Pharmacodynamics and pharmacokinetics of the urotensin II receptor antagonist palosuran in macroalbuminuric, diabetic patients

OBJECTIVE

In patients with renal disease increased urotensin II plasma levels have been observed. We have investigated whether palosuran, a potent, selective, and competitive antagonist of the urotensin II receptor, has effects in patients who are prone to the development of renal disease.

METHODS

Macroalbuminuric, diabetic patients, categorized by renal function, were treated with oral doses of 125 mg palosuran twice daily for 13.5 days in addition to treatment with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The 24-hour urinary albumin excretion rate was determined twice at baseline and after 13.5 days of treatment. Plasma concentrations of palosuran were determined for 12 hours after the first and last drug intake. Renal hemodynamics was measured before and after 12.5 days of treatment. Tolerability and safety parameters were monitored.

RESULTS

An overall clinically significant reduction of 24.3% (geometric mean) (95% confidence interval, 4.1 to 45.0) in the 24-hour urinary albumin excretion rate was observed (P = .014). No effect was observed on renal hemodynamic parameters. Palosuran was rapidly absorbed with maximum plasma concentrations at 1 hour after drug administration. The accumulation factor was 1.7 (geometric mean) (95% confidence interval, 1.3 to 2.1). Palosuran was well tolerated.

CONCLUSIONS

The good tolerability profile and the decrease in the 24-hour urinary albumin excretion rate may benefit diabetic patients with renal failure with regard to their disease progression. Larger placebo-controlled trials in this patient population are needed to investigate whether urotensin II receptor antagonists, given as monotherapy or combination therapy, may improve the current treatment of diabetic nephropathy.

An increase of anticardiolipin antibody in association with stroke and chronic chemical exposure

A chemical worker working with urea-formaldehyde resin hazard for 20 years suffered cerebral ischemia in association with an increase of blood beta2-glycoprotein I-dependent anticardiolipin antibody (aCL)-IgG and IgM isotype, and a prolongation of activated partial thromboplastin time (aPTT). Major histocompatibility complex antigen showed DR4 positivity. On follow-up for over 6 years, aCL-IgG and aPTT decreased to reference range but aCL-IgM was still abnormally high despite a cessation of exposure. This patient highlights the induction of antibody-mediated thrombosis in chronic chemical exposure, especially in an individual with subclinical autoimmune disorder. The role of environment for coagulopathic vascular thrombosis is warranted for investigation.

Randomized clinical trial on the efficacy of a new bleaching lacquer for self-application

BACKGROUND

This study evaluated the clinical efficacy and duration of effectiveness of a new bleaching lacquer for self-application without the use of mouth guards. It compared two different application times.

METHODS

Forty-six adult subjects who requested bleaching treatment were selected to participate in this randomized, single-blind (examiner-blinded), single center, two-group trial. The subjects were randomly divided into two groups (n=23 each), each being instructed to bleach (8% carbamide peroxide) their six maxillary anterior teeth for two weeks. Daily contact time in Group 1 was 20 minutes once a day and, in Group 2, the time was 20 minutes twice a day. Efficacy was measured subjectively using the Chromascop Complete shade scores obtained at baseline and after one, two and three weeks, as well as after one, three, six and nine months.

RESULTS

After two weeks of treatment, the teeth in the Group 1 subjects exhibited a 2.4 +/- 0.2 mean shade scores improvement compared to baseline (p < 0.001; t-test for paired samples), and the subjects' teeth in Group 2 exhibited a 3.5 +/- 0.1 mean shade scores improvement (p < 0.001). However, the difference between both groups was not statistically significant (p > 0.05). The observed effects were stable for six months.

CONCLUSIONS

It can be concluded that the new bleaching lacquer is efficacious; however, a double application does not seem to be obligatory.

Comparison of the clinical efficacy and safety of carbamide peroxide and hydrogen peroxide in at-home bleaching gels

OBJECTIVE

The aim of this study was to evaluate the clinical efficacy of home-administered vital bleaching procedures and possible adverse effects derived from their use. One gel containing 3.5% hydrogen peroxide with a 5% potassium nitrate component (FKD, Kin Lab) was compared with a carbamide peroxide-based gel with a concentration of 10% (Opalescence, Ultradent).

