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Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapy

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003
Mauricio A. Gutierrez
Abstract Objectives: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing , SRP). Material and methods: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths 5 mm and with radiographic angular bone defects >3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain®, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t -tests) was used to compare response to treatment in control versus experimental sites. Results: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3±0.5 mm for control sites and 2.0±0.3 mm for experimental sites. The mean CAL gain was 1.8±0.4 mm for control sites, and 1.4±0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p>0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months. Conclusion: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP. Zusammenfassung Ziel: Das Ziel dieser Studie war die Evaluation eines adjunktiven Gebrauchs von Schmelzmatrixderivaten (EMD) auf die parodontale Heilung nach nicht chirurgischer parodontaler Therapie (Wurzelreinigung und ,glättung, scaling und root planing , SRP). Material und Methoden: Die Studie wurde als eine intraindividuelle, für 3 Monate longitudinale Studie mit einem doppelt blinden, split-mouth, kontrolliertem und randomisiertem Protokoll durchgeführt. 22 Patienten mit moderater bis schwerer chronischer Parodontitis wurden in die Studie einbezogen. Bei jedem Patient wurden zwei Flächen mit Sondierungstiefen5 mm und mit radiographisch feststellbaren angulären Knochendefekten>3 mm ausgesucht. Die Basisuntersuchung umfasste die Messung der Sondierungstiefen (PPD) und des klinischen Stützgewebeniveaus (CAL). Die An- oder Abwesenheit von Plaque und Provokationsblutung an den ausgesuchten Flächen wurden auch dokumentiert. Nach der anfänglichen Untersuchung wurde eine alle Zähne betreffende SRP durchgeführt. Die Studienflächen wurden dann mit 24% EDTA für zwei Minuten behandelt, gefolgt von einer sorgsamen Spülung mit steriler Kochsalzlösung. Die Flächen wurden dann randomisiert. Die experimentellen Flächen erhielten eine subgingivale Applikation von Schmelzmatrixderivaten (Emdogain®, BIORA AB, Malmö, Schweden). Die Kontrollflächen erhielten keine zusätzliche Behandlung. Zum dritten Monat wurden alle Flächen reexaminiert. Die Antwort auf die Therapie bei den experimentellen und Kontrollflächen wurden evaluiert in Hinsicht der Veränderung der Sondierungstiefe und CAL als die primären Ergebnisvariablen. Statistische Analysen (gepaarter t -Test) wurden für den Vergleich der Behandlung zwischen experimentellen und Kontrollflächen genutzt. Ergebnisse: Statistisch signifikante Veränderungen bei der PPD und dem CAL wurden in beiden Behandlungsgruppen zwischen Basis und 3 Monaten beobachtet. Die mittlere PPD Reduktion betrug 2.3±0.5 mm für die Kontrollflächen und 2.0±0.3 mm für die experimentellen Flächen. Der mittlere CAL Gewinn betrug 1.8±0.4 mm für die Kontrollflächen und 1.4±0.3 mm für die experimentellen Flächen. Die statistischen Analysen erbrachten jedoch keine signifikanten Differenzen für PPD Reduktion und CAL Gewinn zwischen den experimentellen und Kontrollgruppen (p>0.4). Es wurden auch keine Differenzen zwischen den Gruppen hinsichtlich Provokationsblutung und Plaqueindex zum dritten Monat beobachtet. Schlussfolgerung: Die Ergebnisse von der vorliegenden Studie unterstützen nicht die Anwendung von EMD während der routinemäßigen nicht chirurgischen Reinigung der parodontalen Taschen, wie die Messungen drei Monate nach SRP. Résumé Objectif: Le but de cette étude fut d'évaluer l'utilisation des dérivés de la matrice amellaire (EMD) sur la cicatrisation parodontale après un traitement parodontal non chirurgical (détartrage et surfaçage radiculaire). Matériel et méthodes: L'étude fut conçue en essai longitudinal intra-individuel d'une durée de 3 mois randomisée, contrôlée en double aveugle et en bouche croisée. 22 patients atteints de parodontites chroniques modérées ou sévères furent enrôlés. Pour chaque patient, 2 sites avec des profondeurs de poches5 mm et des lésions osseuses angulaires radiographiques>3 mm furent sélectionnés. L'examen initial comportait la mesure des profondeurs de poche au sondage (PPD) et les niveaux cliniques d'attache (CAL). La présence ou l'absence de plaque et de saignement au sondage sur les sites sélectionnés furent aussi enregistrées. Après l'examen initial, un détartrage et un surfaçage complet étaient réalisés. Les sites étudiés étaient alors traités par de l'EDTA à 24% pendant 2 minutes, puis fortement rinçés avec du serum physiologique. Les sites étaient alors répartis aléatoirement. Le site expérimental recevait une application sous gingivale d'EMD (Emdogain®, BIORA AB, Malmo, Sweden). Le site contrôle ne recevait pas de traitement supplémentaire. A 3 mois, les sites étaient réévalués. La réponse au traitement était évaluée par les modifications de profondeur de poches et de niveau d'attache comme variables primaires. L'analyse statistique (Test t apparié) permit de comparer la réponse au traitement. Résultats: Des modifications statistiquement significatives de PPD et de CAL ont été observées dans les deux groupes de traitement. La réduction de PPD moyenne était de 2.3±0.5 mm pour les sites contrôles et de 2.0±0.3 mm pour les sites expérimentaux. Le gain de CAL moyen était respectivement de 1.8±0.4 mm et de 1.4±0.3 mm.L'analyse statistique, cependant, ne révélait pas de différences significatives entre les deux groupes (p>0.4). De plus, aucune différence n'apparaissait entre les groupes pour le saignement et les indices de plaque au troisième mois. Conclusion: Les données de cette étude n'étayent pas l'utilisation routinière d' EMD lors du débridement non chirurgical des poches parodontales lorsqu'on en mesure les résultats 3 mois après détartrage et surfaçage radiculaire. [source]

Some effects of enamel matrix proteins on wound healing in the dento-gingival region

