Database: EMBASE <: international biomedical and pharmaceutical literature, 1988 - Jun 2000. [Trial access until 3/2001. Feedback welcome to medical.library@umich.edu] Search Strategy (You Saved Citations 1-206 From Set 57): ----------------------------------------------------------------------------- 1 exp Tooth demineralization/ 7624 2 demineralization.mp. 889 3 caries.mp. 1810 4 caires.mp. 0 5 craies.mp. 0 6 careis.mp. 1 7 carise.mp. 0 8 (teeth adj3 cavit:).mp. 32 9 (tooth adj3 cavit:).mp. 31 10 (dental adj3 cavit:).mp. 54 11 (dentin adj3 cavit:).mp. 14 12 (enamel adj3 cavit:).mp. 6 13 (teeth adj3 decay:).mp. 59 14 (tooth adj3 decay:).mp. 58 15 (dental adj3 decay:).mp. 47 16 (dentin adj3 decay:).mp. 0 17 (enamel adj3 decay:).mp. 1 18 (active adj decay).mp. 5 19 (rampant adj3 decay:).mp. 4 20 (recurrent adj3 decay:).mp. 3 21 (white adj spot:).mp. 226 22 carious.mp. 110 23 cariology.ti,ab. 2 24 (non-cavitated adj3 lesion:).mp. 0 25 (noncavitated adj3 lesion:).mp. 1 26 Tooth remineralization/ 800 27 (dental adj3 fissure:).mp. 7 28 (tooth adj3 fissure:).mp. 3 29 (teeth adj3 fissure:).mp. 1 30 caries-free.mp. 28 31 cariesfree.mp. 0 32 Cariogenic agents/ 3 33 precavit:.mp. 2 34 (filled adj3 teeth).mp. 46 35 (filled adj3 tooth).mp. 9 36 (oral adj fissure:).mp. 4 37 (tooth adj3 remineraliz:).mp. 1 38 (teeth adj3 remineraliz:).mp. 4 39 dft.mp. 560 40 dfs.mp. 992 41 dmf:.mp. 1254 42 cariogeni:.mp. 166 43 or/1-42 12451 44 Meta-analysis/ 9912 45 Meta-analysis.pt. 0 46 medline.ti,ab. 4714 47 (metaanaly: or (meta adj analy$5)).ti,ab. 5599 48 overview$1.ti,ab. 16081 49 review.pt. 293352 50 (systematic adj review:).mp. 1327 51 or/44-50 314307 52 43 and 51 959 53 limit 52 to (human and english language) 739 54 limit 53 to yr=1980-2000 739 55 pc.fs. 157351 56 prevent:.mp. 209887 57 54 and (55 or 56) 206 58 from 57 keep 1-206 206 *************************** <1> UI - 2000203414 AU - Kennedy HF AU - Smith AJ IN - H.F. Kennedy, Dept. of Microbiol., Royal Hosp. For Sick Children, Yorkhill NHS TRust, Glasgow G3 8SJ; United Kingdom. TI - Viridans streptococcal infection in the medically compromised. SO - Reviews in Medical Microbiology Vol 11(2) (pp 77-86), 2000. AB - Viridans streptococci form a heterogeneous group of bacteria traditionally associated with dental caries and recognised as the classical opportunistic cause of infective endocarditis. More recently these organisms have emerged as significant pathogens in immunocompromised patients with malignant disease. In addition to a marked increase in the number and severity of infections caused by viridans streptococci over the last two decades, resistance to antibiotics amongst these organisms has become widespread. Antimicrobial therapy must be prescribed prudently to prevent selective pressure towards overgrowth of resistant strains. Factors which may contribute to the development of infection by viridans streptococci include disease- or treatment-associated immunocompromise, mucosal damage and antibiotic selection pressure. Further studies on potential virulence determinants are required to enhance our knowledge of the mechanisms involved in progression from colonisation to infection. In the past accurate and universally recognised phenotypic identification schemes for viridans streptococci were elusive. With recent advances in molecular characterisation of viridans streptococci, controlled prospective studies may determine whether particular species are associated with specific patterns of infection or severity of disease. (C) 2000 Lippincott Williams and Wilkins. [References: 65] <2> UI - 2000185782 AU - Krauss S IN - S. Krauss, Department of Dentistry, Albert Einstein College of Medicine, Bronx, NY; United States. TI - Dental trauma for the pediatrician. SO - Office & Emergency Pediatrics Vol 13(2) (pp 34-36), 2000. <3> UI - 2000179839 AU - Hanada N IN - N. Hanada, Department of Oral Science, Natl. Institute Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640; Japan. E-Mail: nhanada@nih.go.jp. TI - Current understanding of the cause of dental caries. SO - Japanese Journal of Infectious Diseases Vol 53(1) (pp 1-5), 2000. AB - Dental caries-associated oral streptococci are called the mutans streptococci, with Streptococcus mutans and Streptococcus sobrinus being the most prevalent caries-associated organisms in humans. Strains of the mutans streptococci are highly conserved within not only mothers and their children but also racial groups, suggesting vertical transmission of this organism within human populations. It has been found that the mother-child infection route of the mutans streptococci can be prevented by simply reducing the amount of the mutans streptococci contained in the mothers' saliva. Moreover, a chlorhexidine varnish reduces the salivary mutans streptococci by an average of 3 logs (99.9%), and moved them below detectable levels. We should attempt to eliminate the infection with the mutans streptococci among Japanese people by attempting to break the infectious chain from mothers to children. [References: 38] <4> UI - 2000178633 AU - Makinen KK IN - Prof. K.K. Makinen, International Inst. Preventive Dent., University of Turku, Lemminkaisenkatu 2, 20500 Turku; Finland. TI - Can the pentitol-hexitol theory explain the clinical observations made with xylitol?. SO - Medical Hypotheses Vol 54(4) (pp 603-613), 2000. AB - The natural dietary carbohydrate xylitol has been used as a source of energy in infusion therapy and found to act curatively in certain clinical situations. Xylitol has also been used as a sweetener in the diabetic diet and as a non- or anticariogenic agent. Xylitol is a sugar alcohol (polyhydric alcohol) of the pentitol type. The various advantageous clinical effects associated with enteral and parenteral administration of xylitol can be considered to result from the five-carbon (pentitol) nature of the molecule and from the molecule's special configuration even when compared with other pentitols. Such effects may be regarded as simple consequences of evolutionary expediency in a situation where human nutrition and man's significant energy-yielding metabolic pathways are associated with the six-carbon nature of D-glucose and the close derivatives and polymers of D-glucose and related sugars, and the physiologic involvement of the five-carbon xylitol in several ancillary pathways. Consequently, most clinical effects occasioned by xylitol cannot be expected to be caused by six-carbon hexitols such as D-mannitol and D-glucitol. A simple pentitol-hexitol theory seems to explain most of the clinical effects associated with the administration of xylitol. This theory is in congruence with the general evolutionary development in which the metabolism of C6-based carbohydrates is often inhibited by C5-based ones (as manifested in certain bacterial infections in man), or where the presence of the C5-based xylitol forwards therapeutically significant metabolic pathways (as observed in parenteral nutrition and treatment of certain enzyme deficiencies). The validity of the theory can be verified in controlled clinical trials. (C) 2000 Harcourt Publishers Ltd. [References: 60] <5> UI - 2000171493 AU - Anonymous TI - The role of controlled drug delivery for periodontitis. SO - Journal of Periodontology Vol 71(1) (pp 125-140), 2000. AB - This position paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology and is intended to provide the dental profession with an overview of the evidence regarding the adjunctive use of locally delivered antimicrobials in the management of patients with periodontitis. [References: 102] <6> UI - 2000164378 AU - Srivastava R AU - Srivastava BS IN - R. Srivastava, Division of Microbiology, Central Drug Research Institute, Lucknow 226 001; India. E-Mail: root@cscdri.ren.nic.in. TI - Tuberculosis vaccines: A critical role for T-cells. SO - Current Opinion in Anti-Inflammatory & Immunomodulatory Investigational Drugs Vol 2(2) (pp 100-107), 2000. <7> UI - 2000160043 AU - Merrick J AU - Shapira J IN - Prof. J. Merrick, Division for the Mentally Retarded, Ministry of Labour/Social Affairs, The Hebrew Univ.-Hadassah Faculty, Box 1260, IL-91012 Jerusalem; Israel. E-Mail: jmerrick@aquanet.co.il. TI - Preventive dental health for persons with Down syndrome. SO - International Journal of Adolescent Medicine & Health Vol 12(1) (pp 81-84), 2000. AB - Persons with developmental disability, intellectual disability or mental retardation, such as Down syndrome, usually have great difficulties with oral hygiene and health. The need for preventive programs of oral health is therefore paramount in this population. This communication presents two studies from Jerusalem with pre-adolescent children (aged 8-13 years) with Down syndrome, where in the first study, a chlorhexidine coating solution was applied on their teeth to reduce bacterial plaque and in the other study a comprehensive prevention program was implemented. The integration of motivated dental hygienist, dentist, staff and parents into a oral health prevention program will lead to a high degree of prevention of dental disease. With the trends of de-institutionalization it is cautioned that planners and policymakers should take into account the need for continuous high- level medical, para-medical and dental health care to the population of persons with intellectual disability. [References: 3] <8> UI - 2000160042 AU - Merrick J AU - Shapira J IN - Prof. J. Merrick, Division for the Mentally Retarded, Ministry of Labour/Social Affairs, The Hebrew Univ.-Hadassah Faculty, Box 1260, IL-91012 Jerusalem; Israel. E-Mail: jmerrick@aquanet.co.il. TI - Dental concerns in Down syndrome. SO - International Journal of Adolescent Medicine & Health Vol 12(1) (pp 75-79), 2000. AB - Persons with Down syndrome (DS) have several cranial and oral cavity abnormalities resulting in dental disease. Two dental studies from Israel with a preadolescent (aged 8-13 years) and adult population (aged 20-48 years) of Down syndrome are reviewed. The studies used control groups of healthy and non-Down syndrome children and adults with mental retardation. All in all 84% of the children and 33% of the adults with DS were caries free. Periodontal treatment needs of the DS and non-Down adults were higher that the healthy group of persons and the DS adult group showed periodontal treatment needs three times greater than the DS children. It is recommended to start dental visits for persons with DS between the age of 18-24 months and to continue at least twice every year. [References: 3] <9> UI - 2000129631 AU - Trute JL IN - J.L. Trute, 2100 Country Club, Grosse Pointe Woods, MI 48236; United States. TI - Mineral requirements for the reproductive aged woman. SO - Infertility & Reproductive Medicine Clinics of North America Vol 11(2) (pp 257-269), 2000. AB - There are two types of minerals-major and trace. The major minerals include calcium, sodium, chloride, and potassium. The trace minerals include zinc, selenium, iron, iodine, chromium, and fluoride. Calcium is the most abundant mineral in the body; 99% of it is found in the bones. Calcium is released from bone whenever blood levels drop slightly. The new daily reference intake is 1000 mg for women aged 19 to 50 years and increases to at least 1200 to 1500 mg for women aged more than 50 years. Taking calcium with a meal improves its absorption. Sodium is a component of table salt and accounts for 40% of the compound. It is the major mineral outside the cells, has a key role in acid-base balance regulation and concentration of the blood, and influences muscle contraction. An RDA is not established for sodium; however, the estimated minimum requirement is 500 mg. Chloride helps to maintain fluid and electrolyte balance. It is an important aid in digestion because the ion is a component of hydrochloric acid. The estimated minimum requirement is 750 mg a day. Potassium is primarily an intracellular element. Although an RDA for potassium has not been established, the estimated minimum requirement is 2000 mg. Zinc has an important role in more than 70 enzymes. The RDA for zinc is 12 mg. Selenium is interrelated to vitamin E; the status of one effects the other. The RDA for adult women is 55 mug. Iron is mainly connected to protein compounds, with hemoglobin the predominant form, and is involved in several enzyme systems that are important in energy metabolism. The RDA for adult women is 15 mg. Iodine is an essential component of thyroid hormones, which are important in the regulation of oxygen consumption, metabolic rate, and its effects on growth. The RDA for iodine is 150 mug. Chromium is extremely important in normal glucose metabolism. Although there is no RDA for chromium, the established safe and adequate intake is 50 to 200 mug. Fluoride is found in all foods and drinking water and is a component of bones, teeth, thyroid gland, and skin. The optimal dose to prevent dental cavities is 0.05 to 0.07 mg/kg body weight per day. [References: 25] <10> UI - 2000118275 AU - Cannon GW IN - Dr. G.W. Cannon, VAMC (11E), 500 Foothill Drive, Salt Lake City, UT 84148; United States. TI - Rofecoxib: A specific cyclooxygenase inhibitor. SO - Drugs of Today Vol 36(4) (pp 255-262), 2000. AB - Rofecoxib is a new specific cyclooxygenase-2 inhibitor. The efficacy of rofecoxib has been established in the treatment of osteoarthritis, rheumatoid arthritis and acute pain. Rofecoxib has been approved in the United States for the treatment of osteoarthritis and acute pain. Endoscopically proven gastrointestinal ulceration is much less with rofecoxib than standard nonsteroidal antiinflammatory drugs (NSAIDs) and the ulceration rate with rofecoxib is similar to that seen with placebo. Rofecoxib appears to provide clinical benefit equivalent to standard NSAIDs with less toxicity. (C) 2000 Prous Science. [References: 39] <11> UI - 2000117358 AU - Vyas SP AU - Sihorkar V AU - Mishra V IN - S.P. Vyas, Drug Delivery Research Laboratory, Department Pharmaceutical Sciences, Dr. H. S. Gour University, Sagar (M.P.) 470 003; India. E-Mail: spvyas@bom6.vsnl.net.in. TI - Controlled and targeted drug delivery strategies towards intraperiodontal pocket diseases. SO - Journal of Clinical Pharmacy & Therapeutics Vol 25(1) (pp 