bluuebunny/crossref_metadata_2025 huggingface dataset:
In‐dental‐office screening for diabetes mellitus using gingival crevicular blood
Authors: Beikler T. , Kuczek A. , Petersilka G. , Flemmig T. F.
Published: March 2003

Background: Diabetes mellitus (DM) is undiagnosed in approximately 1/2 of the patients actually suffering from the disease. In addition, the prevalence of DM is more than 2× as high in patients with periodontitis when compared to periodontally healthy subjects. Thus, a high number of patients with periodontitis may have undiagnosed DM.

Aim: The purpose of this pilot study was to evaluate, whether blood oozing from gingival tissues during routine periodontal examination can be used for determining glucose levels. 32 non‐diabetic and 13 diabetic patients with moderate to severe periodontitis were enrolled and subjected to routine clinical periodontal examination. Periodontal pocket probing was performed using a standard force. Blood oozing from gingival tissues of anterior teeth following periodontal pocket probing was collected with the stick of a glucose self‐monitoring device (Elite® 2000, Bayer Diagnostics GmbH, Munich). As control, fingerstick capillary blood was taken. Statistical analysis was performed by Pearson's correlation coefficient.

Results: The patient blood glucose levels ranged from 3.57 mmol/l to 18.01 mmol/l and the values of blood samples taken from gingiva or finger tip showed a very high intrapatient correlation (r=0.98; p<0.0001).

Conclusion: The results suggested that blood oozing during routine periodontal examination may be used for diabetes mellitus screening in a dental office setting.
Oral health and cardiovascular disease in Sweden
Authors: Buhlin K. , Gustafsson A. , Håkansson J. , Klinge B.
Published: March 2003

Objective: The purpose of the present study was to assess the relation between dental health and cardiovascular disease in an adult Swedish population.

Material and method: A questionnaire was sent to 4811 randomly selected Swedes. It contained 52 questions about dental care habits, oral health, cardiovascular disease and their socio‐economic situation. Odd ratios for all cardiovascular diseases (CVD) and the subgroup myocardial infarction, stroke and high blood pressure were calculated with a logistic regression model adjusted for age, gender, smoking, income, civil status and education. These ratios were calculated for subjects 41 years since few people suffer from CVD before this.

Results: The national questionnaire was answered by 2839 (59%) people between 20–84 years of age and, of them, 1577 were 41 years of age or more. We found a significant association between self‐reported bleeding gums (odds ratio 1.60, p=0.0017), presence of dentures (odds ratio 1.57, p=0.0076) and known CVD, which has also been reported in international studies. However, no association between loose teeth, deep pockets and known CVD was detected.

Conclusion: The results indicate that oral health and, especially gingival inflammation is associated with CVD.
The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site
Authors: Del Pizzo Massimo , Modica Fabio , Bethaz Nicola , Priotto Patrik , Romagnoli Roberto
Published: March 2003

Objectives: The aim of this study is to evaluate early healing results of the palatal wound by comparing three different surgical procedures for harvesting a connective tissue graft: the single‐incision (SI), the free gingival graft (FGG) and the trap‐door (TD) techniques.

Material and methods:  36 patients requiring a root coverage procedure were selected for treatment using a bilaminar technique and randomly assigned (12 per group) to the FGG, TD or SI groups. The size of the graft was standardised to 12 × 8 mm and the thickness ranged from 1 to 1.5 mm. The following parameters were recorded at 1, 2, 3, 4, 6 and 8 weeks postsurgery: immediate and delayed bleeding (iB, dB), sensibility (S), complete epithelialisation (CE), discomfort (D), and variation of feeding habits (FH).

Results: The difference in CE between the SI and FGG groups was statistically significant at the third postoperative week (100% and 50%, respectively). The discomfort rate at the first week postsurgery was the same in the SI and TD groups (50% without discomfort), but results were statistically significant different in the FGG group (0% without discomfort). No significant differences were found between the three groups for the other parameters.

Conclusions: Statistically significant differences were found between the SI and FGG techniques in terms of CE, which occurred faster in the SI group. The discomfort rate recorded for both SI and TD groups was significantly lower than for FGG group. No marked differences were noted between SI and TD procedures. The latter was confirmed by patient interviews. The results of this preliminary study have little statistical significance because of the limited number of patients but they represent an important basis for a comparative clinical study, with a larger sample of participants, which is currently in progress.
Correlation and examiner agreement between a new method of plaque scoring and a popular established plaque index, modelled in vitro
Authors: Dababneh Reem H. , Khouri Antwan T. , Smith Roger G. , Addy Martin
Published: March 2003

Background, aims: Scoring of supragingival plaque is common to epidemiological studies, oral hygiene assessments and clinical trials of oral hygiene products. These clinical practices utilize indices such as the Turesky et al. (1970, Journal of Periodontology41, pp. 41–43) modification [Turesky Plaque Index (TPI)] of the Quigley & Hein (1962, Journal of the American Dental Association65, pp. 26–29) plaque index for evaluating plaque extension. Whilst this index is in common use by clinicians, there is potential for ambiguity in the interpretation of scores by different examiners. The aims of this study were to compare examiner agreement between a new method of plaque scoring (NMPS) and TPI, and to determine if there was a correlation between the two indices.

