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About two million people per year in the U.S. have acne severe enough to require treatment with antibiotics. Treatment frequently lasts for more than six months, prompting concerns about antibiotic resistance and other possible consequences of long-term antibiotic use, such as increased susceptibility to infections. This Issue Brief summarizes a large study that evaluates the risk for upper respiratory and urinary tract infections among adolescents and young adults treated with antibiotics for acne.

Background: A proton pump inhibitor (PPI)-based triple therapy with clarithromycin (CAM) and amoxicillin (AMPC) is now a standard regimen for Helicobacter pylori (HP) eradication in Japan. However, the CAM-resistant rate has increased recently and alternative therapies are sorely needed. Therefore the aim of the present study was to evaluate the effectiveness and safety of the PPI-tetracycline (TC)-metronidazole (MNZ) regimen (the PTM regimen) as an alternative therapy in comparison with the PPI-AMPC-MNZ (PAM) regimen., Methods: Sixty-four HP-positive patients visiting the HP-eradication clinic in Tokai University Hospital from July 1998 to March 2003 were treated with either PTM or PAM as alternative therapies. The HP eradication was assessed by urea breath test (UBT), HP stool antigen test, or HP culture method more than 2 months after completion of the treatments. The drug resistances against CAM, AMPC, TC, and MNZ were assessed by the agar dilution method., Results: Fifty-six patients (26 PTM and 30 PAM) completed medication and evaluation of the eradication. The eradication rates of PTM were 82.8% (24/29) and 92.3% (24/26), while those of PAM were 74.3% (26/35) and 89.7% (26/29) by intention-to-treat and per-protocol analysis, respectively. The differences between the regimens were not statistically significant. There were no severe adverse effects observed in either of the regimens. The drug-resistance analyses showed 15 CAM- and one MNZ-resistant cases but no TC or AMPC resistance in the available 25 samples., Conclusion: The PTM and PAM regimens were equally effective and safe as alternative HP eradication therapies. And PTM would be particularly useful in penicillin allergy cases.

Unlabelled: The success of an esthetic rehabilitation depends on the understanding of the patient's need and expectation. The management of patients with moderate to severe tetracycline-stained teeth is very challenging. Tooth whitening may be a valid alternative to more aggressive treatments; however, patients should be aware of the limitations of tooth whitening therapy. Clinicians may select differing treatment plans; tooth whitening can improve intrinsic discoloration in a way so that no further treatment is required. Once tooth whitening is completed, direct or indirect restorative procedures may be afforded to match the existing restoration with the bleached tooth structure. This article describes a conservative clinical approach to rehabilitate the smile of a patient with moderate to severe tetracycline-stained teeth using a combination of tooth whitening and direct composite and indirect porcelain restorations in the maxillary anterior segment., Clinical Significance: The combination of tooth whitening and adhesive restorations allows clinicians a significantly more conservative approach to intrinsically stained teeth; tooth preparation for porcelain veneers and porcelain-fused-to-metal and full-ceramic crowns can be restricted to conditions in which persistent tooth discoloration or significant loss of both dentin and enamel exists.

Among the aging U.S. population, patients are taking significantly more medications than in the past. In view of this, dentists should take careful medical histories, including use of herbal agents, and be aware of medication-related problems and their potential effect on the diagnosis and treatment of periodontal disease. This review highlights major concerns about medications as a risk factor for periodontal therapy. Medications and their impact on periodontal disease can be categorized as those which affect oral hygiene, diagnosis, gingival and oral mucosa, and alveolar bone.

The causes of tooth discoloration are varied and complex but are usually classified as being either intrinsic, extrinsic or internalized in nature. Dietary chromogens and other external elements deposit on the tooth surface or within the pellicle layer either directly or indirectly to form extrinsic discoloration. Stains within the dentine or intrinsic discoloration often results from systemic or pulpal origin, while internalized stains are the result of extrinsic stains entering the dentine via tooth defects such as cracks on the tooth surface.

The authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.

A young, non-obese woman aged 24 years with normal blood pressure developed intracranial hypertension after the oral use of tetracycline. Neuro-ophthalmologic examination revealed severely reduced acuity, papilledema, and concentric impaired visual fields. She was treated with acetazolamide and recurrent lumbar punctures and recovered, but without improvement in either acuity or visual fields. Intracranial hypertension is a fairly rare disease characterised by increased intracranial pressure without structural abnormalities in the brain or hydrocephalus, and is termed idiopathic in the absence of an underlying cause. Tetracycline should be considered as a cause of intracranial hypertension if a patient complains of previously unknown headache a few days after its ingestion. Headache and the presence of bilateral papilledema, decreased visual acuity and visual-field defects are indications for urgent referral to a neurologist. Therapy consists of a combination of repetitive lumbar punctures and medication. Surgical interventions include lumboperitoneal shunting and optic nerve fenestration. Intracranial hypertension may lead to irreversible decreased visual acuity and visual-field defects resulting in disability.

