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Dental erosion is a disease occurring not only in adults but also in children. Thereby, deciduous and permanent teeth are involved. The cause of these lesions is an extended acid exposure due to extrinsic or intrinsic factors. Unlike caries, the erosive process occurs without involving bacteria. Main reasons are extensive consumption of erosive (soft) drinks and foodstuffs or gastrooesophageal reflux with regurgitation of gastric acid into the oral cavity. Often, the first signs of this disease are erosive lesions of the teeth and therefore dentists have an important role in early diagnosis. Two clinical cases are presented and the clinical diagnosis, the course and possible systemic and local preventive and therapeutic measures are discussed. Patients suffering from erosion can be treated successfully if the correct diagnosis and adequate preventive and therapeutic measures are performed.

Radiological investigation of the vertebral column in two patients with low-back pain (53-year-old woman and a 52-year-old man) revealed unusually marked osteoporosis and sintering fractures of the 3rd, and 1st and 4th lumbar vertebrae, respectively. Biochemical tests failed to provide any evidence about metabolic or endocrinological abnormality. Iliac crest biopsy showed mastocytosis. There were no skin changes in either patient. Additional examinations excluded involvement of any internal organs. Despite treatment with calcium, sodium fluoride, vitamin D3 and calcitonin in the woman, and aspirin and chromoglycinic acid in the man the osteoporosis has slowly progressed during the last 7 and 5 years, but the disease has remained limited to the skeletal system. In a case of unusually marked osteoporosis, mastocytosis should be included in the differential diagnosis even in the absence of urticaria pigmentosa.

Fluoride containing varnishes represent clinically proved means for individual caries prevention by topical application due to their prolonged contact time between fluoride and enamel. The fluoride accumulation in vitro and in vivo, the inhibition of demineralization, the experimentally and clinically proved reduction of caries and the toxicological safety during varnish application are reviewed. A reduction of caries between 20-50 per cent may be registered after semiannual application of such varnishes due to their high caries protective properties.

A caries preventive effect depending on the free fluoride concentration was registrated on rats using dentifrices with NaF or MFP (alone or in combination) despite the presence of CaCO3 as abrasive material because the composition of these dentifrices was changed. The free fluoride concentration of dentifrices had induced the accumulation of fluoride into enamel. The ionized fluoride content of NaF-dentifrices was unchanged for 3 years. MFP was hydrolized and had continuously released fluoride ions. The caries preventive effect which was increased by HCO3- was reproducible in correspondence with the fluoride concentration after the storage for two years.

60 female patients with osteoporosis are examined to analyse several parameters of the blood serum relative to their value for diagnosis and therapeutic results. Osteocalcin seems to be a specific factor of the serum to determine formation of bone. The activity of the alkaline phosphatase as an indicator for new formation of bone and the concentration of hydroxyproline in the urine as an indicator for bone resorption are not sensitive enough, to detect slight changes in metabolic bone processes. The concentration of parathormone, calcium and phosphate in the blood serum are not suited for diagnosis and controlling the therapeutical results of osteoporosis. They are rather fit for differential diagnosis of other osteological diseases. Osteocalcin seems to be a serum parameter with relationship to radiological, clinical and laboratory findings. It may help to find the right diagnosis in the case of other osteological diseases and controlling the therapeutical effects.

The aim of the present study was to collect data on urinary fluoride output in 8-16-year old students exposed to either drinking water fluoridation (DWF), or domestic salt fluoridation (DSF). Spot urine samples were collected in the canton of Basel-Stadt (DWF, n = 123), in the canton of Berne (DSF, n = 264), in the county of Davos (DSF, n = 241), and in the city of Winterthur (DSF, n = 40). Furthermore, fluoride concentrations were determined in plasma samples drawn from 33 students from Winterthur. The urinary fluoride concentrations were higher in Basel and Davos (0.62 +/- 0.35 mg/l; 0.61 +/- 0.42 mg/l) than in Berne and Winterthur (0.46 +/- 0.42 mg/l; 0.50 +/- 0.31 mg/l). A relatively high natural fluoride content (0.3 mg/l) in the drinking water explained the difference in urine fluoride concentration between students from Davos and the two other regions with domestic salt fluoridation (Berne, Winterthur). The average fluoride concentration in plasma was 12.7 +/- 3.8 ng/ml. We concluded that, in general, the supply with fluoride consumed with fluoridated domestic salt is close to the level obtained with drinking water fluoridation. However, in areas with very low systemic fluoride supplementation through the drinking water this level might not be reached with salt as the only source of systemic fluoride. Also, the data confirmed the safety of domestic salt fluoridation.