Methods: Simulated plaque was scored from eight study casts, each consisting of 14 teeth. The two indices were both scored twice from the study casts by eight examiners experienced in plaque scoring. The first readings obtained were analysed for a correlation between the indices and between‐examiner variability. Within‐examiner variability was assessed using both first and second readings of each index.

Results: A positive correlation was found between the two indices (r = 0.717). The NMPS was found to have better inter‐ and intra‐examiner agreement than TPI.

Conclusion: The NMPS was found to have less variability within and between examiners than TPI: evaluation of NMPS in a clinical setting would now appear warranted.
Oral health changes in an adult Norwegian population: a cohort analytical approach
Authors: Holst Dorthe , Schuller Annemarie A.
Published: March 2003

Abstract – Objectives: The purpose of this analysis was to study temporal variation in oral health in an adult population. The cohort analysis comprised 1) estimation of longitudinal, cross‐sectional, and time‐lag differences in caries and treatment experience of the adult population in Trøndelag from 1973 to 1983 and to 1994; 2) assessment of which of the effects of age, period and cohort was the most plausible explanation for the observed differences and 3) discussion of causal and other factors underlying the effects of age, period and cohort. Methods: Cohort analysis was used to study changes in oral health over time. Study participants were selected by random sampling in 1973, 1983, and 1994 (n=1959, n=3195, n=2341 respectively). The methods of data collection comprised standardised clinical measurements and a self‐administered questionnaire. Cohort tables were established to analyse changes in DFT from 1973 to 1983 and DFT and DFS from 1983 to 1994. Results: Four patterns of changes in oral health were identified from adolescence to older adulthood. They point in different directions which indicate that complex processes are present. There were two and three significant changes in the subsets of analysis. Assumptions and conditions that allow identification of separate cohort, period, and age effects appeared not to be present. The pattern of changes was consistent with main effects of both age, period, and cohort. The effects were discussed from the perspective of the chosen frame of explanatory factors. Conclusions: The changes in oral health between populations in 1973, 1983 and 1994 were the combined consequences of simultaneously occurring factors that account for both age, period and cohort effects.
Reasons for the caries decline in Slovenia
Authors: Vrbic˘ Vito
Published: March 2003

Abstract – In 1987, 1993 and 1998, nationwide surveys on the prevalence of dental caries were carried out in Slovenia. Sampling and examinations were performed according to WHO standards. The age groups 6, 12, 15, 18, 35–44 and 65 years or older were studied. In each age group, 200 persons or more were examined on each occasion. The results showed that the proportion of caries‐free children and adolescents increased considerably over the 12‐year period between the first and the last survey (from 6% to 40% for 12‐year‐olds). In the same period, the mean DMFT values decreased as follows: from 5.1 to 1.8 for 12‐year‐olds, from 10.2 to 4.3 for 15‐year‐olds, from 12.9 to 7.0 for 18‐years‐olds, from 20.5 to 14.7 for 35–44‐year‐olds, and from 27.0 to 22.5 for subjects aged 65 years or more. The notable improvement of dental health can be explained by the preventive programmes in operation in various periods. The most recent decline was most likely due to supervised brushing (with concentrated fluoride gel) taking place some 16–18 times a year in primary schools attended by children aged 7–15 years, improved oral hygiene, and a comprehensive programme of applying fissure sealants, particularly on first molars.
Evidence for dental caries decline among children in an East European country (Hungary)
Authors: Szöke Judit , Petersen Poul Erik
Published: March 2003

Abstract – In Central and Eastern Europe oral health systems are in transition due to the economic and political changes. The aim of the present study was to highlight the long‐term trend in dental caries prevalence of Hungarian children. A WHO National Pathfinder Survey of oral health status was conducted in 1996 which included 6‐year‐olds (n=900) and 12‐year‐olds (n=900). Similar surveys were performed in 1985 (age 6–7, n=895; age 12, n=893) and in 1991 (age 5–6, n=898; age 12, n=898) and the surveys were based on the same sites and examination criteria. Clinical data were collected by trained dental examiners according to the WHO Basic Methods. In 1996, 73% of 5–6‐year‐olds and 84.5% of 12‐year‐olds were affected by dental caries. At age 5–6 the mean dmft was 4.5 and at age 12 the DMFT was 3.8. In both groups, the d/D‐components were high (5–6 years: dt/dmft=89%; 12 years: DT/DMFT=45%). For children aged 5–6, the mean caries experience increased from 1991 (3.7 dmft) to 1996 (4.5 dmft) (P<0.01) whereas DMFT of 12‐year‐olds declined from 5.0 in 1985 and 4.3 in 1991 (P<0.01). The differences in caries experience by urbanization level were reduced over time. In 1996, 72% of 12‐year‐olds had gingival bleeding (CPI scores 1+2), and 23% had moderate/severe malocclusion. In conclusion, in order to meet the need for dental care in schoolchildren in Hungary health authorities are encouraged to revitalize the school dental services. Implementation of community‐based health promotion is needed to control oral disease in Hungarian children.
Risk indicators associated with tooth loss in Jordanian adults
Authors: Al‐Hadi Hamasha Abed , Sasa Issa , Al Qudah Mansour
Published: March 2003