It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.

H. pylori eradication is a challenge in patients allergic to penicillin, both first-line and failures of prior therapy. We aimed to assess the eradication rate of H. pylori in patients allergic to penicillin, first-line and failures of prior therapy, the efficacy of healing of active duodenal ulcer disease (DUD) and erosive gastritis, and the safety and tolerability of the combination. Twenty patients with documented allergy to penicillin, DUD, and H. pylori infection, 17 (85%) for first-line treatment and 3 (15%) prior therapy failures, were given a 10-day regimen of esomeprazole, 40 mg qid, tetracycline, 500 mg qid, and metronidazole, 500 mg qid. Baseline and follow-up panendoscopy > or =30 days after end of treatment was performed for rapid urease test (Clotest), and four site biopsies for H. pylori, and to document endoscopic peptic ulcer disease. All adverse events during treatment were documented. Eradication rates by intention to treat (ITT) were 85% for first-line treatment and 100% for failures. Seventy percent of all cases had a normal endoscopy at follow-up, and 85 and 100% of patients had healed erosive gastritis and DUD, respectively, from baseline. There were histological improvements in most patients. A high eradication rate was obtained even in patients who had a shorter duration of treatment. The combination was well tolerated. A combination of esomeprazole, tetracycline, and metronidazole is effective for eradication of H. pylori in patients allergic to penicillin, for both first-line treatment and failures of prior treatment.

Background: Root resorption and ankylosis have been reported rarely as sequelae to guided tissue regeneration (GTR). The authors describe a clinical case of root resorption following GTR that involved the use of a bioabsorbable membrane., Case Description: Two years after GTR was performed on a Class II furcation defect, the clinical examination revealed root resorption reaching the pulp chamber. The furcation defect was filled with epithelium and connective tissue, which contained inflammatory infiltrate and fragments of the membrane. The authors also observed areas of the tooth that exhibited points of ankylosis and root resorption., Clinical Implications: Clinical trials have reported favorable clinical and histologic results with GTR. However, this case report, along with other case reports and studies in animals, suggests a high risk of root resorption and ankylosis after GTR, which could limit the indications for this technique.

Background: Current anti-Helicobacter pylori treatment regimens are costly and because of the increasing antibiotic resistance, are becoming ineffective., Aim: To evaluate a triple-layer tablet containing 100 mg bismuth subcitrate, 250 mg metronidazole, and 250 mg tetracycline in a single triple-layer tablet., Methods: H. pylori-infected adult patients received bismuth-metronidazole-tetracycline (two tablets, t.d.s.) and ranitidine (300 mg) once daily for 14 days. Efficacy was determined using 13C-urea breath testing., Results: Thirty-three of 35 enrolled patients were available for evaluation; using the protocol-specified modified intention-to-treat analysis, five failed treatment, two were lost to follow-up (cure rate per-protocol = 85.7%, intention-to-treat = 78.7%). The cure rate among metronidazole-susceptible strains was 100% (22 of 22) (95% confidence interval 84-100%) compared with 55% (five of nine intention-to-treat) (95% confidence interval 21-86%) among metronidazole-resistant strains. In four cases, therapy was truncated at 4-7 days because of side-effects; yet the treatment was effective in three. The three metronidazole-susceptible but clarithromycin-resistant infections were cured., Conclusion: This novel triple-layer tablet combination therapy was effective in all patients with metronidazole-susceptible H. pylori and many of those with resistant organisms. A greater degree of acid suppression may further improve effectiveness.

Objective: The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth restored with a porcelain laminate veneer system (Cerinate, Den-Mat, USA) for aesthetic reasons., Methods: Tetracycline-stained teeth (546) were restored with a porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5, 1.5 and 2.5 years, respectively. Modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction of the colour of the restorations., Results: This study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers required rebonding in the first 6 months; the colour of the veneers was stable and no evident staining was found. Almost all patients were satisfied with the colour match of their restorations 1 year after placement., Conclusions: The research indicated that the porcelain veneer restoration system under investigation provided a reliable and highly satisfactory choice for the aesthetic restoration of tetracycline-stained teeth.