METHOD AND MATERIALS

Two sample groups were designed, each composed of 8 patients. All patients employed both bleaching products, 1 in the maxillary arch and the other in the mandibular arch on a random basis. The treatment was applied for 3 hours a day for 4 weeks. The degree of bleaching was evaluated using the Vita guide arranged by brightness. Dental sensitivity was measured with a specially designed 4-point scale. Gingival irritation was registered by the presence or absence of lesions in the marginal gingiva related to treatment.

RESULTS

The degree of bleaching was similar with both products (4.8 Vita shade tabs). The hydrogen peroxide product with potassium nitrate provoked less dental sensitivity, although the difference between the 2 products was insignificant (P = .063). Gingival irritation appeared in 6 subjects, but was unrelated to the applied product.

CONCLUSION

Under the conditions of this study, no statistically significant differences were detected between 3.5% hydrogen peroxide containing 5% potassium nitrate (FKD) and the 10% carbamide peroxide-based product (Opalescence).

The effect of different fluoridation methods on the red wine staining potential on intensively bleached enamel in vitro

PURPOSE

To study the effect in vitro of different fluoridation methods after intensive bleaching on the color of enamel slabs during a severe staining challenge with red wine.

METHODS

75 specimens were equally divided among five groups. Group 1 (no bleaching, no wine) served as control. Groups 2, 3 and 4 underwent bleaching with 35 % H2O2 for 10 minutes followed by home-bleaching for 8 hours/day with 10% carbamide peroxide on 14 consecutive days. Groups 2 and 3 were fluoridated for 1 hour with either Elmex gelée or Duraphat, respectively whereas Group 4 remained without fluoridation. Group 5 (no bleaching, no fluoride, wine) served as control for the influence of red wine on the color of untreated enamel. Color determination was accomplished using the CIE-Lab System.

RESULTS

Nine successive cycles of wine saliva treatment (10 minutes wine, 23 hours 50 minutes saliva) for Groups 2-5 revealed the highest changes of a-values (deltaa= 4.17) (towards red) for the Duraphat-treated group (bleaching, Duraphat, wine) with significantly higher deltaa-values compared with Group 4 (bleaching, no fluoride, wine) (deltaa= 2.97). After final cleaning no differences were found between the three bleached groups (Groups 2, 3 and 4) for deltaL, deltaa, deltab and deltaE, respectively. Exposure to red wine led to an increase in a-values (deltaa= 0.44) of the intrinsic tooth color in Group 5 (no bleaching, no fluoride, wine) that was significantly different from baseline.

Effect of bleaching agents on the microhardness of tooth-colored restorative materials

STATEMENT OF PROBLEM

There is no consensus concerning the effect of bleaching gels on microhardness of restorative materials. Information about the effect of whitening strips on microhardness of restorative materials is also limited.

PURPOSE

The purpose of this study was to evaluate the effect of a bleaching gel and a whitening strip on the microhardness of 3 tooth-colored restorative materials.

MATERIAL AND METHODS

Forty cylindrical specimens (6 x 2 mm) of each restorative material, including a nanohybrid composite resin (Grandio), a polyacid-modified composite resin (Dyract eXtra), and a glass-ionomer cement (Ionofil Molar AC), were prepared and stored in distilled water at 37 degrees C for 24 hours. The specimens were then polished using medium, fine, and superfine polishing disks and stored in 37 degrees C distilled water for 7 days. Specimens were divided into 4 groups (n=10). One group was selected for baseline Vickers hardness measurements (load 100 g, dwell time 20 seconds) of the top surfaces. The other 3 groups were treated for 21 days with 1 of the following: distilled water (control), bleaching gel (10% carbamide peroxide), or whitening strip (14% hydrogen peroxide). The top surfaces of the treated specimens were also subjected to the same hardness testing performed for the baseline specimens. Data were analyzed with 2-way analysis of variance and Tukey Honestly Significant Difference tests (alpha=.05).

