Chemical and Ultrastructural Characterization of Dentin Treated with Remineralizing Dentifrices

The aim of this study is to investigate dentin chemical and ultrastructural changes upon exposure to remineralizing dentifrices. Dentin disks were obtained from permanent human molars and treated for 7 days with the dentifrices: (1) C group-control (no dentifrice); (2) S group-Sensodyne Repair & Protect; (3) D group-Dentalclean Daily Regenerating Gel; and (4) DB group-D group + Dentalclean regenerating booster. Afterwards, samples were submitted to an additional 7 days of toothbrushing associated with daily acidic challenge. Samples were imaged and analyzed (days 1, 7, and 14) for Young's modulus by atomic force microscopy (AFM), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX), transmission electron microscopy (TEM) and selected area electron diffraction (SAED). SEM and AFM revealed precipitate deposition on dentin surfaces in groups S, D, and DB, formed as early as day 1. Surface elemental analysis showed a Si increase on all brushed surfaces. Similar surface morphology was maintained after the acidic challenge period. Bright-field TEM/SAED revealed the formation of nanocrystalline hydroxyapatite inside the dentin tubules of groups S, D, and DB after day 7. Group C presented a gradual reduction of Young's modulus from days-1-14, whereas all remaining groups had increased values. All evaluated dentifrices led to successful formation of hydroxyapatite and increased dentin stiffness.

Comparison of surface characteristics of denture base resin materials with two surface treatment protocols and simulated brushing

PURPOSE

To investigate the effects of 4 denture base materials, 2 surface treatment protocols, and simulated brushing (SB) on the surface hardness, surface roughness, surface gloss, and the surface loss of denture base materials.

MATERIALS AND METHODS

Four denture base resin material groups (compression-molded, injection-molded, 3D-printed, and milled) with two different surface treatment protocols (polished and glazed) were utilized in this study. A total of 80 samples (n = 10) were evaluated for surface hardness (Vickers) before SB. SB was performed for each sample (custom-built V8 cross brushing machine, 50,000 reciprocal strokes). Surface roughness (Ra) was measured before and after SB with a non-contact optical profilometer. Surface gloss was performed using a glossmeter to determine changes in surface reflectivity of the specimens before and after SB. Surface loss (wear resistance) was measured after SB using optical profilometry. The effects of material, surface treatment, and SB on all surface characteristics were examined with two-way and three-way analysis of variance models (ANOVA) (α = 0.05).

RESULTS

The polished compression-molded group had significantly higher surface hardness than all other groups. The protective glaze coating significantly increased the surface hardness for all groups (P < 0.001). SB increased the surface roughness of all groups regardless of surface treatments (P < 0.001). The increase in surface roughness after SB was significantly higher with polished surface treatment than with a glazed surface treatment in all groups (P < 0.001). Surface gloss was significantly higher with the glazed surface treatment than with the polished surface treatment for all denture base materials (P < 0.001). After SB, milled denture base material showed the highest, and 3D-printed material showed the second highest surface gloss compared to the other groups (P < 0.001), regardless of surface treatment. In all materials tested, surface glaze significantly decreased surface loss (P < 0.001). With the glaze surface treatment, compression-molded denture base material had significantly less surface loss (more surface gain) than other materials, while with the polished surface treatment, 3D-printed denture base material had the least surface loss when compared with other groups.

CONCLUSIONS

A single layer of nano-filled, light-polymerizing protective glaze coating has displayed potential for enhancing the longevity of denture base materials, as evidenced by increased hardness and wear resistance. Following simulated brushing, the milled denture material exhibited the highest surface gloss and lowest surface roughness among all groups, regardless of the surface treatment protocol. This indicates that milled denture base material possesses favorable surface properties and may serve as a viable alternative to traditional denture base materials.

Surface roughness, optical properties, and microhardness of additively and subtractively manufactured CAD-CAM materials after brushing and coffee thermal cycling

PURPOSE

To evaluate the surface roughness, optical properties, and microhardness of additively or subtractively manufactured CAD-CAM materials after simulated brushing and coffee thermal cycling.

MATERIAL AND METHODS

Two additively manufactured resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and 3 subtractively manufactured materials (a reinforced composite (Brilliant Crios, BC), a polymer-infiltrated ceramic network (Enamic, VE), and a feldspathic ceramic (Mark II, VM)) were used to fabricate disk-shaped specimens (Ø10×1-mm) (n = 10). Surface roughness, Vickers microhardness, and color coordinates were measured after polishing, while surface roughness was also measured before polishing. Specimens were then subjected to 25000 cycles of brushing and 10000 cycles of coffee thermal cycling, and measurements were repeated after each time interval. Color difference (ΔE00 ) and relative translucency parameter (RTP) were calculated. Robust analysis of variance test was used to evaluate surface roughness, ΔE00 , and RTP data, while generalized linear model analysis was used for microhardness data (α = 0.05).

RESULTS

Material type and time interval interaction affected tested parameters (p ≤ 0.002). In addition, material type affected all parameters (p < 0.001) other than surface roughness (p = 0.051), and time interval affected surface roughness and microhardness values (p < 0.001). Tested materials mostly had their highest surface roughness before polishing (p ≤ 0.026); however, there was no clear trend regarding the roughness of materials within different time intervals along with ΔE00 and RTP values within materials or time intervals. VS and CT had the lowest microhardness regardless of the time interval, while the remaining materials were listed as VM, VE, and BC in decreasing order (p < 0.001). Coffee thermal cycling only reduced the microhardness of VM (p < 0.001).

CONCLUSIONS

Tested additively manufactured resins can be considered more susceptible to simulated brushing and coffee thermal cycling than the other materials, given the fact that their surface roughness and ΔE00 values were higher than previously reported acceptability thresholds and because they had the lowest microhardness after all procedures were complete.

Prevalence and correlates of dental caries among 2-5 years children with special reference to breastfeeding in Kamrup District, Assam

Background

Dental caries among children is one of the most common health-related issues worldwide.

Aim

To find out the prevalence of dental caries among 2-5 years old children in Kamrup district of Assam with reference to breastfeeding and associated variables.

Materials and Methods

In this community-based cross-sectional study, 1439 children were examined from 15 wards of Kamrup Metro and four randomly chosen blocks of Kamrup Rural. Children were examined to assess the mean decayed/filled primary teeth (dmft) index, and a self-administered validated questionnaire was given to the mothers to collect data on the practice of breastfeeding initiation, its duration, and dental hygiene habits.

Results

Dental caries prevalence was found to be higher in urban areas (54.6%) than rural areas (45.4%). The frequency of using toothpaste was highest among the tooth-cleaning materials. A significant difference in caries prevalence was observed among the children, those who brushed twice a day, and those who did not brush (P = 0.039). The difference was significant in the mean dmft of children from the upper socioeconomic class (P = 0.023) compared with the other classes. A significant difference was also observed between breastfeeding duration (P = 0.010), exclusive and nonexclusive breastfeeding, time of initiation of breastfeeding within 12 h (P < 0.001), and alternative feeding with caries prevalence (P < 0.001).

Conclusions

Dental caries were higher in urban localities and upper socioeconomic classes. Breastfeeding initiation and duration may play an important role in the causation of dental caries. No significant association was found between colostrum, prelacteal feeding, and caries prevalence.