Teeth with severe tetracycline staining can present a restorative challenge to the clinician. While a variety of options facilitate predictable aesthetic treatment of patients with such dentition, they often require significant tooth reduction in order to provide the dentist and the laboratory technician with adequate space for the restorative material to conceal the discoloration. This presentation outlines an alternative to this treatment that uses resin cement to mask the discolorations prior to the cementation of the porcelain laminate veneers.

Objective: To demonstrate the association between tetracycline treatment and pseudotumor cerebri (PTC)., Methods: Consecutive patients from two neuro-ophthalmic referral centers, who developed PTC syndrome post-treatment with tetracycline, were enrolled and followed for a minimum of 2 years after cessation of tetracycline., Results: A total of 243 consecutive patients were diagnosed with PTC; 18 had concurrent history of tetracycline treatment; a third experienced a limited course of illness with no relapses; 12 had a variable course with a prolonged relapsing illness. Mean duration of tetracycline treatment prior to diagnosis was 2.73 months., Conclusions: Tetracycline, and especially minocycline, is currently considered a cause or a precipitating factor for PTC. Although there is little information on the natural course of tetracycline induced PTC, the present cases demonstrate that drug withdrawal is curative only in some patients.

Tetracyclines (TCN) were introduced in 1948 as broad-spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side-effects of tetracyclines is incorporation into tissues that are calcifying at the time of their administration. They have the ability to chelate calcium ions and to be incorporated into teeth, cartilage and bone, resulting in discoloration of both the primary and permanent dentitions. This permanent discoloration varies from yellow or gray to brown depending on the dose or the type of the drug received in relation to body weight. Minocycline hydrochloride, a semisynthetic derivative of tetracycline often used for the treatment of acne, has been shown to cause pigmentation of a variety of tissues including skin, thyroid, nails, sclera, teeth, conjunctiva and bone. Adult-onset tooth discoloration following long-term ingestion of tetracycline and minocycline has also been reported. The remarkable side-effect of minocycline on the oral cavity is the singular occurrence of "black bones", "black or green roots" and blue-gray to gray hue darkening of the crowns of permanent teeth. The prevalence of tetracycline and minocycline staining is 3-6%. The mechanism of minocycline staining is still unknown. Most of the reviewed literature consisted of case reports; longitudinal clinical trials are necessary to provide more information on the prevalence, severity, etiology and clinical presentation of tetracycline and TCN-derivative staining in the adult population.

Objective: To evaluate the opaquing capacity, color compatibility and stability of IPS Empress all-ceramic veneers., Methods: A total of 86 IPS Empress all-ceramic veneers were made for 18 patients. The patients were divided into three groups: Group A was tetracycline teeth, 64 veneers for 5 patients; Group B was non-tetracycline teeth, 22 veneers for 13 patients; Group C was 22 natural vital teeth with normal color as control group. Before and after veneers were inserted, ShadeEye NCC was employed to obtain L * a * b * values of each tooth. The values of cemented veneers used as the baseline, the L * a * b * values of each veneer were measured half a year, 1 year, and 2 years after restoration respectively. All L * a * b * values at different evaluation times were analyzed by SPSS 10.0., Results: Before and after veneers were restored, the L * a * b * values of both Group A and Group B were significantly different, the color difference being 5.01 and 4.15 respectively. The color difference between Group A and selected shade guides was 2.45. Compared with the baseline value, the L * value of Group A significantly decreased 2 years after restoration, but the DeltaE of different evaluation times was not significantly different. The color difference between Group B and Group C was 0.22 and there was no significant color difference after restoration., Conclusions: IPS Empress all-ceramic veneers have excellent opaquing capacity, color compatibility and stability to non-tetracycline teeth. To tetracycline teeth IPS Empress all-ceramic veneers have a certain opaquing capacity, but they cannot completely match with shade guides; the L * value is significantly different after restoration and further studies are needed to evaluate its color effect.

Tetracycline exposure in utero and in early childhood often results in intrinsic tooth staining that varies in severity based upon timing, duration, and form of tetracycline administered. Traditionally, dental aesthetics compromised by tetracycline staining have been restored with modalities requiring aggressive tooth preparation. In this case involving a patient with extremely severe staining of healthy and aesthetically shaped dentition, a conservative tooth preparation strategy and porcelain veneers were utilized to preserve tooth shape and arch form while restoring natural color.