21-42), 2000. AB - Advances in the understanding of the aetiology, epidemiology, pathogenesis and microbiology of periodontal pocket flora have revolutionized the strategies for the management of intraperiodontal pocket diseases. Intra-pocket, sustained release, drug delivery devices have been shown to be clinically effective in the treatment of periodontal infections. Several degradable and non-degradable devices are under investigation for the delivery of antimicrobial agents into the periodontal pocket including non-biodegradable fibres, films (biodegradable and non-biodegradable), bio-absorbable dental materials, biodegradable gels/ointments, injectables and microcapsules. With the realization that pocket bacteria accumulate as biofilms, studies are now being directed towards eliminating/killing biofilm concentrations rather than their planktonic (fluid phase) counterparts. Intraperiodontal pocket drug delivery has emerged as a novel paradigm for the future research. Similarly, bioadhesive delivery systems are explored that could significantly improve oral therapeutics for periodontal disease and mucosal lesions. A strategy is to target a wide range of molecular mediators of tissue destruction and hence arrest periodontal disease progression. Research into regenerating periodontal structures lost as a result of disease has also shown substantial progress in the last 25 years. [References: 129] <12> UI - 2000105137 AU - Bell J AU - Zador D IN - Dr. J. Bell, The Langton Centre, 591 South Dowling St., Surrey Hills, NSW 2010; Australia. E-Mail: jamesb@sesahs.nsw.gov.au. TI - A risk-benefit analysis of methadone maintenance treatment. SO - Drug Safety Vol 22(3) (pp 179-190), 2000. AB - Methadone maintenance treatment for heroin (diamorphine) addiction has been extensively researched. There is consistent evidence that while in treatment, heroin addicts are at a lower risk of death, are less involved in crime, and feel and function better than while using heroin. Despite the research evidence supporting methadone treatment, there remains widespread public scepticism about this form of treatment. This scepticism is frequently expressed in terms of the perceived risks of methadone treatment. The perceived risk that methadone treatment may maintain people in an addicted lifestyle is not supported by research literature. The risks of treatment include an increased risk of death during induction into treatment, and risks of diversion of drugs to the black market. For some patients, adverse effects of methadone pose a problem and the availability of new pharmacotherapies may provide useful options for these patients. Risks can be reduced and benefits increased by directing greater attention to the quality of treatment. [References: 58] <13> UI - 2000096276 AU - Taylor DO IN - Dr. D.O. Taylor, Department of Medicine, Division of Cardiology 4A-100, University Utah Health Sciences Ctr., 50 N. Medical Drive, Salt Lake City, UT 84132; United States. TI - Immunosuppressive therapies after heart transplantation: Best, better, and beyond. SO - Current Opinion in Cardiology Vol 15(2) (pp 108-114), 2000. AB - Despite the significant advances in transplantation immunology and immunosuppressive therapies over the past 30 years, current immunosuppressive regimens are still inadequate in the majority of cardiac transplant recipients. Although short- and long-term survival rates have improved significantly, only 50% will survive 10 years and very few will survive 20 years. Complications of overimmunosuppression and underimmunosuppression account for the majority of these deaths. Only true 'immunologic' tolerance can provide the outcome we pursue, namely, prolonged allograft function and otherwise normal immune function without chronic immunosuppressive therapy and its risks. Until a successful tolerance-inducing protocol is developed, we must use the current and upcoming immunosuppressive agents and techniques. (C) 2000 Lippincott Williams and Wilkins, Inc. [References: 35] <14> UI - 2000070777 AU - Trevisanato SI AU - Kim Y-I IN - Dr. Y.-I. Kim, Department of Medicine, University of Toronto, St. Michael's Hospital, One King's College Circle, Toronto, Ont. M5S 1A8; Canada. TI - Tea and health. SO - Nutrition Reviews Vol 58(1) (pp 1-10), 2000. AB - Tea is a pleasant, popular, socially accepted, economical, and safe drink that is enjoyed every day by hundreds of millions of people across all continents. Tea also provides a dietary source of biologically active compounds that help prevent a wide variety of diseases. It is the richest source of a class of antioxidants called flavonoids and contains many other beneficial compounds such as vitamins and fluoride. A growing body of evidence suggests that moderate consumption of tea may protect against several forms of cancer, cardiovascular diseases, the formation of kidney stones, bacterial infections, and dental cavities. Future research needs to define the actual magnitude of health benefits, establish the safe range of tea consumption associated with these benefits, and elucidate potential mechanisms of action. [References: 72] <15> UI - 2000067731 AU - Talwar GP AU - Diwan M AU - Razvi F AU - Malhotra R IN - G.P. Talwar, Talwar Research Foundation, New Delhi; India. TI - The impact of new technologies on vaccines. SO - National Medical Journal of India Vol 12(6) (pp 274-280), 1999. AB - Vast changes are taking place in vaccinology consequent to the introduction of new technologies. Amongst the vaccines included in the Expanded Programme of Immunization (EPI), the pertussis vaccine has been replaced by accellular purified fractions devoid of side-effects. Non- pathogenic but immunogenic mutants of tetanus and diphtheria toxins are likely to replace the toxoids. An effective vaccine against hepatitis B prepared by recombinant technology is in large-scale use. Conjugated vaccines against Haemophillus influenzae b, S. pneumococcus and meningococcus are now available, as also vaccines against mumps, rubella and measles. Combination vaccines have been devised to limit the number of injections. Vaccine delivery systems have been developed to deliver multiple doses of the vaccine at a single contact point. A genetically-engineered oral vaccine for typhoid imparts better and longer duration of immunity. Oral vaccines for cholera and other enteric infections are under clinical trials. The nose as a route for immunization is showing promise for mucosal immunity and for anti- inflammatory experimental vaccines against multiple sclerosis and insulin- dependent diabetes mellitus. The range of vaccines has expanded to include pathogens resident in the body such as Helicobacter pylori (duodenal ulcer), S. mutans (dental caries), and human papilloma virus (carcinoma of the cervix). An important progress is the recognition that DNA alone can constitute the vaccines, inducing both humoral and cell-mediated immune responses. A large number of DNA vaccines have been made and shown interesting results in experimental animals. Live recombinant vaccines against rabies and rinderpest have proven to be highly effective for controlling these infections in the field, and those for AIDS are under clinical trial. Potent adjuvants have added to the efficacy of the vaccines. New technologies have emerged to 'humanize' mouse monoclonals by genetic engineering and express these efficiently in plants. These recombinant antibodies are opening out an era of highly specific and safe therapeutic interventions. Human recombinant antibodies would be invaluable for treating patients with terminal tetanus and rabies. Antibodies are already in use for treatment of cancer, rheumatoid arthritis and allergies. An advantage of preformed antibodies directed at a defined target and given in adequate amounts is the certainty of efficacy in every recipient, in contrast to vaccines, where the quality and quantum of immune response varies from individual to individual. [References: 75] <16> UI - 2000060417 AU - Simon A AU - Koppeschaar HPF AU - Roijers JFM AU - Hoppener JWM AU - Lips CJM IN - C.J.M. Lips, Department of Internal Medicine, Division of Endocrinology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht; Netherlands. E-Mail: c.j.m.lips@digd.azu.nl. TI - Pseudohypoparathyroidism type Ia. Albright hereditary osteodystrophy: A model for research on G protein-coupled receptors and genomic imprinting. SO - Netherlands Journal of Medicine Vol 56(3) (pp 100-109), 2000. AB - Pseudohypoparathyroidism type Ia (PHP Ia) is a hereditary endocrine disorder, characterised by resistance to parathyroid hormone (PTH), causing disturbance of calcium homeostasis, and to several other polypeptide hormones. Patients with PHP Ia exhibit a complex of somatic abnormalities, termed Albright hereditary osteodystrophy (AHO). Treatment with vitamin D derivatives alleviates symptoms of hypocalcemia and may prevent bone demineralisation. PTH, like many polypeptide hormones, exerts its effects via a G protein-coupled cell surface receptor. PHP Ia is caused by a heterozygous, inactivating mutation in the gene for the alpha-subunit of the G(s) protein, which disrupts G(s)-protein-coupled signal transduction pathways. Several mutations have been described. When the mutation is inherited from the mother, the offspring will develop PHP Ia, i.e., both hormonal resistance and somatic abnormalities. When the mutation is derived from the father, children will have normal hormone responses while exhibiting the somatic features of AHO; this form of the disorder is called pseudo-pseudohypoparathyroidism (PPHP). A combination of tissue-specific genomic imprinting and haploinsufficiency may explain the occurrence of PPHP, and the fact that not all G(s)-mediated polypeptide hormone actions are affected equally. PHP may therefore serve as a model in studying the pleiotropic consequences of impaired G(s)-mediated signal transduction. Copyright (C) 2000 Elsevier Science B.V. [References: 69] <17> UI - 2000040562 AU - Gales MA AU - Nguyen T-M IN - Dr. M.A. Gales, Department of Pharmacy, INTEGRIS, Baptist Medical Center, 3300 Northwest Expressway, Oklahoma City, OK 73112; United States. TI - Sorbitol compared with xylitol in prevention of dental caries. SO - Annals of Pharmacotherapy Vol 34(1) (pp 98-100), 2000. AB - OBJECTIVE: To summarize published data on the comparative efficacy of sorbitol and xylitol for prevention of dental caries. DATA SOURCES: Published double-blind comparative trials, using sorbitol and xylitol products, identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) searches. DATA SYNTHESIS: Clinical trials generally used sorbitol and xylitol gums, which patients chewed three to five times daily for 20-40 months. Xylitol was superior to sorbitol in two longer, secondary dentition trials (30-63% reductions), but not in two primary dentition trials. CONCLUSIONS: The data suggest that xylitol-containing gums may provide superior efficacy in reducing caries rates in high-risk populations. [References: 16] <18> UI - 2000030351 AU - Budd K IN - K. Budd, Mornington Clinic, Bingley, Bradford; United Kingdom. TI - The role of tramadol in acute pain management. SO - Acute Pain Vol 2(4) (pp 189-196), 1999. AB - Tramadol hydrochloride is an opioid which has the additional property of inhibiting intersynaptic reuptake of noradrenaline and serotonin, thus giving it a dual mode of analgesic action. This gives tramadol a unique place in the pain relieving armamentarium in that not only does it provide analgesia over a wide range of pathologies, but it also has significant advantages over other opioids. These include its lack of significant respiratory depressant effects, unlikely development of tolerance and dependence, and a low adverse event profile. Tramadol is especially suited to the treatment of acute pain with a number of formulations available and specific aspects that make it both effective and safe in problematic areas such as paediatric and cardiac surgery. Analgesia is dose-dependent, and in the awake patient, titration to optimal effect is recommended practice. Adverse events can be readily prevented or treated with appropriate therapy and patient compliance appears to be good. As with any agent, there are aspects about the use of tramadol that need care and attention; slow intravenous injection will reduce the incidence of nausea, and administration at the commencement of anaesthesia or before wound closure will ensure that the patient awakes in comfort and with minimal occurrence of adverse events. Tramadol has proved to be a valuable addition to the range of effective analgesic drugs, and as further aspects of its use are revealed, may well become the analgesic of choice for patients in moderate to severe pain. [References: 81] <19> UI - 2000028724 AU - Raucher BG IN - Dr. B.G. Raucher, Department of Infection Control, Beth Israel Medical Center, First Avenue and 16th Street, New York, NY 10003; United States. TI - Infection control in pulmonary and critical care medicine. SO - Seminars in Respiratory Infections Vol 14(4) (pp 372-382), 1999. AB - During the routine care of patients, pulmonary and critical care specialist may have significant exposure to respiratory infections and potentially infectious body fluids such as blood and pleural fluid. Bronchoscopy and intensive care services often require close contact with patients and the use of sharp devices required for intravascular catheterization. Rendering such care places physicians at risk for acquiring agents such as human immunodeficiency virus (HIV), hepatitis viruses, and Mycobacterium tuberculosis. As of December 1998, 188 cases of occupational transmission of HIV to health care workers (HCWs) in the United States have been reported to the Centers for Disease Control. Most documented cases of seroconversion involve percutaneous injury involving blood, with the greatest risks being associated with injury from a hollow-bore needle that has been in an infected patient's vein or artery. Because thousands of HIV-infected persons are unaware of their infection, HCWs must consider all patients to be infected with HIV and improve work practices accordingly. Nevertheless, elimination of all exposures is