RESULTS

There were no significant differences in microhardness between the test groups of each restorative material. However, significant differences in microhardness were observed among restorative materials. For all test groups, composite resin showed the highest hardness values, whereas glass-ionomer cement presented the lowest (P<.05).

CONCLUSION

The bleaching products used in this study did not adversely affect the microhardness of the restorative materials.

Final report of the safety assessment of Urea

Although Urea is officially described as a buffering agent, humectant, and skin-conditioning agent-humectant for use in cosmetic products, there is a report stating that Urea also is used in cosmetics for its desquamating and antimicrobial action. In 2001, the Food and Drug Administration (FDA) reported that Urea was used in 239 formulations. Concentrations of use for Urea ranged from 0.01% to 10%. Urea is generally recognized as safe by FDA for the following uses: side-seam cements for food contact; an inhibitor or stabilizer in pesticide formulations and formulations applied to animals; internal sizing for paper and paperboard and surface sizing and coating of paper and paper board that contact water-in-oil dairy emulsions, low-moisture fats and oils, moist bakery products, dry solids with surface containing no free fats or oil, and dry solids with the surface of fat or oil; and to facilitate fermentation of wine. Urea is the end product of mammalian protein metabolism and the chief nitrogenous compound of urine. Urea concentrations in muscle, liver, and fetuses of rats increased after a subcutaneous injection of Urea. Urea diffused readily through the placenta and into other maternal and fetal organs. The half-life of Urea injected into rabbits was on the order of several hours, and the reutilization rate was 32.2% to 88.8%. Urea given to rats by a bolus injection or continuous infusion resulted in distribution to the following brain regions: frontal lobe, caudate nucleus, hippocampus, thalamus plus hypothalamus, pons and white matter (corpus callosum). The permeability constant after treatment with Urea of whole skin and the dermis of rabbits was 2.37 +/- 0.13 (x 10(6)) and 1.20 +/- 0.09 (x10(3)) cm/min, respectively. The absorption of Urea across normal and abraded human skin was 9.5% +/- 2.3% and 67.9% +/- 5.6%, respectively. Urea increased the skin penetration of other compounds, including hydrocortisone. No toxicity was observed for Urea at levels as high as 2000 mg/kg in acute oral studies using female rats or mice. No signs of toxicity were observed in male piglets dosed orally with up to 4 g/kg Urea for 5 days. Dogs dosed orally with 5 to 30 g/L Urea for 4 to 10 days had signs of toxicity, including weakness, anorexia, vomiting and retching, diarrhea and a decreased body temperature, which led to a deep torpor or coma. No significant microscopic changes were observed in the skin of male nude mice dermally exposed to 100% Urea for 24 h. No observable effect on fetal development was seen in rats and mice dosed orally with an aqueous solution of Urea (2000 mg/kg) on days 10 and 12 of gestation. The mean number of implants, live fetuses, percent fetal resorptions, mean fetal weight, and percent fetuses malformed were comparable to control group. A detergent containing 15% Urea was injected into pregnant ICR-JCl mice and dams and fetuses had no significant differences when compared to control animals. Urea given orally did not enhance the developmental toxicity of N-nitrosomethylurea. Female Sprague-Dawley rats injected in the uterine horn with 0.05 ml Urea on day 3 (preimplantation) or on day 7 (post implantation) exhibited no maternal mortality or morbidity; a dose-dependent reduction in embryo survival was seen with preimplantation treatment. Urea injected intra-amniotically induces mid-trimester abortions in humans. Urea was not genotoxic in several bacterial and mammalian assays; although in assays where Urea was used at a high concentration, genotoxicity was found, many in in vitro assays. Urea is commonly used in studies of DNA because it causes uncoiling of DNA molecules. Urea was not carcinogenic in Fisher 344 rats or C57B1/6 mice fed diets containing up to 4.5% Urea. Exposure of normal human skin to 60% Urea produced no significant irritation in one study, but 5% Urea was slightly irritating and 20% Urea was irritating in other reports. Burning sensations are the most frequently reported effect of Urea used alone or with other agents in treatment of diseased skin. Overall, there are few reports of sensitization among the many clinical studies that report use of Urea in treatment of diseased skin. The Cosmetic Ingredient Review (CIR) Expert Panel determined the data provided in this report to be sufficient to assess the safety of Urea. The Panel did note that Urea can cause uncoiling of DNA, a property used in many DNA studies, but concluded that this in vitro activity is not linked to any in vivo genotoxic activity. Although noting that formulators should be aware that Urea can increase the percutaneous absorption of other chemicals, the CIR Expert Panel concluded that Urea is safe as used in cosmetic products.