Report of a 58 year old patient who, after a 5 year continuous treatment with altogether 146 g sodium fluoride, developed a grade II-III (Roholm) fluorosis. The fluorine treatment had been conducted for a radiologically demonstrated osteoporosis. Renal involvement was not demonstrated: serum creatinine was normal, the creatinine clearance only slightly reduced. The therapeutic goal of this continuous fluoride administration, i.e. freedom from skeletal pain and vertebral stability, was not achieved; new end plate impressions of dorsal vertebrae were found.

Hemodialysis induced osteopenia represents one of the serious late complications of long-term treatment with hemodialysis. The incidence of osteopenia in our hemodialysis-patients ranges between 5 and 10 percent (Atkinson et al. 1973; Delling et al. 1976; Heidler et al. 1976; Parfitt 1976; Fuchs et al. 1977a; Henning et al. 1977; Schulz 1978, 1979; Madsen 1979; Schulz et al. 1980, 1981). Well timed variation of the conventional electrolytecomposition of dialysate can prevent osteopenia in many cases successfully. Precise histological classification of bone (histomorphometrical evaluation of bone-biopsy) and determination of parathormon- and fluor-level are the obligatoric precondition of adequate osteopenia-treatment. Therapy of osteopenia comprises--beside decrease of dialysate calcium and -magnesium--stepwise increase of NaF--and 1,25(OH)2D3-application. Surveillance during therapy should include monitoring of calcium, phosphate and fluor-metabolism, microradioscopy of hand skeleton, rebiopsy of bone (iliac crest) and determination of iPTH.

The influence of sodium fluoride therapy on semiconservative DNA-synthesis and DNA-excision repair was investigated in lymphocytes of the peripheral blood of 6 patients with osteoporosis. The daily dose of sodium fluoride was 25 mg in the first week, and subsequent 50 mg during a period of 15 to 37 weeks. No significant effect on the tested parameters was found in 5 subjects. One patient showed significantly inhibited DNA-repair in the lymphocytes up to the ninth week, but during subsequent therapy normal values were obtained in this patient also. In conclusion sodium fluoride seems to have no effect on DNA-metabolism in lymphocytes of patients with osteoporosis.

Report on 3 female patients who, after treatment of an osteoporosis with sodium fluoride, have developed a skeletal fluorosis. The proof was performed radiologically, histologically and by means of fluoride analysis in the bone ash. The diagnosis was made accidentally. Complaints relating to this are not mentioned. Osteosclerosis after fluoride therapy is no iatrogenically damage for the patient, but the aim of the therapy for the prevention of osteopenic fractures.

The topical fluoride application is a caries-preventive treatment. The fluoride uptake in surface and subsurface sound human enamel differs, depending on the fluoride preparation. Fluoride tablets, solutions, gels, tooth pastes and varnishes are widely used as anticaries agents. The rate of fluoride uptake by the surface enamel from three different fluoride applications (sodium fluoride, amine fluoride and fluorosilicate) was determined. When enamel war treated with amine fluoride the highest and most stable fluoride concentrations were obtained.