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2002
Jan L. Wennström
Abstract Objective: The aim of the present study was to evaluate by clinical means the effect of enamel matrix proteins on the healing of a soft tissue wound produced by periodontal pocket instrumentation. Material and methods: The study was performed as an intra-individual, longitudinal trial of 3 weeks duration with a double-masked, split-mouth, placebo-controlled and randomized design. The patient material was comprised of 28 subjects with moderately advanced, chronic periodontitis. Each patient presented with 3 sites in each of 2 jaw quadrants with a probing pocket depth (PPD) of 5 mm and bleeding following pocket probing (BoP). Baseline examination, including assessments of plaque, gingival inflammation, PPD, BoP and root dentin sensitivity, was carried out one week after oral hygiene instruction and careful self-performed plaque control. All experimental sites were scaled and root planed, and the soft tissue wall of the pocket was curetted to remove the pocket epithelium and adjacent granulation tissue. The site was carefully irrigated with saline. When the bleeding from the pocket had ceased, a 24% EDTA gel was applied in the site and retained for 2 min. This was followed by careful irrigation with saline. Left and right jaw quadrants were then randomized to subgingival application of enamel matrix derivative (Emdogain®) or vehicle-control. All sites were re-examined after 1, 2 and 3 weeks. In addition, a visual analogue scale (VAS) was used to score the degree of post-treatment discomfort. The primary endpoints of treatment success were defined as (i) pocket closure (PPD 4 mm), (ii) no bleeding following pocket probing, (iii) no sign of gingival inflammation (GI score =0) and (iv) low degree of post-treatment discomfort (VAS 20). Statistical analyzes of intra-individual differences between the test and control treatments were performed by the use of Wilcoxon signed rank test. For comparison of the proportions of sites reaching the defined endpoints of treatment success, a site-based analysis was performed using 2×2 tables and the Fisher exact test. Results: The endpoint "GI score =0" was reached at 16% of the sites subjected to application of Emdogain® at 1 week and at 2% of the control sites (p=0.001). At 2 weeks, the corresponding figures were 25% versus 12% (p=0.028). Absence of BoP was at 1 week 57% for the Emdogain® treated sites compared to 35% for the control sites (p=0.003). At 2 weeks, this endpoint was reached in 73% and 59% of the test and control sites, respectively (p=0.051). In terms of the endpoint defined for probing pocket depth, PPD 4 mm, no differences between test and control sites were found. At 1 week, the proportion of patients reporting a VAS score 20 was significantly higher for the Emdogain® treated quadrants than for controls (p=0.002). Conclusion: The results indicated that Emdogain® topically applied in instrumented pockets enhance the early healing of periodontal soft tissue wounds. Zusammenfassung Zielsetzung: Klinische Untersuchung der Wirkung von Schmelzmatrixprotein (SMP) auf die Heilung der durch subgingivale Instrumentierung verursachten Wunde. Material und Methoden: Das Studiendesign entsprach einer randomisierten longitudinalen plazebokontrollierten doppelt verblindeten Halbseitenstudie, an der 28 Patienten mit mäßig fortgeschrittener chronischer Parodontitis teilnahmen. Jeder Patient wies an 3 Stellen zweier Quadranten Sondierungstiefen (ST) 5 mm und Bluten auf Sondieren (BOP) auf. Eine Woche nach Durchführung von Mundhygieneinstruktionen und gründlicher individueller Mundhygiene erfolgte die Basisuntersuchung: Plaque, gingivale Entzündung, ST, BOP und Zahnhalsüberempfindlichkeit. Alle Testzähne wurden subgingival instrumentiert (Scaling und Wurzelglättung), es wurde eine Weichgewebskürettage durchgeführt und mit Kochsalzlösung (NaCl) gespült. Nach dem Stillstand der Taschenblutung wurde ein 24%iges EDTA-Gel subgingival appliziert und für 2 min belassen. Nach gründlicher NaCl-Spülung erfolgte eine randomisierte Zuweisung der subgingivalen Instillation von SMP-Gel (Test) oder nur Trägergel (Plazebokontrolle) zum rechten bzw. linken Quadranten. Nachuntersuchungen erfolgten nach 1, 2 und 3 Wochen. Dabei wurden zusätzlich die postoperativen Beschwerden mit einer visuellen Analogskala (VAS) erfasst. Als Hauptzielkriterien des Behandlungserfolges wurden definiert: (1) Verschluß der parodontalen Tasche (ST 4 mm), (2) kein BOP, (3) keine Zeichen gingivaler Entzündung (GI=0) und (4) nur geringgradige postoperative Beschwerden (VAS 20). Der Vergleich zwischen Test und Kontrolle erfolgte mit dem Wilcoxon-Test bzw. mit 4-Felder-Tafeln und dem Fisher-Exakt-Test. Ergebnisse: Das Erfolgskriterium "GI=0" war nach 1 Woche bei 16% der Test- und und bei 2% der Kontrollstellen erfüllt (p=0.001). Nach 2 Wochen lagen die Proportionen für Test und Kontrolle bei 25% bzw. 12% (p=0.028). Kein BOP war nach 1 Woche bei 57% der Test- und bei 35% der Kontrollstellen zu beobachten (p=0.003), nach 2 Wochen lagen die Werte bei 73% bzw. 59% (p=0.051). Hinsichtlich des Kriteriums ST 4 mm konnten keine Unterschiede zwischen Test und Kontrolle gefunden werden. 1 Woche nach Instrumentierung war der Anteil der Patienten in der Testgruppe, die eine VAS 20 angaben, höher als in der Kontrollgruppe (p=0.002). 3 Wochen nach Therapie wiesen beide Gruppen hinsichtlich keines der Erfolgskriterien mehr statistisch signifikante Unterschiede auf. Schlussfolgerungen: Die topische subgingivale Applikation von SMP in instrumentierte parodontale Taschen könnte die frühe Wundheilung des Weichgewebes begünstigen. Résumé But: Le but de l'étude présente a été d'évaluer cliniquement l'effet des protéines de la matrice amélaire (Emdogain®) sur la guérison des tissus mous produits par l'instrumentation de la poche parodontale. Matériaux et méthodes: Cette étude a été effectuée en tant qu'essai longitudinal intra-individuel de 3 semaines avec un modèle en double aveugle, par bouche divisée, au hasard et contrôlé par placebo. 28 sujets avec parodontite chronique modérement avancée ont participéà cette étude. Chaque patient présentait 3 sites dans 2 quadrants avec une profondeur au sondage (PPD) 5 mm et un saignement au sondage (BoP). L'examen initial comprenant la prise des indices de plaque, d'inflammation gingivale, de PPD, de BoP et de la sensibilité dentinaire a été effectué une semaine après l'instruction en hygiène buccale et le contrôle de plaque dentaire réalisé par la personne elle-même. Tous les sites expérimentaux ont été détartrés et surfacés, et la paroi de tissu mou de la poche a été curetée pour enlever l'épithélium de la poche et le tissu de granulation adjacent. Ce site a été irrigué avec du sérum physiologique. Lorsque le saignement de la poche avait cessé, un gel d'EDTA 24% a été appliqué dans le site et est resté in situ pendant 2 min. Ensuite une nouvelle irrigation avec du sérum physiologique a été prodiguée. Les quadrants gauches et droits étaient ensuite distribués au hasard pour l'application sous-gingivale du dérivé de la matrice amélaire (Emdogain®) ou en tant que véhicule contrôle. Tous les sites ont été ré-éxaminés aprés 1, 2 et 3 semaines. De plus une échelle analogue de vision (VAS) a été utilisée pour mesurer le degré d'inconfort post-traitement. Les points principaux du succès du traitement étaient définis comme suit (1) fermeture de la poche (PPD 4 mm), (2) absence de saignement au sondage, (3) aucun signe d'inflammation gingivale (GI=0) et (4) un faible degré d'inconfort post-traitement (VS20). Les analyses statistiques des différences intra-individuelles entre les traitements tests et contrôles ont été effectuées à l'aide du test par Wilcoxon Signed Rank. Pour la comparaison des proportions de sites atteignant le succès souhaité, une analyse basée sur les sites a été effectuée en utilisant des tables 2×2 et le test exact de Fisher. Résultats: Le but GI=0 a été atteint dans 16% des sites avec Emdogain® après 1 semaine seulement et dans 2% des sites contrôles (p=0.001). A 2 semaines, les figures correspondantes étaient 25% versus 12% (p=0.028). L'absence de BoP a 1 semaine atteignait 57% des sites traités par Emdogain® contre 35% pour les contrôles (p=0.003). A 2 semaines, ce but était atteint dans respectivement 73% et 59% des sites tests et contrôles (p=0.051). En terme de PPD4 mm, aucune différence n'a été trouvée entre les sites. A 1 semaine, la proportion de patients qui avaient un VAS 20 était significativement plus importante dans le groupe traité par Emdogain® que chez les contrôle (p=0.002). Conclusions: Les résultats ont indiqué que l'Emdogain® placé localement dans des poches nettoyées peut augmenter la guérison précoce des tissus mous parodontaux. [source]

Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study

ACTA OPHTHALMOLOGICA, Issue 5 2010
Azadeh Golshahi
Abstract. Purpose:, The aim of this study was to evaluate a possible effect of systemic ketoconazole on visual acuity (VA) and retinal thickness in patients with acute central serous chorioretinopathy (CSCR). Methods:, Fifteen consecutive patients were treated with ketoconazole 200 mg/day for a period of 4 weeks. Another 15 patients served as a control group. Baseline examination and review after 4 weeks included VA testing and measurement of neuroretinal or pigment epithelial detachment by optical coherence tomography (OCT). Fluorescein angiography was performed to verify the diagnosis. Results:, At baseline, mean VA in Snellen units was 0.6 ± 0.2 (logMAR 0.2 ± 0.7) in the treatment group and 0.7 ± 0.3 (logMAR 0.2 ± 0.5) in the control group. On OCT, mean neuroretinal or pigment epithelial detachment measured 288 ± 163 ,m in the ketoconazole group and 225 ± 51 ,m in the control group, respectively. Four weeks later, mean VA improved in both groups. On OCT, neuroretinal or pigment epithelial detachment decreased in both the treatment and control groups. The differences were not statistically significant. Conclusions:, Although a pharmacological decrease in endogenous cortisol synthesis appears to be a rational approach in the treatment of CSCR, systemic ketoconazole at 200 mg/day was not associated with a significantly better outcome in this preliminary study. [source]

Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2001
Stephanie Young FRACO
ABSTRACT Purpose: To report the safety and efficacy of intravitreal triamcinolone in the treatment of inflammatory cystoid macular oedema (CMO) in six patients who were resistant to other forms of therapy. Methods: An open-label unmasked prospective non- randomized pilot study of six patients with idiopathic uveitis and visually significant macular oedema, resistant to periocular and/or systemic corticosteroid treatment, was carried out. Baseline examination and investigations were performed, including fundus fluorescein angiography, and the patients were given a single intravitreal injection of triamcinolone (4 mg/0.1 mL). The primary outcome measure was angiographic resolution of CMO. Patients were reviewed at intervals of 2,4 weeks for 12 months. Results: A single intravitreal injection of triamcinolone induced clinical and angiographic resolution of inflammatory macular oedema in all patients for varying periods of time up to 6 months. Five patients experienced increased intraocular pressure to 30 mmHg or greater which required treatment. Two patients developed posterior subcapsular cataract. Conclusion: One injection of intravitreal triamcinolone was an effective short-term treatment for resistant CMO in uveitis. As with steroids given by other routes, raised intraocular pressure and cataract may occur. As it was so effective in these eyes with resistant CMO, a larger study is warranted to evaluate this form of therapy. [source]

Inflammation and bone resorption as independent factors of accelerated arterial wall thickening in patients with rheumatoid arthritis

ARTHRITIS & RHEUMATISM, Issue 11 2003
Mayumi Nagata-Sakurai
Objective We recently reported that rheumatoid arthritis (RA) patients had increased intima-media thickness (IMT) of the common carotid artery (CCA). The present longitudinal study was performed to determine whether the change in arterial thickness was accelerated in RA patients and to determine which factor was important in the progression of arterial wall changes. Methods We studied 62 female RA patients with stable disease activity and 63 healthy female controls. IMT of the CCA was measured twice by high-resolution B-mode ultrasonography. The second examination was performed 18,36 months after the first, and changes were expressed as millimeters of increase per year. Baseline examinations included blood markers of inflammation and urinary calcium excretion (expressed as the calcium-to-creatinine ratio). Results RA patients showed a significantly greater increase in IMT of the CCA compared with controls. In univariate analyses of the RA patient data, the C-reactive protein (CRP) level correlated with the increase in CCA IMT. Other markers of inflammation (the erythrocyte sedimentation rate and white blood cell and platelet counts) also showed significant positive associations with the annual increase in CCA IMT in multiple regression models when adjusted for age, smoking status, blood pressure, and serum cholesterol level. The urinary calcium-to-creatinine ratio was also significantly associated with an increase in CCA IMT. Moreover, both the CRP level and the urinary calcium-to-creatinine ratio were significantly and independently associated with the increase in IMT of the CCA. Conclusion Patients with RA have a higher rate of increase in thickening of the arterial wall. Inflammation and calcium mobilization are factors closely associated with the accelerated arterial wall changes. [source]

Oral status of 35 subjects with eating disorders , A 1-year study

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2000
Rolf Öhrn
The aim was to record changes over time in the oral status of subjects with diagnosed eating disorders. The outpatient psychiatrist had referred to the hospital dental clinic 35 women (19,47 yr, median 27 yr) with eating disorders, diagnosed according to DSM III-R criteria. At the baseline examination, dental, medical and dietary histories were taken, and intra-oral clinical and radiographic examinations were supplemented by intra-oral photographs, study casts and salivary analysis. The subjects were re-examined 1 yr later. Together, the investigators assessed progression of tooth wear blindly by comparing coded study casts from the baseline and 12-month examinations. Progression of erosive tooth wear was recorded in almost half of the subjects. Several subjects had low unstimulated salivary flow rates (<0.1 ml/min) and very high counts of mutans streptococci and lactobacilli, both at baseline and 1 yr later. The flow rates for paraffin-stimulated saliva at baseline were significantly lower for subjects with progression of erosive tooth wear than for those without. Because of the increased susceptibility to both caries and erosion, patients with eating disorders should be encouraged to have regular dental check-ups. Test of salivary flow may serve as an indicator of patients' risk of progression of erosive tooth wear. [source]

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years

GERODONTOLOGY, Issue 2 2008
Kim Ekstrand
Objectives:, (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods:, (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F-toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow-up examination after 8 months. Results:, (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter-group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion:, The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F-toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F-toothpaste had root caries progression. [source]

Distribution and Correlates of Lipoprotein-Associated Phospholipase A2 in an Elderly Cohort: The Cardiovascular Health Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008
Curt D. Furberg MD
OBJECTIVES: To determine whether high levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) are associated with prevalent cardiovascular disease (CVD) and to evaluate factors most influencing Lp-PLA2 levels in a community-based cohort of older adults. DESIGN: Cross-sectional. SETTING: The Cardiovascular Health Study (CHS), a population-based cohort study of men and women aged 65 and older. PARTICIPANTS: Five thousand five hundred thirty-one CHS participants. MEASUREMENTS: Levels of Lp-PLA2 activity were determined using stored blood samples from the baseline examination. RESULTS: Mean Lp-PLA2 was higher in participants with electrocardiographically determined ventricular conduction defect and major Q-wave abnormality and was positively correlated with left ventricular (LV) mass. It was high in those with echocardiographically determined abnormal LV ejection fraction, which persisted after adjustment. Mean Lp-PLA2 was also higher in participants with mild renal insufficiency and kidney disease. After multivariable adjustment, there was a modest but significant 27% greater risk of prevalent CHF per standard deviation increment of Lp-PLA2 and a modest but significant 12% greater risk of prevalent myocardial infarction. Lp-PLA2 was weakly but mainly most strongly correlated with cholesterol and lipoproteins, but those correlations were not especially strong. Lp-PLA2 was weakly positively correlated with soluble intercellular adhesion molecule-1 but not interleukin-6. In total, all factors considered could explain only 29% of Lp-PLA2 activity. CONCLUSION: Novel findings in the study are the associations, in those aged 65 and older, between Lp-PLA2 activity and LV dysfunction, CHF, and renal disease. CVD risk factors only minimally explain levels of Lp-PLA2. [source]

