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Uncontrolled clinical trials have shown that parenteral administration of GM-CSF reduces the frequency of chemotherapy-induced mucositis. The mechanism of this effect could be related to acceleration of haematopoiesis and/or increase in functional activation of WBC. We conducted a double-blind, placebo-controlled, dose ranging study of GM-CSF (mol-gramostim) mouthwash in patients with breast cancer during the first treatment cycle of a combination chemotherapy regimen which has historically produced dose-limiting (grade > or = 3) mucositis in approximately 39% of patients. Subjects were randomized to receive either placebo mouthwash (0.1 percent albumin) or one of four concentrations of GM-CSF mouthwash (0.01, 0.1, 1.0 or 10 mcg/ml). The primary endpoint was to evaluate the relationship between dose of GM-CSF mouthwash received and probability of grade > or = 3 mucositis using a logistic model. Solutions were administered four times daily starting within 24 hours of chemotherapy initiation and continuing until the end of the cycle (day 21). Mucositis was assessed on days 1-6, 10, 15 and 21. Day 6 plasma samples were assayed for GM-CSF. Forty-five patients were evaluable for response (nine per dosing group). A 42% risk (15/36) of mucositis grade > or = 3 was evident on day 15 in patients receiving GM-CSF compared to 2 of 9 patients on the placebo arm. No evidence of dose response was found by logistic regression. Five patients had a detectable plasma concentration of GM-CSF (56-209 pg/ml). A positive correlation between GM-CSF dose and leukocyte recovery was noted (P = 0.04).

The purpose of this study was to develop a rapid protocol for noninvasive quantification of blood flow at intraoral sites by laser Doppler flowmetry. For each flow measurement, the lowest flow observed over a 30-s period was recorded. Three flow readings at each site were averaged and recorded. Forehead and dorsal right-hand blood flows measured agreed with previous laser Doppler flow measurements. Flows measured with a hand-held probe were not different from flows measured with a stent-stabilized probe on the attached gingiva and an adhesive-stabilized probe on the dorsal hand. High flows were found in the tongue, buccal mucosa, and buccal vestibule. Medium flows were found in the attached gingivae. The lowest flows were found in the teeth. These results indicate that flow in intraoral tissues varies by site and can be noninvasively quantified with the laser Doppler flowmeter when a rigorous measurement protocol is used.

Past trials with soft and calcified tissues have demonstrated that long pulse train (2.5 mus) Er:YAG (2.94 mum) laser may be used to ablate tooth structure of human teeth. Determination of physical and thermal damage to surrounding tissue during removal of enamel and dentin is a primary objective of this study. Extracted human teeth with thermal probes imbedded in the pulp chambers were submitted to cavity preparation using an Erbium YAG laser with water mist. Wavelength selection as well as use of a water mist during the procedure resulted in efficient tissue removal without significant surrounding damage. Ground sections and SEM sections of teeth showed little or no melting or ash formation in adjacent dentin and enamel and no visible change in the pulp chamber. The surfaces produced by laser ablation were rough and irregular with craters and grooves. Average temperature change in the pulp chamber monitored during tooth preparation was 2.2 degrees Centigrade. These findings suggest that constantly available water aids vaporization and microexplosions, increasing the efficiency of tooth structure removal, and aids in cooling of the tooth structures. The long pulse Er:YAG (2.94 mum) laser may be an effective method for tooth reduction applications when used with a water mist.

The purpose of this paper is to illustrate the value of combined aerodynamic and endoscopic examination of velopharyngeal function in the revision of prosthetic speech appliances. Use of these combined measures enables the clinician to identify accurately the site(s) of any under- or overobturation. Furthermore, any needed revision is completed accurately and efficiently.

The purpose of this study was to examine radioautographically the dynamics of tissue changes during healing after reimplantation of maxilliary incisors in adult rhesus monkeys. The period selected for the study was 1 day to 4 months. The study revealed that a new attachment will be restored after tooth reimplantation. Epithelial tissues start to proliferate immediately after reimplantation; this proliferation reaches its peak in 3 days. After 7 days a new junctional epithelium is re-established. Connective tissue proliferation reaches its peak in 7 days and starts mainly from the supracrestal connective tissue and the bone marrow spaces. The interface is undetectable after 7 days, being replaced by young connective tissue which re-establishes the continuity of the periodontal membrane and the supracrestal connective tissue. Orientation and maturation of the fibers are not observed until 4 months after reimplantation. Changes toward root resorption and ankylosis can be seen as early as 14 days after reimplantation.