Resistance of PETG Materials on Thermocycling and Brushing

The aim was to assess the impact of thermocycling and brushing on the surface roughness and mass of PETG material-the most commonly used for orthodontic retainers. A total of 96 specimens were exposed to thermocycling and brushing with three different kinds of toothbrushes depending on the number and thickness of the bristles. Surface roughness and mass were evaluated three times: initially, after thermocycling, and after brushing. In all four brands, both thermocycling and brushing increased surface roughness significantly (p < 0.001), with Biolon having the lowest and Track A having the highest. In terms of brushing, only Biolon samples showed statistically significant increased roughness after brushing with all three types of brushes, in comparison to Erkodur A1, where differences were not statistically significant. Thermocycling increased the mass of all samples, but a statistically significant difference was found only in Biolon (p = 0.0203), while after brushing, decreased mass was found in all specimens, statistically significant only in Essix C+ (CS 1560: p = 0.016). PETG material showed instability when exposed to external influences- thermocycling produced an increase in roughness and mass, and brushing mostly caused an increase in roughness and decrease in mass. Erkodur A1 demonstrated the greatest stability, whereas Biolon demonstrated the lowest.

Application of Inorganic Nanomaterials in Cultural Heritage Conservation, Risk of Toxicity, and Preventive Measures

Nanotechnology has allowed for significant progress in architectural, artistic, archaeological, or museum heritage conservation for repairing and preventing damages produced by deterioration agents (weathering, contaminants, or biological actions). This review analyzes the current treatments using nanomaterials, including consolidants, biocides, hydrophobic protectives, mechanical resistance improvers, flame-retardants, and multifunctional nanocomposites. Unfortunately, nanomaterials can affect human and animal health, altering the environment. Right now, it is a priority to stop to analyze its advantages and disadvantages. Therefore, the aims are to raise awareness about the nanotoxicity risks during handling and the subsequent environmental exposure to all those directly or indirectly involved in conservation processes. It reports the human-body interaction mechanisms and provides guidelines for preventing or controlling its toxicity, mentioning the current toxicity research of main compounds and emphasizing the need to provide more information about morphological, structural, and specific features that ultimately contribute to understanding their toxicity. It provides information about the current documents of international organizations (European Commission, NIOSH, OECD, Countries Normative) about worker protection, isolation, laboratory ventilation control, and debris management. Furthermore, it reports the qualitative risk assessment methods, management strategies, dose control, and focus/receptor relationship, besides the latest trends of using nanomaterials in masks and gas emissions control devices, discussing their risk of toxicity.

Effects of brushing duration on the efficacy of dental plaque removal: An in vitro study

INTRODUCTION

This study was performed to evaluate the effects of varying brushing times on the dental plaque-removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth.

METHODS

A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests.

RESULTS

Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49).

CONCLUSION

Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s.

Effect of Different Artificial Staining Procedures on the Color Stability and Translucency of a Nano-Hybrid Resin-Based Composite

BACKGROUND

To evaluate the effect of different experimental staining procedures on color stability and translucency of a nano-hybrid resin-based composite (RBC).

METHODS

Forty-eight cylindrical-shaped specimens (10 × 2 mm) were prepared with a nano-hybrid RBC (Clearfil Majesty ES-2) and randomly divided in four groups according to the experimental staining procedure: G1) static immersion in a staining solution (coffee) (44 ± 1 °C); G2) staining cycling between coffee (44 ± 1°C) and distilled water (37 ± 1°C) with an experimental staining machine based on Arduino, an Open Source hardware development platform; G3) staining cycles as in G2 + brushing with a low abrasive toothpaste (Relative Dentin Abrasion RDA = 30) (Elmex Sensitive Professional); G4) staining cycles as in G3, with brushing performed with a very strong abrasive toothpaste (RDA = 90) (Lacult Active). Color parameters were recorded at the baseline (T0) after staining procedures (T1) and repolishing (T2) using a spectrophotometer. Color change (∆E00) and translucency (TP, CR) were evaluated. Data were statistically analyzed (p < 0.05).

RESULTS

For ∆E00 after staining, Group 1 showed the highest color change and Group 3 the lowest. All groups were significantly different (p < 0.001) except for Group 2 vs. Group 4; after repolishing, Group 1 was significantly higher than Group 3 (p < 0.001), Group 2 (p < 0.001), and Group 4 (p = 0.003); Group 2 was higher than Group 3 (p < 0.001). For TP variable, after staining procedures, Group 2 was significantly higher than all other groups (p < 0.001), and Group 1 was significantly higher than Group 3 (p < 0.001) and Group 4 (p = 0.007). After repolishing, Group 4 was significantly lower than Group 3 (p = 0.008) and Group 2 (p = 0.027). Repolishing procedure significantly reduced color parameters.

CONCLUSIONS

The investigated staining procedure induced significant differences in color stability and translucency. The use of a very strong abrasive toothpaste (RDA = 90) induced higher color change than a low abrasive one (RDA = 30). Repolishing procedures are able to partially reduce color change induced by artificial staining procedures.

Diagnostic implication of extracellular mucin in pancreatic/biliary brushing and stent cytology

BACKGROUND

Pancreatic and/or biliary (PB) brushing is commonly used to rule out malignant strictures. Many studies have attempted to characterize cytomorphologic characteristics of brushing and stent cytology. However, scant literature exists on the diagnostic implication (DI) of thick extracellular mucin (ECM) indicative of neoplasm in these samples. This study was aimed at reviewing the DI of thick ECM in PB brushing and stent cytology.

METHODS

A retrospective search of consecutive cytologic samples of PB brushings/stents with corresponding surgical pathology or relevant clinical information over a 1-year period was performed. Blinded review of the slides was performed by two cytopathologists. The slides were assessed for the presence, quantity, and quality of ECM. The results were analyzed for statistical significance with the Fisher exact and χ² tests.

RESULTS

One hundred ten cases were identified from 63 patients. Twenty-two cases (20%) were PB brushings only without a prior stent. The remaining 88 cases (80%) had a preexisting stent for symptomatic obstruction. Fourteen of 22 cases (63%) without prior stents and 67 of 88 poststented cases (76%) were nonneoplastic (NN) upon follow-up. ECM was present more frequently in neoplastic cases than in NN cases (p = .03). Among NN cases (n = 87), poststented samples showed more evidence of ECM than prestented samples (15% vs. 45%, p = .045). Identical thick ECM was observed in NN poststent and main-duct intraductal papillary neoplasm samples.

CONCLUSIONS

Although ECM was frequently seen in neoplastic cases, NN cases showed increased evidence of thick ECM among poststented samples. Thick ECM may be common in stent cytology, regardless of the underlying biologic process.

Intraductal papillary neoplasm of the bile duct: Cytomorphologic and molecular features

BACKGROUND

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare premalignant neoplasm that can progress to invasive adenocarcinoma. In this retrospective study, cases of IPNB were reviewed to examine cytomorphologic and molecular features.

METHODS

IPNB cytology cases with histopathologic confirmation were retrieved from the pathology archives. The cytomorphologic features such as cellularity, architecture, cell type, and cellular details were analyzed.

RESULTS

The cohort included 13 cases (six brushings, six fine-needle aspirations [FNA], and one combined brushing and FNA). The lesions involved common bile duct in nine cases (69%) and hepatic duct in four cases (31%). Original cytological diagnoses included adenocarcinoma (five, 38%), suspicious for adenocarcinoma (one, 8%), neoplasm (three, 23%), atypical (three, 23%), and reactive (one, 8%). The cytomorphologic features included moderate/high cellularity (12, 92%), papillary and/or complex papillary architecture (10, 77%), columnar cells (11, 85%), vacuolated cytoplasm (12, 92%), enlarged nuclei (13, 100%), and fine granular chromatin (12, 92%). Background mucin, necrosis and acute inflammation were seen in four (31%), four (31%), and two (15%) cases, respectively. KRAS testing was performed in nine cases with mutant KRAS found in five (56%).