impossible, and postexposure prophylaxis with combination antiretroviral therapy is recommended for persons deemed a high risk of contracting HIV. Pulmonary specialists are at high risk of exposure to tuberculosis; proper precautions include isolation of patients with suspected tuberculosis and the use of DMF-HEPA respirator masks, especially while performing procedures like bronchoscopy. Contaminated bronchoscopes have been implicated in transmission and 'pseudoinfection' of tuberculosis and nontuberculous mycobacteria, underscoring the need for rigorous cleaning and disinfection practices. [References: 42] <20> UI - 2000003253 AU - Steinberg D AU - Friedman M IN - M. Friedman, Department of Pharmacy, School of Pharmacy, Hebrew University, PO Box 12065, Jerusalem 91120; Israel. E-Mail: dorons@cc.huji.ac.il. TI - Dental drug-delivery devices: Local and sustained-release applications. SO - Critical Reviews in Therapeutic Drug Carrier Systems Vol 16(5) (pp 425-459), 1999. AB - Dental diseases are among the most prevalent illnesses in humans. Many pharmaceutical dosage forms are used to prevent and treat these diseases. Toothpastes and mouthwashes are two of the most popular dental medicaments. A local delivery application that prolongs the release of the drug in the mouth offers great advantages in preventing and treating caries and periodontal diseases. Sustained-release devices are a relatively new concept in dentistry. This paper describes several types of sustained-release devices that are available commercially or are in the premarketing stage. [References: 133] <21> UI - 2000003142 AU - Qi X AU - Dorian P IN - X. Qi, 7071B/Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ont. M5B 1W8; Canada. E-Mail: Xiangqian.qi@utoronto.ca. TI - Antiarrhythmic drugs and ventricular defibrillation energy requirements. SO - Chinese Medical Journal Vol 112(12) (pp 1147-1152), 1999. AB - Purpose: To understand the potential interaction between antiarrhythmic therapy and the implantable cardioverter-defibrillator (ICD) in patients who receive pharmacologic therapy as an adjunct to ICD therapy. Data sources: MEDLINE searching was employed and the information was indexed from approximately 3600 journals published world-wide from 1966 to 1998. Study selection and data extraction: Data were collected from 66 of approximately 455 originally identified articles and abstracts using explicit methodological criteria. Results: The ICD therapy has been widely used for therapy of life-threatening ventricular arrhythmias (VT/VF) and prevention of recurrence of sudden cardiac death. Studies reported that 40% - 70% or 10% - 40% of ICD patients required concomitant antiarrhythmic medication to reduce the frequency of sustained arrhythmic episodes and to minimize the frequency of device discharges. Most studies on antiarrhythmic drug-ICD interactions have been performed in experimental animals. Antiarrhythmic drugs can influence the effectiveness of ICD to terminate arrhythmias through their effects on defibrillation threshold (DFT). Studies have demonstrated a rise in DFTs with class Ib agent lidocaine and class Ic agents encainide and flecainide. Class Ia agents, as well as amiodarone, bretylium and propafenone may have more variable effects on DFT probably because of the difference between acute and chronic drug dosing, dose-related changes, active metabolites, and reproducibility in determining DFT. Class III agents, with the exception of amiodarone, consistently decrease DFT. These drugs can be used as front-line agents in ICD patients. Conclusions: Antiarrhythmic drugs can increase, decrease, or have no effect on DFT. Class III agents except amiodarone can be safely administered in conjunction with ICD patients as long as the interaction between these therapeutic modalities is appreciated. [References: 66] <22> UI - 1999417147 AU - Greenstein G IN - Dr. G. Greenstein, 900 West Main Street, Freehold, NJ 07729; United States. TI - Povidone-iodine's effects and role in the management of periodontal diseases: A review. SO - Journal of Periodontology Vol 70(11) (pp 1397-1405), 1999. AB - This review article addresses the effects of povidone-iodine (PVP-1) and its utility in the treatment of periodontal diseases. There are data to support the following statements: PVP-1 is a potent antiseptic and, when used as a component in a rinse with H2O2, the rinse can decrease the level of gingivitis. With regards to patients with adult periodontitis, there is some evidence to indicate that PVP-1 delivered via an ultrasonic device achieves better results in deep pockets than ultrasonic debridement when water is the irrigant. The benefits of PVP-1 in the treatment of refractory periodontitis are unclear. Subgingival irrigation with PVP-1 may reduce the incidence of bacteremia if it is employed as a pre-procedural intrasulcular irrigant; however, this technique is not recommended for high-risk patients. PVP-1 is a safe antiseptic and does not appear to impede wound healing or induce resistant bacteria. It is an approved drug whose intraoral use is an unlabeled indication. In conclusion, the literature suggests that utilization of PVP-1 is potentially beneficial in the management of some periodontal diseases. However, additional clinical trials are needed to verify this assessment, since it is based upon a limited number of studies. [References: 59] <23> UI - 1999402262 AU - Niv Y AU - Mor E AU - Tzakis AG IN - Dr. Y. Niv, Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach-Tikva; Israel. TI - Small bowel transplantation - A clinical review. SO - American Journal of Gastroenterology Vol 94(11) (pp 3126-3130), 1999. AB - The results of small bowel transplantation improved in the last 5 yr because of the development of new immunomodulating drugs and surgical techniques, as well as better candidate selection. We still need much experience until this procedure will be in routine use for terminal intestinal insufficiency. [References: 36] <24> UI - 1999349936 AU - Boyce T AU - Edwards J AU - Scarborough N IN - Dr. N. Scarborough, Osteotech, Inc., 51 James Way, Eatontown, NJ 07724; United States. TI - Allograft bone: The influence of processing on safety and performance. SO - Orthopedic Clinics of North America Vol 30(4) (pp 571-581), 1999. AB - Advances in tissue processing technology have been important for the successful use of bone allografts. The challenge is to prepare allografts that are well cleaned, sterile, and free of viruses while still preserving the natural biologic and biomechanical properties of the tissue. This article discusses how processing techniques aimed at achieving safety and sterility can affect the properties vital for graff incorporation and healing. [References: 97] <25> UI - 1999314395 AU - Iughetti L AU - Marino R AU - Bertolani MF AU - Bernasconi S IN - Prof. S. Bernasconi, Via del Pozzo 71, 41100 Modena; Italy. TI - Oral health in children and adolescents with IDDM - A review. SO - Journal of Pediatric Endocrinology & Metabolism Vol 12(5) (pp 603-610), 1999. AB - Children with insulin-dependent diabetes mellitus have a lower salivary flow rate, pH and buffer capacity, but a higher glucose content and peroxidase, IgA, magnesium and calcium concentration, in comparison with healthy children. Nevertheless the incidence of caries is lower than normal in diabetic children with good metabolic control. Periodontal disease usually starts at puberty as mild gingivitis with bleeding and gingival recession, and it may develop into severe periodontitis, especially in children with poor control of diabetes. Microangiopathy, impaired immune response, different bacterial microflora and collagen metabolism are involved in the pathogenesis of diabetic periodontal disease. The gingival flora is mostly composed of Gram-negative, anaerobic bacteria, while collagen has a lower solubility and is atrophic and inadequate to support the occlusion forces. For these reasons, prevention of periodontitis is important in diabetic children; they should receive oral hygiene instruction and visit a dentist at least twice a year. [References: 39] <26> UI - 1999299548 AU - Soderholm K-JM AU - Tyas MJ AU - Jokstad A IN - K.-J.M. Soderholm, Department of Dental Biomaterials, College of Dentistry, Gainesville, FL 32610-0446; United States. TI - Determinants of quality in operative dentistry. SO - Critical Reviews in Oral Biology & Medicine Vol 9(4) (pp 464-479), 1998. AB - The definition of quality in operative dentistry has often, at least in part, been related to how well a cut preparation compares with an ideal preparation. The ideal preparation follows well-defined design principles. These design principles have their roots in empirical dentistry and scientific evaluations, the latter often being conducted in vitro. Because of the complexity of following these design principles practically, a large portion of dental education consists of perfecting cavity preparations. By focusing on how to cut these cavity preparations as closely as possible to the ideal preparation, dentists with high psycho-motor skills have been able to provide the public with restorative procedures of high standards over the years. However, because of the tendency of relating quality in operative dentistry to the ideal preparation, we found it justifiable to review the literature dealing with the cavity design principles of the Class II amalgam preparation. What triggered this review was a request from the International Dental Federation (FDI) to start a process leading to a scientifically based quality definition of dental restorations, a definition that determines how different factors, including cavity design principles, affect the longevity of both tooth and restoration. From our review, we conclude that patient response and restoration performance over time, rather than how closely a cavity preparation compares with the ideal preparation, will be of more significance in determining the longevity of a Class II amalgam restoration. [References: 125] <27> UI - 1999262251 AU - Ruxton CHS AU - Garceau FJS AU - Cottrell RC IN - Dr. C.H.S. Ruxton, The Sugar Bureau, Dolphin Square, London SW1V 3PW; United Kingdom. TI - Guidelines for sugar consumption in Europe: Is a quantitative approach justified?. SO - European Journal of Clinical Nutrition Vol 53(7) (pp 503-513), 1999. AB - Objectives: There is incongruity between the sugar consumption guidelines set in different European countries. A number have adopted maximum limits ranging from 10-25% energy, while others have no quantitative recommendations at all. This raises the question whether or not there should be a common European guideline for sugar consumption. Design: This paper examines if such a goal for sugar is merited and reviews the published literature on associations between sugar consumption and dental caries, obesity and micronutrient dilution. Results: Evidence showed that higher intakes of sugar were related to leanness, not obesity, and had no detrimental effects on micronutrient intakes in most people. In the case of dental caries, there was a relationship between frequency of sugar intake and the incidence of decay. However, in populations where fluoride use was adequate, associations between sugar intake and caries rarely reached statistical significance. Conclusions: The available evidence does not justify a common quantitative recommendation for sugar. It is suggested that dental caries merits a more integrated public health approach where advice on the frequency of foods containing fermentable-carbohydrates is placed in context alongside oral hygiene. [References: 55] <28> UI - 1999245192 AU - Harris PJ AU - Ferguson LR IN - L.R. Ferguson, Fac. Medicine and Health Science, Cancer Society Research Centre, University of Auckland, Private Bag 92019, Auckland; New Zealand. E-Mail: l.ferguson@auckland.ac.nz. TI - Dietary fibres may protect or enhance carcinogenesis. SO - Mutation Research-Genetic Toxicology & Environmental Mutagenesis Vol 443(1-2) (pp 95-110), 1999. AB - Dietary fibre (DF) is widely considered to protect against cancer, especially colorectal cancer. However, a large prospective epidemiological study has shown no apparent effect of DF intake on the development of colorectal cancer. We suggest that this may be because the term DF represents a wide range of materials, some able to protect, but some able to enhance carcinogenesis. This is consistent with data from animal carcinogenesis experiments. Most of the DF in western diets is in the form of plant cell walls, but these vary in their composition and it is unlikely that all types are protective. The few data available indicate that plant cell walls containing suberin or lignin may be the most protective, although they are present in only small amounts in food plants. DFs are also added to foods. These include components obtained from plant cell walls, such as pectins, as well as soluble DFs from other sources. In general, animal carcinogenesis experiments indicate that soluble DFs do not protect and some may enhance carcinogenesis. Few human intervention studies have been done on DF or sources of DF, with the exception of wheat bran, a good source of DF, which has been shown to protect. Possible mechanisms whereby DF may enhance carcinogenesis are discussed. In addition to DFs, resistant starches and non-digestible oligosaccharides are added to foods; these, like DF, escape digestion in the small intestine. However, so far only a few animal carcinogenesis experiments have been reported using these materials, and no human intervention studies. We believe caution should be exercised in the addition of such materials to food. Copyright (C) 1999 Elsevier Science B.V. [References: 120] <29> UI - 1999200170 AU - Ormerod LD AU - Dailey JP IN - Dr. L.D. Ormerod, Mason Eye Institute, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212; United States. TI - Ocular manifestations of cat-scratch disease. SO - Current Opinion in Ophthalmology Vol 10(3) (pp 209-216), 1999. AB - Bartonella henselae has only recently been isolated, characterized, and found to be the principal cause of cat-scratch disease (CSD). The availability of specific serologic investigations has allowed