Abstract – Objectives: The purpose of this study was to evaluate the risk indicators of tooth loss in Jordanian adults. Methods: A sample of 509 Jordanian adults was randomly selected. The subjects were interviewed regarding demographics, social economic status, smoking habits, and oral hygiene practices and then clinically examined by a single examiner. Multiple regression analysis was performed to estimate the simultaneous impact of risk indicators on tooth loss. Results: The subjects’ mean age was 42.6 years with an average of 20.9 teeth remaining per person. The overall educational level of the subjects was low. More than 40% reported not brushing their teeth regularly and 56% had had no professional teeth cleaning during the last year. Monthly family income averaged JOD 231, and about a third of the subjects were smokers. The mean number of remaining teeth decreased significantly with age. Smokers, those who brushed irregularly, and those who had not had professional teeth cleaning in the last year had significantly fewer remaining teeth. Men also had significantly fewer remaining teeth. Education and income were also significantly associated with the number of remaining teeth. Age, income, brushing, prophylaxis, and gender collectively explain 75.1% of the variance in the number of remaining teeth. Conclusion: Modification of non‐disease independent factors could reduce tooth loss and improve oral health in Jordanians.
Comparison of three salivary flow rate assessment methods in an elderly populationNote
Authors: Jones Jill Marie , Watkins Catherine Ann , Hand Jed Stephen , Warren John Joseph , Cowen Howard Jeffrey
Published: March 2003

Abstract – Measuring salivary flow rates among the frail elderly is a challenge. The currently used spit collection method requires levels of time and cooperation that often may exclude the frail elderly who are at high risk for salivary compromise. A measurement method that is not only valid and reliable, but also feasible and acceptable is needed for use in population studies of compromised adults. This study compared two salivary flow rate assessment methods using a suction machine against the currently accepted spit collection method in an elderly population aged 75 and older. Three methods of flow rate (g/min) assessment were compared at three time periods among 16 elders (mean age 86.6 years). Flow rates using the 2‐min open suction method compared well with the 10‐min spit method (r=0.778) but the 2‐min closed suction method did not (r=0.158). Reliability evaluation of the open suction method and the spit method was assessed using a test/retest with a 1‐week interval. Both methods demonstrated good comparable reliability (spit method r=0.566, P=0.01); open suction method, (r=0.861, P<0.01). Based on a short survey questionnaire about the three methods, 11 of the 16 elderly subjects preferred the use of the suction machine to the spit method. These results indicate that the 2‐min open suction method technique is a valid and reliable means of measuring salivary flow. The lower level of patient cooperation needed, the shorter time period required, and this preliminary report of its acceptability support the use of this method in future population studies of frail elders.
Development of a condition‐specific quality of life measure for patients with dentofacial deformity: I. Reliability of the instrument
Authors: Cunningham Susan J. , Garratt Andrew M. , Hunt Nigel P.
Published: March 2003

Abstract – The assessment of quality of life is becoming increasingly important in clinical research. Its importance in dentistry has been realised only relatively recently. Health‐related quality of life is concerned with the aspects of quality of life that relate specifically to an individual’s health. This may be measured using two groups of instruments: (i) generic measures, which provide a summary of health‐related quality of life and sometimes generate a single index measure of health or (ii) condition‐specific measures, which focus on a particular condition, disease, population or problem and are potentially more responsive to small, but clinically important, changes in health. Objectives: The aim of this study was to develop a condition‐specific quality of life measure for those patients with severe dentofacial deformity who were requesting orthognathic treatment and to assess the reliability of this instrument. Method: Instrument content was derived through a literature review and interviews with clinicians and patients. The resulting instrument was tested for internal consistency and test‐retest reliability. Results and conclusions: The instrument was found to divide into four clinically meaningful domains. Internal consistency and test‐retest reliability were good. Patient acceptance of the questionnaire was also encouraging.
Trends in caries and associated variables among young Israeli adults over 5 decades
Authors: Sgan‐Cohen Harold D. , Katz Joseph , Horev Tuvia , Dinte Arieh , Eldad Arieh
Published: March 2003

Abstract – This study was conducted among a representative sample of 7139 21‐year‐old Israeli adults, upon release from compulsory military service. Data were collected between 1994 and 1997. The average DMFT level found was 8.49±4.95. Untreated caries (according to the D component of DMFT) was 2.25±2.90 and significantly higher among males. Untreated caries was also significantly associated with geographic origin: higher among subjects of African or former USSR descent; and with family size: higher among subjects with four or more siblings; with education: caries was higher among subjects with less than 12 years of schooling; and with smoking: caries was more extensive among those who smoked (P<0.0001 for all the associations). Caries severity (DMFT) was found to be significantly associated with father’s country of origin and number of siblings (highest among subjects of Asian and African descent and those who had four or more siblings). This is the largest and most representative Israeli survey of young adults to date. Data were compared with available data from studies conducted in 1956, 1966, 1973, and 1985. DMFT scores had previously increased from the 1950s until the 1980s. Treatment levels had increased since the 1980s. The present data, together with results of studies conducted among Israeli children, indicate a recent national decrease in caries experience. This study indicates a further increase in caries treatment level, but a persisting inequity according to social variables.
Caries and its association with infant feeding and oral health‐related behaviours in 3–4‐year‐old Brazilian children
Authors: Dini Ercilia Leal , Holt Ruth D. , Bedi Raman
Published: March 2003

