bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of a dip slide test for mutans streptococci in caries risk assessment
Authors: Pinelli Camila , Serra Mônica Campos , De Castro Monteiro Loffredo Leonor
Published: March 2003

Abstract – The aim of this study was to evaluate the efficacy of a dip slide test for mutans streptococci in caries risk assessment, when the microbiological results were compared to well‐defined clinical criteria (DCC) for caries risk, clinically measured through high and low caries activity. Eighty‐one volunteers from the 6th to 8th grades from public schools of Piracicaba, São Paulo, Brazil, were evaluated for dental caries. All free smooth surfaces were evaluated to check whether or not there were white spots. Based on the subjects’ caries experience, a calibrated clinician divided them into groups of high and low caries activity. The subjects were submitted to a salivary test (CARITEST SM®) from the same batch number. Kappa statistics (κ) were applied to verify the reproducibility of the simplified test, checked through interexaminer agreement when the results were classified by independent and blind means. The microbiological results were validated according to expressions of sensitivity and specificity. A moderate agreement was verified as the results were classified according to 6 scores (κ=0.55), and the agreement was substantial when the results were classified according to high and low microbiological count (κ=0.78). The sensitivity and specificity values were 0.59 and 0.85, respectively, showing that the test was more specific than sensitive, and could thus better identify the low caries risk subjects.
Disparities in dental service utilization among Alabama Medicaid children
Authors: Dasanayake Ananda P. , Li Yufeng , Wadhawan Sangeetha , Kirk Katharine , Bronstein Janet , Childers Noel K.
Published: March 2003

Objectives: Access to oral health care and utilization of available services are important factors in minimizing the oral health disparities among underserved minorities. Our objective was to evaluate the racial and other factors related to ‘realized access’ to oral health care among Alabama Medicaid children.

Methods: Data were obtained from 308 538 Alabama Medicaid claims submitted in 1995–96 and analyzed using regression analyses.

Results: A lower proportion of Blacks (24%) and other racial groups (22%) compared to Whites (31%) and a lower proportion of 15–19‐year‐olds (15%) compared to younger age groups (30%) obtained dental services (P < 0.05). Odds of males obtaining care were slightly lower compared to females (OR = 0.96; 95% CI = 0.94–0.99). However, there was a significant interaction of race with other factors in determining service utilization. Subjects who were continuously eligible for Medicaid throughout the fiscal year were more likely to obtain care (OR = 2.86; 95% CI = 2.78–2.93). About one‐fourth of the visits had an emergency procedure included in the treatment rendered. Availability of a participating dentist within the county of residence and the lower reimbursement‐to‐charge ratio were among the other related factors for underutilization of services.

Conclusions: There is a significant racial disparity in utilization of dental services even among the Medicaid‐eligible children. However, this was not a simple function of race, but a complex interaction of race with other factors such as age, gender, and location.

Acknowledgment: Supported by CDC grant #U48/CCU 409679.
Follow‐up study of dental students' esthetic perceptions of mild dental fluorosis
Authors: Levy Steven M. , Warren John J. , Jakobsen Jane R.
Published: March 2003

Objectives: Several studies have assessed people's esthetic perceptions of dental fluorosis, suggesting that concerns may be greater than believed previously. Few studies have assessed dental students' perceptions and none has done so over time. The purpose of this paper is to report on changes in dental students' esthetic perceptions of dental fluorosis and other conditions. Methods: Fourth‐year dental students (n=45) completed questionnaires about computer‐generated photographs of fluorosis and other conditions, using the same protocol as when they were entering dental students. Results were compared for each of the eight images at the individual level using paired statistical tests. Results: Although many patterns were generally consistent, there were a substantial number of differences in results over time, concerning both the mild fluorosis and non‐fluorosis images. In general, students tended to score both fluorosis and non‐fluorosis images more favorably as fourth‐year students. When rating images from very pleased (1) to very embarrassed (10), fourth‐year students rated the images significantly more favorably than they had done as first‐year students for normal/control, incisal third only dental fluorosis, and a more generalized, mild fluorosis. Similarly, with a visual analog scale from satisfactory (0) to unsatisfactory (69), fourth‐year students reported significantly lower (more favorable) scores than they had done as first‐year students for the normal/control, diastema/no fluorosis, more involved mild fluorosis, and incisal third only mild fluorosis. There were no obvious changes in the relative levels of favorable evaluation of fluorosis vs. the other conditions. Conclusions: Fourth‐year dental students generally had more favorable esthetic perceptions of mild dental fluorosis and other conditions than they had reported as entering students.
A longitudinal study of occlusal caries among schoolchildren in Dar es Salaam, Tanzania
Authors: Rugarabamu Paschalis Gerald Ntome , Poulsen Sven , Masalu Joyce Rose Paul
Published: March 2003

