths of non-coated and unloaded, resin-coated and unloaded, and resin-coated and loaded groups were 15.82 +/- 4.22, 15.17 +/- 5.24, and 12.97 +/- 5.82 MPa, respectively. Resin coating with Clearfil Tri-S Bond improved the bonding of resin cement to dentine for loaded specimens. However, it was not effective in reducing the microleakage, regardless of whether it was loaded or unloaded.

Objective: To determine the safety and efficacy of altering the ratio of carbohydrate and protein in low-energy diets in conjunction with a popular exercise program in obese women., Design: Matched, prospective clinical intervention study to assess efficacy of varying ratios of carbohydrate and protein intake in conjunction with a regular exercise program., Participants: One-hundred sixty one sedentary, obese, pre-menopausal women (38.5 ± 8.5 yrs, 164.2 ± 6.7 cm, 94.2 ± 18.8 kg, 34.9 ± 6.4 kg.m⁻², 43.8 ± 4.2%) participated in this study. Participants were weight stable and not participating in additional weight loss programs., Methods: Participants were assigned to either a no exercise + no diet control (CON), a no diet + exercise group (ND), or one of four diet + exercise groups (presented as kcals; % carbohydrate: protein: fat): 1) a high energy, high carbohydrate, low protein diet (HED) [2,600; 55:15:30%], 2) a very low carbohydrate, high protein diet (VLCHP) [1,200 kcals; 63:7:30%], 3) a low carbohydrate, moderate protein diet (LCMP) [1,200 kcals; 50:20:30%] and 4) a high carbohydrate, low protein diet (HCLP) [1,200 kcals; 55:15:30%]. Participants in exercise groups (all but CON) performed a pneumatic resistance-based, circuit training program under supervision three times per week., Measurements: Anthropometric, body composition, resting energy expenditure (REE), fasting blood samples and muscular fitness assessments were examined at baseline and weeks 2, 10 and 14., Results: All groups except CON experienced significant reductions (P < 0.05 - 0.001) in waist circumference over 14 weeks. VLCHP, LCHP and LPHC participants experienced similar but significant (P < 0.05 - 0.001) reductions in body mass when compared to other groups. Delta responses indicated that fat loss after 14 weeks was significantly greatest in VLCHP (95% CI: -5.2, -3.2 kg), LCMP (-4.0, -1.9 kg) and HCLP (-3.8, -2.1 kg) when compared to other groups. Subsequent reductions in % body fat were significantly greater in VLCHP, LCMP and HCLP participants. Initial dieting decreased (P < 0.05) relative REE similarly in all groups. All exercise groups significantly (P < 0.05) improved in muscular fitness, but these improvements were not different among groups. Favorable but non-significant mean changes occurred in lipid panels, glucose and HOMA-IR. Leptin levels decreased (P < 0.05) in all groups, except for CON, after two weeks of dieting and remained lower throughout the 14 week program. Exercise participation resulted in significant improvements in quality of life and body image., Conclusion: Exercise alone (ND) appears to have minimal impact on measured outcomes with positive outcomes apparent when exercise is combined with a hypoenergetic diet. Greater improvements in waist circumference and body composition occurred when carbohydrate is replaced in the diet with protein. Weight loss in all diet groups (VLCHP, LCMP and HCLP) was primarily fat and stimulated improvements in markers of cardiovascular disease risk, body composition, energy expenditure and psychosocial parameters.

Objective: The aim of this study was to assess oral health-related beliefs and attitudes, health behaviour of smokers in relation to the Transtheoretical Model (TTM) of behaviour change, willingness to have smoking cessation provided together with periodontal treatment., Material and Methods: Postal questionnaire was sent to 500 referred patients. Part 1 looked at attitudes and beliefs about periodontal disease, Part 2 aimed at current smokers focused on the TTM and smoking cessation., Results: Response rate was 56% (n=277); 67% females, 33% males. Mean age was 44.9 years (SD 12.45); 24.5% current smokers, 30.3% past smokers, 45.5% never smokers. Fewer smokers reported "bleeding gums" (p=0.027), but more smokers reported "having loose teeth" (p=0.016). The TTM stages of change indicated that 31% of current smokers were in pre-contemplation of quitting smoking, 46% were in contemplation and 23% were in preparation. Twenty-three percent of the past smokers were in action and 77% in maintenance. Smokers showed differences in the "self-re-evaluation" (p=0.001) and "self-liberation" (p=0.015) processes of change depending on their stage of change (pre-contemplation or preparation). Nearly half (49%) of the current smokers who wanted to quit requested smoking cessation to be provided alongside their periodontal treatment., Conclusion: A large proportion of periodontal patient smokers may be considering quitting, and nearly half requested provision of smoking cessation intervention in conjunction with the periodontal treatment.