Abstract – Objectives: To investigate the relationships between socio‐demographic factors, infant feeding habits, oral hygiene and the prevalence and patterns of caries in Brazilian 3–4‐year‐olds. Methods: Systematic random sampling was used to select children enrolled in municipal nurseries in Araraquara, Brazil, in 1998. Clinical examinations were carried out by one examiner using dmft and dmfs indices and WHO criteria. Questionnaires for information related to the socio‐demographic background, oral hygiene and dietary history of the children were completed by their mothers. Results: Caries was seen in 46% of the children; 17% of them had the more extensive pattern involving molars and incisors. Social class, mother’s education, and age at which breast‐feeding terminated showed statistically significant associations with caries. Feeding bottles with added sugars were still being given to 80% of the children. When the significant variables were taken into account only age at which breast‐feeding terminated showed a significant relationship to the pattern of disease. Children who were never breast‐fed or were breast‐fed beyond the age of 24 months had a higher prevalence of the more extensive pattern of caries. Conclusions: The association between the length of time a mother breast‐feeds and extensive caries should be a consideration in any local infant feeding policies or health promotion strategies. The duration for appropriate breast‐ or bottle‐feeding should be emphasised.
Dental caries and sugar intake of children from rural areas with different water fluoride levels in Paraíba, Brazil
Authors: Sampaio Fábio Correia , Hossain Abu Nasir Mohammad Nazmul , Von Der Fehr Frithjof Ramm , Arneberg Pål
Published: March 2003

Abstract – Few reports have investigated caries prevalence in rural areas of Brazil. Objective: The aim of this study was to observe the caries prevalence (DMFT, DMFS) in 12‐year‐old children living in rural villages of Paraíba, Brazil with low and moderate fluoride levels in the drinking water and to relate it to sugar intake and oral hygiene. Methods: One hundred and ninety four children from 13 villages were grouped according to the water fluoride levels: low fluoride (LF, <0.2 ppm F, 96 children) and moderate fluoride (MF, 0.7–1.0 ppm F, 98 children). Caries and oral hygiene (OHI‐S) were scored according to WHO criteria. Sugar intake was assessed through interviews. A sub‐set of subjects (n=23) from the LF group was re‐examined 2 years later. Results: For the LF and MF groups the DMFT (mean, SD) observed was 3.9 (3.7) and 2.5 (2.1) respectively, the DMFS was 9.2 (10.6) and 5.4 (5.7). Both indexes (DMFT, DMFS) showed significant differences (P<0.01, Mann‐Whitney U‐test) according to the fluoride levels in the drinking water. The mean increment of caries in the sub‐set group of subjects was approximately 1.5 surfaces per subject/year. The reported sugar intake was low for both water fluoride groups (P> 0.05). In a regression analysis the water fluoride levels, the use of fluoridated toothpaste and oral hygiene index were related to DMFS (R2=0.08, P≤0.05). Conclusions: Caries prevalence was lower in MF than in LF rural areas of Paraíba. Caries and sugar intake seems to be lower in rural areas than in urban areas of Paraíba with similar fluoride levels in the drinking water.
Is negative affectivity associated with oral quality of life?
Authors: Kressin Nancy R. , Reisine Susan , Spiro Avron , Jones Judith A.
Published: March 2003

Abstract – Objectives: The personality trait of negative affectivity (NA) is associated with reports of worse physical health, more symptoms and worse health‐related quality of life but its associations with oral quality of life (OQOL) are unexplored. In this study we examined the association of NA with OQOL. Methods: We drew on data from two samples of older men: The VA Dental Longitudinal Study (DLS; n=177) and the Veterans Health Study (VHS; n=514), which included three measures of oral quality of life: the Oral Health‐Related Quality of Life Measure (OHQOL), the Oral Health Impact Profile (OHIP), and the Geriatric Oral Health Assessment Instrument (GOHAI). For each OQOL measure, and the GOHAI and OHIP subscales, two regression models were estimated to examine the marginal change in variance due to NA: the first model included age, number of teeth, and self‐rated oral health, and the second added NA. Results: In both bivariate and multivariate analyses, higher NA was consistently associated with worse scores on the OQOL measures. In the regression analyses, NA explained an additional .01 to 18% of the variance in OQOL, explaining the most variance in the OHIP and the least in the OHQOL. The addition of NA explained more variance in the more subjective, psychologically oriented GOHAI and OHIP subscales than it did in the more objective, physical function oriented subscales. Conclusions: Psychosocial factors such as personality are significantly associated with quality of life ratings. Such associations should be taken into account when OQOL measurements are used and interpreted.
Validity and limitations of self‐reported periodontal health
Authors: Buhlin Kåre , Gustafsson Anders , Andersson Kerstin , Håkansson Jan , Klinge Björn
Published: March 2003

Abstract –

Objectives: To study the agreement between self‐reported dental conditions and clinical findings in an adult population (20–84 years of age), and thus evaluate questionnaires as a tool in epidemiological studies of oral health, in general, and periodontal health, in particular.