Objectives: To describe the clinical caries status and the radiographic progression of occlusal caries lesions in permanent first and second molars among primary schoolchildren in Dar es Salaam over a 3‐year period. Methods: Clinical and radiographic diagnosis of caries in first and second permanent molars in 223 children aged 8–16 years were carried out annually from 1994 to 1997. The drop‐out rates from the baseline in 1994 to the follow‐up examinations in 1995, 1996 and 1997 were 16.6%, 22.0% and 35.4%, respectively. Twenty‐one percent of the dropouts were picked up during the study. Results: Less that 5% of all occlusal surfaces that were sound at the beginning of the study developed new clinical caries lesions over the 3‐year study period. The highest rate of new lesions was found in second molars. The mandibular second molars were most frequently affected by new caries lesions followed by the mandibular first molars. Progression of lesions was generally slow. After 1, 2 and 3 years, 30.0%, 47.9% and 52.8% of lesions in occlusal surfaces of first molars had progressed, compared to 47.9%, 71.3% and 100.0% of lesions in second molars. Conclusions: Dental caries prevalence was low. New occlusal lesions were more likely to appear in mandibular second molars. Carious lesions were progressing slowly, especially in the first molars. Fissure abrasion may play a role in minimizing the risk of developing new occlusal lesions as well as progression of existing lesions.
Direct emission of the allergen primin from intact Primula obconica plants
Authors: Christensen Lars P. , Larsen Erik
Published: March 2003

The allergen primin and its precursor miconidin were collected by dynamic headspace technique from Primula obconica Hance and quantified and identified by gas chromatography (GC) and gas chromatography‐mass spectrometry (GC‐MS). The primin concentrations in leaves/stems and flowers (including pedicel and calyx) of P. obconica were 262 μg and 531 μg (g fresh plant material)−1, respectively, whereas miconidin concentrations were 92 μg (g fresh plant material)−1 in leaves/stems and 194 μg (g fresh plant material)−1 in flowers. The amounts of primin released from unchopped leaves/stems and flowers were 65.3 ng and 18.8 ng (g fresh plant material)−1 h−1, respectively. Dynamic headspace analysis of intact P. obconica plants showed that primin is also directly emitted from undamaged plants, although in smaller concentrations (6.2 ng (g fresh plant material)−1 h−1), whereas miconidin was only emitted in minute amounts (less than 0.4 ng (g fresh plant material)−1 h−1) both from intact plants and from unchopped plant parts. The possibility that primin from P. obconica could be a potential airborne allergen and therefore a source of airborne contact dermatitis is discussed.
Patch testing and aeroallergen intradermal testing in suspected allergic contact dermatitis, unclassified endogenous eczema and non‐atopic chronic urticaria
Authors: Li Lin‐feng , Wang Jing
Published: March 2003

The purpose of this study was to investigate the significance of contact allergen and aeroallergen sensitization in suspected allergic contact dermatitis (ACD), unclassified endogenous eczema (UEE) and non‐atopic chronic urticaria (NACU). 63 cases of suspected ACD, 140 cases of suspected UEE and 21 cases of suspected NACU were patch tested with the standard series of Beijing Medical University and, if available, suspected materials as is. 22 such cases of ACD, 104 such cases of UEE and 42 such cases of NACU were intradermally tested with common aeroallergens. Patients with non‐allergic skin disease served as controls. 85.7% of the suspected ACD patients, 57.9% of the suspected UEE patients and 52.4% of the suspected NACU patients were positive on patch testing, and the results in 81.0% of the suspected ACD patients and 23.6% of the suspected UEE patients were considered relevant. No patch test reactions in the NACU patients were considered relevant. 27.1% of the suspected UEE patients, 41.3% of the suspected ACD patients and 14.3% of the suspected NACU patients reacted to 2 or more contact allergens. High positive rates on aeroallergen intradermal testing were also found in suspected NACU (69.0%), UEE (49.0%) and ACD (59.1%) patients. These results support the conclusions that patients with allergic skin diseases will develop multiple sensitization, and that early detection and avoidance of sensitizing allergens is necessary. The exact rôle of aeroallergen sensitization in these diseases needs further study.
The efficacy of a protective cream in a real‐world apprentice hairdresser environment
Authors: Perrenoud D. , Gallezot D. , Van Melle G.
Published: March 2003

The object of this study was to compare the protective action of a new barrier cream (Excipial Protect®, Spirig Pharma AG, Egerkingen, Switzerland) to its vehicle in the context of hand irritation of apprentice hairdressers caused by repeated shampooing and exposure to hair‐care products. This was a double‐blind cross‐over comparing Excipial Protect® (containing aluminium chlorohydrate 5% as active ingredient) against its vehicle alone. The efficacy of the creams was evaluated taking into account: (1) clinical scores by researchers, (2) biometric measurements, (3) subjective opinions of the subjects. An analysis of variance was performed considering order of application, degree of atopy, and reported number of shampoos. We observed very little difference in efficacy between the protective cream and its vehicle. The presence, however, of aluminium chlorhydrate in the protective cream was shown to have a positive effect against work‐related irritation. The cosmetic qualities of the creams seemed, to the participants, to be as important as their real protective and hydrating properties, an important factor in compliance issues.
Stability of thiuram disulfides in patch test preparations and formation of asymmetric disulfides
Authors: Bergendorff O. , Hansson C.
Published: March 2003