the recognition of a spectrum of ocular CSD syndromes that previously were ill defined and considered idiopathic. The primary inoculation complex causing regional lymphadenopathy is represented in the eye by Parinaud's oculoglandular syndrome; B. henselae is the most common cause. Leber's neuroretinitis has been identified for 80 years, and new data suggest that it is commonly a manifestation of CSD; the extent of the association remains to be determined, CSD optic neuritis is also described. The vitreoretinal manifestations include anterior uveitis, vitritis, pars planitis, focal retinal vasculitis, a characteristic retinal white spot syndrome, Bartonella retinitis, branch retinal arteriolar or venular occlusions, focal choroiditis, serous retinal detachments, and peripapillary angiomatous lesions. The pattern of ocular disease in AIDS-associated B, henselae infections is poorly delineated; unusual manifestations include conjunctival and retinal bacillary angiomatosis. The benefit of antimicrobial therapy for CSD in immunocompetent individuals has been difficult to establish, partly because most infections are self limited. Empirically, azithromycin, ciprofloxacin, rifampin, parenteral gentamicin, or trimethoprim-sulfamethoxazole provide the best therapeutic choices to minimize damage to the eye. [References: 72] <30> UI - 1999181790 AU - Jones G AU - Riley M AU - Couper D AU - Dwyer T IN - Dr. G. Jones, Menzies Ctr. Population Health Res., GPO Box 252-23, Hobart, TAS 7001; Australia. E-Mail: G.Jones@utas.edu.au. TI - Water fluoridation, bone mass and fracture: A quantitative overview of the literature. SO - Australian & New Zealand Journal of Public Health Vol 23(1) (pp 34-40), 1999. AB - Objective: To use the technique of meta-analysis to address the following research questions: Is water fluoridation associated with altered fracture risk at a population level and are the differences between studies consistent with confounding or chance variation between studies? Method: The data sources utilised were Medline 1966-97, reviews and bibliographies. The search terms were fluoridation, bone mass and/or fracture. We included all observational studies published in English relating water fluoridation to bone mass and/or fracture in the initial assessment. Results: Water fluoridation had no evident effect on fracture risk (RR 1.02, 95% CI 0.96-1.09, n = 18 studies). There was marked heterogeneity between studies which could be explained, in part, by the combination of gender, urbanicity and study quality (R2 0.25, p = 0.05, weighted analysis). Conclusions: Water fluoridation both at levels aimed at preventing dental caries and, possibly, at higher naturally occurring levels appears to have little effect on fracture risk, either protective or deleterious, at a population level. The small effect on bone mass seen in studies performed at the individual level is consistent with this finding. Variation between studies is also likely to be due to differences in the distribution of other recognised fracture risk factors between different populations. Confirmation of these findings is required in large studies performed at the individual level. [References: 40] <31> UI - 1999173816 AU - Sakagami H AU - Oi T AU - Satoh K IN - Prof. H. Sakagami, Department of Dental Pharmacology, Meikai University, School of Dentistry, Sakado, Saitama 350-0283; Japan. E-Mail: sakagami@dent.mekai.ac.jp. TI - Prevention of oral diseases by polyphenols (review). SO - In Vivo Vol 13(2) (pp 155-171), 1999. AB - This review summarizes the current data on the effects of natural products on various oral diseases, together with their basic biological activities. We have focused on polyphenols and their secondary metabolites, such as tannins, lignins and flavonoids, and their modulating factors, including saliva proline-rich proteins. These substances are found in a wide variety of plant sources such as vegetables, herbs, nuts and teas, and effectively reduce the incidence of carcinogenesis in the oral cavity, inhibit plaque growth and adsorption of oral bacteria, and inhibit the replication of various viruses. The mechanism of their action includes: the direct inactivation of the bacteria and viruses, inhibition of their replication enzymes, induction of apoptosis in tumor cells, stimulation of monocytes/macrophages to produce cytokines, and stimulation of myeloperoxidase-dependent iodination of neutrophiles. Polyphenols showed biphasic actions, acting as antioxidants at lower doses, but acting as prooxidants at higher doses. The development and progression of oral diseases might be modified not only by these natural products, but also by interaction with saliva, proline-rich proteins, antioxidants, metals and dental materials. [References: 179] <32> UI - 1999158961 AU - Hennequin M AU - Faulks D AU - Veyrune J-L AU - Bourdiol P IN - M. Hennequin, Faculte de Chirurgie Dentaire, Universite d'Auvergne, 11 Boulevard Charles de Gaulle, 63000 Clermont Ferrand; France. E-Mail: martine.hennequin@u-clermont1.fr. TI - Significance of oral health in persons with Down syndrome: A literature review. SO - Developmental Medicine & Child Neurology Vol 41(4) (pp 275-283), 1999. <33> UI - 1999115965 AU - Budd K AU - Langford R IN - K. Budd, The Mornington Clinic, Bradford BD16 1TZ; United Kingdom. TI - Tramadol revisited. SO - British Journal of Anaesthesia Vol 82(4) (pp 493-495), 1999. <34> UI - 1999081605 AU - McChesney LP IN - Dr. L.P. McChesney, Creighton Univ. School of Medicine, Alpha Omega Alpha, Omaha, NE; United States. TI - Part II. Advances in pancreas transplantation for the treatment of diabetes. SO - Disease-A-Month Vol 45(3) (pp 88-100), 1999. <35> UI - 1999101494 AU - Barry JM IN - Dr. J.M. Barry, Div. Urology Renal Transplantation, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201; United States. TI - Renal transplantation. SO - Current Opinion in Urology Vol 9(2) (pp 121-127), 1999. AB - There has been an increase in the transplantation of kidneys from living, genetically unrelated donors and from extended criteria cadaver donors. The past policies about paid renal donors are being reconsidered. Techniques have been developed to reduce morbidity for the living renal donor. The variety of immunosuppressants allows individuation of therapy. Guidelines for conception and pregnancy have been established. [References: 37] <36> UI - 1999090413 AU - Flack JM AU - Hamaty M IN - Dr. J.M. Flack, Cardiovasc Epidemiol Clin Apps Prog, Detroit Medical Center, Central Region Hospitals, Detroit, MI 48201; United States. E-Mail: jflack@oncgate.roc.wayne.edu. TI - Difficult-to-treat hypertensive populations: Focus on African-Americans and people with type 2 diabetes. SO - Journal of Hypertension - Supplement Vol 17(1) (pp S19-S24), 1999. AB - The awareness, treatment, and control of hypertension has risen steadily over the past three decades, until the early 1990s. However, blood pressure control to < 140/90 mmHg is attained in fewer than 25% of all hypertensive patients and fewer than 50% of drug-treated hypertensive patients, except for white women. Two special populations, African-Americans and diabetics, share several important attributes. First, they both have a high prevalence of hypertension, including stage 3 hypertension (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension VI: >= 180/110 mmHg), relative to other subgroups. African-Americans have an approximate 8% prevalence of stage 3 hypertension, and elevated systolic blood pressure is highly prevalent among diabetic people, particularly older African-American women. Second, both groups have high levels of blood-pressure-related target-organ damage, which contributes to their inordinately high absolute risk for cardiovascular disease complications (i.e. stroke, congestive heart failure, renal failure) at a given level of blood pressure. Moreover, the reduced natriuretic capacity common to each group contributes to the attenuated efficacy of antihypertensive drug monotherapy, particularly for drug classes other than diuretics and calcium antagonists. These two special populations are also typically salt-sensitive, an intermediate blood pressure phenotype that raises blood pressure medication requirements. This phenomenon has been associated with an attenuation in the normal nocturnal fall in blood pressure. The high absolute risk for cardiovascular disease among diabetics led to the formulation of more aggressive treatment recommendations for antihypertensive drug therapy. In diabetics, blood pressure therapy is initiated at blood pressures >= 130/85 mmHg, and treatment goals are at least to this level, unless proteinuria is >= 1 g/day (in which case the goals are < 125/75 mmHg). The more aggressive treatment targets for diabetics will not be reached with most currently available single antihypertensive agents in many African-Americans. While at best only 50-60% of hypertensive patients can be controlled with single drug therapy, that percentage falls dramatically in persons with stage 3 hypertension and renal insufficiency, thereby necessitating the use of combination drug therapy. Treatment alone is not enough; treatment to goal blood pressure is an essential first step towards optimal target-organ protection. While circulating levels of renin are suppressed, in general, in these special populations, each group manifests an inordinate burden of blood-pressure-related target-organ damage that has been linked to excessive levels of angiotensin II or a reduced bradykinin and nitric oxide tissue effect. The renin-angiotensin-aldosterone-kinin system is therefore an attractive therapeutic target that might conceivably provide target-organ protection over and above that attributable solely to lowering the blood pressure. [References: 45] <37> UI - 1999090262 AU - Dooley M AU - Goa KL IN - M. Dooley, Adis International Limited, 41 Centorian Drive, Mairangi Bay, Auckland 10; New Zealand. E-Mail: demail@adis.co.nz. TI - Sibrafiban. SO - Drugs Vol 57(2) (pp 225-230), 1999. AB - - Sibrafiban is the orally administered, nonpeptide, double-prodrug of Ro 44-3888 which is a selective glycoprotein IIb/IIIa receptor antagonist. It is currently undergoing clinical trials for secondary prevention of cardiac events in patients stabilised after acute coronary syndromes. - In a phase II dose-finding study (TIMI 12) in patients stabilised after a myocardial infarction (MI) or an episode of unstable angina, there was a dose-dependent inhibition of platelet aggregation which correlated closely with the plasma concentration of the total active drug. - An ongoing phase III study (SYMPHONY) compares the effects of sibrafiban on cardiac events with that of aspirin in patients stabilised after a Q wave MI or an episode of unstable angina. - This large trial uses twice daily dosage regimens to produce the plasma concentrations which were associated with less bleeding in the earlier dose-ranging trial. - A long term (minimum duration 12 months) phase III study (2nd SYMPHONY) is under way to compare the effects of sibrafiban on cardiac events with those of aspirin in patients stabilised after an MI or an episode of unstable angina. - The most common adverse events associated with sibrafiban include bleeding, with minor haemorrhages occurring more often than with aspirin. [References: 9] <38> UI - 1999063181 AU - Duo TTT AU - Lavigne GJ IN - T.T.T. Duo, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ont. M5G 1G6; Canada. TI - Oral splints: The crutches for temporomandibular disorders and bruxism. SO - Critical Reviews in Oral Biology & Medicine Vol 9(3) (pp 345-361), 1998. AB - Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial. Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of the condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's 'harmful' oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed. [References: 198] <39> UI - 1999063850 AU - Allolio B AU - Lehmann R IN - Prof. B. Allolio, Medizinische Universitatsklinik, Josef-Schneider-Str 2, D-97080 Wurzburg; Germany. TI - Drinking water fluoridation and bone. SO - Experimental & Clinical Endocrinology & Diabetes Vol 107(1) (pp 12-20), 1999. AB - Drinking water fluoridation has an established role in the prevention of dental caries, but may also positively or negaytively affect bone. In bone fluoride is incorporated into hydroxylapatite to form the less soluble fluoroapatite. In higher concentrations fluoride stimulates osteoblast activity leading to an increase in cancellous bone mass. As optimal drinking water fluoridation (1 mg/l) is widely used, it is of great interest, whether long-term exposition to artificial water fluoridation has any impact on bone strength, bone mass, and - most importantly - fracture rate. Animal studies suggest a biphasic pattern of the effect of drinking water fluoridation on bone strength with a peak strength at a bone fluoride content of 1200 ppm followed by a decline at higher concentrations eventually leading to impaired bone quality. These changes are not paralleled by changes in bone mass suggesting that fluoride concentrations remain below the threshold level required for activation of osteoblast activity. Accordingly, in most epidemiological studies in humans bone mass was not altered by optimal drinking water fluoridation. In contrast, studies on the effect on hip fracture rate gave conflicting results ranging from an increased fracture incidence to no effect, and to a decreased fracture rate. As only ecological studies have been performed, they may be biased by unknown confounding factors - the so-called ecological fallacy. However, the combined results of these studies indicate that any increase or decrease in fracture rate is likely to be small. It has been calculated that appropriately designed cohort studies to solve the problem require a sample size of > 400,000 subjects. Such studies will not be performed in the foreseeable future. Future investigations in humans should, therefore, concentrate on the effect of long-term drinking water fluoridation on bone fluoride content and bone strength. [References: 76] <40> UI - 1999047189 AU - Walton AG AU - Welbury RR AU - Foster HE AU - Thomason JM IN - Dr. R.R. Welbury, Dental