CONCLUSIONS

Our study demonstrated that IPNB cytology specimens were relatively cellular with a wide spectrum of cytomorphology; however, most cases harbored adenocarcinoma or high-grade dysplasia. The characteristic cytomorphologic features included papillary/complex papillary clusters of columnar cells with vacuolated cytoplasm, enlarged nuclei, and fine granular chromatin in relatively cellular specimens. KRAS mutations identified may have potential diagnostic and therapeutic implications.

Analysis of the Effectiveness of Removing Surface Defects by Brushing

The paper presents the results of a study on the effectiveness of removing surface defects by brushing. Damage to machine components usually begins on their surface or in the surface layer area. This determines the development of methods, conditions, and process parameters that will positively affect the stereometric and physical properties of the surface layer. Experiments were conducted in which surface defects were generated on a specially designed test stand. By controlling the load and speed of the defect generator it was possible to affect the geometry, depth, and width of the surface defect. A FEM simulation of the brushing treatment was carried out in order to determine the effect of fibers passing through a surface defect in the form of a groove with a small depth and width. It was shown that for certain conditions of brushing treatment, surface defects could be removed effectively. Moreover, the microhardness of the surface layer after the brushing process was analyzed. Changes in microhardness due to brushing reached up to 50 μm for EN AW-2024 aluminum alloy and up to 150 μm for AZ91HP magnesium alloy. The results demonstrated that brushing was an effective method for strengthening the surface layer and that the value of strengthening in the area of defects depended on the effectiveness of their removal.

Feeding and Manual Brushing Influence the Release of Oxytocin, ACTH and Cortisol Differently During Milking in Dairy Cows

Aim

This study aimed to examine the effects of feeding or abdominal brushing on the release of the hormones oxytocin, ACTH and cortisol during milking in dairy cows.

Methods

Twelve cows in early lactation were used (2 × 2 factorial experimental design), testing the effects of two types of sensory stimulation during milking over a 3 day period; feeding concentrate or manual abdominal brushing (1 stroke/s). Blood samples for hormone analyses were collected at time at −15, −1, 0 (onset of cluster), every min for 8 min, at 10, 12, 14, 16, 30, and 60 min. Hormone levels were assayed and AUC was calculated.

Results

Milking was associated with an immediate and significant rise of oxytocin. When milking was combined with feeding, significantly higher levels of oxytocin were observed at 2 and 4 mins (p < 0.05). No effect of brushing on oxytocin levels was observed. Milking alone was associated with a significant rise of ACTH levels. Feeding in connection with milking reduced the immediate rise of ACTH levels (p < 0.05) and AUC (p < 0.02), whereas no effects of brushing were found. Milking caused a progressive rise of cortisol levels. Concomitant feeding did not influence cortisol levels, whereas brushing significantly decreased cortisol levels at 1, 5 and 14 mins after onset of milking (p < 0.05).

Conclusion

Feeding increases oxytocin release in response to milking and decreases ACTH levels. Abdominal brushing did not influence these variables, but decreased cortisol levels. These data demonstrate that activation of afferent vagal nerve fibres and of cutaneous sensory nerves originating from the abdominal skin in front of the udder influence milking related hormone release differently.

Oral Hygiene Status in Rheumatoid Arthritis Patients and Related Factors

Objectives

To evaluate oral hygiene status in Rheumatoid arthritis (RA) patients, to analyse possible related factors, and to investigate the role of the rheumatologist in information about importance of adequate oral hygiene status in RA patients.

Methods

A cross-sectional study that included 100 consecutive RA patients (89% female, mean age 46.7 ± 11.7 years). For each patient, we recorded oral symptoms, oral hygiene status and role of rheumatologist in information on the oral hygiene status. Factors associated with regular brushing (≥2/day) were also analysed.

Results

Median disease duration was 8 years (4;2). Dental pain was reported by 74% of patients and bleeding by 51% of them. Regular brushing was noted in 45% of patients. The use of a correct brushing method was noted in 14% of cases. Two patients reported visiting a dentist regularly. Information explaining that poor oral hygiene has a negative impact on RA was delivered by rheumatologist to 11 patients. Regular brushing of teeth was recommended by rheumatologist to 8 patients and 10 patients were advised by their rheumatologist to consult a dentist. Regular brushing was more important in women (48,3% vs 18,2%; p=0.05) and in the literate patients (57,6 vs 31,2%, p<0.01). No association was found between regular brushing, Disease Activity Score 28 (DAS28) and health Assessment Questionnaire (HAQ).

Conclusion

This study illustrates bad oral hygiene status in RA patients, which seems more important in men and illiterate patients. It also highlights poor information given by the rheumatologist.

Alterations to Titanium Surface Depending on the Fluorides and Abrasives in Toothpaste

Fluoride and abrasives in toothpastes may cause corrosion and deterioration of the titanium used for implants and other prostheses. The purpose of this study was to investigate how the presence or absence and types of fluoride and abrasives affected the titanium surface texture. Brushing with toothpastes was performed on pure-titanium discs using an abrasive testing machine. Unprocessed titanium discs without brushing were used as control samples. Surface roughness, color, and gloss of titanium were measured and the differences compared with the control were analyzed. Additionally, titanium surfaces and abrasives in toothpastes were observed using a scanning electron microscope to compare the surface texture of each sample. Some toothpastes (abrasive+) significantly increased the difference in surface roughness, color, and gloss, compared with ultrapure water. Toothpaste (fluoride+/abrasive+) that had many polygonal abrasive particles led to the largest color differences and exhibited notable scratches and a larger number of contaminant- or corrosion-like black spots. In contrast, brushing with toothpaste without fluoride or abrasives (fluoride-/abrasive-) caused little change to the titanium surface. These results suggest that both fluoride and abrasives in toothpaste used for brushing may be factors that affect surface texture and corrosion resistance of titanium.

Plant Response to Mechanically-Induced Stress: A Case Study on Specialized Metabolites of Leafy Vegetables

Plants have evolved various adaptive mechanisms to environmental stresses, such as sensory mechanisms to detect mechanical stimuli. This plant adaptation has been successfully used in the production practice of leafy vegetables, called mechanical conditioning, for many years, but there is still a lack of research on the effects of mechanically-induced stress on the content of specialized metabolites, or phytochemicals with significant antioxidant activity. Therefore, the aim of this study was to determine the content of specialized metabolites and antioxidant capacity of lettuce and green chicory under the influence of mechanical stimulation by brushing. Mechanically-induced stress had a positive effect on the content of major antioxidants in plant cells, specifically vitamin C, total phenols, and flavonoids. In contrast, no effect of mechanical stimulation was found on the content of pigments, total chlorophylls, and carotenoids. Based on the obtained results, it can be concluded that induced mechanical stress is a good practice in the cultivation of leafy vegetables, the application of which provides high quality plant material with high nutritional potential and significantly higher content of antioxidants and phytochemicals important for human health.

Abrasion Behaviour of Different Charcoal Toothpastes When Using Electric Toothbrushes

OBJECTIVES

The purpose of this in vitro study was to compare the abrasion behaviour of different charcoal toothpastes when brushing with electric toothbrushes on human enamel.

MATERIALS AND METHODS

A self-designed brushing machine was built using six commercially available electric toothbrushes in abrasion chambers. Each chamber was constantly supplied with a toothpaste-water mix. Pieces of human enamel, which were embedded in PMMA, were brushed for 4 h. Before and after brushing, profilometer measurements were performed in order to determine the substance loss due to brushing.

RESULTS

The following calculated mean removal values (mean ± SD) were found: (4.6 ± 0.6) µm (Group C: Splat Blackwood), (3.2 ± 0.9) µm (Group D: Curaprox Black is White), (2.3 ± 0.7) µm (Group B: Sensodyne Pro Schmelz), (1.7 ± 0.6) µm (Group A: Water), (1.4 ± 0.6) µm (Group E: Prokudent Black Brilliant). A post hoc Tukey HSD test (p = 0.05) showed that the results for Group A/B/E, Group B/D and Group C each lie within subsets that differ statistically significantly from the other subsets.