The thiuram mix used in patch testing originally contains 4 compounds. However, chemical analysis of the test preparation revealed that several new compounds are spontaneously formed during storage. The structures of these compounds have been determined and the rate of their formation has been studied in buffer solution at pH 7.4. After a few hours, a large amount of mixed disulfides are formed in solutions originally containing only symmetric disulfides. The impact on the test result of the formation of asymmetric disulfides has been investigated by testing on thiuram‐sensitive volunteers with different preparations of mixed thiuram disulfides. In our study, the formation of new asymmetric thiuram disulfides from the original symmetric thiuram disulfides in the test preparation had no influence on the result of the patch testing. However, as the chemical analysis showed that the mix composition changes during the period when the preparations are used, and differs between suppliers, the question is raised as to whether it is acceptable to use test preparations with a composition that is different from that labelled on the protocol.
Contact dermatitis from topical antiviral drugs
Authors: Holdiness Mack R.
Published: March 2003

The literature has been reviewed for contact dermatitis from topical antiviral drugs. 15 agents have been identified including acyclovir, imiquimod, podophyllin, podofilox, cidofovir, penciclovir, vidarabine, idoxuridine, trifluridine, tromantadine, lamivudine, interferon intralesional injections and ophthalmic solution, fomivirsen and foscarnet intravitreal injections and ganciclovir intraocular implants. Patch testing has been documented in certain individuals and cross‐sensitization has been observed to contribute significantly to some allergic reactions.
Evaluation of a quantitative clinical method for assessment of sensory skin irritation
Authors: Robinson Michael K. , Perkins Mary A.
Published: March 2003

Sensory skin irritation refers to the myriad of symptomatic complaints (e.g., sting and burn) frequently associated with inflammatory skin conditions or skin intolerance to various chemicals or finished products. Sensory irritation is an important factor in consumer acceptance of the products that they buy and use; however, from a safety testing and risk assessment standpoint, it has been difficult to evaluate. Recently, methods have been developed to more quantitatively assess sensory irritation using a semantically‐labeled scale of sensation intensity, the labeled magnitude (LM) scale. Using this device, studies were conducted to determine if test subjects’ perceptions of recalled or imagined sensory responses (from a series of survey questions) were related to their actual sensory reactivity to chemical challenge. Subjects were presented with 15 skin sensation scenarios of varying intensities and asked to record their self‐perceived recalled or imagined responses using the LM scale. Individual and mean responses to each of the 15 survey questions were compared within and across studies. Considerable variation was seen between subjects’ responses to the questions, particularly for questions pertaining to stronger stimuli (e.g., scalding water or skin lacerations). There was also little consistency seen in the pattern of individual responses across the questions. However, among 4 different study populations, the group mean scores for each of the 15 survey questions showed a high degree of consistency. Also, in spite of the variability in perceived responses to the recalled/imagined skin sensations, statistically significant dose‐response and time‐response patterns were observed in chemical (lactic acid and capsaicin) challenge studies. In one capsaicin study, a direct relationship was observed, among 83% of the study subjects, between the mean recall intensity scores and actual responses to subsequent capsaicin challenge. This pattern was not seen in a lactic acid challenge study. However, a similar relationship was seen in this study if only recall stimuli related to sting‐type responses were included in the analysis. Hence, use of recall/imagined skin sensation perception data for prediction of actual reactivity to chemical probes may have screening utility depending on the survey questions used. On the whole, the LM scale is of practical use for quantifying subjective sensory irritation responses. Combined with evolving noninvasive instrumental and bioassay procedures for identifying biophysical or inflammatory markers of sensory irritation, better methods are on the horizon for improving our sensory skin irritation testing and risk assessment capabilities.
Evaluation of the Skin and Cancer Foundation standard series in the diagnosis of allergic contact dermatitis
Authors: Ciconte Antoinette , Mar Adrian , Horton Jeremy J
Published: March 2003

The use of a standard series of 37 allergens was evaluated in a retrospective study of 817 consecutive patients seen between April 1988 and January 1993 at the Skin and Cancer Foundation, Melbourne, Australia. Of the 316 patients with clinically relevant patch test results, 134 (42%) reacted to an allergen in the standard series alone, while an additional 122 (39%) had reactions to allergens in both the standard and supplementary series. The remaining 60 (19%) patients reacted only to allergens in the supplementary series. These data suggest that the use of our standard series alone will detect about 80% of allergic contact dermatitis cases, but that many of these may be insufficiently evaluated. Use of supplementary allergen testing in a specialised clinic is recommended for patients who may have allergic contact dermatitis.
Arthus reaction to lepirudin, a new recombinant hirudin, and delayed‐type hypersensitivity to several heparins and heparinoids, with tolerance to its intravenous administration
Authors: Jappe U. , Reinhold D. , Bonnekoh B.
Published: March 2003