Material and methods: A questionnaire was sent to 900 randomly selected subjects in the age groups 20–29, 50–59 and 75–84 years. Of these, 723 subjects (81.0%) answered the questionnaire and 20% of them underwent a clinical examination.

Results: As regards the remaining teeth, there was a mean difference of 1.4 teeth between the number indicated in the questionnaire and that found on the clinical examination. This difference was most marked in the older subjects. Eight of the nine subjects with removable dentures reported in their answers that they had removable dentures. Periodontal variables – we found significantly more subjects with pathological gingival pockets among those who stated that they had pockets than among those who answered that they did not (P = 0.01; chi‐square independent test). Gingival bleeding was common in those who answered ‘Yes’ than in those who answered ‘No’ to the question concerning bleeding gums. This difference was significant (P = 0.05; chi‐square independent test) in the three age groups. However, there was no correlation between the questionnaires and the clinical examination concerning tooth mobility.

Conclusion: Questionnaires concerning oral status are valid concerning the number of remaining teeth and use of removable dentures. They are less reliable about specific periodontal variables, but can still become a valuable tool for epidemiological studies of periodontal health.
Development of a condition‐specific quality of life measure for patients with dentofacial deformity: II. Validity and responsiveness testing
Authors: Cunningham Susan J. , Garratt Andrew M. , Hunt Nigel P.
Published: March 2003

The assessment of quality of life is becoming increasingly important in dentistry. This may be measured using two groups of instruments: generic and condition‐specific. Objectives: This paper describes the processes of validity and responsiveness testing of a condition‐specific quality of life measure for patients who present with severe dentofacial deformity requesting orthognathic treatment (the so‐called Orthognathic Quality of Life Questionnaire). The development of the instrument is described in a previous paper. Method: The OQLQ was tested for validity using a visual analogue scale and also the Short‐Form 36 health survey questionnaire. Responsiveness was tested using longitudinal data obtained before, during and after orthognathic treatment. Results and Conclusions: The OQLQ shows good evidence of validity and responsiveness. This, together with previous evidence of good reliability, suggests that the instrument may prove useful in both clinical trials and in quality assurance.
Risk indicators for apical periodontitis
Authors: Kirkevang Lise‐Lotte , Wenzel Ann
Published: March 2003

Abstract –

Objectives: The aim of the study was to identify risk indicators for apical periodontitis (AP) in the individual. A parameter was defined as a ‘risk indicator’ when its presence increased the individual's risk of exhibiting AP. Risk indicators may, but need not be directly associated with the disease.

Methods: The study included full‐mouth surveys of 613 randomly selected individuals, who were 20–60 years old and living in Aarhus County. Logistic regression analyses were performed. The outcome variable was ≥1 AP/no AP. The independent variables were obtained from information on socioeconomic and dental status.

Results: It was found that smoking, no usage of services from the dentist, ≥2 secondary caries lesions, ≥3 inadequate coronal fillings and the presence of root filling(s) were statistically associated with AP. A separate analysis for individuals with no previous root fillings showed that individuals with regular dental visits as well as individuals who had all their teeth (third three molars excluded) were less likely to have AP, whereas individuals who had ≥3 inadequate coronal fillings were more likely to have AP.

Conclusions: The results from the present study of a Danish population showed that the most important risk indicator of having AP in the individual was the radiographic evidence of root fillings. The presence of several caries lesions, the quality of the dental treatment, the regularity of dental visits and smoking were also statistically associated with AP. Further, the socioeconomic status of the individual did not provide much additional information on the periapical status.
The results of ingredient patch testing in contact dermatitis elicited by povidone‐iodine preparations
Authors: Nishioka Kazue , Seguchi Tokuji , Yasuno Hidetoshi , Yamamoto Toshihiko , Tominaga Kazuyuki
Published: March 2003

10 cases of contact dermatitis which began during the application of povidone‐iodine preparations were examined with patch tests using 2 kinds of povidone‐iodine preparations and their ingredients, i.e., povidone‐iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone‐iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone‐iodine preparations and povidone‐iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinylpyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone‐iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone‐iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone‐iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.
Use of the local lymph node assay for the estimation of relative contact allergenic potency
Authors: Basketter D. A. , Blaikie L. , Dearman R. J. , Kimber I. , Ryan C. A. , Gerberick G. F. , Harvey P. , Evans P. , White I. R. , Rycroft R. J. G.
Published: March 2003