Tooth whitening products and the risk of oral cancer

Tooth whitening products (TWP) containing hydrogen peroxide (HPO) or carbamide peroxide (CPO) were evaluated in relation to potential oral cancer risk from their use. HPO is genotoxic in vitro, but such activity is not expressed in vivo. The genotoxic risk of HPO exposure of the oral mucosa encountered from TWP use is likely therefore to be vanishingly small. Available animal data on the carcinogenicity of HPO are of limited relevance to risk assessment of oral hazard of HPO exposure from TWP, and where relevant, do not indicate that there is an increased oral cancer risk for people using TWP. Clinical data on HPO-containing TWP only show evidence of mild, transient gingival irritation and tooth sensitivity, with no evidence for the development of preneoplastic or neoplastic oral lesions. Exposures to HPO received by the oral cavity, including areas commonly associated with oral cancer, are exceedingly low and do not plausibly pose a risk for the promotion of initiated cells or for induction of co-carcinogenic effects in conjunction with cigarette smoke or alcohol. The use of TWP was concluded not to pose an increased risk for oral cancer in alcohol abusers and/or heavy cigarette smokers. Furthermore, TWP were concluded to be safe for use by all members of the population, including potential accidental use by children.

Hydrogen peroxide tooth-whitening (bleaching): review of safety in relation to possible carcinogenesis

Hydrogen peroxide in the form of carbamide peroxide is widely used in professionally and self-administered products for tooth whitening. Hydrogen peroxide is a highly reactive substance that can damage oral soft and hard tissues when present in high concentrations and with exposures of prolonged duration. This review examines the issue of oral mucosal damage and possible carcinogenicity relating to the use of hydrogen peroxide in the mouth for tooth whitening, with an emphasis on safety with prolonged exposure to low concentrations of peroxide products.

ROAT: morphology of ROAT on arm, neck and face in formaldehyde and diazolidinyl urea sensitive individuals

The morphology of early allergic contact dermatitis reactions was studied in formaldehyde allergic individuals exposed to a cream product preserved with 4 different concentrations of diazolidinyl urea. The study was made using a dose-escalating design in 3 different anatomical regions, the upper arm, neck and face. On the arm and neck, the dominant initial morphology was an eczematous papular eruption. In the face, the initial skin changes were more homogeneous and infiltrated erythema.

Can an imidazolidinyl urea-preserved corticosteroid cream be safely used in individuals hypersensitive to formaldehyde?

A topical corticosteroid preparation on the Swedish market, Flutivate cream, contains a fairly high concentration of formaldehyde (FA). In this study, we have investigated the clinical relevance of contact allergy to FA when treating an allergic eczema with Flutivate cream, containing an FA-releasing preservative. In a randomized, double-blind study, 7 patients hypersensitive to both FA and nickel repeatedly applied Flutivate cream containing FA or Betnovate cream not containing FA to areas of experimentally induced nickel dermatitis. 17 controls allergic to nickel, but not FA, went through the same procedure. In 29 per cent of the FA-allergic individuals, the experimental dermatitis healed when treated with Flutivate cream compared with 71 per cent of the controls (P = 0.04). The conclusion to draw from this study is that an individual hypersensitive to FA should not use the corticosteroid preparation Flutivate cream on dermatitis skin.