The pathogenesis of allergic reactions to heparin is poorly understood. Clinically, this phenomenon is relevant because of its increasing incidence and the resulting therapeutic challenges due to various cross‐reactions between unfractionated and low‐molecular weight heparins as well as between heparins and heparinoids. A 44‐year‐old female patient had developed a delayed‐type hypersensitivity to certoparin‐sodium. Diagnostic allergy testing revealed various cross‐reactions between different heparins as well as an intolerance to heparinoids. After subcutaneous challenge with the recombinant hirudin lepirudin (Refludan®) the patient developed a local Arthus reaction at the injection site. In general, recombinant hirudins do not cross‐react with high‐ or low‐molecular weight heparins and heparinoids because of a different molecular structure and are therefore an alternative in case of adverse reactions to heparins and heparinoids. Whereas a local Arthus reaction has already been described twice for low‐molecular weight heparins, this is to the best of our knowledge the first observation of a superficial leukocytoclastic vasculitis due to s.c. applied lepirudin. Intravenous administration of heparins and heparinoids in case of hypersensitivity to these drugs following topical application risks a generalized eczematous reaction in patients with delayed‐type allergy to both groups of substances. In our patient with delayed‐type hypersensitivity to heparins and heparinoids and superficial vasculitis due to lepirudin, the intravenous challenge with heparin and a heparinoid was justified as an ultima ratio measure and proved to be the useful therapeutical alternative.
Different physical forms of maleopimaric acid give different allergic responses
Authors: Nilsson Anna‐Malin , Gäfvert Elisabeth , Nilsson J. Lars G. , Karlberg Ann‐Therese
Published: March 2003

Endo‐maleopimaric acid (MPA) is a contact allergen formed when colophonium is “modified” with maleic anhydride or fumaric acid. Previous patch testing showed a higher allergic response to petrolatum (pet.) preparations of MPA in amorphous form compared to MPA in crystalline form. In the present study, the impact of the physical form of MPA on the allergic response was investigated. Since the amorphous form is difficult to standardize, crystalline MPA mechanically incorporated or dissolved in pet. was used. A lower eliciting capacity was obtained from crystalline MPA, compared to that obtained from dissolved MPA, in guinea pigs intradermally induced with MPA. Using3H‐MPA a 3× difference in the dissolution into synthetic sweat from MPA dissolved in pet., compared to MPA mechanically incorporated, was demonstrated. A difference in bio‐availability between dissolved and crystalline MPA could therefore be assumed. Crystalline MPA had a low sensitizing capacity compared to that seen for amorphous MPA in previous studies. The amorphous form of MPA is likely to have a larger surface area than crystalline MPA, with less ordered molecules, resulting in a higher dissolution rate and a greater bio‐availability. Modified colophonium exists as amorphous solids and as viscous liquids. Thus, exposure will probably be to non‐crystalline MPA and cases of contact allergy could be overlooked when screening with crystalline MPA.
Identification of sensitizing diethyleneglycol maleate in a two‐component polyester cement
Authors: Pfäffli Pirkko , Jolanki Riitta , Estlander Tuula , Tarvainen Kyllikki , Kanerva Lasse
Published: March 2003

Unsaturated polyester (UP) cement caused allergic contact dermatitis in car repair work. The resin was a condensate of polyols and maleic anhydride with reactive solvent, auxiliary substances, and inorganic reinforcement substances. To identify the causative chemicals, the cement was tested on a sensitized patient. For analysis, samples of the resin were eluted with acetone and eluted with hexane to precipitate inorganic material and large polyester molecules. The eluate was evaporated. The remainder, dissolved in acetone, was separated into fractions on silica plates by thin layer chromatography (TLC). On the developed (hexane/chloroform, 15/85) plates, 20 bands were obtained under UV‐light at 254 nm. Samples of the bands were scraped and used for patch testing. The scraping at a retention factor (Rf) of 0.24 caused a skin reaction. The bands at this retention were removed from six plates, combined, eluted with acetone and purified again by TLC. The purified fraction mixed in petrolatum in the dilution series was used for conclusive patch testing on the patient. An allergic reaction was induced at down to 0.003% wt/wt. According to MS and IR analyses, the isolated compound was diethyleneglycol maleate (DEGM, MW204). In addition to the resin part, the sanding dust also contained this monomer.
Implementation of fatty acid carriers to skin irritation and the epidermal barrier
Authors: Schürer N. Y.
Published: March 2003

Acute perturbations are followed by barrier repair and enhanced lipid synthesis, as well as cellular fatty acid trafficking, yet irritation of the skin may be induced by repeat disturbance of barrier function. Recently, new insights in cellular fatty acid transport and metabolism have evolved with respect to skin irritation and barrier disturbances: (1) Employing sodium dodecyl sulfate, skin irritation is accompanied by the induction of an epidermal (E) cytosolic fatty acid binding protein (FABP) associated with enhanced barrier repair. Whether E‐FABP contributes to the water barrier function in normal skin remains to be elucidated; (2) Cutaneous inflammation, as it occurs in irritant contact dermatitis, can be reduced by peroxisome proliferating activated receptor (PPAR) agonists, such as linoleic acid, with clinical effects comparable to that of glucocorticoids; (3) PPARα agonists accelerate barrier recovery and enhance lamellar body synthesis, neutral lipid synthesis, in particular that of ceramides and cholesterol; (4) PPARα agonists increase the minimal erythema dose in UVB‐irradiated human skin. This review provides a brief overview of the current understanding of mammalian fatty acid (FA) metabolism with respect to epidermal barrier abrogation and repair, including new insights into cellular FA transport and metabolism.
A review of the scientific basis for uncertainty factors for use in quantitative risk assessment for the induction of allergic contact dermatitis
Authors: Felter Susan P. , Robinson Michael K. , Basketter David A. , Gerberick G. Frank
Published: March 2003