Hospital, Richardson Road, Newcastle upon Tyne NE2 4AZ; United Kingdom. TI - Juvenile chronic arthritis: A dental review. SO - Oral Diseases Vol 5(1) (pp 68-75), 1999. AB - A review of the literature relating to juvenile chronic arthritis (JCA) is presented. It includes a description of the disease itself and identifies our knowledge of the increased risk of dental disease associated with this condition. In addition the impact of JCA therapy on the dental management of the patient is discussed. The review highlights the need for further research into the effects of the disease on dental caries, periodontal disease and saliva. [References: 48] <41> UI - 1999002993 AU - Creighton PR IN - P.R. Creighton, Department of Pediatric Dentistry, Children's Hospital of Buffalo, 219 Bryan Street, Buffalo, NY 14222; United States. E-Mail: creighto@acsu.buffalo.edu. TI - Common pediatric dental problems. SO - Pediatric Clinics of North America Vol 45(6) (pp 1579-1600), 1998. AB - Physicians who provide primary care for children have a unique position to provide diagnostic, triage, educational, and preventive dental care for patients. Several papers have been published regarding primary pediatricians' participation in the preventive dental health care of their patients. One publication, a survey of physicians in Alabama focusing on physicians' overall awareness of dental issues, concluded that most physicians believe they have a role in the oral health of their patients, yet most were not aware of many of the American Academy of Pediatric Dentistry's recommendations. Most physicians report that they routinely perform oral examinations during physical examinations of children and deliver preventive, oral information by the age of 6 months or earlier; however, most recommend that infants' first visit should be at 3 years of age, not at the time of first-tooth eruption as the authors recommend. Furthermore, many primary care physicians do not talk about oral health during prenatal counseling. Many physicians understand the preventive advantages of fluoride, yet most do not prescribe vitamin combinations that contain fluoride. If an understanding of the aforementioned issues of dental care, as well as aspects of preventive care in infants and children, become more uniform among primary care physicians, the prevention-based practice of pediatric dentistry will become much more successful, and children and adults will enjoy better dental health. [References: 21] <42> UI - 1999008766 AU - Scheie AAa AU - Fejerskov OB IN - A.Aa. Scheie, Department of Oral Biology, Dental Faculty, University of Oslo, Pb 1052 Blindern, 0316 Oslo; Norway. TI - Xylitol in caries prevention: What is the evidence for clinical efficacy?. SO - Oral Diseases Vol 4(4) (pp 268-278), 1998. AB - Xylitol has attracted much attention as an alternative sweetener. Essentially all clinical studies concerning the effect of xylitol on caries development consent to its non-cariogenicity and to the beneficial effect of substituting sucrose with xylitol in chewing gums and sweets. However, claims of anti-caries or therapeutic effects, and superiority of xylitol over other polyols are still to be confirmed by well designed and conducted studies from independent research groups. [References: 111] <43> UI - 1998395999 AU - Loesche WJ IN - W.J. Loesche, Univ. of Michigan Sch. of Dentistry, School of Medicine, Ann Arbor, MI; United States. TI - The diagnosis and treatment of anaerobic periodontal infections. SO - Infections in Medicine Vol 15(11) (pp 788-790+792-797), 1998. AB - Dental infections are the most common infections in humans, and periodontal disease is the primary dental problem for older individuals. Current management relies on periodic debridement of tooth surfaces for prevention and on surgery for advanced cases of periodontal disease. A new treatment paradigm is based on evidence that periodontal disease is a chronic but specific bacterial infection that can be treated by a combination of debridement and systemic and/or local delivery of antimicrobial agents, such as metronidazole. This article presents a brief review of the pathophysiology of periodontal disease, along with results from 3 double-blind clinical trials in which short-term metronidazole was used successfully in patients with advanced periodontal disease. [References: 57] <44> UI - 1998418862 AU - Meraw SJ AU - Sheridan PJ IN - Dr. P.J. Sheridan, Department of Dental Specialties, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905; United States. TI - Medically induced gingival hyperplasia. SO - Mayo Clinic Proceedings Vol 73(12) (pp 1196-1199), 1998. AB - Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. Speech, mastication, tooth eruption, and aesthetics may be altered. Controlling the inflammatory component through an appropriate oral hygiene program may benefit the patient by limiting the severity of the gingival overgrowth. In patients in whom gingival overgrowth is present or may be anticipated, recognition of this condition and referral to a general dentist or periodontist are appropriate steps to management. The physician's awareness of the potential for development of overgrowth and the dental practitioner's role in attempting to prevent or minimize this problem are important aspects. In this article, we discuss the medications associated with gingival hyperplasia and describe appropriate recommendations. [References: 42] <45> UI - 1998404731 AU - Montazem A IN - Dr. A. Montazem, Dept. of Oral/Maxillofacial Surgery, Mount Sinai School of Medicine, Box 1187, One East 100th Street, New York, NY 10029; United States. TI - Antibiotic prophylaxis in dentistry. SO - Mount Sinai Journal of Medicine Vol 65(5-6) (pp 388-392), 1998. AB - Antibiotic prophylaxis for the prevention of infective endocarditis related to dental therapy is a widespread therapeutic intervention. Recently, updated and revised guidelines on this treatment modality have been set forth in the form of consensus statements. It is evident that the risk of spontaneous bacteremia is much greater in a diseased oral cavity than it is in a healthy oral cavity. Perhaps most important in the prevention of infective endocarditis is early identification of at-risk patients and prompt referral to oral health specialists for comprehensive evaluation and treatment. The judicious use of antibiotic prophylaxis for prevention of infective endocarditis, in conjunction with optimal oral health care, should serve to minimize the adverse effects of antibiotic therapy and at the same time reduced the significant morbidity and mortality associated with these infections. [References: 35] <46> UI - 1998390413 AU - Ratakonda U IN - Dr. U. Ratakonda, 24 Kaithwood Road, White Plains, NY 10607; United States. TI - Malaria complicating pregnancy: Report of two cases and review of management. SO - Primary Care Update for Ob/Gyns Vol 5(6) (pp 306-310), 1998. AB - Diseases considered rare in the United States are now being seen with increasing frequency in urban area hospitals as a result of increased travel between continents. Obstetrician/Gynecologists, in their role as primary care providers, should be conversant with medical and surgical illnesses seen in their patients. Malaria complicating pregnancy is a serious illness when it occurs in a nonimmune individual. Delay in diagnosis and initiation of appropriate treatment can result in significant maternal and fetal morbidity. A working knowledge of antimalarial drugs and safety of their use in pregnancy is essential for providing optimal treatment and for advising prophylactic measures to pregnant women considering foreign travel. This article describes two cases of falciparum malaria complicating pregnancy seen in a teaching hospital in New York City and reviews the salient features of malaria relevant to pregnancy. [References: 18] <47> UI - 1998388204 AU - Durack DT IN - D.T. Durack, Becton Dickinson Microbiol. Systems, 7 Loveton Circle, Sparks, MD 21152-0999; United States. TI - Antibiotics for prevention of endocarditis during dentistry: Time to scale back?. SO - Annals of Internal Medicine 15 NOV 1998Vol 129(10) (pp 829-831), 1998. AB - In this issue, Strom and colleagues suggest that dental procedure- related endocarditis occurs too rarely to justify routine use of antibiotic prophylaxis. What benefits and problems would ensue if the current recommendations on prophylaxis against endocarditis were scaled back?. [References: 20] <48> UI - 1998384826 AU - Brett LHR IN - L.H.R. Brett, Dental Surgery, 2 Grant Street, Kamo, Whangarei; New Zealand. TI - Fluoridation and child dental health in New Zealand - An update. SO - Fluoride Vol 31(4) (pp 219-220), 1998. AB - The most recent available statistics indicate that child dental health in New Zealand is still not significantly better in fluoridated areas. [References: 12] <49> UI - 1998380289 AU - Minasian A AU - Dwyer JT AU - Peterson DE AU - Sist TC IN - A. Minasian, Beth Israel Deaconess Medical Center, 1 Autumn Street, Boston, MA 02215; United States. TI - Nutritional implications of dental and swallowing issues in head and neck cancer. SO - Oncology Vol 12(8) (pp 1155-1169), 1998. AB - Tumors of the head and neck account of 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health, swallowing ability, and nutritional status. Optimal treatment of dental, swallowing, and nutritional problems of head and neck cancer patients requires practical strategies that address these problems. These strategies should include appropriate referrals to the dentist, speech/language pathologist, and registered dietitian to enhance patient comfort, prevent secondary malnutrition and dental disease, and improve treatment outcomes. Since dental, swallowing, and nutritional issues are interrelated, appropriate therapeutic strategies hinge on timely, integrated input from each discipline. A better understanding of the dental and swallowing therapies used in patients with head and neck cancer by health professionals will help promote the comprehensive care of these patients. <50> UI - 1998338941 AU - Musaiger AO IN - Dr. A.O. Musaiger, Envtl. and Biological Programme, Bahrain Centre for Studies/Research, State of Bahrain; Bahrain. TI - Health and nutritional profile for adolescent girls in the GCC countries. SO - Bahrain Medical Bulletin Vol 20(3) (pp 102-105), 1998. AB - Studies of adolescent girls in this region demonstrate a number of health and nutritional problems. Iron deficiency anaemia is the main problem among adolescents in all socio-economic groups. Also a major concern is inadequate energy intake leading to underweight among a relatively high percentage of these girls. At the same time the prevalence of obesity in adolescent girls has increased, suggesting a predisposing factor for chronic disease such as heart disease, diabetes and hypertension. One of the main reasons for the increasing prevalence of overweight and obesity among teenage girls are intake of foods high in energy and fat, lack of physical exercise and sedentary lifestyle. Such chronic diseases are the main causes of death in the region, and thus any programme to prevent and control these diseases should start with children and adolescents. [References: 23] <51> UI - 1998338933 AU - Harvey Anderson G IN - G. Harvey Anderson, Department of Nutritional Sciences, University of Toronto, Toronto, Ont.; Canada. TI - Carbohydrate, behaviour and health. SO - Bahrain Medical Bulletin Vol 20(3) (pp 69-76), 1998. AB - The ingestion of all forms of dietary carbohydrate confers benefits to human behaviour and health. Dietary carbohydrate is an essential component of healthy diets. It is a macronutrient that not only provides energy, but also serves as an important regulator of the nervous system of human behaviours and of metabolism. Carbohydrate ingestion affects the nervous system through its provision of glucose and energy source and by its effect on neurotransmitter synthesis in the brain and by activation of the sympathetic nervous system. As a result, carbohydrate ingestion has a positive effect on several human behaviours, including appetite, sleep, activity, mood, cognition and physical performance. Through their effects on metabolism, high carbohydrate diets, compared with high fat diets, are generally associated with lower risk of chronic diseases, including obesity, diabetes, cancer and heart disease. An exception is dental caries which, in the absence of fluoridated water and attention to oral hygiene are increased by consumption of fermentable carbohydrate. Dietary advice on carbohydrate should recognise the health benefits of all carbohydrate foods including those containing sugars, oligosaccharides and polysaccharides. An optimum diet contains at least 55% of total energy from carbohydrates, the sources of which may be selected, at least in part, on the basis of their glycemic index. [References: 75] <52> UI - 1998335331 AU - Fox RI AU - Tornwall J AU - Maruyama T AU - Stern E IN - Dr. R.I. Fox, Division of Rheumatology, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037; United States. TI - Evolving concepts of diagnosis, pathogenesis, and therapy of Sjogren's syndrome. SO - Current Opinion in Rheumatology Vol 10(5) (pp 446-456), 1998. AB - Differences in diagnostic criteria for Sjogren's Syndrome (SS) have led to confusion in the research literature and in clinical practice. A particular challenge is the clinical diagnosis of the patients with sicca symptoms, fibromyalgia, chronic fatigue, vague cognitive defects, and a low titer antinuclear antibody. Until recently, many of these patients would have been classified as primary SS using the European criteria. A suggested revision of the European criteria will require inclusion of anti-SS-A antibody or characteristic minor salivary gland biopsy, leading to greater agreement between European and San Diego criteria. Recent studies have emphasized that lacrimal and salivary gland flow involves an entire 'functional' unit that includes the mucosal surface (the site of inflammation), efferent nerve signals sent to the midbrain (lacrimatory and salvatory nucleus), efferent neural signals from the brain, and acinal/ductal structures in