Cosmetic dermatitis in Chinese eczema patients patch tested with a modified European standard series of allergens

The prevalence of cosmetic allergic contact dermatitis (CACD) in Chinese eczema patients (CEP) has not been reported. The purpose of our study was to analyse CACD in CEP and examine the frequency of patch test (PT) reactions to common cosmetic-related allergens (CRA). 378 consecutive CEP patch tested with a modified European standard series of allergens during a 2-year period in our clinic were analysed. 73 patients (19.3%) were considered as suspected CACD and 37 patients (9.8%) were confirmed. The frequencies of the positive PT reactions in suspected CACD and confirmed CACD to at least 1 CRA were 64.4% and 89.2%, to para-phenylenediamine (PPD) were 31.5% and 59.5%, to fragrance mix (FM) were 27.4% and 32.4% and to imidazolidinylurea were 5.5% and 8.1%, respectively. These results were much higher than those of CEP without cosmetic reactions (26.3% for at least 1 CRA, 5.8% for PPD, 8.8% for FM, and 0 for imidazolidinylurea) (P < 0.01 for all, Chi-square test and Fisher's exact test). These results suggested that CACD is very common in CEP patch tested. PPD and FM are the leading allergens identified. CACD should be strongly considered in CEP with positive PT reactions to PPD, FM and imidazolidinylurea.

Experimental elicitation of contact allergy from a diazolidinyl urea-preserved cream in relation to anatomical region, exposure time and concentration

The elicitation potential of the cosmetic preservative diazolidinyl urea was studied in formaldehyde- and diazolidinyl urea-sensitized volunteer patients using a stepwise controlled exposure design. The test product was a facial moisturizer, preserved with varying concentrations of diazolidinyl urea, ranging from 0.05% to 0.6%. A repeated open application-like exposure test was performed on volunteers and a control group with the test product containing increasing preservative concentrations, on arm, neck and face, sequentially, for 2 weeks or until dermatitis developed. The preservative action in the cream at different test concentrations was tested in microbial challenge tests and was found effective at all concentrations tested. The study established a non-eliciting concentration of diazolidinyl urea of 0.05% in formaldehyde-sensitive patients and showed that the skin reactivity depends on the anatomical region, increasing from the upper arm to neck and, possibly, to the face. The study design, beginning on the upper arm and moving on to the neck and face seems to be relevant for the study of reactions to cosmetic products. A clear dose-response relationship was seen regarding preservative concentration in the product.

Photoreceptors in the rat retina are specifically vulnerable to both hypoxia and hyperoxia

The current study aims to assess the vulnerability of photoreceptors in rat retina to variations in tissue oxygen levels. Young adult Sprague-Dawley rats were exposed to air with the concentration of oxygen set at 10% (hypoxia), 21% (room air, normoxia), and four levels of hyperoxia (45%, 65%, 70%, and 75%), for up to 3 weeks. Their retinas were then examined for cell death, using the TUNEL technique. Hypoxia (10% oxygen) for 2 weeks caused a limited but significant rise in the frequency of TUNEL+ (dying) cells in the retina, the great majority (> 90%) being located in the outer nuclear layer (ONL). Hyperoxia also induced an increase in the frequency of TUNEL+ cells, again predominantly in the ONL. The increase rose with duration of exposure, up to 2 weeks. At 2 weeks exposure, the increase was limited yet significant at 45% oxygen, and maximal at 65%. Where the frequencies of TUNEL+ cells were high, it was evident that photoreceptor death was maximal in the midperipheral retina. The adult retina is vulnerable to maintained shifts in oxygen availability to the retina, both below and above normal. The vulnerability is specific to photoreceptors; other retinal neurons appeared resistant to the exposures tested. Shifts in retinal oxygen levels caused by variations in ambient light, by the persistence of light through the normally dark (night) half of the day–night cycle, or by depletion of the photoreceptor population, may contribute to photoreceptor death in the normal retina.