Safety evaluations for chemicals which possess the ability to cause sensitization by skin contact have traditionally been done using an ad hoc comparative risk assessment technique. Recently, several papers have been published supporting the use of an alternative, and potentially better, quantitative risk assessment approach. While they represent a relatively new approach to risk assessment for sensitizers, quantitative methods have been used for decades to support risk assessments for systemic toxicity. Historically, these methods have involved the extrapolation of toxicity data − generally from studies in laboratory animals at relatively high doses to human exposures at lower doses. For toxicity endpoints with a threshold, this process has traditionally involved the use of uncertainty factors. For example, uncertainty factors are commonly used to extrapolate from laboratory animals to humans, and from ‘average’ humans to sensitive subpopulations. In the absence of data to support a different value, a default factor of 10 is widely accepted for each of these areas. Recent papers have advocated the use of a similar approach to characterize the risk of the induction of skin sensitization by allergens of varying potency and potential for skin contact. As with other forms of toxicity, a quantitative assessment of risk for allergic skin reactions can be approached by identifying a NOAEL (no observed adverse effect level) and applying appropriate uncertainty factors. Three major areas of data extrapolation have been identified: inter‐individual susceptibility, the influence of vehicle or product matrix, and exposure considerations. This paper provides an overview of each of these areas with an evaluation of the available scientific database to support an uncertainty factor in the range of 1–10 for each area.
Variability in responsiveness to irritants: thoughts on possible underlying mechanisms
Authors: Willis C. M.
Published: March 2003

Patch testing with chemical irritants almost always produces a striking variability in the intensity of reaction between individuals, even amongst normal, healthy subjects. Whilst there have been many attempts to define factors which predispose to heightened or, conversely, to diminished reactivity, the underlying cellular mechanisms responsible for the variability remain poorly understood. In this review, a number of possible explanations are proposed, with a particular emphasis on those which relate to the influence of pre‐existing disease or to the genetic regulation of certain immunological and inflammatory processes.
Principles and methodology for identification of fragrance allergens in consumer products*
Authors: Gimenez‐Arnau A. , Gimenez‐Arnau E. , Serra‐Baldrich E. , Lepoittevin J.‐P. , Camarasa J. G.
Published: March 2003

Fragrances contain several hundreds of different chemicals, a few major and many minor, which are responsible for the complexity of the odour. Fragrances are a major cause of allergic contact dermatitis. As a diagnostic tool, the current fragrance mix is very useful though not ideal. A 50‐year‐old woman presented with a pruriginous, erythematous eruption, characterized by papules, vesicles, exudation and crusting over the neck and chest. With the suspicion of fragrance allergy, patch testing was performed. Initially, the only positive reaction observed was with her own eau de toilette named Woman®. The TRUE Test® fragrance mix patch test was negative. Chemical fractionation of Woman® perfume concentrate was combined with a sequenced patch testing procedure and with structure‐activity relationship studies. Ingredients supplied by the manufacturer were also included in the study. Benzophenone‐2, Lyral®, α‐hexyl cinnamic aldehyde and α‐damascone were found to be responsible for the patient's contact allergy to the commercial product. These substances contain chemical structural alerts giving them antigenic ability. The common use of new chemicals to manufacture fragrances, and the increased number of patients sensitive to them but with negative fragrance mix reactions, makes it necessary to identify new potential fragrance sensitizers in commercial products.
Relaxin affects the dentofacial sutural tissues
Authors: Nicozisis Jonathan L. , Nah‐Cederquist Hyun‐Duck , Tuncay Orhan C.
Published: March 2003

This is a report of an exploratory study of how the hormone relaxin might modulate the remodeling of connective tissue within the craniofacial sutures and periodontal tissues. Relaxin is a hormone that was discovered to be produced by the pregnant female. It is responsible for the relaxing of the pubic symphysis; the birth canal is widened for parturition. It has also been shown to have effects on other areas of the body, including ligaments and regions containing collagen and fibroblastic activity. Twenty‐one Swiss retired‐breeder mice were used to: 1) immunohistochemically demonstrate the presence of relaxin within the sutures; 2) demonstrate its effects on the integrity of the suture‐like tissues; and 3) assay its effects on protease activity. Relaxin in concentrations of 250 and 500 ng/ml was used in the treated samples and allowed to incubate in complete tissue culture for 24 h. The results indicate the presence of relaxin within the cranial suture. Histological observations revealed definite changes in the collagen fibril arrangement in the PDL – from being dense and highly organized with a perpendicular direction between tooth and bone to randomly organized and loose, lacking any direction between tooth and bone. An elevation in the protease activity was evident in the relaxin‐treated samples. This naturally occurring hormone might be used as an adjunct to orthodontic therapy as it appears to have the capacity to alter the physical properties of the connective tissue within sutures, gingival tissue, and the PDL. Potential indications for use include instances of sutural and soft tissue adaptation of orthopedic expansion in non‐growing patients by a reduction in the tension of the stretched soft tissue envelope following orthognathic surgery (particularly the expanded palatal mucosa), periodontal ligament remodeling during or after tooth movement promoting stability, rapid gingival tissue remodeling during space closure in extraction sites, and by a decrease in the amount of scar tissue formation following frenectomies.
Types of corrosion in removable appliances: annotated cases and preventative measures
Authors: Kusy Robert P.
Published: March 2003