Longitudinal study on the relationship between serum albumin and periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2008
Masanori Iwasaki
Abstract Aim: The purpose of this study was to evaluate the relationship between periodontal disease and the general health status in community-dwelling elderly using the serum albumin concentration as a criterion index of the severity of underlying disease and nutrition. Material and Methods: Six hundred subjects aged 70 years underwent a baseline examination. Dental examinations were carried out at baseline and once a year for 4 years. Periodontal conditions were estimated for subjects with at least one remaining tooth. Clinical attachment levels at six sites of all teeth present were measured. A change in loss of attachment of 3 mm or greater in 1 year at each site was defined as periodontal disease progression. Data were analysed in subjects for whom data were available for 4 years. Results: Serum albumin concentration at baseline ranged from 3.4 to 5.0 g/dl with a mean of 4.3±0.2. When the analysis was stratified by smoking status, we found that serum albumin concentration had a significant effect on periodontal disease progression among non-smokers (standardized regression coefficient=,0.16; p=0.017), using multiple regression analysis. Conclusions: The findings of the present study suggest that serum albumin concentration is a significant risk predictor of periodontal disease progression among elderly non-smokers. [source]

Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2007
Ana Belén Navarro-Sanchez
Abstract Objetives: The purpose of this study was to compare the local efficacy of nonsurgical periodontal therapy between type 2 diabetic and non-diabetic patients and the effect of periodontal therapy on glycaemic control. Background: A complex two-way relationship exists between diabetes mellitus and periodontitis. Material and Methods: After selection, 20 subjects (10 diabetic and 10 non-diabetic) underwent baseline examination, periodontal clinical study and biochemical analysis of gingival crevicular fluid (GCF). After the pre-treatment phase, subgingival scaling and root planing were performed. Subsequently, all subjects continued the maintenance programme and were re-examined at 3 and 6 months. Results: Diabetic and non-diabetic subjects responded well after therapy, showing a very similar progression during the follow-up period. Both groups showed clinically and immunologically significant improvements. Significant reductions were also found in the total volume of GCF and levels of interleukin-1, and tumour necrosis factor- ,. Diabetic subjects showed an improvement in their metabolic control. The change in glycosylated haemoglobin (HbA1C) was statistically significant at 3 and 6 months. Conclusions: The clinical and immunological improvements obtained were accompanied by a significant reduction in HbA1C values in type 2 diabetic subjects. Larger studies are needed to confirm this finding and establish whether periodontal therapy has a significant effect on glycaemic control. [source]

Anti-gingivitis effect of a dentifrice containing bioactive glass (NovaMin®) particulate

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2006
Bao Jun Tai
Abstract Background: The objective of this pilot clinical trial was to evaluate the anti-gingivitis and anti-plaque effects of a dentifrice containing bioactive glass (NovaMin®) compared with a placebo control dentifrice in a 6 weeks clinical study. Methods: The study design was a randomized, double-blinded, controlled clinical trial. One hundred volunteers took part in the study and were matched for plaque index (PLI), gingival bleeding index (GBI), age and gender. The protocol was reviewed and approved by the Ethical Committee of the University. The subjects received a supragingival prophylaxis to remove all plaque, calculus and extrinsic stain. Following the baseline examination, subjects were instructed to brush with their assigned dentifrice and toothbrush. The PLI and GBI were determined for the baseline and 6 weeks. The data were analysed using a repeated-measures anova conducted on the two dependent measures to compare the effect between the test and control group. Results: Ninety-five subjects finished the study. The results showed that the PLI (baseline=1.54, 6 weeks=1.29) and GBI (baseline=1.14, 6 weeks=0.47) were significantly reduced, respectively, over the 6 weeks period in the test group (p<0.001 for each measure). There was a 58.8% reduction in gingival bleeding and a 16.4% reduction in plaque growth. There was no difference of the PLI (baseline=1.60, 6 weeks=1.57) and GBI (baseline=1.18, 6-week=1.02) over the 6 week period in the control group. Conclusion: This study demonstrated that a dentifrice containing NovaMin® significantly improves oral health as measured by a reduction in gingival bleeding and reduction in supragingival plaque compared with a negative dentifrice over the 6 weeks study period. [source]

Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2001
G. Serino
Abstract Aim: A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy. Material and Methods: Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (6 mm) and with 6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3,4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of 5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of 2 mm at 4 teeth), he/she was exited from the study and given additional treatment. Results: It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1,3 year period following active therapy than SU-treated subjects. Conclusion: In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy. Zusammenfassung Zielsetzung: Eine klinische Studie wurde durchgeführt, um 1.) die Kurzzeitergebnisse nicht-chirurgischer und chirurgischer Therapie von Patienten mit fortgeschrittener marginaler Parodontitis und 2.) das Auftreten von Parodontitisrezidiven im Verlauf von 12 Jahren unterstützender Parodontitistherapie (UPT) zu untersuchen. Material und Methoden: Jeder der 64 Patienten, die in diese Studie aufgenommen wurden, wies 1.) Zeichen generalisierter gingivaler Entzündung auf und hatte 2.) mindestens 12 Zähne, die keine Molaren waren, mit tiefen Taschen (6 mm) sowie 6 mm Knochenabbau. Diese Patienten wurden zufällig auf 2 Therapiegruppen verteilt: 1.) chirurgische (MW: modifizierter Widman-Lappen) und 2.) nicht-chirurgische (SRP: subgingivales Scaling und Wurzelglättung) Therapie. Nach der Anfangsuntersuchung wurden allen Patienten ihre Erkrankung ausführlich erläutert und eine Mundhygieneinstruktion gegeben. Sowohl MW als SRP wurden unter Lokalanästhesie und in 4,6 Sitzungen durchgeführt. Nach der aktiven Therapiephase wurden die Patienten in ein UPT-Programm eingegliedert, das 3,4 Sitzungen pro Jahr umfasste. Stellen, die während der UPT-Sitzungen auf Sondierung bluteten (BOP) und Sondierungstiefen (ST) 5 mm aufwiesen, wurden einer erneuten subgingivalen Instrumentierung unterzogen. Gründliche Nachuntersuchungen wurden in den Jahren 1, 3, 5 und 13 der UPT durchgeführt. Wenn ein Patient zwischen den jährlichen Routineuntersuchungen deutliche Parodontitisprogression zeigte (zusätzlicher Attachmentverlust 2 mm an 4 Zähnen) wurde er/sie aus der Studie herausgenommen und einer weiterführenden Behandlung zugeführt. Ergebnisse: Es wurde beobachtet, dass 1.) die chirurgische Therapie (MW) hinsichtlich Reduktion der mittleren ST (ST nach 1 Jahr: MW: 2.6 mm; SRP: 4.2 mm; p<0.01) und Eliminierung der tiefen Taschen effektiver war als nicht-chirurgische Therapie (SRP) und dass 2.) in den ersten 1,3 Jahren nach aktiver Therapie bei mehr Patienten aus der SRP-Gruppe (8/25%) ein Fortschreiten der Parodontitis auftrat also bei Patienten der MW-Gruppe (4/12%). Schlussfolgerungen: Bei Patienten mit fortgeschrittener marginaler Parodontitis führte chirurgische Therapie zu günstigeren Kurz- und Langzeitergebnissen hinsichtlich ST-Reduktion und scheint deshalb bei weniger Patienten eine zusätzliche unterstützende Therapie erforderlich zu machen als SRP. Résumé But: Un essai clinique a été réalisé pour déterminer (i) le résultat initial des traitements non chirurgicaux et chirurgicaux chez des sujets présentant des parodontites avancées et (ii) l'incidence de maladie récurrente pendant les 12 ans de maintenance qui ont suivi la thérapeutique active. Matériaux et méthodes: Chacun des 64 patients inclus dans cette étude présentait des signes de (i) inflammation gingivale généralisée, (ii) avaient au minimum 12 dents en dehors des molaires avec des poches profondes (6 mm) et avec une perte osseuse 6 mm. Ils furent assignés au hasard à deux groupes de traitement (chirurgical (SU) et non chirurgical (SRP)). Après un examen initial, tous les patients reçurent une mallette de présentation détaillée comportant des instructions d'hygiène bucco-dentaire. Les sujets SU subirent une chirurgie d'accès alors qu'un traitement non chirurgical était donné au groupe SRP. Suite à ce traitement de base, tous les sujets suivirent un programme de maintenance comportant de méticuleux soins parodontaux de soutien (SPT) 3,4 × par an. Les sites qui, lors d'une visite de contrôle saignaient légèrement au sondage et présentatient une valeur de PPD 5 mm étaient à nouveau instrumentés. De nouveaux examens complets êtaient réalisées après 1, 3, 5, 13 ans de SPT. Si un sujet présentait entre deux visites annuelles une progression évidente de la maladie, (par exemple, une perte d'attache supplémentaire 2 mm sur plus de 4 dents), il ou elle était exclu de l'étude et recevait un traitement complémentaire. Resultats: Il fut observé que (i) le traitement chirurgical (SU) était plus efficace que le traitement non-chirurgical (SRP) pour réduire les profondeurs de poche au sondage moyennes générales et pour l'élimination des poches profondes, (ii) et plus de sujets du groupe SRP présentaient des signes de progression de leur maladie avancée dans la période de 1,3 ans suivant le traitement actif. Conclusions: Chez les sujets présentant une maladie parodontale avancée, le traitement chirurgical apporte de meilleures réductions des poches parodontales à court et long terme et pourrait diminuer le nombre de sujets nécessitant une traitement supplémentaire. [source]