The effective toxicological evaluation of skin sensitization demands that potential contact allergens are identified and that the likely risks of sensitization among exposed populations assessed. By definition, chemicals which possess the toxicological property of skin sensitization potentially are capable of causing allergic contact dermatitis (ACD) in humans. However, this hazard is not an all‐or‐none phenomenon; clear dose‐response relationships can be discerned and thresholds identified for both the induction of sensitization and the elicitation of contact dermatitis. Commonly, these parameters are grouped under the heading of potency, determination of which is vital for risk assessment. In the present investigation, the local lymph node assay (LLNA) has been employed to determine the relative potency of a range of 20 chemicals. The parameter used is the estimated concentration required to produce a 3‐fold increase in draining lymph‐node cell proliferative activity, the EC3 value. These measurements have been compared with an assessment of the human sensitizing potency of the 20 selected chemicals, each being assigned to 1 of 5 classes based on their human sensitizing potency. The EC3 value, derived from LLNA work carried out in acetone/olive oil vehicle, correlated well with the human classification, with the strongest sensitizers having low EC3 values (<0.1%), weaker sensitizers having EC3 values generally in the 1–10% range, and non‐sensitizing chemicals having EC3 values in excess of 100%. In conclusion, the derivation of the EC3 for a chemical provides an objective and quantitative estimate of potency that is of considerable utility for skin sensitization risk assessment.
Skin irritation from air‐oxidized ethoxylated surfactants
Authors: Bodin Anna , Fischer Torkel , Bergh Margareta , Nilsson J. Lars G. , Karlberg Ann‐Therese
Published: March 2003

Surfactants are known to be skin irritants, but change in their irritant potential due to change in composition during handling and storage has not previously been investigated. The aim of this study was to investigate the influence of oxidation products on the irritant potential of a non‐ionic ethoxylated alcohol, C12E5. Pure and oxidized C12E5 were tested, using 2 different patch test procedures; 1 with a single 24 h exposure and 1 with repeated exposures. 18 healthy volunteers participated in each of these studies. Evaluations were made by visual scoring and by measurement of transepidermal water loss and skin blood flow. In the single exposure study, no significant difference in skin irritation was observed between pure C12E5 and a sample of oxidized C12E5 at the concentrations tested (1, 3, 9 and 27%). After repeated exposures, however, the oxidized C12E5 was significantly more irritant than pure C12E5 at the concentrations 9% and 27% (p<0.05). Non‐ionic ethoxylated surfactants are known for their weak skin irritant effect and are, due to this, often included in products with prolonged contact with the skin, i.e., skin care products. An increased irritant potential after oxidation might be of importance due to the conditions of use.
Angry back syndrome is often due to marginal irritants: a study of 17 cases seen over 4 years
Authors: Cockayne Sarah E. , Gawkrodger David J.
Published: March 2003

17 patients with angry back syndrome were identified over a 4‐year period (1994–97). 10 such patients were classified as multiple reactors and 7 as exacerbations of atopic eczema. The 10 multiple reactors reacted most commonly to medicaments, rubber chemicals, fragrances, methylchloroisothiazolinone/methylisothiazolinone, colophonium and nickel. A final diagnosis of relevant allergic contact dermatitis was made in 8 of the 10 patients with multiple reactions. Relevant contact allergens were rubber chemicals, plants, metals and preservatives, all of which can be marginal irritants. None of the reactions in the patients with exacerbation of dermatitis were thought to be relevant or helpful in the further management of the patient. Reactions in the angry back syndrome appear to be due most commonly to marginal irritants. In multiple reactors, marginal irritants were also the most common allergens finally identified.
Contact allergy to Disperse Blue 106 and Disperse Blue 124 in German and Austrian patients, 1995 to 1999
Authors: Uter Wolfgang , Geier Johannes , Lessmann Holger , Hausen Björn M.
Published: March 2003

Between 1995 and 1999, 1986 patients were tested in the 31 participating centres of the Information Network of Departments of Dermatology (IVDK), all of them members of the German Contact Dermatitis Research Group, with a textile dyes series containing Disperse Blue (DB) 106 and 124, and since 1997 also with a mix of both. 86 patients (4.3%) reacted positively to DB 106 and/or DB 124; with good concordance between the 2 allergens (Cohen’s weighted kappa 0.72), and the single allergens and the mix (κ=0.75 in both cases), which had been tested in parallel in 969 and 975 patients, respectively. In contrast, concordance between DB 106/124 and p‐phenylenediamine and p‐aminoazobenzene, respectively, was poor. Some 70% of positive reactions to DB 106/124 had current clinical relevance. Furthermore, a significant increase in the proportion of DB 106/124‐positive patients among those tested was found from 1995 to 1999. Hence, DB 106/124 are important allergens deserving close monitoring. The use of a mix of DB 106 and DB 124 seems justified in view of the close chemical similarity of both compounds. If possible, the presence of the allergen(s) in individual textiles considered causative should be checked by thin layer or column chromatography.
Identification and allergenic activity of hydroxyaldehydes – a new type of oxidation product from an ethoxylated non‐ionic surfactant
Authors: Bodin Anna , Shao Li Ping , Nilsson J. Lars G. , Karlberg Ann‐Therese
Published: March 2003