CONCLUSIONS

Within the limitations of this in vitro study, it can be stated that some charcoal toothpastes lead to significantly higher abrasion on human enamel, when brushing with electric brushes.

CLINICAL RELEVANCE

As low-abrasion toothpaste is generally advisable, and some charcoal toothpastes should be viewed critically with regard to their abrasive properties.

Impact of Brushing Protocols on Dentin Abrasion Caused by Different Abrasive Slurries

PURPOSE

To determine the impact of the brushing protocol on dentin wear by comparing continuous to intermittent brushing, with the same total time of brushing.

MATERIALS AND METHODS

Dentin specimens (n = 120) were evently distributed into six groups (A-F). The samples were brushed with slurries of different relative dentin abrasivity (RDA): Groups A+B (Sident 2480-1; RDA 85), groups C+D (Zeodent 113; RDA 67), and groups E+F (Zeodent 103; RDA 174). Groups A+C+E were brushed continuously (25 min) with one slurry preparation, while groups B+D+F were brushed intermittently (25 x 1 min) with a renewal of the slurry after each sequence. Dentin wear was determined using surface profilometry and statistically analysed with ANOVA and post-hoc tests.

RESULTS

Neither the mode of brushing (p = 0.72) nor the interaction (p = 0.18) of the brushing mode with the type of abrasive particles had a significant influence on the abrasive dentin wear. Only the type of abrasive particles had a statistically significant influence on abrasive dentin wear (p < 0.001).

CONCLUSION

The mode of brushing (continuously or intermittently) has no influence on abrasive dentin wear.

Weekly and Daily Tooth Brushing by Care Staff Reduces Gingivitis and Calculus in Racing Greyhounds

Simple Summary

Dental disease affects many dogs worldwide and is believed to be particularly problematic for racing greyhounds. It costs the industry and rehoming charities financially and likely causes unnecessary suffering to a large number of dogs. The risk factors for dental disease in this population are debated, and the best methods to overcome it are relatively unresearched. We carried out a trial in which 160 racing greyhounds were divided into three groups. The staff looking after them either brushed their teeth daily, weekly or never, for a period of two months. An experimenter measured the dog’s level of calculus (hardened dental plaque) and gingivitis (gum inflammation) at the start, and again after two months. We found that both weekly and daily brushing resulted in significant reductions in calculus, but for gingivitis only daily brushing resulted in a significant reduction. The effects, however, were not noticeable on the front incisor teeth. Since the staff implementing the routine reported a minimal time commitment and positive experiences, we suggest that daily brushing is recommended for racing greyhounds, and that emphasis is placed on brushing all teeth groups. Similar trials need to be conducted with retired greyhounds since these have been shown to present particularly high levels of periodontal disease.

Abstract

Periodontal disease is one of the most common conditions affecting dogs worldwide and is reported to be particularly prevalent in racing greyhounds. A range of potential risk factors have been hypothesised. Previous research has suggested that regular tooth brushing can reduce both calculus and gingivitis, but the frequency required is unclear. Here, we report a controlled blinded in situ trial, in which kennel staff brushed 160 racing greyhounds’ teeth (living at six kennel establishments), either weekly, daily or never over a two-month period. All of the visible teeth were scored for calculus and gingivitis, using previously validated scales. We calculated average scores for each of the three teeth groups and overall whole mouth scores, averaging the teeth groups. Changes were compared to the baseline. After two months, the total calculus scores (controlling for baseline) were significantly different in the three treatment groups, (F_(2,129) = 10.76, p < 0.001) with both weekly and daily brushing resulting in significant reductions. Gingivitis was also significantly different between groups (F_(2,128) = 4.57, p = 0.012), but in this case, only daily brushing resulted in a significant reduction. Although the dogs in different kennels varied significantly in their levels of both calculus (F_(5,129) = 8.64, p < 0.001) and gingivitis (F_(5,128) = 3.51 p = 0.005), the intervention was similarly effective in all of the establishments. The teeth groups varied, and the incisors were not significantly affected by the treatment. Since the trainers implementing the routine, reported a minimal time commitment and positive experiences, we suggest that daily brushing is recommended for racing greyhounds, and that any instructions or demonstrations should include attention to all teeth groups including the incisors. Similar trials need to be conducted with retired greyhounds since these have been shown to present particularly high levels of periodontal disease.

Abnormal cytology in oropharyngeal brushings and in oral rinses is not associated with HPV infection: The OHMAR study

BACKGROUND

No screening is available for human papillomavirus (HPV)-associated oropharyngeal cancers. The authors investigated whether cytology may be used as a screening tool and whether oral HPV infection is associated with cytologic abnormalities detected in oropharyngeal brushings and in oral rinse-and-gargle specimens from asymptomatic individuals at increased risk for oral HPV infection.

METHODS

Specimens were collected from men who have sex with men at 6-month intervals. Oropharyngeal samples and oral rinse-and-gargle specimens were collected using a cytobrush and mouthwash, respectively. Exfoliated cells were dispersed in PreservCyt. Liquid-based slides were stained with Papanicolaou. An HPV genotyping test using a linear array was used for HPV detection. Associations with abnormal cytology were investigated using logistic regression.

RESULTS

Overall, 631 brushings and 802 rinses collected from 310 individuals were evaluated; of these specimens, 2 brushings (0.3%) and 10 rinses (1.2%) were inadequate for morphologic evaluation. Of the adequate samples, 35 of 629 brushings (5.5%) and 19 of 792 rinses (2.4%) were abnormal. No associations of high-risk HPVs or HPV-16 infection with cytologic abnormalities were observed for oropharyngeal brushings (high-risk HPVs: odds ratio [OR], 1.19; 95% CI, 0.41-3.50; P = .75; HPV-16: OR, 0.76; 95% CI, 0.10-5.84; P = .79) or for oral rinses (high-risk HPVs: OR, 1.13; 95% CI, 0.26-4.98; P = .87; HPV-16: OR, 0.62; 95% CI, 0.04-10.60; P = .74). Concurrent moderate/heavy drinking and smoking significantly increased the risk of cytologic abnormalities in the brushings (hazard ratio, 4.84; 95% CI, 1.15-20.43; P = .03).

CONCLUSIONS

Oral HPV infection by high-risk HPVs and HPV-16 does not confer an increased risk of cytologic abnormalities in oropharyngeal brushings and oral rinses. Abnormal cytology seems to be associated with smoking and drinking habits.

Modified toothpaste application using prepared toothpaste delivering technique increases interproximal fluoride toothpaste delivery

OBJECTIVES

We devised a "prepared toothpaste delivering technique" (PTD technique), a modified the application of toothpaste method for using fluoride toothpaste more effectively. This study aimed to investigate the change in viscosity and fluoride intake into hydroxyapatite of a toothpaste, and deliverability of fluoride toothpaste to the interproximal site with the PTD technique using an interproximal model.

METHODS

Eight toothpaste samples were prepared at the following concentrations: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, ×4.00, and ×5.00. Viscosity of the toothpaste was measured by a Type-B viscometer. Dissolution rate of toothpaste and fluoride uptake into the hydroxy apatite pellet were analyzed by a fluoride selective electrode. Application paste volume and delivery rate was measured using interproximal model and image analysis software during using a finger brush front (FBF), finger brush back (FBB), and toothbrush.