Background: Tetracyclines may cause esophageal injury., Goals: The aims of this study are to describe 2 distinct clinical patterns of esophageal injury induced by tetracycline or its derivate doxycycline and to compare these patterns with respect to demographic, endoscopic, and clinical characteristics of the patients., Study: Forty-eight patients with the diagnosis of doxycycline- or tetracycline-induced esophageal injury by endoscopy were analyzed retrospectively. The patients were considered in 2 groups according to the type and the location of esophageal lesions (Group A: mid-esophageal ulceration, n = 18; Group B: distal esophagitis, n = 30)., Results: Patients in Group A were significantly younger than in Group B (P = 0.0014). In Group A, 15 patients (83%) had single ulceration, 2 (11%) double, and 1 (6%) circumferential at the mid-esophagus. In Group B, all patients had multiple micro-ulcerations in the distal esophagus. Development of mid-esophageal ulceration was induced predominantly by doxycycline, whereas distal esophagitis was induced by tetracycline. The description of drug ingestion with little or no water by patients in Group A was significantly more frequent than in Group B (94% vs. 10%, P < 0.001). Associated medical and benign gastric diseases and esophageal candidiasis were significantly more frequent in Group B (P = 0.006, P < 0.001, P < 0.001, respectively). Prompt response to medical therapy was observed in both groups with no significant difference (P = 0.093)., Conclusions: The type of tetracyclines used by patients may give some clues to physicians on the pattern of esophageal injury because mid-esophageal ulceration seems to be more frequently associated with doxycycline and distal esophagitis with or without candidiasis with tetracycline.

Background: Quadruple therapy provided inadequate eradication rate when given twice-a-day at breakfast and evening meals., Aim: To test twice daily (mid-day and evening) quadruple therapy for Helicobacter pylori eradication., Methods: This was a single-centre pilot study in which H. pylori-infected (positive histology and culture and RUT) patients were given 2 x 250 mg of metronidazole and 2 x 250 mg of tetracycline, two Pepto-Bismol tablets, plus one 20 mg rabeprazole tablet twice-a-day for 14 days. H. pylori status was confirmed 4 or more weeks after the end of therapy., Results: Thirty-seven patients including 3 with peptic ulcer disease, 19 asymptomatic infected, 4 GERD, and 11 with NUD. Mid-day quadruple therapy was successful in 92.3% (95% CI: 79-98%) including 96.2% of those with metronidazole-susceptible strains, and in 83.3% (10/12) of those with metronidazole-resistant H. pylori. Compliance was 100% by pill count except in one individual who stopped medication after 12 days because of side-effects and who failed therapy. Moderate or greater side-effects were experienced by five patients., Conclusion: Twice-a-day, mid-day, quadruple therapy proved effective using the combination of bismuth subsalicylate and rabeprazole instead of bismuth subcitrate and omeprazole. Detailed studies of different formulations (e.g. 2 x 250 mg versus 1 x 500 mg of metronidazole or tetracycline) and timing of administration (breakfast and evening meal versus mid-day and evening meals) may result in significant improvements in H. pylori eradication regimens.

Actually, some 67% of therapeutical used antibiotics in livestock in the European Union are tetracyclines. Their use can result in unwanted residues in food of animal origin. Apart the risk of the possible development of resistances in enterobacteriaceae we have to keep in mind secondary circuits. This paper focuses on tetracycline residues in bones. Bones have been widely used as raw material for meat and bone meal and gelatine, and are also a frequent contamination of mechanical recovered meat. Bones contain tetracycline residues in concentrations up to 50 mg/kg. These bound tetracycline residues have ever been thought to be of no significance to health. Nevertheless, recent studies have shown that these tetracyclines could be released in vivo and re-obtain their bioavailability. Further, several toxic degradation products of tetracyclines could be formed during heating. Additionally, in acid solutions from the production of gelatine high tetracycline concentrations have been found. These solutions are processed to dicalciumphosphate, which is used as a feed supplement in animal husbandry and as fertilizer in agriculture.

Tetracycline is well known to cause pigmentation of various body tissues, such as teeth, bone, lunulae, conjunctivae, and lymph nodes. It has not been reported to cause discoloration of the skin, unlike its semisynthetic derivative, minocycline. We report an 18-year-old girl who developed lower extremity pigmentation in areas of trauma during treatment with tetracycline.