the gland. Thus, symptoms of dryness or pain can result from interferences with any part of this functional unit. The initiating antigens in SS remain unknown, but immune reactivity against SS-A, SS-B, fodrin, alpha-amylase, and carbonic anhydrase have been demonstrated in patients with established disease. The inflammatory process in the gland releases metalloproteinases that alter the relationship of epithelial cells to their matrix, an interaction that is necessary for glandular function and survival. Therapies for SS remain inadequate. In SS patients with immune-mediated extraglandular manifestation (ie, lung, kidney, skin, nerve), the therapeutic approach is similar to systemic lupus erythemalosus, although these therapies have relatively little effect on tear or saliva flow. [References: 139] <53> UI - 1998327355 AU - Torres A AU - El-Ebiary M IN - A. Torres, Servei de Pneumologia, Hospital Clinic, Villarroel 170, 08036 Barcelona; Spain. TI - Basis for the management and prevention of respiratory tract infections acquired during mechanical ventilation. SO - European Respiratory Monograph Vol 3(8) (pp 114-138), 1998. AB - Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation, with an incidence ranging from 9-70% depending upon the period of mechanical ventilation. A crucial feature in the aetiopathogenesis of VAP is the abnormal colonization of the oropharynx and its contiguous structures such as sinuses, dental plaque, trachea and gastric reservoir. Understanding the pathogenesis and the pathophysiology of VAP are important steps to provide preventive and curative measures. Efforts regarding prevention of VAP should be directed to the different steps of the aetiopathogenesis. Histological patterns of VAP are complex. Different classifications have been used to describe this rapidly changing entity. The proper knowledge of the different histological patterns of evolution and severity could greatly influence our decision in the further management of patients with VAP. Several diagnostic methods have been developed to microbiologically diagnose respiratory infections in mechanically-ventilated patients. These methods require the use of bacterial quantitative cultures, regardless of the technique employed. For each method there is a specific bacterial threshold that orientates about the presence or absence of infection (in absence of antibiotic treatment). Despite the enormous amount of literature regarding this topic, there is still an open debate about whether invasive fibreoptic bronchoscopic techniques are really required. Appropriate initial antibiotic management is decisive to improve the outcome of VAP patients. The adequacy of initial empirical treatment is vital as mortality in VAP seems to be influenced by this fact. Following recommended guidelines is useful to standardize the way we manage these patients. Besides, several possible causes for rapid deterioration or failure to improve can exist. Only an accurate analysis of clinical and bacteriological data characterizing a given patient can lead to the decision of whether to treat the patient or not. The clinician should always keep in mind that VAP is a complex and rapidly changing entity. In the present chapter, all the issues mentioned above have been thoroughly evaluated. [References: 71] <54> UI - 1998315051 AU - Wiggs RB AU - Lobprise H AU - Mitchell PQ IN - R.B. Wiggs, Coit Road Animal Hospital, 12600 Coit Road, Dallas, TX 75251; United States. TI - Oral and periodontal tissue. Maintenance, augmentation, rejuvenation, and regeneration. SO - Veterinary Clinics of North America - Small Animal Practice Vol 28(5) (pp 1165-1188), 1998. AB - This article discusses the controversies, usefulness, and limitations of oral and periodontal tissue maintenance, augmentation, rejuvenation, and regeneration in the dog and cat. It details many of the specialized materials and techniques used in these procedures in attempts to re-establish healthy conditions within the periodontium. Bone loss following tooth extraction is discussed with consideration as to which teeth should have alveolar ridge maintenance procedures and the important reasons as to why. Radiographs show the degree of improvement demonstrated in treatment of various cases involving bone loss from periodontal disease, treatment of bone injuries with oral fractures, and their prevention. [References: 85] <55> UI - 1998284638 AU - Kodali VRR IN - V.R.R. Kodali, Nobles I.O.M. Hospital, Westmoreland Road, Douglas, Isle of Man M1M 4QA; United Kingdom. TI - The interface of nutrition and dentition. SO - Indian Journal of Pediatrics Vol 65(4) (pp 529-539), 1998. <56> UI - 1998280439 AU - Jacobson P AU - Uberti J AU - Davis W AU - Ratanatharathorn V IN - Dr. V. Ratanatharathorn, Department of Internal Medicine, Cancer Center, University Michigan Medical Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0914; United States. TI - Tacrolimus: A new agent for the prevention of graft-versus-host disease in hematopoietic stem cell transplantation. SO - Bone Marrow Transplantation Vol 22(3) (pp 217-225), 1998. AB - Tacrolimus (FK506) is a macrolide lactone with potent immunosuppressive activity 100 times that of cyclosporine by weight. The molecular mechanism of action is mediated via an inhibition of the phosphorylase activity of calcineurin by drug-immunophilin complex, resulting in the inhibition of IL-2 gene expression. There are emerging studies now showing significant efficacy of tacrolimus in GVHD prevention in both related and unrelated donor transplantation. Three multicenter randomized studies comparing tacrolinus to cyclosporine have been completed, one each in related and unrelated donor transplantation; the remaining study involved both related and unrelated donor transplantation. All three studies showed a significantly lower incidence of grade II-IV acute GVHD in patients who received tacrolimus. One study in sibling donor transplantation showed that patients with advanced disease who received tacrolimus had a poorer survival than patients who received cyclosporine, but the survival was similar in patients with non-advanced disease. The remaining two studies, one in unrelated donors and the other combining both related and unrelated donors did not show any survival difference between the tacrolimus and cyclosporine groups. In addition, this review also highlights some of the critical questions regarding the role of this agent in allogeneic stem cell transplantation: (1) the contribution of methotrexate in combination with tacrolimus; (2) the starting i.v. dose of tacrolimus; (3) the suggested whole blood level of tacrolimus and its effect on nephrotoxicity; and (4) whether tacrolimus should be used in patients with advanced malignancy. Future studies using tacrolimus in combination with other immunosuppressants, and its use in patients with advanced malignancy will be warranted. [References: 129] <57> UI - 1998246496 AU - Evans KL IN - Dr. K.L. Evans, Department of Otolaryngology, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN; United Kingdom. TI - Recognition and management of sinusitis. SO - Drugs Vol 56(1) (pp 59-71), 1998. AB - Acute sinusitis frequently follows upper respiratory tract infections. Patients complain of headache, facial pain, fever and purulent rhinorrhoea. Diagnosis is based upon the symptoms, and treatment comprises symptomatic relief with analgesics, topical or systemic decongestants and steam inhalation. If indicated, antibiotics should be given for an adequate period of time. Patients with chronic sinusitis complain of a combination of nasal obstruction, rhinorrhoea and postnasal drip associated with intermittent facial pain, with symptoms persisting for 3 months or more. Predisposition to the condition may be caused by rhinitis (allergic or nonallergic) and anatomical variants. Failure of mucociliary transport and sinus ostial obstruction leads to mucosal oedema, mucous hypersecretion and chronic infection. Current treatment aims are to control rhinitis and improve ventilation and function of the sinuses. Rhinitis may be controlled with the long term use of topical corticosteroids, mast cell stabilisers or antihistamines, either alone or in combination. Secretions may be cleared with steam inhalation and/or saline nasal douching. Failure to control chronic sinusitis with medical treatment may indicate surgery. The aim of surgery is to improve ventilation and facilitate drainage of the sinuses, allowing the restoration of normal function. Removal of nasal polyps, reduction of inferior turbinates or septal straightening may be all that is required. Some patients will need endoscopic ethmoidectomy and middle meatal antrostomy. Improved ventilation in the ethmoid infundibulum may help to resolve disease in the maxillary and frontal sinuses. Medical treatment of underlying rhinitis will need to be continued postoperatively, often in the long term, while special consideration needs to be paid to sinusitis in children, in relation to dental disease and in the immunosuppressed. Complications of acute and chronic sinusitis include intraorbital and intracranial sepsis. These potentially lethal complications need urgent evaluation with high resolution computerised tomography (CT) scanning, intravenous administration of broad spectrum antibiotics (including anaerobic and microaerophilic cover) and urgent surgical drainage as appropriate. [References: 39] <58> UI - 1998222145 AU - Mayrand D AU - Grenier D IN - D. Grenier, Faculte de Medecine Dentaire, Universite Laval, Laval, Que. G1K 7P4; Canada. TI - Bacterial interactions in periodontal diseases. SO - Bulletin de L'Institut Pasteur Vol 96(2) (pp 125-133), 1998. AB - The oral cavity comprises a vast number of different bacterial populations which constitute a perfect example of microbial ecology. Bacterial species present in the various oral sites normally coexist harmoniously. However, under specific conditions which favour some species with pathogenic potential over the other members of the community, periodontal diseases are initiated. On the one hand, bacterial interactions both positive (mutualism, commensalism and synergism) and negative (competition and antagonism) may play a significant role in these mixed infections by ultimately favouring the periodontopathogenic species. On the other hand, certain types of bacterial interactions may help maintain a healthy state by preventing colonization of subgingival sites by pathogenic species. This review will focus on positive and negative bacterial interactions involving the principal periodontopathogens: Porphyromonas gingivalis, Treponema denticola, Bacteroides forsythus and Actinobacillus actinomycetemcomitans. [References: 55] <59> UI - 1998211031 AU - Rasmussen LB AU - Lyhne N AU - Ovesen L IN - L.B. Rasmussen, Veterinary and Food Admin. Denmark, Division of Nutrition, Morkhoj Bygade 19, DK-2860 Soborg; Denmark. TI - Sugar - A harmless indulgence?. SO - International Journal of Food Sciences & Nutrition Vol 49(4) (pp 253-264), 1998. AB - The consumption of sugar is relatively high in Denmark - and other industrial countries - and many persons have a consumption which exceeds the recommended level of maximally 10% of energy intake. A high sugar consumption may reduce the nutrient density of the diet and increase the risk of vitamin and mineral deficiency, especially in low energy consumers. The sugar intake and the fat intake, expressed as percentage of energy, usually show an inverse association. This has lead to the statement that a diet with both a low sugar content and a low fat content is incompatible, but we will argue that this is not the fact. The significance of sugar for the development of obesity is not clarified. A high fat content in the diet seems to promote the development of obesity, while a high carbohydrate content tends to reduce obesity. It is not known if sugar in this connection is comparable to the other carbohydrates in the diet, primarily because of the high energy density of sugar. Diabetes mellitus and heart diseases do not seem to have any direct connection with a high sugar consumption. Sugar continues to be a risk factor for the development of caries. Further, it cannot be excluded that high sugar consumption is a risk factor for cancer in the gastrointestinal tract or for Crohn's disease. It seems reasonable to keep the current recommendations about sugar intake. [References: 131] <60> UI - 1998198591 AU - Chalmers DJ IN - Dr. D.J. Chalmers, Dept Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin; New Zealand. E-Mail: dchalmers@gandalf.otago.ac.nz. TI - Mouthguards. Protection for the mouth in rugby union. SO - Sports Medicine Vol 25(5) (pp 339-349), 1998. AB - The mouthguard is a resilient device or appliance which is placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth and fractures and dislocations of the jaw. There is clear support in the scientific literature for the use of mouthguards in contact sports such as rugby. Moreover, there is evidence that mouthguards are effective in protecting against concussion and injuries to the cervical spine. There is a high level of acceptance of mouthguards by players and an increasing number are regularly wearing mouthguards. This is especially true among the elite players, but acceptance and wearing rates are moderately high among club players as well. There is strong support among players and researchers for mouthguard wearing to be made compulsory. It is generally recommended that: (i) mouthguards be worn during both practice sessions and games; (ii) the habit of wearing a mouthguard begins at an early age; (iii) mouthguards be regularly replaced while children are still growing; and (iv) adult players replace their mouthguards at least every 2 years. The selection of a mouthguard will depend on a number of factors including the age of the individual, effectiveness and cost. The type I (stock), or 'off-the-shelf', mouthguards are considered inferior when compared with the other available types, and their use is discouraged. Type II (mouth-formed) mouthguards come in 2 forms, the shell-liner version and the popular thermoplastic 'boil and bite' version. While the effectiveness of