26 women were treated for osteoporosis with 40 mg of sodium fluoride twice a day (equivalent 36 mg of fluorine) for a longer period. Mostly by reason of incompatibility, a reduction to half of the dose was necessary in six of these patients. The control of plasma fluoride concentration indicated that only 10 patients took their medicine regularly. Before treatment as well as three and six months after beginning of treatment the patients were examined. In these examinations bone density was measured across the middle phalanx of the middle finger with a I-125-profile scanner. Size and function of the thyroid gland were evaluated by clinical aspects and with in vivo- and in vitro-methods for thyroid diagnostic. The program includes also a check up with a 12 canal-serum-autoanalyzer. In 10 patients with warranted regular intake of the drug the increase of bone density was significant after three months already. In all 26 patients a considerable increase of the alkaline phosphatase after three months was evident. Under the influence of sodium fluoride no change was seen in function and size of thyroid gland. This result verifies the efficiency of sodium fluoride in osteoporosis-therapy without any measurable influence on thyroid function.

It has proved worthwhile to treat osteoporosis simultaneously in two ways. For symptomatic treatment of the pain, passive and active physiotherapy is important, backed up by treatment with analgesic and antirheumatic agents and calcitonin, while any other drugs are given mainly for treatment of the osteoporosis itself. For women in high-risk categories for osteoporosis long-term (10-12 years) preventative treatment with estrogens (plus progesterone) is indicated. When osteoporosis is already apparent on radiological examination, fluoride (+ calcium) is generally given over 3-4 years, while calcitonin therapy is appropriate in acute painful and rapidly progressive osteoporosis with fresh vertebral fractures. In this case both the antiosteoclastic and the analgesic effect of the hormone come into play. Calcium can be used for pre- and postmenopausal prophylaxis and as a supplement to fluoride therapy.

Two experiments carried out with one hundred rats from the Osborne-Mendel-strain were supposed to prove the influence of selenium-containing-drinking-water on caries. The animals were divided into five experimental groups of twenty rats each. Selenium was tested in different doses as an addition to drinking-water in shape of Na2SeO4, as well as in combination with a tooth-paste containing NaF.-Its toxicity was to be determined by the water consumption, the mortality and above all by the body weight of the animals at the end of the test. During the first experiment three groups received Na2SeO4 in doses of 1, 5 and 10 ppm in the drinking water and the cariogenic diet Stephan 580 as food. Two other groups served as control, one receiving the cariogenic diet Stephan 580 and the other one getting the normal breeding diet. The analysis of variance carried out for the assessment of caries and the test of SCHEFFE only show a different attack concerning those groups, receiving the cariogenic diet and the control group fed with the breeding diet Altromin R. Nine of the 40 animals of the groups that had received the selenium doses of 5 and 10 ppm did not survive the experiment. The average value of the water consumption and the body weight of the animals of the selenium group was below the average of the remaining groups, which points out a strong toxicity of Na2SeO4. In regard to the water consumptions, however, one cannot exactly define, whether it is an effect of the selenium of the cariogenic diet. All groups of the second experiment received the cariogenic diet Stephan 580; two of them got Na2SeO4 in doses of 4ppm within their drinking water. The molars of the lower jaws of one of these group were brushed with a tooth-paste containing NaF. The molars of the other group were treated with a paste, serving as a placebo. Two other groups were provided each with the paste containing fluorine and the paste serving as a placebo, but without selenium in their drinking water. Furthermore 20 animals were used as a control group. The analysis of variance showed the widely known protective effect of the fluorine by the statistically significant different distribution of the caries. Comparing those two groups, whose drinking water contained Na2SeO4 with the two other groups whose molars were treated with the paste containing fluorine and the one serving as a placebo respectively, we may conclude, that Na2SeO4 has no influence on the protective effect of the fluorine. A comparison of the group treated with the paste serving as a placebo with the control group shows, that the tooth-brushing obviously has no great effect. In respect to the body weight at the end of the experiment one cannot demonstrate a clear effect using the linear contrast of SCHEFFE, and there also is no infleunce of selenium on the total water consumption, which coincides with the results of the first experiment. The two experiments have shown that Na2SeO4 is toxic in the doses applied...

After 7 years of use of a Na2FPO3 paste, the reduction of DMF surfaces was reduced by 36-38%, relating to the control group. The caries inhibiting effect is statistically ensured. Separate consideration of the first molar shows a caries reduction of 40-42%.