Background: Pleurodesis is important in the management of malignant pleural effusions, but no consensus exists on the optimal agent or methods of pleurodesis. How pleurodesis is practiced worldwide has not been studied., Objectives: To identify variations in the clinical practice of pleurodesis in major English-speaking countries, and to quantify the experience of pulmonologists on the effectiveness and adverse effects of different pleurodesis agents worldwide., Methods: Eight hundred fifty-nine pulmonologists practicing in the United States, United Kingdom, Canada, Australia, and New Zealand participated in a Web-based survey., Results: The respondents collectively perform > 8,300 pleurodesis annually. Talc was the preferred agent by most respondents (slurry, 56%; poudrage, 12%), followed by tetracycline derivatives (26%), and bleomycin (7%). Differences were seen in pleurodesis practice patterns among practitioners among and within the surveyed countries. Physicians' overall satisfaction with the available pleurodesis agents was modest (5.0 out of 8), and the reported success rate averaged only 66%. Talc (both poudrage and slurry) was perceived as significantly more effective, but was associated with significantly more pain, nausea, and fever (p < 0.05). Respiratory failure occurred more commonly with talc poudrage than with other agents (p < 0.05), and had been observed by 70% and 54% of physicians who used talc poudrage and slurry, respectively., Conclusions: Significant variations exist in how pleurodesis is performed worldwide. Pleurodesis agents currently available are perceived as suboptimal. Talc poudrage and slurry were perceived to be more effective, but were associated with more complications, including respiratory failure.

We used data from a randomized placebo-controlled clinical trial to examine the relationship between Helicobacter pylori and reflux symptoms in nonulcer dyspepsia patients randomly assigned anti-Helicobacter pylori triple therapy alone, calcium carbonate alone, or in combination with triple therapy, tetracycline, or placebo. We compared risk differences for posttreatment Helicobacter pylori status and increased reflux symptoms from crude, multivariable and stratified multivariable analyses. In crude analyses, 54% of subjects without Helicobacter pylori after-treatment reported an increase in reflux compared to 41% of those with persistent infection (risk difference = 13%; P = 0.07). Only subjects with multifocal atrophic gastritis assigned to calcium carbonate reported an increase in reflux symptoms more frequently when Helicobacter pylori was absent versus when it persisted (risk difference = 52%; P = 0.0001). Therefore, the interaction of calcium carbonate use, chronic multifocal atrophic gastritis, and the absence of Helicobacter pylori may increase reflux symptoms.

Hepatotoxicity associated with any antibiotic is rare. With the wide-spread use of antimicrobial agents, however, hepatic injury is not an infrequent occurrence. Penicillins remain a widely used class of antimicrobials with a well defined record of low hepatotoxicity. The combination of clavulanate with amoxicillin may be associated with the greatest risk for liver injury from any antimicrobial agent. Significant hepatotoxicity also may occur with sulfamethoxazole/ trimethoprim and combination regimens used to treat tuberculosis. An autoimmune-like hepatitis may result from minocycline or nitrofurantoin exposure and most often resolves with cessation of therapy. Treatment with high doses of tetracycline and oxacillin may be associated with severe hepatotoxicity. Early suspicion of hepatocellular injury in the setting of antimicrobial exposure should prompt cessation of therapy and avoidance of rechallenge.

Objective: The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth corrected with Cerinate porcelain laminate veneer system for esthetic purpose., Methods: 546 tetracycline-stained teeth were corrected with Cerinate porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5 year, 1.5 years and 2.5 years, respectively. modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction with the shade of the restorations., Results: this study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers were rebonded after debond in the first half year application; the color of the veneers was stable and no evident staining was found. Almost all patients were satisfied with their restoration color after 1 year's application., Conclusion: The research indicated that Cerinate porcelain veneer restoration system is a reliable and ideal choice for the correction of tetracycline-stained teeth.

Background: The high prevalence of Helicobacter pylori resistance to metronidazole demands treatments more effective than standard bismuth-based triple therapy against these strains., Aim: To evaluate the H. pylori eradication rate in both metronidazole-sensitive and -resistant strains following quadruple therapy using single-triple capsules of bismuth biskalcitrate, metronidazole and tetracycline, given with omeprazole., Methods: One hundred and seventy valid patients with duodenal ulcer, gastric ulcer or non-ulcer dyspepsia were treated in eight centres located in five countries. H. pylori was confirmed at baseline using 13C-urea breath test, histology and/or culture. Patients received three single-triple capsules q.i.d. and omeprazole, 20 mg b.d., for 10 days. Each capsule contained bismuth biskalcitrate, 140 mg (as 40 mg Bi2O3 equivalent), metronidazole, 125 mg, and tetracycline, 125 mg. 13C-Urea breath test was repeated at least 4 and 8 weeks post-treatment., Results: Overall eradication rates were 93% (158/170) by modified intention-to-treat analysis and 97% (142/146) by per protocol analysis. Eradication rates were 93% (40/43) and 95% (38/40) for strains resistant to metronidazole and 95% (82/86) and 99% (75/76) for strains sensitive to metronidazole by modified intention-to-treat and per protocol analysis, respectively., Conclusion: This omeprazole-bismuth biskalcitrate-metronidazole-tetracycline 10-day regimen is a very effective and well-tolerated treatment, which overcomes metronidazole resistance.