the shell-liner mouthguard was examined in one experimental study, no such research has been reported for the thermoplastic mouthguard. Type III (custom-fabricated) mouthguards are recommended for players playing in the more vulnerable positions and in the higher grades. Most experimental studies in which the effectiveness of mouthguards has been demonstrated have involved type III mouthguards. [References: 42] <61> UI - 1998178859 AU - Spencer AJ IN - Prof. A.J. Spencer, Department of Dentistry, University of Adelaide, Adelaide, SA 5005; Australia. TI - New, or biased, evidence on water fluoridation?. SO - Australian & New Zealand Journal of Public Health Vol 22(1) (pp 149-154), 1998. AB - The recent review, 'New evidence on fluoridation', by Diesendorf, Colquhoun, Spittle, Everingham and Clutterbuck claims a consistent pattern of evidence pointing to fluoride damaging bone, a negligible benefit in dental caries reduction from ingested fluoride, and any small benefit from fluoride coming from the action of fluoride at the tooth surface. Public health authorities are allegedly reluctant to pursue such evidence. In the interest of scholarly debate, invited by Diesendorf et al., this reaction paper examines six separate areas raised in the original paper: fluoridation and hip fracture; fluoridation and osteosarcomas; pre-eruptive and posteruptive benefits in dental caries reduction; fluoride ingestion; benefit in dental caries reduction for contemporary Australian children; and bias of health authorities and responsible science. Numerous examples of bias in the identification, selection and appraisal of the evidence on water fluoridation presented by Diesendorf et al. are developed. Further, this reaction paper puts forward both studies and appraisal indicating that water fluoridation should continue to be regarded as a safe and effective public health measure. [References: 49] <62> UI - 1998173971 AU - Mani KS IN - K.S. Mani, Neurological Clinic, No. 1, Old Veterinary Hospital Road, Basavanagudi, Banglore - 560 004; India. TI - Global campaign against epilepsy. Agenda for IEA/IES. SO - Neurology India Vol 46(1) (pp 1-4), 1998. <63> UI - 1998169988 AU - Cosentino D AU - Valli MC IN - D. Cosentino, Department of Radiotherapy, Ospedale S. Anna, via Napoleona 60, 22100 Como; Italy. TI - Clinical application of integrated treatments in breast cancer. SO - Tumori Vol 84(2) (pp 223-228), 1998. AB - In this paper we analyse the problems related to the 'state of the art' in the treatment of stage I and II breast cancer which has become, in Italy too, an increasingly prominent problem: it is the most frequently diagnosed female cancer, accounting for about 45,000 new cases/year (150% 100,000 women). In the last decade the approach to this disease has greatly evolved because of new surgical techniques, advances in adjuvant medical therapies, innovations in the field of radiotherapy, and wider use of biological parameters. We emphasize the emerging problem of ductal and lobular carcinoma in situ, because their biological patterns will be better identified and the related treatment extensively practiced in the next future. The innovations in surgery, which has now a less demolishing role, are reviewed focusing on the 'sentinel axillary node' and the actual need for axillary dissection. In relation to chemotherapy (CT), we evaluate the role of adjuvant treatment also in node negative patients, and the impact of neoadjuvant schedules on survival and toxicity. Radiotherapy (RT) is complementary to conservative surgery, and its important role in preventing local relapse and in increasing OS (overall survival) has been established; recent and more sophisticated techniques have reduced its acute and late toxicity. We are however waiting for answers concerning the usefulness of a booster dose, the impact of RT on local relapse in DCIS, and the impact of RT to the breast regional lymph nodes on OS and disease-free survival (DFS). The optimal sequencing and timing of postoperative RT and CT are unknown, both concerning each other and surgery. Some possibilities includes giving all planned CT before RT, all CT after RT, giving both concurrently, or giving a portion of CT before RT and then completing CT afterwards (sandwich technique): we analyse the advantages and the problems of these different therapeutic schedules in relation to the OS, the DFS and cosmesis. In conclusion, there are very few certainties to guide us in the clinical practice: the general feeling is that we need to collect more data on homogeneous groups of patients to better understand which are the prognostic factors we can rely on, in order to choose the best treatment strategy, and which are the optimal schedules of adjuvant treatments (CT and RT), with the aim of improving OS, DFS and cosmesis. [References: 48] <64> UI - 1998163610 AU - Woolf SH AU - Ismail AI AU - Lewis DW AU - Dingle JL TI - Counseling to prevent dental and periodontal disease (an excerpt from Guide to Clinical Preventive Services, 2nd edition). SO - Primary Care Update for Ob/Gyns Vol 5(3) (pp 123-129), 1998. <65> UI - 1998162935 AU - Niethammer D AU - Mayer E IN - Dr. D. Niethammer, Department of Paediatrics, University of Tubingen, Rumelinstrasse 23, 72070 Tubingen; Germany. TI - Long-term survivors: An overview on late effects, sequelae and second neoplasias. SO - Bone Marrow Transplantation Vol 21(SUPPL. 2) (pp S61-S63), 1998. AB - A large number of haematological and oncological diseases as well as inborn errors can be cured today by stem cell transplantation. However, the chemotherapy and radiation used for the preparation of BMT can induce late effects which can be rather severe. Especially in malignant diseases the late toxicity of previous conventional therapy has an additional impact. The function of various organs can be impaired, such as the eyes, the central nervous system, the teeth, the legs, the heart, the kidneys, the liver, the endocrine functions and growth. Second neoplasias occur during various times after BMT: lymphoproliferative disease may occur during the first year, leukemias and myelodysplastic syndromes develop after several years, whereas solid tumours occur even later. The incidence of second neoplasias after BMT seems to be higher in children than in adults. Many late sequelae as well as psychological disturbances can impair the quality of life of the survivors of BMT. Paediatricians should take this fact into account when they think about stem cell transplantation in a child. This all means that a longterm observation in these persons is necessary and this is done best within a standardised follow-up programme. Meanwhile such programmes have been developed in some countries, and this should be promoted within the working party 'Paediatric Diseases' of EBMT. [References: 15] <66> UI - 1998122519 AU - Bartlett DW AU - Smith BGN IN - D.W. Bartlett, Department of Conservative Dentistry, UMDS, Guy's Hospital, London SE1 9RT; United Kingdom. TI - Etiology and management of tooth wear: The association of drugs and medicaments. SO - Drugs of Today Vol 34(3) (pp 231-239), 1998. AB - Teeth are sometimes worn excessively by erosion (chemical damage), abrasion (physical damage) or attrition (wear between opposing teeth). The most important role of self-prescribed or physician-prescribed drugs is the management of conditions which cause ragurgitation erosion. [References: 55] <67> UI - 1998121812 AU - Castioni NV AU - Baehni PC AU - Gurny R IN - N.V. Castioni, School of Dental Medicine, Faculty of Medicine, University of Geneva, 19 rue Barthelemy-Menn, CH-1211 Geneva 4; Switzerland. E-Mail: nathalie.viviencastioni@medecine.unige.ch. TI - Current status in oral fluoride pharmacokinetics and implications for the prophylaxis against dental caries. SO - European Journal of Pharmaceutics & Biopharmaceutics Vol 45(2) (pp 101-111), 1998. AB - Fluoride plays a central role in the prevention of dental caries. There is evidence that its effect is mainly topical and that continuous presence of fluoride ions in low concentration at the plaque/enamel interface is essential. The present paper reviews the most important aspects of fluoride kinetics in the oral cavity and discusses their implications on preventive approaches to dental caries. As a continuous presence of fluoride ions in saliva is important for an optimum prophylactic effect, new formulations capable of delivering low levels of fluoride over prolonged periods of time have been developed. These systems consist either of intra-oral devices, or of restorative materials into which fluoride has been incorporated. Among all the preparations investigated, bioadhesive tablets and membrane-controlled reservoirs are the most promising. [References: 76] <68> UI - 1998092751 AU - Darlow LA IN - Dr. L.A. Darlow, Dept. of Community/Family Medicine, Saint Louis Univ. School of Medicine, Saint Louis, MO; United States. TI - Management of the anticoagulated dental patient. SO - Hospital Practice 15 FEB 1998Vol 33(2) (pp 79-82), 1998. <69> UI - 1998091517 AU - Meurman JH AU - Pyrhonen S AU - Teerenhovi L AU - Lindqvist C IN - J.H. Meurman, Institute of Dentistry, University of Helsinki, Helsinki University Central Hospital, Helsinki; Finland. TI - Oral sources of septicaemia in patients with malignancies. SO - Oral Oncology Vol 33(6) (pp 389-397), 1997. AB - This article reviews papers dealing with oral infections of adult septicaemia patients, searched from MEDLINE, Current Contents and Core Biomedical Collection databases from January 1966 to November 1996. Case reports were excluded. The systematic review of literature revealed that our knowledge of the topic is mostly based on very small patient material. There are no multicentre studies on the effects of various oral health treatment modes on the prevention of septicaemia of oral origin. The number of controlled and comparative studies on the efficacy of the different treatment protocols of oral infections is also small. Current recommendations in this respect are mainly empirical and not evidence based. Clinical practice guidelines are therefore urgently needed. Nevertheless, close co-operation between oncological and oral health units is emphasised because many studies have shown that the oral cavity is indeed an important source of bacteraemia. Life-threatening infections may follow if maintenance of oral health is neglected during anticancer therapy and if potential oral infection foci are left untreated before immunosuppressive therapy. [References: 67] <70> UI - 1998083199 AU - Aldridge J AU - Wilson R IN - J. Aldridge, 2 Springfield Road, London SW19 7AL; United Kingdom. TI - Dental health and the cardiovascular patient. SO - British Journal of Cardiology Vol 5(1) (pp 28-34), 1998. <71> UI - 1998054176 AU - Fitzsimons D AU - Dwyer JT AU - Palmer C AU - Boyd LD IN - C. Palmer, Tuffs Univ. School of Dental Med., 1 Kneeland St, Boston, MA 02111; United States. TI - Nutrition and oral health guidelines for pregnant women, infants, and children. SO - Journal of the American Dietetic Association Vol 98(2) (pp 182-189), 1998. AB - Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime. [References: 19] <72> UI - 1997382959 AU - Spencer CM AU - Goa KL AU - Gillis JC IN - C.M. Spencer, Adis International Limited, 41 Centorian Drive, Mairangi Bay, Auckland; New Zealand. E-Mail: demail@adis.co.nz. TI - Tacrolimus. An update of its pharmacology and clinical efficacy in the management of organ transplantation. SO - Drugs Vol 54(6) (pp 925-975), 1997. AB - Tacrolimus (FK 506) has been evaluated as immunosuppressive therapy in patients with a variety of solid organ and other transplants. Extensive data have now confirmed its efficacy as primary or rescue therapy in renal and hepatic transplantation. In prospective and historically controlled studies of primary therapy, tacrolimus generally demonstrated greater efficacy than the conventional formulation of cyclosporin for preventing episodes of acute rejection and allowed reduction of corticosteroid use. Chronic rejection rates were also significantly lower with tacrolimus in a large randomised liver transplantation trial. However, patient and graft survival rates were similar in both treatment groups (although numerically larger in adults with liver transplants). In children, rejection rates and corticosteroid requirements were usually lower with tacrolimus and patient and graft survival were generally similar with the 2 immunosuppressants. The finding of reduced corticosteroid requirements with tacrolimus may be of particular benefit in prepubertal children, who are still growing. A small amount of evidence has also accumulated regarding the use of tacrolimus as primary therapy in patients who have undergone bone marrow or heart and/or lung transplantation. Data are not conclusive, particularly in children, but tacrolimus appears to be useful for treating patients who have undergone these organ transplantation and may be associated with a lower incidence of obliterative bronchiolitis than cyclosporin in the latter group. Potential efficacy has also been shown in a limited number of patients with pancreas or pancreas-kidney, pancreatic islet and intestinal or multivisceral transplants, and in children who have undergone heart or heart-lung transplantation. Tacrolimus also has a use as rescue therapy in bone marrow, heart, lung and pancreatic transplantation, but data are currently insufficient for conclusions to be made. However, these results support the need for further study in these populations. Adverse effects occurring during tacrolimus therapy are generally of the type common to all immunosuppressive regimens. However, diabetes mellitus, neurotoxicity and nephrotoxicity are more common in tacrolimus than cyclosporin recipients. Hyperlipidaemia, hypertension, hirsutism and gingival hyperplasia are more common with cyclosporin. In 2 large multicentre clinical trials (US liver and European renal), tacrolimus was discontinued more frequently during the first year because of adverse events. However, the tolerability of tacrolimus appears related to dosage, improving as the dose is reduced. Tacrolimus should be considered an effective primary