The effect of 10% carbamide peroxide, carbopol and/or glycerin on enamel and dentin microhardness

This study evaluated the effects of 10% carbamide peroxide, carbopol and glycerin and their associations on microhardness over time on enamel and dentin. Eight treatment agents were evaluated: a commercial bleaching agent containing 10% carbamide peroxide (Opalescence 10% Ultradent), 10% carbamide peroxide, carbopol, glycerin, 10% carbamide peroxide + carbopol, 10% carbamide peroxide + glycerin, carbopol + glycerin and 10% carbamide peroxide + carbopol + glycerin. Three hundred and twenty human dental fragments, 80 sound enamel fragments (SE), 80 demineralized enamel fragments (DE), 80 sound dentin fragments (SD) and 80 demineralized dentin (DD) fragments, were exposed to the treatment agents (n=10). These agents were applied onto the surface of the fragments eight hours a day for 42 days. After eight hours, they were washed from the dental fragment surfaces after five back-and-forth movements with a soft bristle toothbrush under distilled and deionized running water. During the remaining time (16 hours per day), the fragments were kept in individual vials in artificial saliva. After the 42-day treatment period, the specimens were kept individually in artificial saliva for 14 days. Knoop microhardness measurements were performed at baseline, after eight hours, and 7, 14, 21, 28, 35 and 42 days, and 7 and 14 days post-treatment (corresponding to 49 and 56 days after the initial treatment agent applications). The non-parametric Kruskal-Wallis analysis showed significant differences among the agents at each time interval, except at baseline for sound and demineralized enamel and dentin. For SE, SD and DD, there was a decrease in microhardness values during treatment with all agents. There was a tendency towards lower microhardness values after treatment with carbopol and its associations for sound tissues. DD showed low microhardness values during and after treatment with CP and its associations. For DE, there was an increase in microhardness values during treatment with all agents and in the post-treatment phase. The baseline microhardness values were not recovered during the 14-day post-treatment phase. Opalescence 10%, carbamide peroxide, carbopol, glycerin and their associations may change the microhardness of sound and demineralized dental tissues, even in the presence of artificial saliva.

Effect of direct peroxide bleach application to bovine dentin on flexural strength and modulus in vitro

OBJECTIVES

The objective of this study was to determine the effects of carbamide peroxide (CP) and hydrogen peroxide (HP) bleaching on the flexural strength (FS) and flexural modulus (FM) of dentin.

METHODS

2x2x20mm bovine dentin specimens were immersed in the bleaching agents to simulate overnight (10 or 15% CP, 6h daily, 2 weeks), exaggerated overnight (10% CP, 6h/day, 5 days/week, 2 months), daytime (6.5 or 7.5% HP, 1h daily, 3 weeks) and in-office (35% HP, 1h/day, 2 days/week, 3 weeks) treatment protocols. Distilled water (DW) and a placebo gel acted as control immersion materials. After immersion, the specimens were rinsed and stored in DW. Mechanical testing was performed 24h after the last treatment using an Instron Universal Testing Machine with a crosshead speed of 0.75 mm/min. The results were analyzed by ANOVA and Tukey's tests (p<0.05).

RESULTS

There were significant reductions in the FS and FM of dentin after 2-week and 2-month exposures to CP. There were no significant differences in the FS or the FM of the dentin among the HP treatment and control groups.

CONCLUSIONS

Direct in vitro application of CP bleaches caused significant decreases in dentin FS and FM. Similar decreases were not observed among the HP-treated dentin groups, which were exposed to shorter treatment times. Further research is needed to determine the effect of CP and HP on dentin in vivo.

Effectiveness and safety of tooth bleaching in teenagers

PURPOSE

The purpose of this study was to compare the efficacy and safety outcomes of a currently marketed, peroxide-containing, tray-based, tooth-whitening system to a peroxide-containing, "trayless" tooth-whitening system.

METHODS

Fifty-seven subjects, 12 to 17 years of age, participated in this study and were divided into 2 balanced groups. Twelve subjects received custom trays with 10% carbamide peroxide gel that they were instructed to wear overnight. Forty-five subjects received 10% hydrogen peroxide polyethylene strips to wear for 30 minutes twice a day. Teeth were bleached for 2 weeks. Digital image analysis measured color in B, L, and A color spaces, where B indicated yellowness, L indicated lightness, and A indicated redness. Oral examinations and interviews were used to ascertain any adverse events that may have occurred during treatment.