A patient, diagnosed with a combination of level 3 endemic dental fluorosis and degree 1 tetracycline staining, was treated sequentially by macroabrasion techniques and nightguard vital bleaching. Various pairings of diamond and carbide burs, abrasive disks, rotary polishing points, and diamond polishing pastes were tested to obtain the optimal combination for macroabrasion. This conservative treatment regimen produced results that were termed "excellent" by the patient and met the goals of the dentists.

Purpose: The purpose of this longitudinal whitening study was to determine the stability, post-treatment side effects, and patient satisfaction at 90 months post treatment after 6 months of active treatment of tetracycline-stained teeth with 10% carbamide peroxide., Materials and Methods: Fifteen of 21 participants enrolled in the study (71%) were contacted and asked to participate in a survey concerning their whitening experience. Participants were asked whether there had been any change in the shade of their teeth after treatment and if they had experienced any side effects that they believed were treatment related. Eight of the 15 participated in a clinical examination., Results: Nine participants (60%) reported no obvious shade change or only a slight darkening not noticed by others. None reported darkening back to the original shade; however, four had re-treated their teeth. Examiners were in agreement with the participants' perception of shade change upon comparing pretreatment and post-treatment photographs and Vita shade (Vita Zahnfabrik D-79713, Bad Sackingen, Germany) values. The degree of improvement over the pretreatment shade was significant for the 90-month post-treatment shade (p < .01). All respondents (n = 15) denied having to have a crown or root canal or tooth sensitivity that they believed was treatment related., Clinical Significance: The results of this study of nightguard vital bleaching indicate that tetracycline-stained teeth can be whitened successfully using extended treatment time and that shade stability may last at least 90 months post treatment (range 84-100 mo). Patients participating in this study were over-whelmingly positive about the procedure in terms of shade retention and lack of post-treatment side effects.

Tetracyclines, antibiotics widely used in medical practice, have many effects independent of their antimicrobial activity, among others they exert anti-collagenolytic activity. The paper presents a review of literature concerning the effects of tetracyclines on the skeletal system.

Objective: The degree of color change and the dental sensitivity associated with the use of different concentrations (10%, 15%, and 20%) of carbamide peroxide every night for 6 months was evaluated in tetracycline-stained teeth., Method and Materials: Fifty-nine subjects were shown how to place two different concentrations of carbamide peroxide in the custom trays with reservoirs. For a period of 6 months, the patients were to insert the tray every evening before retiring. Patients returned in 1 and 2 weeks and at 1, 2, 3, 4, 5, 6, 7, 8, and 9 months for evaluation of the degree of color change by subjective shade matching and by photographic means. Sensitivity of hard or soft tissues was self-reported., Results: Fifty-two subjects attended more than 90% of the recalls. A colorimeter was used to convert shade guide tabs to Commission Internationale de l'Eclairage color spaces (CIELAB). The most rapid whitening occurred in the first month. At 3 and 9 months, 91% and 85% of the subjects, respectively, were at least "a little pleased" with the results of the bleaching. In the professional evaluation, 90% of the teeth were deemed to have an excellent or satisfactory esthetic result. The higher the concentration of carbamide peroxide, the more rapidly the lightness value and color difference changed. There was no difference among the three concentrations in resulting gingival sensitivity. Patients experienced less tooth sensitivity with 10% gel than they did with 15% and 20% gels., Conclusion: Bleaching with 10%, 15%, and 20% carbamide peroxide is effective for removing tooth staining caused by tetracycline. The 10% concentration has the most advantages and the fewest disadvantages.

Intrapleural loculation can increase morbidity in hemothoraces or parapneumonic effusions. Intrapleural fibrin precedes visceral-parietal pleural adhesions. We speculated that single-chain urokinase plasminogen activator alone or bound to its receptor could prevent these adhesions by their relative resistance to local inhibition by plasminogen activator inhibitors. We found that recombinant human single-chain urokinase-bound rabbit pleural mesothelial cells or lung fibroblasts with kinetics similar to that reported for human cells (kD of approximately 5 nM). The receptor-bound fibrinolysin maintained in vitro fibrinolytic activity in the presence of pleural fluids from rabbits with tetracycline-induced pleural injury over 24 hours. In rabbits given intrapleural single-chain urokinase 24 and 48 hours after intrapleural tetracycline (n = 10 animals), adhesions were prevented, whereas the receptor-complexed form (n = 12) attenuated adhesions versus vehicle/tetracycline-treated rabbits (n = 22, p