Ethoxylated alcohols, which are widely used as surfactants, are susceptible to oxidation on air exposure. A complex mixture of oxidation products is formed, among which alkylated aldehydes, alkylated formates, formaldehyde and peroxides have previously been identified by our group. In the present study, we have identified a new class of oxidation product from the nonionic ethoxylated surfactant C12E5. These oxidation products are highly water‐soluble hydroxyaldehydes with the general formula HO(CH2CH2O)nCH2CHO, n=1–4. To facilitate the identification of the hydroxyaldehydes in oxidized C12E5, reference compounds were synthesized. The sensitizing potential of 1 of the identified hydroxyaldehydes, HO(CH2CH2O)3CH2CHO, was studied in guinea pigs and was found to be weak. A significant cross‐reactivity between this aldehyde and the next shorter homologue, HO(CH2CH2O)2CH2CHO, was observed. Irritant components, present in the oxidation mixture, facilitate the skin penetration of allergens, which further accentuates the importance of controlling the conditions of storage and handling of ethoxylated surfactants, to reduce the formation of allergenic and irritant oxidation products.
Irritancy of the skin disinfectant n‐propanol
Authors: Lübbe Jann , Ruffieux Christiane , Van Melle Guy , Perrenoud Daniel
Published: March 2003

Hand disinfection with short‐chain aliphatic alcohols, so‐called “rub‐ins” is the method of choice for cross‐infection prevention in health care environments, but their irritant potential is not well known. Skin tolerance is a major compliance factor, and a high proportion of health care workers suffer from low‐grade irritant contact dermatitis. Therefore, assessment of the irritancy of the skin disinfectant n‐propanol 60%, and comparative 100% and 0% solutions, was performed in the setting of experimental low‐grade ICD. ICD was induced by overnight patch exposure to H2O, and to 0.3% sodium dodecyl sulfate (SDS), in 12 probands, followed by repeated open exposure to the test substances. Outcome variables were transepidermal water loss (TEWL), and skin surface capacitance. On skin sites pre‐irritated by SDS, all n‐propanol concentrations (100%, 60%, 0%) increased TEWL. However, a clear divergence appeared between pure n‐propanol, and the lower concentrations. In contrast to pure n‐propanol, n‐propanol 60% and 0% had no significant effect on TEWL on H2O‐pre‐irritated skin sites. Capacitance of pre‐irritated skin sites was increased by exposure to H2O‐containing n‐propanol solutions (60% and 0%). These results show a clear difference between the irritant potential of n‐propanol 100% on one side, and n‐propanol 60% and 0% on the other side. The level of pre‐existent skin irritation is a pertinent factor in susceptibility to irritation, as the irritant potential of n‐propanol 60%, the concentration used in daily practice, and n‐propanol 0% (water) became significant only on detergent‐irritated skin. Thus, preventive skin care may be a constructive approach in increasing tolerance of modern hand disinfection practices.
Which bioengineering assay is appropriate for irritant patch testing with sodium lauryl sulfate?
Authors: Aramaki Jun , Effendy Isaak , Happle Rudolf , Kawana Seiji , Löffler Christin , Löffler Harald
Published: March 2003

For testing with sodium lauryl sulphate (SLS), measurements of transepidermal water loss (TEWL) and cutaneous blood flow with laser Doppler (LD) are considered to be the most reliable methods. The aim of this study was to determine which method of measurement should be preferred when conducting SLS testing under varying conditions. Patch testing with SLS at different concentrations and exposure times was performed. TEWL values were compared with those of LD. TEWL values showed distinct changes at low SLS concentrations and short application periods. By contrast, higher SLS concentrations were necessary to increase LD values. Short application of patches changed TEWL rather than LD values. When evaluating SLS patch testing by bioengineering methods, TEWL measurement appears to be more suitable for a test procedure that provokes mild skin reactions (SLS concentration <1%), whereas LD measurement is more appropriate to evaluate pronounced skin reactions (SLS concentration 1%).
Biophysical changes after mechanical injury of the stratum corneum in normal skin
Authors: Huh Chang Hun , Seo Koo Il , Kim Sang Duck , Han Ji Hyun , Eun Hee Chul
Published: March 2003

Scrubbing off the stratum corneum with a rough towel after soaking in warm water is a bathing custom unique to Korea. However, Korean dermatologists have advised against this practice due to the potential harm that it may cause, though there is little data to support this advice. This study aimed to evaluate the changes in biophysical characteristics after such mechanical injury of stratum corneum, as reflected by water‐holding capacity, stratum corneum barrier function, and stratum corneum turnover time (SCTT). 10 Korean female volunteers (aged 19–34 years) were enrolled in this study to investigate the acute effects and 32 volunteers (aged 19–49 years) the chronic effects. After soaking in warm water (36 °C) for 5 min, the flexor surfaces of the forearms were scrubbed with a rough towel. The volunteers' forearms were divided into 4 compartments, and each compartment was scrubbed 0, 5, 10, and 15×, respectively. After a single injury of the stratum corneum, there was an initial decrease in water‐holding capacity until 6 h. Thereafter, it increased until day (D) 3, when it began to descend to the normal range. The transepidermal water loss (TEWL) values also peaked at D2 and declined thereafter. However, there were no changes in either water‐holding capacity or skin barrier function, and only the SCTT was significantly shortened, after chronic injury of the stratum corneum.
Occupational irritant and allergic contact dermatitis among healthcare workers
Authors: Nettis Eustachio , Colanardi Maria Cristina , Soccio Anna Lucia , Ferrannini Antonio , Tursi Alfredo
Published: March 2003