RESULTS

As the dilution ratio increased, the viscosity of the toothpaste decreased sharply, F uptake decreased, and dissolution rate increased. F uptake was significantly reduced when the toothpaste was diluted more than 1.75 times. Therefore, in order to improve the effectiveness of the fluoride toothpaste, it is important to deliver the toothpaste to interproximal areas and pit clefts at low dilution. It was observed that PTD technique can be effectively implemented by the finger brush.

CONCLUSIONS

The use of a FBF surface in the analysis of an acrylic interproximal model could aid in applying pressure while blocking the space of the groove and preventing outflow of the toothpaste. It was considered that the PTD technique would improve the effects of the fluoride toothpaste, especially in the interproximal site.

Individual Variability of Pleasantness Ratings to Stroking Touch Over Different Velocities

Many studies have investigated the perception of tactile pleasantness over a range of stroking velocities. On average, pleasantness is low at slow (e.g. 0.3 cm/s) and fast (e.g. 30 cm/s) stroking velocities, but is rated highest at velocities between 1 and 10 cm/s. On a group level, this results in an inverted-U shape pleasantness ratings curve, which is described statistically by a negative quadratic equation. We reanalyzed the data from five earlier studies to investigate whether the inverted-U shape pleasantness curve at the group level is also present at the level of the individual, - a precondition for using tactile pleasantness perception as a diagnostic marker. We pooled the data from five studies with a total of 127 participants. Each study included a 'standard condition' of stroking on the dorsal forearm over different velocities (0.3, 1, 3, 10, 30 cm/s) and participants rated the pleasantness. Factors other than stroking velocity were also varied in these studies. On the whole-group level and in each study, pleasantness ratings produced a significant negative quadratic pleasantness curve over the stroking velocities. In individual participants, ratings varied greatly and only 42% of the participants showed a significant negative quadratic curve. The steepness of the inverted-U correlated only moderately across other experimental conditions, showing that the experimental circumstances can influence pleasantness ratings. Our findings have important implications for future work, where differences in the tactile pleasantness curve should not be used to predict or diagnose issues at an individual level.

Glass Fiber Reinforced Composite Orthodontic Retainer: In Vitro Effect of Tooth Brushing on the Surface Wear and Mechanical Properties

Fiber reinforced composites (FRCs) are metal free materials that have many applications in dentistry. In clinical orthodontics, they are used as retainers after active treatment in order to avoid relapse. However, although the modulus of the elasticity of FRCs is low, the rigidity of the material in the form of a relatively thick retainer with a surface cover of a flowable resin composite is known to have higher structural rigidity than stainless steel splints. The aim of the present study is to measure load and bending stress of stainless steel wires, as well as flowable resin composite covered and spot-bonded FRC retainer materials after tooth brushing. These materials were tested with a three point bending test for three different conditions: no brushing, 26 min of brushing, and 60 min of brushing. SEM images were taken before and after different times of tooth brushing. Results showed that stainless steel was not significantly affected by tooth brushing. On the other hand, a significant reduction of values at maximum load at fracture was reported for both FRC groups, and uncovered FRCs were most affected. Concerning maximum bending stress, no significant reduction by pretreatment conditions was reported for the materials tested. SEM images showed no evident wear for stainless steel. Flowable resin composite covered FRCs showed some signs of composite wear, whereas spot-bonded FRCs, i.e., without the surface cover of a flowable resin composite, showed signs of wear on the FRC and exposed glass fibers from the FRC’s polymer matrix. Because of the significant changes of the reduction of maximum load values and the wear for spot-bonded FRCs, this technique needs further in vitro and in vivo tests before it can be performed routinely in clinical practice.

The Tool Life and Coating-Substrate Adhesion of AlCrSiN-Coated Carbide Cutting Tools Prepared by LARC with Respect to the Edge Preparation and Surface Finishing

Nanocomposite AlCrSiN hard coatings were deposited on the cemented carbide substrates with a negative substrate bias voltage within the range of −80 to −120 V using the cathodic arc evaporation system. The effect of variation in the bias voltage on the coating-substrate adhesion and nanohardness was investigated. It was clear that if bias voltage increased, nanohardness increased in the range from −80 V to −120 V. The coating deposited at the bias voltage of −120 V had the highest nanohardness (37.7 ± 1.5 GPa). The samples were prepared by brushing and wet microblasting to finish a surface and prepare the required cutting edge radii for the tool life cutting tests and the coating adhesion observation. The indents after the static Mercedes indentation test were studied by scanning the electron microscope to evaluate the coating-substrate adhesion. The longer time of edge preparation with surface finishing led to a slight deterioration in the adhesion strength of the coating to the substrate. The tool wear of cemented carbide turning inserts was studied on the turning centre during the tool life cutting test. The tested workpiece material was austenitic stainless steel. The cemented carbide turning inserts with larger cutting edge radius were worn out faster during the machining. Meanwhile, the tool life increased when the cutting edge radius was smaller.

Effect of Long-Term Brushing on Deflection, Maximum Load, and Wear of Stainless Steel Wires and Conventional and Spot Bonded Fiber-Reinforced Composites

Fiber-reinforced composite (FRC) retainers are an aesthetic alternative to conventional Stainless Steel splints. They are generally used with a full bonded technique, but some studies demonstrated that they could be managed with a spot bonding technique to significantly decrease their rigidity. In order to propose this FRC spot bonding technique for clinical use, the aim of this study was to evaluate mechanical properties and surface wear of fibers left uncovered. Tests were made by simulating tooth brushing, comparing FRC spot bonding technique splints with stainless steel and FRC traditional technique splints. Specimens were tested both at 0.1 mm of deflection and at maximum load, showing higher values of rigidity for the FRC full bonded technique. After tooth brushing, no significant reduction in values at 0.1 mm deflection was reported, while we found a similar reduction in these values for the Stainless Steel and FRC spot bonding technique at maximum load, and no significant variation for the FRC full bonded technique. SEM images after tooth brushing showed wear for FRC fibers left uncovered, while no relevant wear signs in metal and conventional FRC fibers were noticed. Results showed that FRC spot bonding technique has advantages in mechanical properties when compared to the FRC traditional full bonding technique, also after tooth brushing. However, the surface wear after tooth brushing in the FRC spot bonding technique is considerable and other tests must be performed before promoting this technique for routine clinical use.

Measurements of Forces and Selected Surface Layer Properties of AW-7075 Aluminum Alloy Used in the Aviation Industry after Abrasive Machining

Measurements of forces during machining, especially thin-walled structures typical of the aviation industry, are important in the aspect of instability caused by vibration. One of the last stages of manufacturing by machining is the finishing treatment and deburring of the product’s edges. Brushes with ceramic fibres are often employed in deburring, especially for large-sized elements specific to the aviation industry due to the possibility of automatic machining directly on machining centres. This study set out to analyse the effect of variable brushing conditions on axial forces and the selected surface layer properties of AW-7075 aluminium alloy. Experimental studies have examined factors such as surface roughness and topography, axial cutting force in ceramic brush treatment and surface free energy in the aspect of adhesive joints. The tested variable process parameters were the fibre material and the adjustment sleeve spring stiffness. Based on the tests, it was found that the axial force applied by the brush was more strongly connected with the spring stiffness rather than the type of bristle. For most cases, an increase in the value of free surface energy after brushing was observed compared to the initial machining which was milling.

Bile duct involvement by hepatocellular carcinoma: A rare occurrence and poor prognostic indicator in bile duct brushing samples

BACKGROUND

Hepatocellular carcinoma (HCC) rarely involves the biliary tree and may be inadvertently sampled on bile duct brushings (BDBs).

METHODS

The pathology archives of 5 institutions were searched for BDBs with HCC involvement.