Background: There are no guidelines on second-line therapies for Helicobacter pylori eradication failures of omeprazole-clarithromycin-amoxicillin triple therapy., Aim: To compare the efficacy of two second-line therapies for persistent H. pylori infection., Methods: Over a 6-year period, patients with persistent H. pylori infection following omeprazole-clarithromycin-amoxicillin eradication therapy were randomized to receive omeprazole, 20 mg twice daily, bismuth, 120 mg four times daily, metronidazole, 500 mg twice daily, and either tetracycline, 500 mg four times daily, or clarithromycin, 500 mg twice daily, given for 7 days. Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori infection was confirmed by histology., Results: Of the 95 randomized patients, 88 (93%) completed the study. Age, sex, smoking, ulcer/non-ulcer dyspepsia ratio and antibiotic resistance were not significantly different between the treatment groups. On intention-to-treat analysis, eradication was achieved in 41 of the 49 patients (84%; 95% confidence interval, 70.4-92.7%) and 27 of the 46 patients (59%; 95% confidence interval, 43.3-73.0%) of the tetracycline- and clarithromycin-containing groups, respectively (P=0.007). On multivariate regression analysis, the sensitivity of H. pylori to metronidazole had a likelihood ratio of 5.2 (P=0.022), followed by the type of quadruple therapy (likelihood ratio, 4.4; P=0.036)., Conclusions: Tetracycline-containing quadruple rescue therapy is highly effective in treating H. pylori eradication failures of the omeprazole-amoxicillin-clarithromycin regimen.

This study compared the whitening effect of three bleaching agents on the teeth of rats and demonstrated differences in bleaching where dentin was exposed or enamel was thin. Thirty Albino rats were peritoneally injected with tetracycline solution daily for two weeks. Thirty-two disc-shaped specimens were cut from the crowns of incisors removed from sacrificed rats and were irradiated with UV light for 16 hours. Sections were stored in saline. Eight sections served as controls and were not bleached. Three bleaching agents (Opalescence, Rembrandt and Nite White) were applied to eight specimens each, five times a day for two weeks, and images of the sections were recorded at the following times: before bleaching (baseline), day 1, day 3, day 5, day 7, day 9, day 11 and day 14. Mean colors to demonstrate any change (deltaE) from baseline for each time period were as follows: control-9.78 (baseline), 9.17, 9.36, 9.65, 9.40, 9.99, 10.57, 11.36; Opalescence-10.08, (baseline) 7.63, 6.72, 6.04, 5.10, 4.87, 4.89, 4.27; Rembrandt-9.83 (baseline), 11.27, 9.55, 8.36, 7.75, 6.94, 7.11, 7.04; Nite White-10.44 (baseline), 9.92, 7.58, 6.80, 5.45, 5.05, 4.73, 4.01. All bleached teeth were lightened (p<.01). Another 56 tetracycline-stained rat incisors were UV irradiated for three days. Three different penetration depths were tested: penetration through lingual dentin and labial enamel (DN group), penetration through labial enamel only (RE group) and penetration through labial enamel covered with 1.0 mm human enamel (HE group). Specimens were bleached with Opalescence for one hour five times a day for one week or four weeks. A control group of unbleached teeth was also examined. Results (deltaE) were as follows: control--11.67; 1-week DN--13.55; 1-week RE--12.80; 1-week HE--12.07; 4-week DN--7.48; 4-week RE--7.50; 4-week HE--11.69. The color change in the 4-week DN and the 4-week RE groups showed the greatest reduction (p<.01).

This article reviews the efficacy of a new 6.5% hydrogen peroxide tooth-whitening gel strip for bleaching teeth that have been intrinsically stained from tetracycline. Given the severity of staining in the cases presented during a recently conducted clinical trial, the resulting efficacy is dramatic. Additionally, the continuous use of these strips for 30 minutes per day, twice daily for 2 months with no meaningful adverse effects is noteworthy.