Aim: Transient bacteraemia and endotoxaemia, and elevated levels of systemic cytokines have been reported following subgingival debridement. This study aimed to investigate the effect of chlorhexidine (CHX) solution on circulating levels of lipopolysaccharide (LPS) and interleukin-6 (IL-6) when used as an irrigant during ultrasonic debridement in patients with periodontitis., Material and Methods: Eighteen patients with moderate to advanced chronic periodontitis were treated in a split-mouth, crossover, single-masked study. Irrigation with 0.02% CHX solution or water was used during treatment of two ipsilateral quadrants on two separate occasions 7 days apart, randomized as to order. Peripheral blood samples were collected for circulating levels of LPS and IL-6 at baseline, 5 and 120 min. after instrumentation commenced., Results: Median concentrations of LPS were elevated from baseline to 5 min. into treatment with both CHX and control irrigant (p<0.05). Median levels of IL-6 increased with both treatments from baseline to 120 min. (p<0.001): CHX, 0.81-1.85 pg/ml; control, 0.78-1.78 EU/ml., Conclusions: Ultrasonic instrumentation in patients with moderate to advanced periodontitis increases circulating levels of LPS after 5 min. and IL-6 120 min. after commencement of treatment, and is not affected by using 0.02% CHX as an irrigant instead of water.

This study investigated the hypothesis that coating eroded teeth with a resin-based dentin bonding agent gave protection from tooth wear. Nineteen adults with palatal tooth wear exposing dentin were recruited, following referral by their general dental practitioner. Alternate teeth were coated with the resin adhesive, while the uncoated teeth acted as controls. Accurate impressions of the eroded teeth, onto which were cemented machined stainless steel discs to act as reference areas, were scanned with a non-contacting laser profilometer at 3, 6, 12 and 24 months. The mean thickness of resin at baseline application was 0.15 mm and, from 0 to 6 months, the rate of wear of the control teeth was higher than those covered with Seal & Protect. There was a statistically significant difference in "wear" measured between resin covered and control teeth at three months. The Inter Class Correlations (repeated measurements) for the step heights obtained for the original and repeat impressions was excellent at 0.99. This study shows that coating eroded teeth with a resin-based adhesive has the potential to prevent further tooth wear.

Objectives: The aim was to investigate the relationship between bone mineral density (BMD) of the jaws (mandible and maxilla) and other skeletal sites. In addition, the influence of gender, smoking and the number of years without natural teeth were examined., Materials and Methods: 18 edentulous patients (9 females, 9 males) with a mean age of 67.1 (sd 12.6) years had DXA scans to assess the BMD of the lumbar spine and hip, together with the ramus, body and symphysis of the mandible and the anterior of the maxilla., Results: BMD values for the ramus were similar to those for the femur but significantly lower than the lumbar spine. The body and anterior mandible had higher values and the anterior maxilla lower values than both the femur and ramus. The ramus BMD showed moderately strong relationships with the standard measures of BMD in the spine and hip, but the BMD of other areas of the jaws showed no relationship with skeletal sites. The BMD for both the hip and the ramus showed an inverse relationship with increasing age. There was no statistically significant relationship between BMD of hip, spine and jaw and either years edentulous or cigarette years. (207), Conclusions: Although the ramus of the mandible may show correlation of BMD with skeletal sites, the areas of the jaws where implants may be placed do not. Therefore BMD of the skeletal sites could not be used to predict BMD of the jaws. The BMD of the jaws as measured by DXA showed no relationship with either years edentulous or cigarette smoking.

The aim of this study was to measure differences in oral pH after subjects drank carbonated and noncarbonated acidic soft drinks. Oral pH was measured in 17 subjects at 4 oral sites with beetrode electrodes after each subject drank 50 mL of noncarbonated and carbonated blackcurrant beverages. There were no statistical differences for either beverage regarding the time taken to recover a pH of 5.5, 6.0, and 6.5. Oral pH recovered to 6.5 within 90 seconds with both drinks. The median lowest pH recorded after 30 seconds at the 4 sites for both drinks was > pH 4.9, but there was no statistical difference in the clearance between the drinks. The implication may be that carbonation is not directly responsible for the erosive potential of different beverages.

Background: Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease., Objective: To test the hypothesis that smokers have more disease in the upper anterior region., Methods: A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels., Results: The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3+/-25.5%, non-smokers: 48.3+/-31.2%, p<0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3+/-6.8%, non-smokers: 9.8+/-8.8%; p=0.050)., Conclusion: The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.

Purpose: The aim of this study was to compare the clearance of an acidic drink in patients with tooth wear caused by regurgitation erosion to that in patients without tooth wear., Materials and Methods: Oral clearance was measured using antimony electrodes at 4 soft tissue sites around the mouth in the patients with erosion caused by regurgitation and compared to a matched control group. The data were analyzed for pH at the resting state, the time below 5.5, and the lowest recorded pH. In addition, the resting hydration levels and viscosity of fluid from the minor salivary glands, the pH of resting saliva, and the flow rate and buffering capacity of stimulated saliva were compared between the 2 groups of patients., Results: The pH recorded at the tip of the tongue reached a lower level in the controls than in those in the erosive tooth wear group (P < .05) and the time that the pH remained below 5.5 was longer in the controls than those with tooth wear (P < .05). The flow rate from the minor salivary glands (P < .05) and the viscosity of resting saliva appeared to differ between the two groups (P < .001)., Conclusion: Oral clearance at the tip of the tongue, measured as a function of the lowest pH reached and the time below 5.5, was quicker in those with erosive tooth wear than the controls. It is suggested that this may be a result of a feedback mechanism from constant exposure of the oral environment to low pH.

