Inhibition of enamel erosion and promotion of lesion rehardening by fluoride: a white light interferometry and microindentation study

OBJECTIVE

The primary aim of the present in vitro studies was to investigate fluoride as an inhibitor of citric acid-mediated demineralization of human enamel and promoter of lesion repair using a combination of white light interferometry, scanning electron microscopy, and microindentation. Secondary aims included investigation of the importance of brushing on bulk tissue loss, and comparison of the relative efficacy of commercially available toothpastes on inhibiting enamel surface softening and rehardening of incipient erosive lesions.

METHODS

Resin-mounted polished enamel specimens were prepared from extracted human molars and pre-molars. Mean surface roughness (Sa) and bulk tissue loss following exposure to an erosive challenge, or an erosive challenge plus brushing were investigated using a MicroXAM ADE PhaseShift white light interferometer. Surface morphology was determined using a Zeiss Evo 50 scanning electron microscope (SEM). The utility of fluoride-based treatments to protect against subsequent acid demineralization and to promote remineralization of pre-formed incipient lesions was determined using microindentation-based enamel surface softening and enamel lesion rehardening models.

RESULTS

Treating human enamel specimens with Sensodyne Pronamel conferred a clear protective benefit against a subsequent 300-second citric acid challenge as evidenced by the interferometry and SEM data. The increase in Sa and bulk tissue loss caused by an erosive challenge followed by brushing was markedly reduced by pre-treatment with sodium fluoride (NaF) in a concentration-dependent manner. Sensodyne Pronamel statistically outperformed Colgate Sensitive Enamel Protect both in the enamel surface softening model and lesion rehardening model, and conferred statistically superior enamel fluoride uptake. Treatment of erosive lesions with Sensodyne Pronamel resulted in statistically superior rehardening versus two Crest Pro-Health formulations containing stannous fluoride (SnF2) and sodium hexametaphosphate (NaHMP); the latter did not differ significantly from the fluoride-free negative control paste. Sensodyne Pronamel exhibited statistically significant superiority in a human saliva-based lesion rehardening model compared to Zendium Sensitive containing nominally comparable concentrations of NaF, as well as Colgate Sensitive and Colgate Sensitive Multi Protection containing sodium monofluorophosphate (NaMFP).

CONCLUSION

The utility of NaF, whether delivered from simple solution or toothpaste, to reduce citric acid-mediated surface roughening and bulk tissue loss has been clearly demonstrated. The effectiveness of Sensodyne Pronamel as an anti-erosion toothpaste has also been demonstrated in various microhardness models. Crest Pro-Health toothpastes containing SnF2 and NaHMP were not statistically differentiable from a fluoride-free control paste in the lesion rehardening model. The latter result indicates that the benefit of fluoride to promote mineral formation is outweighed by the effect of NaHMP as a mineralization inhibitor in this model.

Fluoride penetration from toothpastes into incipient enamel erosive lesions investigated using dynamic secondary ion mass spectrometry

OBJECTIVE

The primary aim of this study was to assess the utility of dynamic secondary ion mass spectrometry (DSIMS) as a convenient and sensitive technique for determining fluoride uptake and distribution into incipient human enamel erosive lesions in vitro. A secondary aim was to correlate the extent of lesion rehardening following treatment with a toothpaste slurry, with relative fluoride uptake determined by DSIMS. The final aim was to compare fluoride uptake by incipient lesions treated with toothpastes containing different sources of fluoride using DSIMS.

METHODS

Relative fluoride uptake into the surface and body of enamel erosive lesions was monitored by DSIMS as a function of fluoride concentration in a series of formulation-matched experimental pastes. Fluoride uptake into lesions that had been subjected to treatment with different toothpaste slurries in a single-treatment enamel lesion rehardening model was also determined, and its relationship with regard to the extent of rehardening and also the fluoride source investigated.

RESULTS

Fluoride uptake by incipient erosive lesions treated with toothpastes containing NaF was quantitatively compared by DSIMS and found to be directly proportional to the fluoride concentration over the studied range (0-1400 ppm). Lesion repair observed in a single-treatment lesion rehardening model was positively correlated with the extent of fluoride uptake by the treated lesions. DSIMS was also able to show differences between commercial toothpastes containing different sources of fluoride and their ability to deliver the fluoride into the body of the lesion. The detrimental effect of sodium hexametaphosphate (NaHMP) present in Crest Pro-Health formulations previously reported in the single-treatment lesion rehardening model was also evident from the DSIMS elemental line scans obtained from the lesion cross-sections.

CONCLUSION

DSIMS has been shown to be a powerful selective technique for quantifying relative fluoride uptake into enamel erosive lesions, and determining the extent and depth of lesion penetration. The relative efficacy of toothpastes containing fluoride from a variety of sources in the single-treatment lesion rehardening study is positively correlated with fluoride uptake and penetration determined by DSIMS.

Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project

BACKGROUND

A growing body of international literature points to the importance of a system approach to improve the quality of care in primary health care settings. Continuous Quality Improvement (CQI) concepts and techniques provide a theoretically coherent and practical way for primary care organisations to identify, address, and overcome the barriers to improvements. The Audit and Best Practice for Chronic Disease (ABCD) study, a CQI-based quality improvement project conducted in Australia's Northern Territory, has demonstrated significant improvements in primary care service systems, in the quality of clinical service delivery and in patient outcomes related to chronic illness care. The aims of the extension phase of this study are to examine factors that influence uptake and sustainability of this type of CQI activity in a variety of Indigenous primary health care organisations in Australia, and to assess the impact of collaborative CQI approaches on prevention and management of chronic illness and health outcomes in Indigenous communities.