RESULTS

A total of 17 BDBs from 14 patients were obtained. There was a male:female ratio of 6:1; the median age of the patients was 59.5 years (range, 22-80 years). The median hepatic tumor size was 6.2 cm (range, 2.2-13.0 cm). HCC risk factors included viral hepatitis (5 patients), cirrhosis (5 patients), hemochromatosis (1 patient), and alcoholic steatohepatitis (1 patient). Jaundice with elevated bilirubin, liver enzymes, and α-fetoprotein was common. Endoscopic retrograde cholangiopancreatography demonstrated bile duct dilatation, polypoid intraductal masses (5 samples), clots/debris (2 samples), or strictures (4 samples). All BDBs had single and clustered large cells with naked atypical nuclei, granular cytoplasm, high nuclear/cytoplasmic ratios, and nuclei with prominent macronucleoli. Less common findings included clear/microvesicular cytoplasm (35%), papillae (29%), and anisonucleosis (35%). Classic HCC features (widened trabeculae [35%], endothelial wrapping [24%], multinucleation [24%], and cytoplasmic bile pigment [35%]) were uncommon. A total of 11 BDBs were diagnosed as malignant (10 with HCC and 1 with cholangiocarcinoma), 2 were diagnosed as atypical, and 1 BDB was diagnosed as negative; approximately two-thirds were found to have polysomy on fluorescence in situ hybridization. Approximately 71% of patients died of disease at a median of 3.5 months.

CONCLUSIONS

HCC may extend into the intrahepatic and/or extrahepatic biliary tree, causing masses and/or strictures that may be sampled on BDB. Although cytologically malignant, the classic features of HCC are uncommon, which can cause misdiagnosis. Cytopathologists should be mindful of this differential when evaluating BDBs, particularly when concomitant liver masses and/or HCC risk factors are present. Because of the associated high mortality and rapid rate of death, its presence should be conveyed clearly in pathology reports.

Inhibition Effects of Different Toothpastes on Demineralisation of Incipient Enamel Lesions

PURPOSE

To evaluate the inhibitory effects of different toothpastes on demineralisation of incipient enamel lesions using a toothbrush simulator.

MATERIALS AND METHODS

Fifty enamel specimens were prepared from extracted human molars. The specimens were randomly assigned to the following groups (n = 10/group): 1. no treatment (control); 2. toothpaste containing arginine (ProRelief, Colgate;); 3. fluoride toothpaste (Pronamel, Sensodyne GlaxoSmithKlein); 4. tooth mousse containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (Recaldent, GC); 5. toothpaste (Restore, Dr. Collins) containing bioactive glass (NovaMin, GlaxoSmithKlein). All specimens were exposed to pH cycling. The remineralising agents were applied to the samples with a toothbrush simulator for 2 min twice a day for five days. The weight percentage of mineral changes for the elements calcium (Ca), phosphorus (P), sodium (Na) and silica (Si) were measured by SEM energy-dispersive x-ray spectroscopy (SEM-EDX). SEM revealed properties of treated enamel surfaces. The data were analysed using one-way ANOVA.

RESULTS

Statistically significantly higher levels of Ca and P were found in all groups compared to the control (p < 0.05).

CONCLUSIONS

The toothpastes' efficacy of inhibiting demineralisation depended on the active ingredients in the respective toothpaste. The demineralisation inhibition efficacy of the tested toothpastes depended on the active ingredients in the toothpaste.

Neutron Radiography Study of Laboratory Ageing and Treatment Applications with Stone Consolidants

A nano-silica consolidant and nano-titania modified tetraethyl-orthosilicate were applied on two building stones, a carbonate and a silicate, by brush, poultice or capillary absorption. Neutron radiography was used to monitor capillary water absorption, and to analyse changes in physical properties caused by heat treatment of specimens for the purposes of artificially ageing and different treatment applications with stone consolidants. Moreover, ultrasonic pulse velocity and gravimetrically determined water absorption were analysed to cross-validate neutron radiography. The results reveal that reactive systems like tetraethyl-orthosilicates need an unknown period for polymerisation, which makes nano-silica consolidants more favourable for construction follow-up work. While polymerisation is incomplete, hydrophobic behaviour, water trapping and pore clogging are evident. Within the tetraethyl-orthosilicate treatment, poultice and brushing are strongly influenced by the applicant, which results in wide ranging amounts of water absorbed and anomalous water distributions and kinetics. The carbonate lithotype displays polymerisation initiated in the core of the specimen, while the lateral surfaces are still mostly hydrophobic. Reaction time differences can be attributed to the different amounts of consolidants applied, which is a result of the chosen application settings. Artificial ageing of stone specimens is a prerequisite when mechanical strength gain is studied, as demonstrated by sound speed propagation.

S1 Employs Feature-Dependent Differential Selectivity of Single Cells and Distributed Patterns of Populations to Encode Mechanosensations

The primary somatosensory (S1) cortex plays an important role in the perception and discrimination of touch and pain mechanosensations. Conventionally, neurons in the somatosensory system including S1 cortex have been classified into low/high threshold (HT; non-nociceptive/nociceptive) or wide dynamic range (WDR; convergent) neurons by their electrophysiological responses to innocuous brush-stroke and noxious forceps-pinch stimuli. Besides this “noxiousness” (innocuous/noxious) feature, each stimulus also includes other stimulus features: “texture” (brush hairs/forceps-steel arm), “dynamics” (dynamic stroke/static press) and “intensity” (weak/strong). However, it remains unknown how S1 neurons inclusively process such diverse features of brushing and pinch at the single-cell and population levels. Using in vivo two-photon Ca²⁺ imaging in the layer 2/3 neurons of the mouse S1 cortex, we identified clearly separated response patterns of the S1 neural population with distinct tuning properties of individual cells to texture, dynamics and noxiousness features of cutaneous mechanical stimuli. Among cells other than broadly tuned neurons, the majority of the cells showed a highly selective response to the difference in texture, but low selectivity to the difference in dynamics or noxiousness. Between the two low selectivity features, the difference in dynamics was slightly more specific, yet both could be decoded using the response patterns of neural populations. In addition, more neurons are recruited and stronger Ca²⁺ responses are evoked as the intensity of forceps-pinch is gradually increased. Our results suggest that S1 neurons encode various features of mechanosensations with feature-dependent differential selectivity of single cells and distributed response patterns of populations. Moreover, we raise a caution about describing neurons by a single stimulus feature ignoring other aspects of the sensory stimuli.

Non-carious cervical lesions and risk factors: A case-control study

OBJECTIVES

To evaluate whether the presence of non-carious cervical lesions (NCCLs) was related to the considered risk factors and to show the corresponding odds ratio in a predictive model.

METHODS

The sample was 280 dentistry students. In an initial clinical examination, 140 cases were selected that presented one or more teeth with non-carious cervical wear. For each case, a similar sex and age control without any tooth with non-carious cervical lesions was selected. An occlusal examination and periodontal probing were performed in all cases and controls by skilled dentists. All the subjects answered a questionnaire referring to factors of brushing, bruxism, preferred chewing side, consumption of extrinsic acids and the presence of intrinsic acids. Data were analysed by means of univariate and multivariate logistic regression.

RESULTS

Of all the study variables, only the protrusion interferences, interferences on the non-working side, the brushing force, CPITN value and the consumption of salads increase the risk of NCCLs in the univariate regression. The best predictive model was formed by the combination of CPITN variables >1, the consumption of acidic salads, self-reported bruxism, brushing force and attrition. However, it only correctly classifies 68.75% of subjects.

CONCLUSIONS

This study supports the multifactorial aetiology of NCCLs, the combination of several factors being necessary to explain their presence. The risk factors that make up the predictive model are not sufficient to explain the appearance of NCCLs. Dentists should take into account all these risk factors in prevention, diagnosis and treatment.