Purpose: Matrix metalloproteinases (MMPs) are involved in tumor invasion and metastasis and are overexpressed in Kaposi's sarcoma (KS) cells. The primary aim was to define the safety and toxicity of the MMP inhibitor COL-3 in patients with AIDS-related KS. Secondary aims were to evaluate tumor response, pharmacokinetics, and changes in blood levels of MMP-2, MMP-9, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF)., Patients and Methods: COL-3 was administered orally once daily, and doses were escalated in cohorts of three to six subjects. Patients with symptomatic visceral KS or severe tumor-associated edema were excluded. Antiretroviral therapy was permitted but not required. Study end points were grade 3 or 4 toxicity or progressive KS. Serial blood specimens were obtained for pharmacokinetics and levels of MMP-2, MMP-9, VEGF, and bFGF., Results: Eighteen patients received COL-3 in dosing cohorts of 25, 50, and 70 mg/m(2)/d. Prior KS therapy was reported by 17 patients (94%). COL-3-related grade 3 or 4 adverse events were reported by six patients and included photosensitivity, rash, and headache. There was one complete response and seven partial responses, for an overall response rate of 44%, with a median response duration of 25+ weeks. The median COL-3 half-life was 39.3 hours (range, 4.1 to 251.1 hours). There was a significant difference between responders and nonresponders with respect to the change in MMP-2 serum levels from baseline to minimum value on treatment (P =.037)., Conclusion: COL-3 administered orally once daily to patients with AIDS-related KS is reasonably well tolerated. The most common adverse event was dose-related photosensitivity. Antitumor activity was noted. Further evaluation of COL-3 for the treatment of KS is warranted.

The discoloration of tooth roots is rare. We report here a 22-year-old Japanese woman with blackish-brown staining of the roots of the upper and lower third molars. Staining was found in the dentin and cementum. Electron probe X-ray microanalysis showed no significant difference in the composing elements between the stained tooth root and control tooth. Fluorescent bands coincided with staining in the dentin of the root and cementum along the incremental lines under confocal laser-scanning microscope.

Eight of 35 patients with cancer receiving COL-3, a tetracycline derivative with antiangiogenic properties, developed anemia while on treatment. All of these patients were enrolled on an approved Phase I clinical trial at the National Cancer Institute. Three of these patients had bone marrow examinations that revealed ringed sideroblasts. This paper describes these cases. Am. J. Hematol. 67:51-53, 2001. Published 2001 Wiley-Liss, Inc.

The objectives of the study were to describe the oral health status and treatment needs of the 5- to 6-year-old and 12-year-old children in Southern China; to describe the patterns of oral health behaviors, knowledge, and attitudes among the 12-year-olds; and to assess the effects of socio-behavioral factors on the 12-year-old children's dental caries experiences. The study sample was comprised of 1,587 5- to 6-year-old and 1,576 12-year-old urban and rural schoolchildren living in Guangdong Province. Three calibrated dentists clinically examined the children, and trained interviewers interviewed the 12-year-olds. Caries prevalence of the 5- to 6-year-old children was high (urban 78% vs. rural 86%); the mean dmft of the urban and rural children was 4.8 and 7.0, respectively. The caries prevalence and mean DMFT score of the 12-year-olds were 41% and 0.9 (urban) and 42% and 0.9 (rural). Only 2% of the 12-year-olds exhibited no calculus or gingival bleeding, while more than 70% had calculus. In conclusion, there is an urgent need for establishing caries-preventive activities for preschool children. The prevalence of caries among the 12-year-olds was not high, but their periodontal condition was unsatisfactory. Knowledge about gum bleeding and the use of fluoride was low. More oral health education activities should be organized, especially for the rural children.

Although potentially significant adverse reactions and drug interactions have been reported in association with erythromycin, oral tetracyclines, and trimethoprim-sulfamethoxazole, overall these agents are associated with excellent safety profiles, especially considering their widespread use over many years. It must be considered that when these antibiotics are used for the treatment of rosacea and also for acne vulgaris, their use is on a long-term basis rather than their typical short-course regimens for most infectious diseases. As a result, dermatologists prescribing these agents may feel assured that most patients will not encounter any significant problems, but they do need to be aware of potential adverse reactions to allow for early recognition and discontinuation of the offending drug when needed. Early recognition also allows for favorable management of adverse reactions. In addition, potentially significant drug interactions may be recognized by obtaining a thorough medical history and avoiding combinations of drugs that may interact unfavorably. Fortunately, there are several choices that allow us to individually select a treatment regimen that is optimal for the individual patient, allowing for effective control of rosacea.

Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing commencing within minutes of exposure to ultraviolet (UV) and visible light, and generally resolves in a few hours. We describe a 28-year-old woman who developed pruritus and erythema 5 min after sun exposure while on tetracycline for treatment of perioral dermatitis. Phototesting elicited urticarial reactions in the UVA, UVB and visible spectra. Repeat phototesting after cessation of tetracycline was negative. This report documents the first case of solar urticaria induced by tetracycline.