METHODS/DESIGN

The study will be conducted in 40-50 Indigenous community health centres from 4 States/Territories (Northern Territory, Western Australia, New South Wales and Queensland) over a five year period. The project will adopt a participatory, quality improvement approach that features annual cycles of: 1) organisational system assessment and audits of clinical records; 2) feedback to and interpretation of results with participating health centre staff; 3) action planning and goal setting by health centre staff to achieve system changes; and 4) implementation of strategies for change. System assessment will be carried out using a System Assessment Tool and in-depth interviews of key informants. Clinical audit tools include two essential tools that focus on diabetes care audit and preventive service audit, and several optional tools focusing on audits of hypertension, heart disease, renal disease, primary mental health care and health promotion. The project will be carried out in a form of collaborative characterised by a sequence of annual learning cycles with action periods for CQI activities between each learning cycle. Key outcome measures include uptake and integration of CQI activities into routine service activity, state of system development, delivery of evidence-based services, intermediate patient outcomes (e.g. blood pressure and glucose control), and health outcomes (complications, hospitalisations and mortality).

CONCLUSION

The ABCD Extension project will contribute directly to the evidence base on effectiveness of collaborative CQI approaches on prevention and management of chronic disease in Australia's Indigenous communities, and to inform the operational and policy environments that are required to incorporate CQI activities into routine practice.

Balancing the risk of chronic gastrointestinal bleeding and thromboembolic events in a patient with a metallic aortic valve

Evidence shows clear benefit of anticoagulation for prosthetic heart valves but consideration must be given to coexisting medical conditions.

Light flux density threshold at which protein denaturation is induced by synchrotron radiation circular dichroism beamlines

New high-flux synchrotron radiation circular dichroism (SRCD) beamlines are providing important information for structural biology, but can potentially cause denaturation of the protein samples under investigation. This effect has been studied at the new CD1 dedicated SRCD beamline at ISA in Denmark, where radiation-induced thermal damage effects were observed, depending not only on the radiation flux but also on the focal spot size of the light. Comparisons with similar studies at other SRCD facilities worldwide has lead to the estimation of a flux density threshold under which SRCD beamlines should be operated when samples are to be exposed to low-wavelength vacuum ultraviolet radiation for extended periods of time.

Computational prediction of absorbance maxima for a structurally diverse series of engineered green fluorescent protein chromophores

By virtue of its self-sufficiency to form a visible wavelength chromophore within the confines of its tertiary structure, the Aequorea victoria green fluorescent protein (GFP) is single-handedly responsible for the ever-growing popularity of fluorescence imaging of recombinant fusion proteins in biological research. Engineered variants of GFP with altered excitation or emission wavelength maxima have helped to expand the range of applications of GFP. The engineering of the GFP variants is usually done empirically by genetic modifications of the chromophore structure and/or its environment in order to find variants with new photophysical properties. The process of identifying improved variants could be greatly facilitated if augmented or guided by computational studies of the chromophore ground and excited-state properties and dynamics. In pursuit of this goal, we now report a thorough investigation of computational methods for prediction of the absorbance maxima for an experimentally validated series of engineered GFP chromophore analogues. The experimental dataset is composed of absorption maxima for 10 chemically distinct GFP chromophore analogues, including a previously unreported Y66D variant, measured under identical denaturing conditions. For each chromophore analogue, excitation energies and oscillator strengths were calculated using configuration interaction with single excitations (CIS), CIS with perturbative correction for double substitutions [CIS(D)], and time-dependent density functional theory (TD DFT) using several density functionals with solvent effects included using a polarizable continuum model. Comparison of the experimental and computational results show generally poor quantitative agreement with all methods attempted. However, good linear correlations between the calculated and experimental excitation energies (R2>0.9) could be obtained. Oscillator strengths obtained with TD DFT using pure density functionals also correlate well with the experimental values. Interestingly, most of the computational methods used in this work fail in the case of nonaromatic Y66S and Y66L protein chromophores, which may be related to a significant contribution of double excitations to their excited-state wavefunctions. These results provide an important benchmark of the reliability of the computational methods as applied to GFP chromophore analogues and lays a foundation for the computational design of GFP variants with improved properties for use in biological imaging.

PCO2 and room air saturation values in premature infants at risk for bronchopulmonary dysplasia

OBJECTIVE

To determine the capillary partial pressure of carbon dioxide (PCO(2)) and room air transcutaneous hemoglobin saturation (RA SAT) at 36 weeks' postmenstrual age (PMA) in infants born with weight between 501 and 1250 g.

STUDY DESIGN

Multicenter, prospective investigation with primary data collection within 72 h of 36 weeks PMA or discharge, whichever first. PCO(2) and RA SAT determinations were done at rest on infants not requiring mechanical ventilation or nasal continuous positive airway pressure (NCPAP).

RESULT

A total of 220 infants were enrolled (mean gestational age 27.7 weeks, mean birthweight 951 g). In infants with traditionally defined chronic lung disease (CLD) compared to those without CLD, the mean PCO(2) was significantly higher (54 versus 45 mm Hg) and the median RA SAT significantly lower (<80 versus 97%). In infants with the new classification of bronchopulmonary dysplasia (BPD), there was a significant linear trend toward increasing PCO(2) with increasing severity of BPD (45, 47, 54 and 62 mm Hg in No, Mild, Moderate and Severe BPD). There was a significant linear trend toward decreasing RA SAT with increasing severity of BPD (97, 95 <80, <80% in No, Mild, Moderate and Severe BPD).

CONCLUSION

Defining CLD as BPD based upon a RA SAT test is a more discriminate, objective method to categorize lung injury. PCO(2) is an objective measure of lung function that inversely correlates with RA SAT. These determinations done together at 36 weeks PMA may provide more precise and accurate estimates of lung injury that might allow for better understanding of pulmonary therapies and clearer comparison of BPD rates and severities among NICUs.