Effects of SCN,/H2O2 combinations in dentifrices on plaque and gingivitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2001
Michael Rosin
Abstract Objectives: A 10-week, double-blind, placebo-controlled clinical study on 140 male subjects was conducted to determine the effect on plaque and gingivitis of 5 dentifrices containing various thiocyanate (SCN,)/hydrogen peroxide (H2O2) combinations. Materials and Methods: The dentifrices consisted of a gel base without any detergents or abrasives (placebo, group A) to which SCN, and/or H2O2 were added as follows: 0.1% SCN, (group B), 0.5% SCN, (group C), 0.1% SCN,/ 0.1% H2O2 (group D), 0.5% SCN,/0.1% H2O2 (group E) and 0.1% H2O2 (group F). A baseline examination was performed in which the Silness and Löe Plaque Index (PI), the Mühlemann and Son Sulcus Bleeding Index (SBI), and the amount of gingival crevicular fluid (GCF) were recorded using the Periotron 6000 on teeth 16, 12, 24, 36, 32, and 44. The subjects were randomly assigned to either the placebo group (n=40) or one of the test groups (n=20) and used their respective dentifrices over a period of 8 weeks. Finally, each group used the placebo for another 2 weeks (wash-out). Re-examinations were performed after 1, 4, and 8 weeks and the 2-week wash-out period employing the clinical parameters used at baseline. Intragroup changes were analyzed with the Wilcoxon signed-ranks test, using the baseline and wash-out points as references. The Mann-Whitney U test was used for comparisons between the treatment groups and the placebo group. Results: At the 8-week examination, the plaque index in group E (p=0.017) and group F (p=0.032) was lower than in the placebo group. The Sulcus Bleeding Index in group F after 1 week was increased (p=0.023) and the SBI in group E after 8 weeks was reduced (p=0.047) as compared to the placebo group. Conclusion: The results demonstrated that a dentifrice containing 0.5% SCN, and 0.1% H2O2 but no detergents or abrasives inhibited plaque and decreased gingivitis. Zusammenfassung Zielsetzung: Eine 10 Wochen dauernde placebokontrollierte Doppelblindstudie wurde bei 140 männlichen Probanden durchgeführt, um die Auswirkungen von 5 Zahnpasten, die verschiedene Kombinationen von Thiozyanat (SCN,) und Wasserstoffperoxide (H2O2) enthielten, auf Plaque und Gingivitis zu untersuchen. Material und Methoden: Die Zahnpasten bestanden aus einer Gelbasis ohne jegliche Detergentien oder Putzkörper (Placebo, Gruppe A), der SCN, und/oder H2O2 wie folgt beigemengt waren: 0.1% SCN, (Gruppe B), 0.5% SCN, (Gruppe C), 0.1% SCN,/0.1% H2O2 (Gruppe D), 0.5% SCN,/0.1% H2O2 (Gruppe E) und 0.1% H2O2 (Gruppe F). Zu Beginn der Studie wurden der Plaque Index (PI), der Sulkus-Blutungs-Index (SBI) und die Sulkusflüssigkeitsfließrate (SFFR) mit dem Periotron 6000 an den Zähnen 16, 12, 24, 36, 32 und 44 bestimmt. Die Probanden wurden zufällig der Placebogruppe (n=40) oder einer der 5 Testgruppen (n=20) zugewiesen und benutzten die entsprechende Zahnpasta über einen Zeitraum von 8 Wochen. Schließlich benutzte jeder Proband die Placebopasta für weitere 2 Wochen ("wash-out"). Nachuntersuchungen fanden nach 1, 4 und 8 Wochen sowie nach der "wash-out"-Periode statt. Ergebnisse: Zur 8-Wochen-Nachuntersuchung war der PI in den Gruppen E (p=0.017) und F (p=0.032) niedriger als in der Placebogruppe. Der SBI in Gruppe F war im Vergleich zur Placebogruppe nach einer Woche erhöht (p=0.023) und in Gruppe E nach 8 Wochen reduziert (p=0.047). Schlußfolgerungen: Die Ergebnisse zeigen, daß eine Zahnpasta, die 0.5% SCN, und 0.1% H2O2 aber keinerlei Detergentien oder Putzkörper enthält Plaque hemmen und Gingivitis reduzieren kann. Résumé Une étude clinique en double aveugle, controlée par un placebo, sur 10 semaines a été réalisée sur 140 sujets masculins pour déterminer les effets sur la plaque et la gingivite de 5 dentifrices contenant des combinaisons variées de thiocyanate (SCN,)/peroxyde d'hydrogene (H2O2). Les dentifrices étaient constitués d'une base de gel sans détergents ni abrasifs (placebo, groupe A) à laquelle étaient ajoutés SCN, et/ou H2O2 comme suit: 0.1% SCN, (groupe B), 0.5% SCN, (groupe C), 0.1% SCN,/0.1% H2O2 (groupe D), 0.5% SCN,/1% H2O2 (groupe E), et 0.1% H2O2 (groupe F). Un examen initial était réalise au cours duquel, l'indice de plaque de Silness et Löe (PI), l'indice de saignement sulculaire de Mühlemann et Son (SBI), et la quantité de fluide gingival (GCF) étaient enregistrés en utilisant le Periotron 6000 sur les dents 16, 12, 24, 36, 32 et 44. Les sujets étaient assignés au hasard soit dans le groupe placebo (n=20), soit dans un groupe test (n=20) et utilisaient leur dentifrices respectifs pendant une période de 8 semaines. Finalement, chaque groupe utilisait le placebo pendant 2 semaines supplémentaires (lessivage). Une réexamination était réalisée après 1, 4, 8 semaines et après la période de lessivage final de 2 semaines avec les mênes indices qu'à l'examen initial. Les modifications intragroupe étaient analysées par le test de Wilcoxon signed ranks, en utilisant les indices initiaux et ceux relevés lors de la période de lessivage. Le test de Mann-Whitney U fut utilisé pour comparer les groupes test et le groupe placebo. A l'examen de la huitième semaine, les indices de plaque du groupe E (p=0.017) et du groupe F (p=0.032) étaient plus bas que dans le groupe placebo. L'indice de saignement sulculaire du groupe F après une semaine était augmenté (p=0.023) et le SBI du groupe E après 8 semaines était diminué (p=0.047), comparé au groupe placebo. Les résultats montrent qu'un dentifrice contenant 0.5% SCN, et 0.1% H2O2, mais ni détergents, ni abrasifs, inhibe la plaque et réduit la gingivite. [source]