Three different types of electrochemical corrosion cells are discussed – composition, concentration, and stress cells. Annotated cases are presented for each type of corrosion cell in removable appliances using conventional photography, scanning electron microscopy, and X‐ray elemental analyses. The complexity that corrosion can attain is illustrated via the case of a palatal expansion device. Specific examples of galvanic cells, which are possible in orthodontic practice, are summarized in terms of the anodic and cathodic half‐cells. These include material differences, oxygen gradients, presence of debris, changes in pH, induced stress levels, changes in stress states, and variations in as‐received history. A galvanic series is constructed from the orthodontist's perspective that includes titanium, nickel–titanium, cobalt–chromium, and stainless steel alloys, as well as glass‐fiber‐reinforced polymer‐matrix composites. Preventative measures are presented from the perspectives of the raw material manufacturers, the dental laboratories, the chair‐side practitioner, and the patient. A list of materials is provided, which are known to promote corrosion in the event that stainless steels are sensitized as a consequence of improper handling. In the final analysis, however, retainers and removable appliances are reliable if corrosion cells are conscientiously averted and preventative measures are routinely employed.
Development of a three‐dimensional imaging system for analysis of facial change
Authors: Bourne C.O. , Kerr W.J.S. , Ayoub A.F.
Published: March 2003

The objective of this report is to present facial changes produced by the Twin Block appliance in three‐dimensional visual and numerical formats. Using a C3D system, stereophotogrammetric records were made of two children with Class II division 1 malocclusions prescribed treatment with a Twin Block appliance. Three‐dimensional images of their faces were captured. Comparison of specified regions of the three‐dimensional images was made using landmark identification and superimpositions. In addition to obvious visual evidence, numerical data in the form of surface area measurements were also generated. The three‐dimensional, C3D, system, provides a flexible imaging tool which should become increasingly useful as more improvements are made.
Bacterial degradation of composite bonding materials
Authors: Donker H.J. , Melsen B. , Frandsen E.V.G.
Published: March 2003

The causes of bracket loss during the late phases of orthodontic treatment have hitherto been considered to be of mechanical nature (e.g. trauma, high forces applied). Recently, it was hypothesized that bacterial degradation of composite resin could be a reason for late bracket failure. This was based on the observation of apparently degraded composite on bracket bases sent to a recycling company, and on a weight loss of 0.1–1% of a limited number of composite resin foils incubated with bacteria. To further elucidate the basis for this hypothesis, we examined brackets, immediately after debonding, for signs of potential decay and tested the ability of selected bacterial species to degrade composites. Out of a total of 1056 brackets collected, 6.2% displayed signs of decay indicative of inclusion of air bubbles, corrosion of the bracket base and discoloration of the composite and comparable to the decay observed on brackets received from the recycling company. Composite discs of two different brands were each incubated with either of five strains representing different bacterial species. The incubation lasted 3 months or until the bacteria had died. There was no significant difference in weight change of the discs incubated with bacteria and control discs incubated without bacteria. Thus, our results do not support that bacterial degradation of composite resin bonding materials is a likely cause of bracket loss.
Changes in masticatory jaw movement and muscle activity following surgical orthodontic treatment of an adult skeletal Class III case
Authors: Miyawaki Shouichi , Yasuda Yoshitaka , Yashiro Kohtaro , Takada Kenji
Published: March 2003

This case report examines the masticatory jaw movements and electromyograph (EMG) recordings of anterior and posterior temporal and masseter muscles before and after surgical orthodontic treatment in an adult patient with incisor crossbite and skeletal Class III jaw base relationship. The prescribed treatment resulted in a good occlusion and skeletal and dental Class I relationship. The chopping type jaw movement pattern during gum chewing was transformed to more of a grinding motion after treatment. But this motion was not as broad as is normally seen. This observation is indicative of the difficulties associated with improving the masticatory jaw movements in an adult patient to a completely normal pattern even after retention. In this patient, the high frequency of silent periods on the EMG that were observed in the early intercuspal phase before treatment were decreased to normal low levels after treatment. A similar decrease was also seen in the mean duration of the chewing cycle. We conjecture that this patient unsuccessfully attempted to compensate for the silent periods by increasing the period of his chewing cycle.
Computer‐aided measurement and grading of cranial asymmetry in children with and without torticollis
Authors: Chang Pei‐Yeh , Chien Y‐Wien , Huang Fu‐Yuan , Chang Nin‐Chun , Perng Der‐Baau
Published: March 2003

Our aim was to develop a simple, non‐invasive method that could be used to objectively record cranial symmetry over time. We utilized this new method to investigate the relationship between torticollis and progressive plagiocephaly. From 1995 to 1999, the head shapes of 419 torticollis patients and 1 211 normal children were evaluated. We used Ezeform strip, a splint material, to make a permanent ring of the head circumference. Each head ring was recorded, scanned, and analyzed. An asymmetric index (AI) was designed. Double‐blind comparisons of clinical assessment with AI values demonstrated a good agreement. Asymmetry of the cranium was found with similar frequency in torticollis and normal babies up to 12 months old. After 1 year of age, the deformity persists in patients with torticollis into their adolescence, while the normal group shows increased symmetry. This new recording system offers an objective and efficacious methods for following the natural history of cranial asymmetry.
Apoptosis in the areas of squamous differentiation of irritated seborrheic keratosis
Authors: Pesce Carlo , Scalora Stefano
Published: March 2003