RESULTS

Fifty-one patients completed this study. Both whitening systems yielded significant (P<.001) color improvement, as evidenced by decreased yellowness, increased lightness, and decreased redness. Groups did not differ significantly (P>.39) regarding color improvement for B, L, or A on either the maxillary or mandibular teeth. Twelve subjects (27%) in the polyethylene strip group reported adverse events compared to 5 subjects (42%) in the tray-delivered group. Minor and transient tooth sensitivity and oral irritation were the most common adverse events.

CONCLUSIONS

Both the daytime strip and overnight tray groups significantly (P<.0001) whitened teeth; there were no significant differences between the 2 groups in any of the color parameters; both whitening systems were well tolerated, and most adverse events were mild in severity.

Efficacy, side-effects and patients' acceptance of different bleaching techniques (OTC, in-office, at-home)

This clinical study compared the efficacy of three different bleaching techniques with respect to the bleaching times required in order to achieve six grades of whitening in human teeth. Any side effects that were noted and the patients' acceptance of the method were recorded by a visual analog scale ranging from 0 to 10. Moreover, epoxy casts from the study teeth were analyzed by scanning electron microscopy in order to detect any potential changes in the enamel surface due to treatments. Thirty-nine volunteers participated in the study and were allocated randomly to one of three different bleaching treatments: Group A (n=13) used Whitestrips (over-the-counter technique; one cycle=30 minutes), Group B (n=13) used Opalescence PF 10% (at-home bleaching technique; one cycle=8 hours) and Group C (n=13) used Opalescence Xtra Boost (in-office bleaching technique; one cycle=15 minutes) until a defined whitening of six tabs compared to the baseline were reached (assessed by the VITA shade guide). All three methods achieved six grades of whitening. The mean treatment time required to reach the defined level of whitening was 31.85 +/- 6.63 cycles in Group A, 7.15 +/- 1.86 cycles in Group B and 3.15 +/- 0.55 cycles in Group C. All products differed significantly from each other in terms of treatment cycles and required treatment time (p<0.001 by ANOVA and Mann-Whitney-U-test). Using the VA scale, side effects noted within the three groups were minimal. Tooth hypersensitivity ranged from 2.62 (Whitestrips) to 3.38 (Opalescence PF), and gingival irritation ranged between 0.23 (Opalescence Xtra Boost) and 0.85 (Whitestrips). The most accepted method was the at-home bleaching technique. None of the teeth studied showed detectable enamel surface changes in the subsequent SEM analysis using 200x and 2000x magnification.

The clinical performance of professionally dispensed bleaching gel with added amorphous calcium phosphate

BACKGROUND

The authors undertook a study to measure how the addition of amorphous calcium phosphate (ACP) to a professionally dispensed 16 percent carbamide peroxide equivalent bleaching gel affects tooth color and dentinal hypersensitivity.

METHODS

The authors assigned two groups to use either the test gel containing ACP or a control gel. Both groups used their respective products for three hours daily for 14 days. At checkpoints during the treatment period, the authors studied tooth color, gingival health and three measures of hypersensitivity. They performed double-blinded clinical measurements on days three, seven, 14 and on the fifth day post-treatment.

RESULTS

The test group demonstrated significantly lower (P < .05) mean thermal sensitivity scores compared with baseline (day 14: 0.21 versus 0.31; fifth posttreatment day: 0.06 versus 0.18). Tactile sensitivity also was substantially lower (P < .05) for test subjects (day 14: 0.26 versus 0.48; fifth posttreatment day: 0.06 versus 0.19). Furthermore, at the conclusion of the study, twice as many subjects were free of thermal sensitivity (test group, 80 percent, compared with control group, 40 percent; P < .001) and there was a similar significant (P < .001) percentage difference for tactile sensitivity. Both groups demonstrated equivalent and significant tooth color enhancement as compared with baseline (control: -7.73 shade change versus test: -8.12; P < .05).

CONCLUSIONS

This study demonstrates that ACP could be added to a 16 percent carbamide peroxide equivalent bleaching gel and result in a significant reduction of clinical measures of dentinal hypersensitivity, both during and after treatment.