Resolution of interdental inflammation with 2 different modes of plaque control

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 12 2000
Thomas Kocher
Abstract Background, aims: The aim of the study was to assess the effect on existing plaque and gingivitis of an oral hygiene regimen which utilizes triclosan/copolymer and to compare it with a regimen which uses interdental cleaning devices to control the interdental inflammation. Method: For this investigation, 39 subjects were recruited. They were examined for plaque and gingivitis using the criteria of Turesky modification of the Quigley-Hein index and the papillary bleeding index. Plaque and gingivitis were only scored interdentally. Following the baseline examination, the subjects were randomly assigned into 2 groups. The control group used a dentifrice identical to the test dentifrice but without triclosan/copolymer; subjects in this group were taught to brush their teeth with the modified Bass technique and were instructed to additionally use appropriate interdental cleaning devices. The test group used a dentifrice containing triclosan/copolymer (Colgate Total). They were not instructed to use interdental cleaning devices. Results: Both groups were re-examined after 4 weeks, and 4 and 7 months. In both groups, plaque and gingivitis levels were modestly reduced, more pronounced in the anterior and less in the posterior teeth. Conclusions: This investigation demonstrated that a dentifrice containing triclosan in combination with a copolymer can reduce plaque and gingival inflammation to levels comparable to regular interdental cleaning. [source]

Body mass index, chronic atrophic gastritis and heartburn: a population-based study among 8936 older adults from Germany

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010
L. Gao
Aliment Pharmacol Ther 2010; 32: 296,302 Summary Background, Obesity and overweight have been positively related to gastro-oesophageal reflux disease (GERD). It has been suggested that this relationship is as a consequence of an increased gastric acid reflux, which is caused by an enhanced intra-abdominal pressure. Aim, To assess potential interaction of the association between body mass index (BMI) and GERD by chronic atrophic gastritis, which goes along with decreased acid production. Methods, In the baseline examination of ESTHER, a study conducted in 9953 older adults in Saarland, information on frequency of heartburn, potential risk factors and medical history was obtained by self-administered standardized questionnaire. Serological measurements of pepsinogen I and II were taken for definition of chronic atrophic gastritis. Results, In total, 2565 (28.7%) of the included subjects experienced heartburn within the previous 4 weeks. A pronounced dose-response relationship was observed between BMI and heartburn occurrence (P < 0.001) among people without chronic atrophic gastritis, but not among people with chronic atrophic gastritis (P -value for interaction = 0.018). Obese/overweight people with chronic atrophic gastritis had a much lower risk of heartburn compared with obese/overweight people without chronic atrophic gastritis (OR = 0.31, 95% CI = 0.24,0.40). Conclusion, Our results are consistent with the hypothesis that BMI is related positively to GERD symptoms by its impact on acid reflux. [source]

Dynamics of Helicobacter pylori infection in early childhood in a high-risk group living in Germany: loss of infection higher than acquisition

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2002
D. Rothenbacher
SUMMARY Background : The dynamics of Helicobacter pylori infection in early childhood are not yet well understood. Aim : To conduct a prospective study in a population of children known to be at high risk of H. pylori infection to elucidate the incidence and loss of infection in childhood. Methods : Asymptomatic Turkish children [aged 1 (n = 56 children), 2 (n = 55 children) and 4 years (n = 69 children)] at baseline, on whom participating paediatricians had performed routine health screening examinations between September 1997 and October 1998, were included in the study. A follow-up was performed about 1 year later. The infection status was defined by means of an antigen-based stool assay. Results : In total, for 137 of 180 (76%) children, follow-up information was available. At baseline examination, the prevalence of infection in children with follow-up information was 27%[95% confidence interval (CI), 20,35%]. The incidence of H. pylori infection amongpreviously uninfected children was 7% (95% CI, 3,14%) and the loss of infection among previously infected children was 35% (95% CI, 20,54%) during follow-up. Conclusions : This prospective cohort study in a high-risk group of children living in Germany showed that H. pylori colonization may often not persist at an early age. Furthermore, the use of penicillins and macrolides may be associated with the loss of infection at an early age. [source]

Grb2-associated binder 1 (Gab1) genetic polymorphism, Helicobacter pylori infection, and chronic atrophic gastritis among older adults from Germany

MOLECULAR CARCINOGENESIS, Issue 10 2010
Lei Gao
Abstract Grb2-associated binder 1 (Gab1) plays an important role in the regulation of cell growth and transformation. A single nucleotide polymorphism (SNP) (rs3805246) in the Gab1 gene has been suggested to be related to the risk of Helicobacter pylori infection and chronic atrophic gastritis (CAG) in a study from Japan. We aimed to assess the associations in a population-based study from Germany. In the baseline examination of ESTHER, a population-based study conducted in Saarland, serum pepsinogen I and II and H. pylori serostatus were measured by ELISA. The Gab1 SNP (rs3805246) was genotyped in 351 serologically defined CAG cases and 351 age- and sex-matched non-CAG controls. A nonsignificant association was observed between the Gab1 SNP and CAG, with an adjusted odds ratio of 1.15 (0.85,1.55) for AA/AG carriers compared to GG carriers. The magnitude of the association did not change when the analysis was restricted to H. pylori seropositive subjects. Furthermore, no significant relation was found between the SNP and H. pylori seropositivity among non-CAG controls. We could not confirm a major association between Gab1 SNP (rs3805246) and the predisposition to H. pylori infection and CAG in this study population from Germany. Further studies with larger sample size are needed to clarify a potential modest effect of Gab1 genetic polymorphisms. © 2010 Wiley-Liss, Inc. [source]

Association of Activities of Daily Living and Indices of Mental Status with Subsequent 20-year All-Cause Mortality in an Elderly Japanese Population

NURSING & HEALTH SCIENCES, Issue 3 2002
Wakako Kushiro
Purpose: To examine the associations of activities of daily living (ADL) and indices of mental status with the risk of subsequent mortality in an elderly Japanese population. Design: Prospective cohort study. Participants: 725 men and 984 women aged 65 years or older at time of baseline examination in 1976,1977. Measurements: Demographic data, levels of disability in ADL, and indices of mental status including self-rated health (SRH), dementia, and depression. Main outcome measures: The subsequent 20-year all-cause mortality. Results: (1) Disability in ADL and several indices of mental status (i.e. bad SRH, high dementia score, decreased pleasure, low morale, and prone to tears) were significantly associated with an increased risk of subsequent 20-year all-cause mortality. (2) The risk of all-cause mortality among people who had no disability in ADL with either of bad SRH, decreased pleasure, high dementia score, or low morale was similar to that among people who had some disability in ADL with either good SRH, increased pleasure, low dementia score, or high morale, respectively. Conclusion: There were strong associations among the levels of disability in ADL and several indices of mental status with subsequent mortality. It was concluded that good mental status may improve longevity even when elderly people have some disability in ADL. [source]

Asbestos-related disease among sheet metal workers 1986,2004: Radiographic changes over time,,

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009
FACOEM, Laura S. Welch MD
Abstract Background In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO,>,1/0), and 21% (3,827) had pleural scarring. Methods 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination. Results By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination. Conclusions Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation. Am. J. Ind. Med. 52:519,525, 2009. © 2009 Wiley-Liss, Inc. [source]