A Noninvasive Test for MicroRNA Expression in Oral Squamous Cell Carcinoma

MicroRNAs have recently been proposed as non-invasive biomarkers in Oral Squamous Cell Carcinoma (OSCC). The aim of this study was to analyze the expression of a panel of miRNAs in epithelial cells collected by oral brushing from OSCCs from regenerative areas after OSCC surgical resection and from their respective normal distant mucosa. Oral brushing specimens were collected from 24 healthy donors, 14 OSCC patients with specimens from tumour and normal distant mucosa, and from 13 patients who had OSCC resection, with samples from regenerative areas after OSCC resection and normal distant mucosa. Expression levels of eight targets (miR-21, miR-375, miR-345, miR-181b, miR-146a, miR-649, miR-518b, and miR-191) were evaluated by real-time Polymerase Chain Reaction (PCR). A highly significant between-group difference was found for miR-21 (F = 6.58, p < 0.001), miR-146a (F = 6.974, p < 0.001), and miR-191 (F = 17.07, p < 0.001). The major difference was observed between samples from healthy donors and from OSCC brushing, whereas no significant differences were observed between areas infiltrated by OSCC and their respective normal distant mucosa. Furthermore, altered expression of miR-146a and miR-191 was also observed in regenerative areas after OSCC resection.

CONCLUSIONS

Oral brushing could be proposed as a noninvasive method to study microRNA expression in oral mucosa in OSCC patients.

Changes to Glazed Dental Ceramic Shade, Roughness, and Microhardness after Bleaching and Simulated Brushing

PURPOSE

To evaluate shade stability, surface roughness, microhardness, and compressive strength of a glazed feldspathic ceramic subjected to bleaching and simulated brushing.

MATERIALS AND METHODS

Eighty-eight glazed feldspathic ceramic specimens were made from microparticulate leucite and divided into eight groups (n = 10). The whitening products used were: Opalescence Trèswhite Supreme (Ultradent), Opalescence®\ PF 15% (Ultradent), and Oral-B 3D White Whitestrips. All substances for whitening were used for 4 hours/day for a period of 14 days; the control group was not bleached. Next, half of the specimens were individually brushed. Microhardness and surface roughness data were subjected to three-way ANOVA and Tukey test. The diametrical tensile strength data were subjected to two-way ANOVA. The shade change data were analyzed using Kruskal-Wallis, Mann-Whitney, and the Student-Newman-Keuls test. The significance level was set at 5%.

RESULTS

Glazed feldspathic ceramic surface microhardness was significantly affected by bleaching agents (p = 0.007). Initially, glazed ceramic microhardness was significantly higher than that observed after contact with the bleaching agents, whether or not brushing was performed. The specimens submitted to bleaching in preloaded trays presented lower surface roughness values after brushing (p = 0.037). The surface roughness was significantly lower in the brushed specimens (p = 0.044). The diametrical tensile strength was not significantly affected by the application of bleaching agents (p = 0.563) or by brushing (p = 0.477). When the specimens were brushed, however, shade change was significantly influenced by the bleaching agent used (p = 0.041).

CONCLUSIONS

Bleaching agents associated with brushing cycles can alter surface properties and shade stability of glazed feldspathic ceramics, though such findings may not reflect the performance of unglazed feldspathic ceramics.

Comparing sensibility for touch, cold, and warmth in different skin areas

The primary objective of this pilot study was to assess if the magnitude estimation of suprathreshold brushing, warmth (40 °C), and cold (25 °C) stimuli of the skin over the dorsum of the hand and the dorsum of the foot are comparable to the perceived intensity for the same stimuli applied to the skin over any of the following areas: forehead, m. trapezius, m. deltoideus, thoracic back, and lumbar back, respectively. Thirty-two subjects aged 18-64 years were included. Participants were examined by two physicians on two different occasions, 1-58 days apart. Participants rated the magnitude of the perceived sensation of each stimulus on an 11-point numerical rating scale (NRS) 0-10, where 0 was anchored to "no sensation at all for touch/cold/warmth" and 10 anchored to "the most intense imaginable non-painful sensation of touch/cold/warmth". The criterion for sensory equivalence for one modality was arbitrarily considered satisfactory if two regions had the same numerical rating ±1 point in at least 85% of the individuals. Based on the pre-study criteria for sensory equivalence applied in this study only one area was found to be equivalent to the foot skin for the percept of brushing, that is, the skin over the deltoid muscle and one area for the hand, that is, the skin over the forehead. We failed to find any area with equivalent sensitivity to the hand or the foot for the cold or warm stimuli.

The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study

BACKGROUND

Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated.

METHODS

A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared.

RESULTS

Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found.

CONCLUSIONS

Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.

Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013

Objectives: We conducted a large household survey in 2013 to determine the current status of oral health practices and use of oral health services in the Kingdom of Saudi Arabia (KSA). Methods: The Saudi Health Information Survey is a national multistage survey of individuals ≥ 15 years of age. We used a backward elimination multivariate logistic regression model to measure the association between having been to a dental clinic during the last year, and sex, age, marital status, education, time since last routine medical examination, history of diagnosis with a cardiovascular chronic condition, brushing or flossing teeth and use of Miswak (a chewing stick). Results: Between April and June 2013, 10,735 participants completed the survey (89.4% of the households contacted). An estimated 1.5 million (11.5%) and 6.3 million (48.6%) Saudi Arabian people, ≥ 15 years of age, had visited a dental clinic for a routine check-up and for a complaint during the last year, respectively. In total, 16.3%, 85.0% and 52% of Saudi Arabian people never brush their teeth, never floss their teeth or never use Miswak, respectively. The probability of visiting a dental clinic increased with education, among individuals who brushed or flossed their teeth and who used Miswak. Conclusions: Oral hygiene practices are not common among Saudi Arabian people, and use of health care for prevention of oral disease is limited. Hence, the need for oral health promotion is pressing. The KSA Ministry of Health should develop and implement programmes, through its primary health clinics, to increase the awareness of the importance of good oral health.

Overexpression of CD55 from Barrett's esophagus is associated with esophageal adenocarcinoma risk

BACKGROUND AND AIM

Although several molecular biomarkers for esophageal adenocarcinoma (EAC) have been shown to be useful disease indicators, none has been established as a reliable indicator for risk of EAC or have progressed to routine use. The aim was to identify biomarkers of high risk for EAC in patients with Barrett's esophagus (BE).

METHODS

Following endoscopic observation by magnified endoscopy with narrow band imaging (ME-NBI), brushing was followed by obtaining biopsy samples from columnar-lined esophagus (CLE) and from EAC lesions of EAC patients, and from age- and sex-matched non-EAC controls with BE. Total RNA was extracted for microarray analysis using Affymetrix GeneChip Human Genome U133 plus 2.0 Array. Real-time-PCR analysis of identified candidate genes was used to confirm the results.

RESULTS

Overall, 9 EAC patients and 50 patients with BE were studied. Seventy-nine candidate genes were identified by microarray analysis based on a proportional hazards model (P < 0.005). Six genes exhibited significantly differential expressions in both BE and cancer lesions of the EAC group compared to BE of the controls. In the brushing samples, median CD55 relative expression levels in cancer lesions were highest and decreased in BE of EAC group and BE of the controls, in that order (P < 0.001).

CONCLUSION

Over expression of CD55 in brushing samples taken from BE may be associated with the risk of EAC.