Aim: To review the potential biological mechanisms underlying the effects of tobacco smoking on periodontitis., Main Findings: Smoking has major effects on the host response, but there are also a number of studies that show some microbiological differences between smokers and non-smokers. Smoking has a long-term chronic effect on many important aspects of the inflammatory and immune responses. Histological studies have shown alterations in the vasculature of the periodontal tissues in smokers. Smoking induces a significant systemic neutrophilia, but neutrophil transmigration across the periodontal microvasculature is impeded. The suppression of neutrophil cell spreading, chemokinesis, chemotaxis and phagocytosis have been described. Protease release from neutrophils may be an important mechanism in tissue destruction. Tobacco smoke has been found to affect both cell-mediated immunity and humoral immunity. Research on gingival crevicular fluid has demonstrated that there are lower levels of cytokines, enzymes and possibly polymorphonuclear cells in smokers. In vitro studies have shown detrimental effects of nicotine and some other tobacco compounds on fibroblast function, including fibroblast proliferation, adhesion to root surfaces and cytotoxicity., Conclusion: Tobacco smoking has widespread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment.

Background: The acute-phase response involves molecules including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and C-reactive protein (CRP). This study aimed to determine whether subgingival scaling resulted in rapid changes in plasma concentrations of these molecules., Methods: Twenty-three non-smoking adults with chronic periodontitis received subgingival scaling for 60 minutes. Venous blood samples were taken at 0, 15, 30, 60, and 120 minutes. TNF-alpha and IL-6 were assayed from all samples and CRP from the baseline and final samples. Lipopolysaccharide (LPS) was assayed at 0, 15, and 30 minutes using limulus lysate assay (LAL) and EndoCAb Ig assays., Results: LPS assays were suggestive of a transient low-grade bacteremia, but changes in LPS approaching significance (P=0.061) were seen with LAL only. There was a significant increase in circulating TNF-alpha (P=0.0387) and IL-6 (P<0.0001), and the degree of change in TNF-alpha was correlated with the severity of periodontal breakdown (P=0.001). There was also a significant correlation between levels of IL-6 and TNF-alpha (P<0.001)., Conclusions: Chronic periodontitis patients undergoing an episode of subgingival scaling show a significant elevation in circulating TNF-alpha and IL-6. This may account for anecdotal reports of pyrexia following treatment and may be significant in terms of the relationship between periodontal disease, bacteremia, and cardiovascular disease.

Statement of Problem: The accuracy of an implant fixture-level impression is affected by the type of impression tray used., Purpose: The purpose of this in vitro study was to investigate the accuracy of open tray implant impressions comparing polycarbonate stock impression trays and rigid custom-made impression trays to make implant fixture-level impressions., Material and Methods: Gold cylinder pairs, splinted by gold bars (reference frameworks) were constructed on an aluminum typodont. Polyether impressions were made of 2 pairs of Brånemark 3.75-mm diameter fixtures mounted in an aluminium typodont, with 3 stock impression trays, 3 close-fit custom trays, and 3 spaced custom impression trays, by use of an open tray technique. The casts produced were assessed for accuracy by attaching the reference frameworks with alternate single screws and measuring the vertical fit discrepancy of these reference frameworks to the analogs within the working cast using a traveling microscope. Comparison of gap dimensions by tray type was performed with a nonparametric Kruskal-Wallis analysis of variance (ANOVA) followed by pair-wise Mann-Whitney U tests. To adjust for multiple comparisons in the post-ANOVA contrasts (P<.02). Comparison of gap dimensions between anterior and posterior regions were performed with Mann-Whitney U tests (P <.05)., Results: The results showed that the mean fit accuracy, as measured by vertical fit discrepancy, of casts from the stock trays (23 +/- 20 microm) were statistically significantly less (P<.001) than the spaced custom trays (12 +/- 10 microm) or close fit custom trays (11 +/- 10 microm). The difference in median gap size for analogs with a 20-mm separation was 10 microm., Conclusion: Within the limits of this in vitro study, rigid custom trays produced significantly more accurate impressions than the polycarbonate stock trays. The stock trays used in this study could not produce accurate impressions consistently. For analogs with a 20-mm separation, there was a difference in medians of 10 microm in accuracy between the stock and custom trays.

Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands., Methods: Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography., Results: In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was available in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged (4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%) failed to improve. Sialographic data were available on 21 glands: in 10 (48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction., Conclusions: Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases.

Purpose: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction., Methods: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire., Results: Of 86 cases of sialolithiasis treated, in 55 (64%) it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed., Conclusions: Stone removal from the salivary duct system by radiologically guided, minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.