Anosmia after general anaesthesia: a case report

ANAESTHESIA, Issue 12 2009
I. Konstantinidis
Summary Although anaesthetic drugs are included among the aetiological factors of anosmia, limited reports exist of anosmia induced by general anaesthesia. We present the case of a 60-year-old female patient with a 3-month history of altered smell and taste immediately after recovery from general anaesthesia for a urological operation. The anaesthetic drugs used were fentanyl, propofol and sevoflurane. Clinical examination and a computed tomography brain scan did not reveal any pathology. Psychophysical testing showed anosmia and normal taste function. Imaging studies using single photon emission computed tomography of the brain were performed twice: as a baseline examination; and after odour stimulation with phenyl ethyl alcohol. Normal brain activity without reaction to odorous stimuli suggested peripheral dysfunction or stimuli transmission problems. The patient, after four months of olfactory retraining, demonstrated significant improvement. The onset of the dysfunction in relation with the imaging findings may imply that anaesthetics could induce the olfactory dysfunction. [source]

Body mass index and risk of stroke among Chinese men and women

ANNALS OF NEUROLOGY, Issue 1 2010
Lydia A. Bazzano MD
Objective The relationship between body mass index (BMI) and stroke incidence and mortality remains controversial, particularly in Asian populations. Methods We conducted a prospective cohort study in a nationally representative sample of 169,871 Chinese men and women age 40 years or older. Data on body weight was obtained at baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999 to 2000, with a response rate of 93.4%. Results After excluding those participants with missing body weight or height values, 154,736 adults were included in the analysis. During a mean follow-up of 8.3 years, 7,489 strokes occurred (3,924 fatal). After adjustment for age, gender, physical inactivity, urbanization, geographic variation, cigarette smoking, diabetes, and education, compared with participants of normal weight (BMI 18.5,24.9), relative hazard (95% confidence interval) of incident stroke was 0.86 (0.80,0.93) for participants who were underweight (BMI < 18.5), 1.43 (1.36,1.52) for those who were overweight (BMI 25,29.9), and 1.72 (1.55,1.91) for those who were obese (BMI , 30). The corresponding relative hazards were 0.76 (0.66,0.86), 1.60 (1.48,1.72), and 1.89 (1.66,2.16) for ischemic stroke and 1.00 (0.89,1.13), 1.18 (1.06,1.31), and 1.54 (1.27,1.87) for hemorrhagic stroke. For stroke mortality, the corresponding relative hazards were 0.94 (0.86,1.03), 1.15 (1.05,1.25), and 1.47 (1.26,1.72). Linear trends were significant for all outcomes (p < 0.0001). Interpretation These results suggest that elevated BMI increases the risk of both ischemic and hemorrhagic stroke incidence, and stroke mortality in Chinese adults. ANN NEUROL 2010;67:11,20 [source]

Five-year incidence of visual impairment and blindness in older Icelanders: the Reykjavik Eye Study

ACTA OPHTHALMOLOGICA, Issue 3 2010
Elin Gunnlaugsdottir
Abstract. Purpose:, This study examined age, sex and cause-specific 5-year incidence of visual impairment and blindness in a middle-aged and elderly Icelandic population. Methods:, The study cohort consisted of a population-based, random sample of citizens aged , 50 years. Of 1379 eligible subjects, 1045 underwent a baseline examination in 1996; 846 of the 958 survivors (88.2%) underwent a 5-year follow-up examination in 2001. All participants underwent an extensive ophthalmological examination including best corrected visual acuity (BCVA) using a Snellen chart. We used World Health Organization (WHO) criteria, which define visual impairment as BCVA in the better eye of < 6/18 and , 3/60 and blindness as BCVA in the better eye of < 3/60. We also used US criteria, which consider BCVA of < 6/12 and > 6/60 in the better eye to represent visual impairment and BCVA of , 6/60 in the better eye to represent blindness. The causes of incident visual loss in either eye were determined. Deterioration or improvement in vision were defined as a loss or gain of , 2 Snellen lines. Results:, According to WHO criteria, 5-year incidence of bilateral visual impairment and blindness were 1.07% (95% confidence interval [CI] 0.37,1.76) and 0.35% (95% CI 0.00,0.76), respectively. Using US criteria, equivalent incidence of bilateral visual impairment and blindness were 3.49% (95% CI 2.24,4.74) and 0.95% (95% CI 0.29,1.60), respectively. Age-related macular degeneration and cataract were the major causes of incident visual impairment and blindness. Conclusions:, Incidences of visual impairment and blindness increased significantly with age. Age-related macular degeneration, present in 75% of affected persons, was the most common cause of 5-year incident legal blindness in this middle-aged and elderly Icelandic population. [source]

Incidence of open-angle glaucoma in central Sweden

ACTA OPHTHALMOLOGICA, Issue 7 2008
Curt Ekström
Abstract. Purpose:, To estimate the incidence rate of open-angle glaucoma (OAG) in a population in which pseudoexfoliation is a common finding. Methods:, A population-based survey of 760 people aged 65,74 years was conducted in the municipality of Tierp, in central Sweden, during 1984,86. Visual fields (VFs) were tested with the Competer 350 automated perimeter. The present report concerns 711 people, all of whom participated in the survey and were not diagnosed with glaucoma. Since 1988, a follow-up study of the 530 individuals in this cohort with normal and reliable VFs has been in progress. Incident cases of OAG were identified among study participants and patients seeking medical attention at the Eye Department in Tierp. Records of prescriptions for anti-glaucoma drugs were used to search for unidentified patients. A time-weighted mean intraocular pressure (IOP) for all visits was calculated. Results:, By the end of the study in May 2006, 51 new cases of definite OAG had been identified, 31 with capsular and 20 with chronic simple glaucoma. Of these, 46 cases were detected in the follow-up study, corresponding to an incidence of 7.11 (95% confidence interval 5.06,9.17) per 1000 person-years. Twelve of the 51 cases were classified as normal-tension glaucoma, all of which were found in the follow-up study. Open-angle glaucoma with a mean IOP , 23 mmHg tended to emerge closer to the baseline examination than OAG with a mean IOP < 23 mmHg. Conclusions:, The incidence of OAG was high compared with that reported for other studies conducted in White populations. [source]

Implant-Supported Fixed Prostheses for the Rehabilitation of Periodontally Compromised Dentitions: A 3-Year Prospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2001
Odont(hc), Seung-Won Yi DDS
ABSTRACT Background: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth-supported fixed partial dentures has demonstrated excellent long-term treatment outcome. Purpose: A clinical and radiographic study was performed to document and evaluate the short- and medium-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISFPs) in patients treated for advanced peri-odontal disease. Materials and Methods: Forty-three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two-stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri-implant conditions, and radiographs. These examinations were repeated annually during the 3-year observation period. Results: No single implant was lost during the 3-year follow-up period. The percentages of plaque-harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft-tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. Conclusions: The present clinical trial demonstrates that, at least during a 3-year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs. [source]

Implants in fresh extraction sockets: a prospective 5-year follow-up clinical study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2008
Daniele Botticelli
Abstract Objective: The aim of this prospective study was to evaluate the 5-year clinical outcome of the ,immediate implants.' Material and methods: One week after the cementation of the prosthesis, a clinical baseline examination was carried out. Clinical measurements were performed of the following: plaque, mucositis, probing pocket depth, and soft tissue position. The height of the keratinized mucosa was measured at the buccal/lingual aspects. Standardized intra-oral radiographs were taken. The marginal level of bone to implant contact [radiographic (Rx) bone level] was measured, and Rx bone level change over time was evaluated. The clinical/radiographic measurements were repeated on a yearly basis. The subjects were enrolled in a carefully supervised oral hygiene program. Results and conclusion: It was demonstrated that ,immediate implants' that were loaded after 5,7 months had a high success rate. During the 5-year interval, no implant was lost, and the mean Rx bone level at the implants was maintained or even improved. The plaque and mucositis scores were low (<20%) at baseline and at all re-examinations. Implant sites located adjacent to the teeth showed bone gain during the initial period while sites that were facing edentulous zones lost some bone. [source]