Seborrheic keratosis (SK) consists of a localized proliferation of basaloid keratinocytes, often accompanied by hyperkeratosis and hyperpigmentation. In irritated SK, these features are associated with areas of squamous differentation with larger keratinocytes and squamous cell eddies. This work is concerned with the evaluation of apoptosis, as demonstrated by the TUNEL method, in the different varieties of SK. Apoptosis was highly expressed in the areas of squamous differentiation of irritated SK, but only mildly increased in the other varieties of SK. These data support the hypothesis that apoptosis has a role in the squamous differentiation of irritated SK. In consideration also of previous data showing that irritated SK is associated with downregulation of EGF‐R expression and 125I‐EGF binding, we postulate that the morphologic features of irritated SK could correspond to an involution phase of the disease, characterized by altered cell balance with inadequate cell renewal and increased cell loss.
A case of localized follicular hamartoma: an ultrastructural and immunohistochemical study
Authors: Morohashi M. , Sakamoto F. , Takenouchi T. , Hashimoto T. , Tago O. , Ito M.
Published: March 2003

We report the case of a 22‐year‐old woman with a nevoid plaque that we termed localized follicular hamartoma. The plaque was noticed at puberty on a unilateral site of the face and scalp. Clinically, it revealed numerous, skin‐colored to light brown papules alone and in groups, occasionally bearing a single hair. Histologically, branched epithelial nests of squamoid and/or basaloid cells were revealed in connection with the interfollicular epidermis and the upper portions of hair follicles, of which the lower portions showed normal structures. Immunohistochemically, the epithelial nests showed the keratin expression consisted with that of the infundibular epithelium. S‐100‐positive cells were found in the epithelial nests and the stroma. Factor XIIIa‐positive dendritic cells were numerous in adjacent to the epithelial nests. Ultrastructurally, immature melanocytes with a small number of premelanosomes and Merkel cells were found in the nests. Stromal dendritic cells showed the adherent features of the cytoplasmic processes to anchoring fibrils or basal lamina of the epithelial nests. From these findings, our case is a hamartoma, which seems to be an abortive growth of secondary hair germs with a limited differentiation to the upper follicular portion.
Topoisomerase II‐alpha expression in melanocytic nevi and malignant melanoma
Authors: Mu Xiao C. , Tran Tien Anh , Ross Jeffrey S. , Carlson J. Andrew
Published: March 2003

Malignant melanoma (MM) is considered to be a chemotherapy‐refractory tumor. New anti‐cancer drugs (e.g. etoposide) that target DNA topoisomerases (e.g. topoisomerase II‐alpha (topo IIα)) show activity against a wide variety of solid tumors. In this study, we investigated the frequency and rate of labeling for topo IIα in 163 MMs (primary and metastatic) and 67 melanocytic nevi to determine whether topo IIα expression is elevated in MM. Primary MM exhibited significantly more frequent topo IIα expression compared to benign nevi (86% vs. 56%, p=0.0001). The rate of topo IIα labeling in dysplastic melanocytic nevi, radial growth phase MM, vertical growth phase MM and metastatic MM revealed significant differences amongst groups and a positive covariance with advancing stage (means: 0.3, 0.5, 5, and 8 ‘+’ cells/hpf, respectively; r=0.3, all p≤0.02). Topo IIα labeling significantly correlated with increasing mitotic activity, depth of invasion and Clark's level, diminishing tumor infiltrating lymphocytes, and poor outcome (all p≤0.01) in primary MM. For metastatic MM, a minority (30%) exhibited marked elevation of topo IIα expression. These findings indicate topo IIα as a potential therapeutic target and marker for MM. Immunohistochemical analysis of disseminated MM may allow for correlation with clinical response and enable selection of candidates sensitive for specific chemotherapy ( Note).
Squamous metaplasia of sebaceous gland
Authors: Buezo Guadalupe F. , Fernández Javier Fraga , Tello Esteban Daudén , Díez Amaro García
Published: March 2003

Squamous metaplasia in the skin has been reported in the eccrine ducts as eccrine squamous syringometaplasia (ESS). To our knowledge, squamous metaplasia of sebaceous gland (SMSG) has not been described in human skin. Twenty‐two biopsy specimens from patients with pressure lesions after cardiac surgery with extracorporeal circulation were evaluated for the presence of SMSG. Squamous metaplasia of sebaceous gland was identified in five of the eight scalp biopsies and none of the buttock biopsies. The squamous metaplasia began in the germinative outer layer and advanced in a centripetal way. We believe that SMSG is an unspecific change of the sebaceous cells secondary to a chronic injury. Ischemia appears to play a mayor role, but other factors such as chronic trauma or toxicosis can not be ruled out.
Atrophic dermatofibroma. Elastophagocytosis by the tumor cells
Authors: Kiyohara T. , Kumakiri M. , Kobayashi H. , Ohkawara A. , Lao L‐M.
Published: March 2003