The bioavailability of Ossin, a drug for the treatment of osteoporosis, containing 40 mg of NaF, was investigated. Because of the enteric coating of the tablet, intestinal absorption occurs when the tablet leaves the stomach. The sustained release of the F--in the intestine results in a slow F-- -absorption. Maximal F-- -serum concentrations are reached more than 4 hours after absorption has begun. In contrast to non-sustained release NaF tablets the slow absorption of Ossin leads to lower, and less variable F-- -serum concentrations. Following administration of 1 tablet Ossii b.i.d., the steady state concentrations were between 130 and 220 ng/ml. The absorption was at least 86%. As calculated by the renal F-- -elimination, the therapeutically important F-- -retention in bone amounted to more than 50%. The enteric coating of the Ossin tablets, the low and relatively steady F-- -serum concentrations and the high F-- -retention in bone, are expected to contribute to an improvement in tolerance and therapeutic efficacy in the treatment of osteoporosis.

Twenty-three patients with primary osteoporosis were treated with sodium fluoride over 25 months. Mean total dose was 21 g fluoride. Symptoms, body size, biochemical results, radiological changes and skeletal mineral content as well as bone histomorphometry were evaluated in assessing results of treatment. Accordingly, no advance in the disease process was demonstrable in 13 patients, while there was definite improvement in six, but in four there was further progression.

The spread of caries in the city of Rostock was studied from 1979 to 1988 in pupils from classes 1 to 8 where the fluoride varnish application three times a year (Duraphat) was the most important caries prophylaxis measure. All children were included in the evaluation, even those who had entered the school for the first time during the study period and had not had any prior prophylactic treatment. A special study was also made in a single class in the 1st and 6th years, respectively, to compare varnish application by cotton swabs with barrel ampoule injection. A significant reduction in caries was registered in all age groups. The application with barrel ampoule injection proved to be more economical and practical than the cotton swab application. On the whole Duraphat fluoride varnish reasserted its importance in caries prophylaxis and can be regarded as extremely well suited for individual and collective prevention.

To evaluate a therapeutic effect, biochemical parameters of bone metabolism and photonabsorption densitometry have been compared in patients with senile osteoporosis under long-term continuous or intermittent sodium fluoride treatment. A comparable increase of trabecular bone density is found after continuous and intermittent therapy for at least one year. The well-known effect of defective mineralization under long-term continuous therapy with sodium fluoride corresponds to a statistically significant increase in urinary hydroxyproline and calcium excretion and a trend towards a rise in serum alkaline phosphatase in this study. Similar findings cannot be observed in patients on intermittent sodium fluoride treatment. The increase in bone density without concomitant changes in biochemical parameters suggests a beneficial therapeutic effect without biochemical evidence for defective mineralization.

In 10 patients with primary and 13 patients with glucocorticoid osteoporosis a NaF-therapy with an average daily dose of 80 mg was carried out in a period of 1/2 to 4 1/2 years. 22 patients spoke about an improvement of the complaints. Radiologically an osteogenesis could be proved in 19 patients. Dose and duration of the therapy as well as eventual additional treatments, frequency and severity of the side-effects are discussed and the indication for a NaF-medication are elaborated.

25 female patients with different forms of osteoporosis (progredient form in elderly patients, steroid osteoporosis, involutive osteoporosis) treated during a period varying between 1 to 24 months with a new compound preparation containing 25 mg sodium fluoride and 200 mg L-ascorbic acid per tablet. The daily dose amounts to 2 tablets. Clinical success was observed in 18 patients, X-ray controls showed increase of bone density in 8 patients. In 3 cases it was necessary to discontinue treatment because of side effects (2 patients with pains in the bones and joints, 1 patient with stomach troubles). Late side effects have not been observed. At present the treatment of certain forms of osteoporosis with sodium fluoride is the only effective therapy of this disease.