Salt fluoridation and dental caries in Jamaica

COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 4 2001
Saskia R. Estupiñán-Day
Abstract ,Purpose: In 1987, Jamaica initiated a comprehensive island-wide salt fluoridation program. A survey was conducted in 1995 to monitor the impact of salt fluoridation among children in Jamaica. Methods: Dental examinations of 1120 children aged 6,8, 12, and 15 years were conducted according to World Health Organization criteria to assess dental caries, fluorosis, the presence of and need for dental sealants, and Community Periodontal Treatment Needs (CPI). Results: Age specific DMFT means observed in 1995 were 0.2 at age 7, 0.4 at age 8, 1.1 at age 12 and 3.0 at age 15. The mean DMFT scores in children 6, 12 and 15 years of age were dramatically lower than the corresponding scores of 1.7, 6.7 and 9.6 obtained at the baseline examination in 1984 for children of the same age groups, respectively (baseline data for 7- and 8-year-olds were not collected). The mean percentage of sound permanent teeth for all age groups was 90% in 1995. The percentage of children caries-free at baseline was 27.6% for 6 years, 2.8% for 12 years and 0.3% for 15 years of age. In 1995, the percentage of caries-free children (permanent teeth) was 61%. In 1984, 23 children were scored as having very mild or mild fluorosis. In 1995, five children were scored in the same categories of fluorosis, using Dean's criteria; thus, fluorosis remained at negligible levels in 1995. Conclusions: The oral health survey conducted in Jamaica in 1995 indicated a significant decline in dental caries compared with findings in 1984. The major change in Jamaica during the interval was the introduction of salt fluoridation in 1987. Dental fluorosis was low in the 1995 survey. [source]

Antiplaque and antigingivitis effectiveness of a hexetidine mouthwash

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2003
N. C. Sharma
Abstract Objective: To assess the antiplaque/antigingivitis efficacy of a hexetidine-containing mouthwash. Methods: This examiner-blind, parallel group, controlled clinical study examined the effectiveness of a hexetidine (0.1%) mouthwash both in inhibiting the development of supragingival plaque and in reducing gingivitis. One hundred and thirty-four adult subjects completed the 2-week experimental gingivitis model study. Following baseline examinations, which included plaque index, modified gingival index and gingival bleeding index, subjects received a full dental prophylaxis. Subjects were randomly assigned to one of three mouthwashes (hexetidine 0.1%, chlorhexidine 0.12% (positive control) or a 5% hydroalcohol negative control) and commenced three times daily supervised rinsing as their sole method of oral hygiene. All indices were rescored after 2 weeks. Results: Compared to the negative control group, the hexetidine group demonstrated a statistically significant inhibition and reduction of supragingival plaque and gingival inflammation with reductions of 6.3%, 33.5% and 56% for gingivitis, plaque and gingival bleeding, respectively. The results of the chlorhexidine group were used to validate the study. Conclusion: The study confirms the efficacy of a hexetidine rinse in reducing supragingival plaque and gingival inflammation. Zusammenfassung Zielsetzung: Untersuchung der Antiplaque- und Antigingivitiseffektivität einer Hexetidin-Mundspüllösung. Methoden: Diese kontrollierte klinische Studie mit verblindetem Untersucher im Parallelarm-Design untersuchte die Effektivität einer Hexitidin-Mundspüllösung (0,1%) sowohl für die Hemmung supragingivaler Plaquebildung als auch zur Reduktion der Gingivitis. 134 erwachsene Probanden beendeten die 2 Wochen dauernde Studie mit experimenteller Gingivitis. Nach der Erstuntersuchung, die die Erhebung des Plaque Index, des Modifizierten Gingival Index und des Gingivalen Blutungs Index umfasste, erhielten die Probanden eine professionelle Zahnreinigung. Den Probanden wurden randomisiert 3 Spüllösungen zugewiesen (Hexitidin 0,1%, Chlorhexidin 0,12% [positive Kontrolle] oder ein 5%iger Hydroalkohol [negative Kontrolle]) und begannen damit als alleinige Mundhygienemaßnahme 3 mal täglich unter Aufsicht zu spülen. Nach 2 Wochen wurden die Indizes erneut erhoben. Ergebnisse: Im Vergleich zur negativen Kontrolle zeigte die Hexitidin-Gruppe eine statistisch signifikante Hemmung und Reduktion der supragingivalen Plaque und gingivalen Entzündung mit Reduktionen von 6,3%, 33,5% bzw. 56% für Gingivitis, Plaque bzw. gingivale Blutung. Die Ergebnisse der Chlorhexidin-Gruppe dienten zur Validierung der Studie. Schlussfolgerung: Diese Studie bestätigt die Wirksamkeit von Hexitidin zur Reduktion supragingivaler Plaque und gingivaler Entzündung. Résumé Cette étude clinique contrôlée par groupe parallèle avec examinateur aveugle a estimé l'efficacité d'un bain de bouche à 0,1% d'héxatidine tant à inhiber le développement de la plaque sus-gingivale qu'à réduire la gingivite. Cent trente-quatre adultes ont achevé un gingivite expérimentale de deux semaines. A la suite de l'examen de base comprenant l'indice de plaque, l'indice gingival modifié et l'indice de saignement gingival, les sujets ont reçu une prophylaxie dentaire complète. Ils ont ensuite été répartis de manière randomisée pour utiliser un des trois bains de bouche suivants : héxatidine 0,1%, chlorhexidine 0,12% (contrôle positif) ou l'hydroalcool 5% (contrôle négatif), et ont commencé a effectuer un rinçage supervisé trois fois par jour comme unique méthode d'hygiène buccale. Tous les indices ont été relevés après deux semaines. Comparé au groupe négatif le groupe héxatidine montrait une inhibition et une réduction significatives de la plaque sus-gingivale et de l'inflammation gingivale avec des réductions respectives de 6,3, 33,5 et 56% pour la gingivite, la plaque dentaire et le saignement gingival. Les résultats du groupe chlorhexidine ont été utilisés pour valider cette étude. Celle-ci confirme l'efficacité de l'héxatidine à réduire la plaque dentaire sus-gingivale et l'inflammation gingivale. [source]

Correlation between vision- and health-related quality of life scores

ACTA OPHTHALMOLOGICA, Issue 3 2009
Brighu N. Swamy
Abstract. Purpose:, To examine the correlation between health-related quality of life (HRQOL) scores [assessed using the generic Short Form Health Survey (SF-36) questionnaire] and vision-related quality of life (VRQOL) scores [assessed using the National Eye Institute Visual Function Questionnaire (NEI-VFQ25)]. Methods:, Cross-sectional analytic study. All surviving participants of the Blue Mountains Eye Study (n = 1952, aged 60 years and older) were invited to attend comprehensive eye examinations 10 years after baseline examinations and were asked to complete both questionnaires. Results:, Complete data were available for 1436 participants. After controlling for age, sex and the presence of either unilateral or bilateral visual impairment, the number of hospital admissions, chronic medical conditions and disabilities, we found that the composite NEI-VFQ score was significantly associated with the two main domains of the SF-36 survey: the summary physical component score (P < 0.001) and the mental component score (P < 0.001). There was relatively low correlation (r < 0.3) between the NEI-VFQ25 subscales and SF-36 subscales including the physical and mental composite scores. Conclusion:, VRQOL is influenced by both general health and HRQOL. However, there is a relatively low correlation between the individual subscales of these two quality of life questionnaires. [source]