Monocentric study of bile aspiration associated with biliary brushing performed during endoscopic retrograde cholangiopancreatography in 239 patients with symptomatic biliary stricture

BACKGROUND

The cytologic diagnosis obtained by brushing or biopsy in malignant biliary strictures is considered to be highly specific but poorly sensitive. The diagnostic association of biliary brushing and bile exfoliate cytology has been suggested but is rarely performed in clinical practice. The objective of this study was to assess the diagnostic performance of bile aspiration associated with biliary brushing during therapeutic endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

From 2004 to 2009, 239 consecutive patients who underwent ERCP were included in the study. The biliary strictures were considered clinically benign in 26% of patients, uncertain in 25%, and malignant in 49%. The 298 cytologic samples collected were divided in 3 groups: bile aspiration alone (26%), biliary brushing alone (20%), and bile aspiration combined with brushing (54%). The definitive diagnosis of malignancy was obtained by biopsy, surgery, and fine-needle aspiration or was determined by an unfavorable disease course.

RESULTS

The cytologic diagnoses were as follows: 149 samples were benign (50%), 114 were malignant (38%), 34 had atypia (12%), and 1 had no diagnostic value. The procedure output values were as follows: for bile aspiration alone, sensitivity was 56.4%, specificity was 93.9%, the positive predictive value (PPV) was 91.7%, and the negative predictive value (NPV) was 64.6%; for brushing alone, sensitivity was 62.5%, both specificity and the PPV were 100%, and the NPV was 73%; and, for bile aspiration and brushing combined, sensitivity was 81%, both specificity and the PPV were 100%, and the NPV was 75%.

CONCLUSIONS

For patients who have symptomatic biliary stricture, bile aspiration during ERCP is a simple and safe procedure. Bile aspiration combined with brushing significantly increases the yield of cytology for malignant biliary tumors (sensitivity, 81%), particularly in cholangiocarcinomas. Cancer Cytopathol 2016;124:330-9. © 2015 American Cancer Society.

Diagnostic yield of non-guided flexible bronchoscopy for peripheral pulmonary neoplasia

Background

The role of conventional bronchoscopy for peripheral pulmonary neoplasia remains controversial. We aimed to assess the diagnostic yield and the added value of non-guided bronchial aspiration, bronchoalveolar lavage (BAL), and brushing for the diagnosis of pulmonary neoplasia not visible endoscopically.

Methods

We retrospectively assessed 207 consecutive patients with a final diagnosis of peripheral lung malignancy who underwent bronchoscopy with non-guided aspiration, brushing, and BAL as their initial evaluation. The influence of clinical and radiological factors on diagnostic yield was assessed using univariate logistic regression analyses.

Results

The overall sensitivity of non-guided bronchoscopy was 25.6%, whereas sensitivities for bronchial aspiration, BAL, and brushing were 14.2%, 11.6%, and 16.5%, respectively. Younger age, larger lesion, central/intermediate distance from the hilum, presence of a bronchus sign, and higher standardized uptake value (SUV) on positron emission tomography scan were predictors of a higher diagnostic yield. Conversely, forced expiratory volume in one second, fellow implication in the procedure, and tumor histology did not influence sensitivity. The overall sensitivity of bronshoscopy was >40% for tumors >4 cm, located in the central/intermediate thirds of the lung, showing a bronchus sign, with an SUV >12 or occurring in patients <50 years of age. Conversely, the sensitivity was <10% for tumors <2 cm, located peripherally or with an SUV <4.

Conclusion

Neoplasia characteristics may help targeting situations in which conventional bronchoscopy could be used as the initial diagnostic procedure when advanced techniques are unavailable. However, advanced diagnostic tools should probably be proposed as the initial modality for the diagnosis of peripheral malignant lesions when available.

Comparison of three different brushing techniques to isolate and culture primary nasal epithelial cells from human subjects

PURPOSE

Primary nasal epithelial cells are used for diagnostic purposes in clinical routine and have been shown to be good surrogate models for bronchial epithelial cells in studies of airway inflammation and remodeling. We aimed at comparing different instruments allowing isolation of nasal epithelial cells.

METHODS

Primary airway epithelial cell cultures were established using cells acquired from the inferior surface of the middle turbinate of both nostrils. Three different instruments to isolate nasal cells were used: homemade cytology brush, nasal swab, and curette. Cell count, viability, time until a confluent cell layer was reached, and success rate in establishing cell cultures were evaluated. A standard numeric pain intensity scale was used to assess the acceptability of each instrument.

RESULTS

Sixty healthy adults (median with interquartile range [IQR] age of 31 [26-37] years) participated in the study. Higher number of cells (×10(5) cells/ml) was obtained using brushes (9.8 [5.9-33.5]) compared to swabs (2.4 [1.5-3.9], p < 0.0001) and curettes (5.5 [4.4-6.9], p < 0.01). Cell viability was similar between groups. Cells obtained by brushes had the fastest growth rate, and the success rate in establishing primary cell cultures was highest with brushes (90% vs. 65% for swabs and 70% for curettes). Pain was highest with curettes (VAS score 4.0 [3.0-5.0] out of 10). The epithelial phenotype of the cultures was confirmed through cytokeratin and E-cadherin staining.

CONCLUSIONS

All three types of instruments allow collection and growth of human nasal epithelial cells with good acceptability to study participants. The most efficient instrument is the nasal brush.

Is human immunodeficiency virus (HIV) stage an independent risk factor for altering the periodontal status of HIV-positive patients? A South African study

BACKGROUND

The immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices).

METHODS

One hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients' medical records and patients' HIV stage determined and grouped according to their CD4+ T cell counts into A (<200 cells /mm3), B (200-500 cells /mm3) and C (>500 cells /mm3).

RESULTS

The mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170).

CONCLUSION

The findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.

Identification of factors predictive of malignancy in patients with atypical biliary brushing results obtained via ERCP

Biliary brushings obtained during ERCP can have one of three cellular interpretations: benign, malignant, or "atypical." Atypical interpretations usually result in further testing, and may cause controversy over management and increases in cost. We evaluated a large cohort of patients with atypical biliary brushings for analysis and risk stratification. All biliary brushing specimens collected between January 1, 2001 and December 31, 2010 that had an atypical result were included. Hospital electronic records were reviewed for these patients to include: demographics, indication for ERCP, endoscopist/pathologist impressions, serologic testing, stricture site, and information relating to the final clinical diagnosis. Eighty-six patients were included. Totally, 60/86 patients (70%) had malignancies while 26/86 (30%) had no evidence of malignancy during long term follow up. Univariate analysis showed that the risk of malignant outcomes was significantly associated with older age, suspicious/malignant endoscopic impression, pancreatic mass, indications including jaundice and/or dilated bile ducts, stricture location within the common bile duct, PSC, and CA 19-9 levels >300 U/mL. We created a novel scoring system for prediction of malignancy based on clinical and endoscopic factors. We identified parameters that are typically available to the clinician to categorize patients with an "atypical" bile duct brushing results into "high risk" and "lower risk" classifications. Our proposed scoring system would allow such risk stratification to take place.

Matching visual saliency to confidence in plots of uncertain data

Conveying data uncertainty in visualizations is crucial for preventing viewers from drawing conclusions based on untrustworthy data points. This paper proposes a methodology for efficiently generating density plots of uncertain multivariate data sets that draws viewers to preattentively identify values of high certainty while not calling attention to uncertain values. We demonstrate how to augment scatter plots and parallel coordinates plots to incorporate statistically modeled uncertainty and show how to integrate them with existing multivariate analysis techniques, including outlier detection and interactive brushing. Computing high quality density plots can be expensive for large data sets, so we also describe a probabilistic plotting technique that summarizes the data without requiring explicit density plot computation. These techniques have been useful for identifying brain tumors in multivariate magnetic resonance spectroscopy data and we describe how to extend them to visualize ensemble data sets.