immunosuppressant in renal and hepatic transplantation. The drug is also a useful agent for rescue therapy in patients experiencing rejection or poor tolerability to cyclosporin. Thus, tacrolimus provides the clinician with an effective option for patients requiring immunosuppression and, with a different tolerability and efficacy profile to cyclosporin, it will better allow the tailoring of therapy to meet the needs of individual patients. [References: 224] <73> UI - 1997382959 AU - Spencer CM AU - Goa KL AU - Gillis JC IN - C.M. Spencer, Adis International Limited, 41 Centorian Drive, Mairangi Bay, Auckland; New Zealand. E-Mail: demail@adis.co.nz. TI - Tacrolimus. An update of its pharmacology and clinical efficacy in the management of organ transplantation. SO - Drugs Vol 54(6) (pp 925-975), 1997. AB - Tacrolimus (FK 506) has been evaluated as immunosuppressive therapy in patients with a variety of solid organ and other transplants. Extensive data have now confirmed its efficacy as primary or rescue therapy in renal and hepatic transplantation. In prospective and historically controlled studies of primary therapy, tacrolimus generally demonstrated greater efficacy than the conventional formulation of cyclosporin for preventing episodes of acute rejection and allowed reduction of corticosteroid use. Chronic rejection rates were also significantly lower with tacrolimus in a large randomised liver transplantation trial. However, patient and graft survival rates were similar in both treatment groups (although numerically larger in adults with liver transplants). In children, rejection rates and corticosteroid requirements were usually lower with tacrolimus and patient and graft survival were generally similar with the 2 immunosuppressants. The finding of reduced corticosteroid requirements with tacrolimus may be of particular benefit in prepubertal children, who are still growing. A small amount of evidence has also accumulated regarding the use of tacrolimus as primary therapy in patients who have undergone bone marrow or heart and/or lung transplantation. Data are not conclusive, particularly in children, but tacrolimus appears to be useful for treating patients who have undergone these organ transplantation and may be associated with a lower incidence of obliterative bronchiolitis than cyclosporin in the latter group. Potential efficacy has also been shown in a limited number of patients with pancreas or pancreas-kidney, pancreatic islet and intestinal or multivisceral transplants, and in children who have undergone heart or heart-lung transplantation. Tacrolimus also has a use as rescue therapy in bone marrow, heart, lung and pancreatic transplantation, but data are currently insufficient for conclusions to be made. However, these results support the need for further study in these populations. Adverse effects occurring during tacrolimus therapy are generally of the type common to all immunosuppressive regimens. However, diabetes mellitus, neurotoxicity and nephrotoxicity are more common in tacrolimus than cyclosporin recipients. Hyperlipidaemia, hypertension, hirsutism and gingival hyperplasia are more common with cyclosporin. In 2 large multicentre clinical trials (US liver and European renal), tacrolimus was discontinued more frequently during the first year because of adverse events. However, the tolerability of tacrolimus appears related to dosage, improving as the dose is reduced. Tacrolimus should be considered an effective primary immunosuppressant in renal and hepatic transplantation. The drug is also a useful agent for rescue therapy in patients experiencing rejection or poor tolerability to cyclosporin. Thus, tacrolimus provides the clinician with an effective option for patients requiring immunosuppression and, with a different tolerability and efficacy profile to cyclosporin, it will better allow the tailoring of therapy to meet the needs of individual patients. [References: 224] <74> UI - 1997375841 AU - Mor E AU - Yussim A AU - Chodoff L AU - Schwartz ME IN - Dr. M.E. Schwartz, Department of Surgery, Division of Liver Transplantation, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029; United States. TI - New immunosuppressive agents for maintenance therapy in organ transplantation focus on adverse effects. SO - Biodrugs Vol 8(6) (pp 469-488), 1997. AB - Traditional cyclosporin-based immunosuppressive protocols are associated with relatively high incidences of early acute rejection and late graft loss due to chronic rejection. In addition, long-term immunosuppression with cyclosporin and corticosteroids has been associated with significant metabolic, infectious, malignant and cosmetic adverse effects. In the last decade, the goals of immunosuppression strategies have included not only short-term survival but also graft acceptance, with a low incidence of early acute rejection and minimal long-term toxicity. Tacrolimus and mycophenolate mofetil are 2 new immunosuppressive agents that have recently been approved for use. The mechanism of action and toxicity profile of tacrolimus are similar to that of cyclosporin. Tacrolimus reduces early acute rejection and is also effective in salvage of allografts with refractory rejection. A wide spectrum of adverse effects, including nephrotoxic, neurotoxic, gastrointestinal, metabolic and hematological effects, has been reported in association with tacrolimus but, unlike cyclosporin, this agent is not associated with hirsutism or gingival hyperplasia. Mycophenolate mofetil, an antimetabolite, has been effective in reducing early acute rejection and in treatment of refractory rejection when used in combination with cyclosporin instead of azathioprine. Its myelosuppressive and gastrointestinal toxicities are mild and reversible, but it may be associated with an increased-risk of infections. Both agents permit early corticosteroid withdrawal. Other new immunosuppressive agents that act on different stages of the cell cycle but that have not yet been introduced for wide clinical use, including sirolimus (rapamycin), brequinar, mizoribine and gusperimus, are also discussed in this review. [References: 114] <75> UI - 1997351256 AU - Boyd LD AU - Dwyer JT AU - Papas A IN - L.D. Boyd, Tufts University School Nutrition, Frances Stern Nutrition Center, New England Medical Center, Boston, MA 02111; United States. TI - Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: A case study. SO - Nutrition Reviews Vol 55(10) (pp 362-368), 1997. AB - Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia. [References: 22] <76> UI - 1997341107 AU - Herlich A IN - Dr. A. Herlich, Department of Anesthesiology, Eye and Ear Institute Pavilion, Univ. of Pittsburgh Medical Center, Pittsburgh, PA; United States. TI - Complications from securing the difficult airway. SO - International Anesthesiology Clinics Vol 35(3) (pp 13-30), 1997. AB - Attempts to secure the difficult airway, especially the pediatric airway, can have nightmarish consequences if not successful and may be followed by complications even when successful. Some complications are common and some are rare. To minimize the risk of any complications, the clinician needs to be prepared mentally and technically to manage the difficult airway, must prepare the equipment, and must educate the patient/parents regarding possible difficulties with airway management. [References: 50] <77> UI - 1997321893 AU - Chikindas ML AU - Novak J AU - Caufield PW AU - Schilling K AU - Tagg JR IN - J.R. Tagg, University of Otago, Department of Microbiology, PO Box 56, Dunedin; New Zealand. TI - Microbially-produced peptides having potential application to the prevention of dental caries. SO - International Journal of Antimicrobial Agents Vol 9(2) (pp 95-105), 1997. AB - Strategies advanced to decrease the occurrence of dental caries have in the past typically focussed upon attempting to reduce plaque accumulation by application of bread-spectrum antibacterial agents. In recent years however there has been growing interest in the application of a more targeted approach to the selective elimination from plaque of those bacterial species that are specifically implicated as the aetiological agents of this disease. This review focuses upon a number of the small bacterially-produced peptide antibiotics known as bacteriocins that are currently being explored for their potential role in the treatment and prevention of dental caries. [References: 122] <78> UI - 1997311266 AU - Ochiai T AU - Isono K IN - T. Ochiai, Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260; Japan. TI - Advances in the development of immunosuppressive agents in organ transplantation. SO - Surgery Today Vol 27(10) (pp 883-891), 1997. <79> UI - 1997267636 AU - Jones DH AU - Beltrani VS IN - Dr. V.S. Beltrani, 29 Fox Street, Poughkeepsie, NY 12601; United States. TI - Oral mucous membrane contact dermatitis. SO - Immunology & Allergy Clinics of North America Vol 17(3) (pp 471-485), 1997. AB - Oral mucous membrane contact dermatitis (or contact stomatitis) is relatively rare. The oral mucosa is constantly bathed in saliva, which washes sensitizers from the mucosal surface and prevents adequate contact. Abundant mucosal vasculature allows for rapid absorption and clearing of allergens. Nevertheless, contact reactions can occur on the mucous membrane. Although the prevalence of allergic contact sensitivity in the mouth is unknown, a number of substances have been reported to cause oral symptoms. This article reviews clinical presentations, chemical and traumatic injury, dental and mouth care products, dental impression compounds, antiseptics and preservatives in oral medications, surface or topical anesthetics, diagnosis, and therapy. [References: 61] <80> UI - 1997258521 AU - Anderson L AU - Shaw J-M AU - McCargar L IN - Dr. L. McCargar, 4-10 Agriculture Forestry Centre, University of Alberta, Edmonton, Alta. T6G 2P5; Canada. E-Mail: maccarger@afns.ualberta.ca. TI - Physiological effects of bulimia nervosa on the gastrointestinal tract. SO - Canadian Journal of Gastroenterology Vol 11(5) (pp 451-459), 1997. AB - Bulimia nervosa is an eating disorder characterized by frequent bouts of binge eating followed by compensatory behaviour for preventing weight gain (purging). It is estimated that 3% to 5% of young women are affected by bulimia nervosa, and its prevalence is increasing. Bulimia nervosa afflicts both sexes and all races. It can lead to serious medical complications. The expression of the disease in the gastrointestinal tract may have a critical role in the diagnosis of bulimia nervosa. Physiological effects of bulimia nervosa on the gastrointestinal tract include dental caries and enamel erosion; enlargement of the parotid gland; esophagitis; changes in gastric capacity and gastric emptying; gastric necrosis; and alterations of the intestinal mucosa. Identification of any of these factors may aid in establishing an early diagnosis, which has been shown to increase the likelihood of recovery. [References: 79] <81> UI - 1997247851 AU - Adams LB IN - L.B. Adams, 297 Claudia Court, Moraga, CA 94556; United States. TI - An overview of adolescent eating behavior barriers to implementing dietary guidelines. SO - Annals of the New York Academy of Sciences Vol 817 (pp 36-48), 1997. AB - Adolescents continue to report food and nutrient intake and physical activity levels that conflict with the U.S. Dietary Guidelines and the Year 2000 objectives. Some of the barriers to healthier eating and exercise are related to factors within the adolescent's environment, such as access to healthy food choices or availability of preventive nutritional guidance as part of routine health care. Many barriers, though, fit into the theoretical framework that attempts to describe determinants of other risky behaviors of adolescents. These include (1) adolescent and peer subgroup norms that devalue healthy eating behavior; (2) participation in other risky behaviors; (3) low competency (actual and perceived) in sports, food selection, and food preparation; and (4) familial and cultural expectations. Implications were discussed for intervention approaches and policy recommendations that help confront these barriers. [References: 27] <82> UI - 1997241402 AU - Sonis A AU - Castle J AU - Duggan C IN - A. Sonis, Nutrition Support Service, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; United States. TI - Infant nutrition: Implication for somatic growth, adult onset diseases, and oral health. SO - Current Opinion in Pediatrics Vol 9(3) (pp 289-297), 1997. AB - The gold standard for assessing the adequacy of nutrient intake in pediatrics is that diet which promotes optimal growth and development. Thus, it is crucial that our methods for measuring these outcomes be valid, reliable, and widely accepted. A review of the recent medical literature in the field of clinical nutrition indicates that both growth data and dietary standards continue to evolve as more data accrue concerning their applicability in both health and disease. In addition, oral nutrition is clearly a determinant of perhaps the most prevalent infectious disease in pediatrics: dental caries. Research in this field stresses the importance of oral fluoride intake in the prevention of caries, as well as the fact that current efforts at reducing milk-bottle tooth decay are inadequate. [References: 53] <83> UI - 1997233825 AU - Markowitz AJ AU - Winawer SJ IN - Dr. A.J. Markowitz, Memorial Sloan-Kettering Can. Ctr., 1275 York Avenue, New York, NY 10021; United States. TI - Screening and surveillance for colorectal carcinoma. SO - Hematology - Oncology Clinics of North America Vol 11(4) (pp 579-608), 1997. AB - Screening and surveillance examinations are effective in lowering colorectal cancer risk. Screening tests have been demonstrated to reduce colorectal cancer mortality. Colonoscopic removal of adenomatons polyps has been determined to reduce colorectal cancer incidence. High-risk individuals and their family members should be identified and offered more aggressive recommendations for appropriate screening and surveillance guidelines. Colorectal cancer screening strategies are in an acceptable range of cost effectiveness. [References: 128] <84> UI