A 55‐year‐old woman presented with an asymptomatic red plaque on the left upper back for 6 or 7 years. The lesion was depressed in response to finger pressure. The clinical diagnosis was anetoderma. Histopathologically, the characteristic cells of cellular dermatofibroma proliferated within the thinned dermis, which showed atrophy of about 60 or 70%. The proliferated cells were positive for factor XIIIa and negative for CD34. The involved dermis showed the loss of elastic fibers on elastica van Gieson stain. Electron microscopically, the proliferating cells phagocytized the elastic fibers. We report a typical case of atrophic dermatofibroma and show the possibility that the cause of this disease might be elastophagocytosis between the collagen fibers by the dermatofibroma cells.
Unusual second malignancies following radiation therapy: subcutaneous pleomorphic rhabdomyosarcoma and cutaneous melanoma. Two case reports
Authors: Miracco Clelia , Materno Maria , De Santi Maria Margherita , Pirtoli Luigi , Ninfo Vito
Published: March 2003

Background: Among nonepithelial second neoplasms which are known to be induced by irradiation, rhabdomyosarcomas are extremely rare, and melanomas are infrequent. We report a high‐grade sarcoma with rhabdomyoblastic differentiation, which appeared 30 years after megavoltage irradiation for an endometrial adenocarcinoma, and a malignant melanoma which arose after 6 years in the irradiation field of a fibrosarcoma.

Methods: Histology and immunohistochemistry were performed in both cases. In the first case, electron microscopy was also performed. In the second, the previous tumor was re‐evaluated.

Results: The first case showed histological, immunohistochemical and ultrastructural features of a rhabdomyosarcoma. In the second case, a lentigoid malignant melanoma was histologically and immunohistochemically demonstrated, whereas the previously resected tumor was a fibrosarcoma negative to melanoma markers.

Conclusions: Rare cases of rhabdomyosarcomas and melanomas are induced by irradiation, although in some cases other factors (i.e., genetic risk, chemotherapy) may have a prominent etiopathogenetic role in their development. A close follow‐up and a careful examination of the irradiated area should facilitate an early diagnosis of these aggressive postradiation second neoplasms.
Cutaneous carcinomas and preinvasive neoplastic lesions. Role of MMP‐2 and MMP‐9 metalloproteinases in neoplastic invasion and their relationship with proliferative activity and p53 expression
Authors: Verdolini Roberto , Amerio Paolo , Goteri Gaia , Bugatti Leonardo , Lucarini Guendalina , Mannello Bruno , Filosa Giorgio , Offidani Annamaria , Brancorsini Donatella , Biagini Graziella , Giangiacomi Mirella
Published: March 2003

Background: Metalloproteinases (MMPs) are thought to be involved in the process of destruction of basement membranes and stromal invasion by neoplastic epithelial cells.

Aims: In order to investigate the role of MMPs in cutaneous oncogenesis we studied the expression of MMP‐2 and MMP‐9 in 34 cases of epidermal preinvasive neoplastic lesions and invasive carcinomas. We also studied their relationship with the expression of tissue inhibitors of MMPs and with proliferative activity and p53 expression in neoplastic epithelial cells.

Results: MMP‐9 was found to be focally expressed by neoplastic epithelial cells at the infiltrative edges in microinvasive carcinomas and in dyskeratotic foci in Bowen’s disease and widely invasive carcinomas. Gradation of Mib‐1 positivity and p53 expression was found with increasing abnormality in the spectrum of malignancy.

Conclusions: Our results seem to suggest the involvement of MMPs in microinvasive carcinomas, which show also low proliferative activity and p53 expression, whether other factors seem to be more important in widely invasive carcinomas.
Programmed cell death in human acute cutaneous wounds
Authors: Edwards Malcolm J. , Jones Dylan W.
Published: March 2003

Resolution of the inflammatory response in acute cutaneous wounds is critical to healing and delays in this process may lead to impaired wound maturation and closure. Apoptotic cells were identified by histological examination of tissue sections and by in situ TdT‐mediated dUTP end‐labelling of DNA fragments. Apoptotic cells were detected in the dermal inflammatory infiltrate at the wound margins and in the granulation tissue of 7‐day healing wounds. In 42‐day healing wounds a large proportion of the apoptotic cells were localised to the mature granulation tissue and to the dermal inflammatory infiltrate under the newly closed epidermis. Apoptotic cells were not detected in the epidermis of 7‐day and 42‐day healing wounds. The percentage of apoptotic cells to the total number of cells in the dermal inflammatory infiltrate of 7‐day wounds was 30.5% (26–35%) and 60.7% (range 56–67%) in 42‐day healing wounds. The existence of an overall relationship between the numbers of apoptotic cells in the 7‐day and 42‐day healing wounds was determined using the Spearman’s rank correlation coefficient. Taking all the samples into consideration, apoptosis in 7‐day wounds was not found to be related (r=0.123, p=0.050) to apoptosis in the 42‐day healing wounds. This study demonstrates that programmed cell death or apoptosis is responsible for the elimination of the dermal inflammatory infiltrate from healing human cutaneous acute wounds.