CLINICAL IMPLICATIONS

The results of this study offer evidence in support of clinical decisions to treat patients with bleaching gel containing ACP when uncompromised tooth whitening efficacy is desired, yet dentinal hypersensitivity may be a concern.

Daily and alternate-day supplementation of urea or biuret to ruminants consuming low-quality forage: III. Effects on ruminal fermentation characteristics in steers

Five ruminally and duodenally cannulated steers (491 +/- 21 kg BW) were used in an incomplete 5 x 4 Latin square with four 24-d periods to determine the influence of supplemental nonprotein N (NPN) source and supplementation frequency (SF) on the dynamics of ruminal fermentation in steers consuming low-quality grass straw (4% CP). Treatments (TRT) included an unsupplemented control (CON) and a urea or biuret supplement that were placed directly into the rumen at 0700 daily (D) or every other day (2D). The NPN treatments were formulated to provide 90% of the estimated degradable intake protein requirement; therefore, the urea and biuret treatments received the same amount of supplemental N over a 2-d period. Daily TRT were supplemented with CP at 0.04% of BW/d, whereas the 2D TRT were supplemented at 0.08% of BW every other day. Forage was provided at 120% of the previous 5-d average intake in two equal portions at 0715 and 1900. Ruminal fluid was collected 0, 3, 6, 9, 12, and 24 h after supplementation on a day of and a day before supplementation for all TRT. Ruminal NH3-N increased (P < 0.04) with CP supplementation on the day all supplements were provided and on the day on which only daily supplements were provided compared with the CON. However, an NPN source x SF interaction (P = 0.03) on the day all supplements were provided indicated that NH3-N increased at a greater rate for urea as SF decreased compared with biuret. Ruminal NH3-N on the day only daily supplements were provided was greater (P = 0.02) for D compared with 2D. On the day all supplements were provided, D increased (P = 0.05) ruminal indigestible acid detergent fiber passage rate and ruminal fluid volume compared with 2D. These results suggest that urea or biuret can be used effectively as a supplemental N source by steers consuming low-quality forage without adversely affecting ruminal fermentation, even when provided every other day.

Daily and alternate day supplementation of urea or biuret to ruminants consuming low-quality forage: I. Effects on cow performance and the efficiency of nitrogen use in wethers

Two experiments were conducted to determine the influence of supplemental nonprotein N (NPN) provided daily (D) or every other day (2D) on ruminant performance and N efficiency. Treatments included an unsupplemented control (CON) and a urea (28.7% CP) or biuret (28.6% CP) supplement provided D or 2D at 0700. In Exp. 1, five wethers (39 +/- 1 kg BW) were used in an incomplete 5 x 4 Latin square with four 24-d periods to determine the influence of supplemental NPN source and supplementation frequency (SF) on the efficiency of N use in lambs consuming low-quality grass straw (4% CP). The amount of CP supplied by each supplement was approximately 0.10% of BW/d (averaged over a 2-d period). In Exp. 2, 80 Angus x Hereford cows (540 +/- 8 kg BW) in the last third of gestation were used to determine the effect of NPN source and SF on cow performance. The NPN treatments were formulated to provide 90% of the estimated degradable intake protein requirement. The supplemented treatments received the same amount of supplemental N over a 2-d period; therefore, the 2D treatments received double the quantity of supplemental N on their respective supplementation day than the D treatments. In Exp. 1, total DM, OM, and N intake; DM, OM, and N digestibility; N balance; and digested N retained were greater (P < 0.03) for supplemented than for CON wethers, with no difference (P > 0.05) between NPN sources or SF. Plasma urea-N (PUN) was increased with N supplementation compared with CON (P < 0.01), and urea treatments had greater PUN than biuret (P < 0.01). In addition, PUN was greater (P = 0.02) for D than for 2D treatments. In Exp. 2, pre- and postcalving (within 14 d and 24 h after calving, respectively) cow weight and body condition score change were more positive (P < 0.05) for supplemented groups than for CON. These results suggest that supplements containing urea or biuret as the primary source of supplemental N can be effectively used by lambs and cows consuming low-quality forage, even when provided every other day.