Three different preparations containing 1 mg fluoride were given to 12 volunteers: preparation A, 1 hydrous solution, = 1 mg F-/100 ml, preparation B = 2 tablets at 0.5 mg F- and preparation C = 1NaF tablet with 1 mg F-. Representactive kinetic data could be obtained by means of restricted fluoride in the diet, a reproducible method yielding minimum detectable fluoride concentration and selection of suitable volunteers.. The enteral absorption of fluoride from solution A was more rapid (half-life of invasion = 20.2 min and 16.9 min, respectively). The delayed release is a consequence of the galenic mixture. In addition, the maximum concentration in plasma was greater and was reached sooner in preparation A when compared to the other preparations. In contrast, there was no difference in the areas under the curves, indicating that the relative bioavailability of fluoride is the same in all preparations.

40 patients with various types of osteoporosis, aged 17 to 76 years, were treated for 12 months with a new NaF-drug (Ossiplex-Retard, film tbl. 25 mg NaF plus 200 mg vitamine C). Daily dosage was 50-100 mg. Clinical symptoms, X-ray-status of the axial skeleton, alkaline serum phosphatase and the consumption of analgetics were used for assessment. 2/3 of the patients with presenile and steroid induced osteoporosis responded well to treatment, while those with osteogenesis imperfecta, idiopathic osteoporosis and plasmocytosis did not show clinical or radiological improvement. In senile osteoporosis, a physiological process of aging, should only be given NaF-treatment, if fractures without callus formation are present. Harmless side effects, (gastrointestinal intolerance in 15% and a painful tendoperiostosis syndrome in 12.5%), necessitated discontinuation of treatment in 3 cases. The NaF-drug with added vitamine C has less side effects than other NaF-containing compounds and should therefore be included as part of the therapeutical regimen of certain types of osteoporosis.

Cylindrical enamel blocks with initial carious lesions were treated for one hour with Duraphat or Fluor-Protector. After removal of the fluoride varnishes the enamel blocks were kept in the mouths of 3 probands for 5 days. Plaque was allowed to accumulate on half of the enamel cylinders, while the other half was kept clean. Part of the enamel cylinders were retained as fluoridated controls. Compared with Duraphat the application of Fluor-Protector resulted in a significantly higher uptake of KOH soluble and firmly bound fluoride. During the 5 days of the experiment the amount of KOH soluble fluorides decreased in both groups. In the presence of plaque the fluoride loss was higher. The amount of firmly bound fluoride increased both in the plaque covered and in the clean enamel. The durable cariostatic effect of fluoridated varnishes seems to be due to the slow dissolution of Ca F2-like precipitates on the enamel surface and the concomitant fluoride uptake in the underlying demineralized enamel.

Every form of osteoporosis--except the physiological involution osteoporosis--requires treatment. Osteoporosis is no disease by itself but a result or a concomitant phenomenon of various diseases. Therefore the primary disease has to be treated also. Only for the so-called idiopathic osteoporosis hitherto no cause is known. Today sodium fluoride is the only substance with an influence upon the bone which may induce re-ossification and re-stabilization. In the described series of investigations this compound, with which treatment by gradual dosage is possible, has proved its effectiveness. Osteoporosis is more than bone porosity, therefore additionally afflicted organic or functional system like the muscular apparatus, bone marrow, or the intraosseous blood supply, must be treated too. Psychological guidance of the patient is necessary as he must be motivated for activity.

Fluoride varnishes Durpahat and Fluor Protector are commonly used and have proven to be effective as caries preventive agents. In the first part of this paper the features of fluoride varnishes in terms of fluoride uptake, caries prevention and toxicological safety are discussed. The effect of both varnishes under high cariogenic conditions is discussed in the second part. In the presented study, 8 patients carried 3 enamel specimens (Fluor Protector, Duraphat, Control) intra-orally during 4 months. They kept plaque accumulation intact on the specimen and avoided fluoride administration from other sources. After 4 months of substantial cariogenic challenge, the enamel was analysed by microradiography and the degree of caries protection obtained for each varnish type was calculated. The results show that under high-risk caries conditions enamel treated with Fluor Protector was significantly better protected (65%) than enamel treated with Duraphat (3%).