Contact dermatitis is the most frequent occupational dermatosis and non‐specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work‐related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid ‘wet work’ and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.
The sensitizing potential of various biocides in the guinea pig maximization test
Authors: Zissu Danièle
Published: March 2003

Biocides are chemicals used as preservatives added to most cosmetics and toiletries and to industrial water‐based products such as cutting fluids, paints and glues. There are numerous biocide formulations used in water‐based metalworking fluids. All these products, characterized by a low molecular weight, can react with endogenous proteins and may induce allergic contact dermatitis. Thus, numerous reports on occupational allergic contact dermatitis have been published. The purpose of this experimental study was to compare the sensitizing potential of the various classes of biocides used in metalworking fluids by means of the maximization test of Magnusson & Kligman. The results show that, from the 9 samples tested, 7 biocides induced sensitization varying in grade from moderate to strong, while 2 benzisothiazoline‐based samples did not induce allergic contact dermatitis.
Epidemiology of contact allergy: an estimation of morbidity employing the clinical epidemiology and drug‐utilization research (CE‐DUR) approach
Authors: Schnuch A. , Uter W. , Geier J. , Gefeller O. ,   (for the IVDK study group)
Published: March 2003

Clinical epidemiology (CE) is considered unable to estimate morbidity concerning either contact sensitization (CS) or allergic contact dermatitis (ACD) at the population level. Drug‐utilization research (DUR) methods estimate the morbidity of suitable diseases based on prescription data for disease‐specific drugs. Our objective was to estimate population figures for incidence and prevalence of ACD and CS based on sales data for patch test material in Germany and on patient data from the Information Network of Departments of Dermatology (IVDK). Approximately 600,000 standard series are sold per year in Germany, according to the 2 main manufacterers. This raw sales figure was corrected for certain effects (discarded preparations, proportion of formerly patch‐tested patients, proportion of patients with ACD seeking medical advice) to obtain an estimate of the denominator of patients eligible for patch testing annually, and combined with patch test results from the Information Network of Departments of Dermatology (IVDK). In 17.8% (of 9,266 IVDK patients) ACD was established. Extrapolated to the general population, an incidence of ACD of between 1.7 and 7 per 1000 per year was estimated, depending on whether conservative or more liberal assumptions concerning the above effects were made. Of 78,067 IVDK patients tested between 1992 and 2000, 46.8% had at least 1 positive reaction (+ to + + +), and 22.7% had at least 1 stronger positive reaction (+ + or + + +).The 9‐year prevalence of CS was estimated to lie between 4.0% and 16.6% for the first outcome, and between 2.0% and 8.1% for the second. Concerning single allergens, 1.9–4.5 million individuals are probably sensitized to nickel, and 1.4–3.4 million to fragrance mix among the German population of 82 million inhabitants. The morbidity data found in this study are in good accordance with data from population‐based epidemiological studies. In comparison to these, the CE‐DUR approach seems to be an economically feasible method to estimate continuously the population impact of ACD and CS.
Further important sensitizers in patients sensitive to fragrances*
Authors: Frosch P. J. , Johansen J. D. , Menné T. , Pirker C. , Rastogi S. C. , Andersen K. E. , Bruze M. , Goossens A. , Lepoittevin J. P. , White I. R.
Published: March 2003

The aim of this study was to determine the frequency of responses to selected fragrance materials in consecutive patients patch tested in 6 dermatological centres in Europe. 1855 patients were evaluated with the 8% fragrance mix (FM) and 14 other frequently used well‐defined fragrance chemicals (series I). Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Reactions to FM occurred in 11.3% of the subjects. The 6 substances with the highest reactivity following FM were Lyral® (2.7%), citral (1.1%), farnesol P (0.5%), citronellol (0.4%), hexyl cinnamic aldehyde (0.3%), and coumarin (0.3%). 41 (2.2%) of the patients reacted only to materials of series I and not to FM. 6.6% of 1855 patients gave a history of adverse reactions to fragrances which was classified as certain. This group reacted to FM only in 41.1%, to series I and FM in 12.0% and to series I only in 7.2%. 74.3% of the 39 patients reacting to both FM and 1 of the materials of series I had any type of positive fragrance history, which was significantly higher in comparison to those with isolated reactions to series I (53.6% of 41), p = 0.04. The study identified further sensitizers relevant for patch testing of patients with contact dermatitis, of which Lyral® is the most important single chemical.