bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral mucosal lesions in a representative cross‐sectional study of aging Germans
Authors: Reichart Peter A.
Published: March 2003

Abstract – Objectives: To determine prevalence of oral mucosal lesions in a cross‐sectional study among aging Germans. Methods: Three specially trained dental teams examined adults (35–44 yrs, Group 1) and senior individuals (65–74 yrs, Group 2) in 90 sample points of which 60 were located in the former West and 30 in the former East part of Germany. The spectrum comprised 28 different oral lesions with subforms. Results: 655 individuals in Group 1 (35–44 yrs) and 1367 individuals in Group 2 (65–74 yrs) were studied. 33.8% (Group 1) and 33.9% (Group 2) were without any pathology of the oral mucosa. Several lesions were not recorded in both Groups like oral hairy leukoplakia and gingival hyperplasia (Group 1 and two) and xerostomia (Group 1). In Group 1 history for labial herpetic lesions (31.7%), Fordyce granules (26.6%), history for recurrent aphthous ulceration (18.3%) and lip and/or cheek biting (10.1%) were recorded. In Group 2 Fordyce granules (23.7%), history of labial herpes (20.0%), plicated tongue (19.0%) and denture stomatitis (18.3%) were those lesions most frequently recorded. Leukoplakia was seen in 1.8% (West) and 0.9% (East) respectively; men were more often affected than women (2.3% versus 0.0% P<0.05, Group 1; 2.3% versus 0.9%, Group 2. There was association between the prevalence of leukoplakia and a lower (3.3%) or higher educational level (0.5%). Denture associated lesions were seen in 18.3% (Group 2) compared to 2.5% (Group 1) (P<0.001). Other age‐related lesions were lip and/or cheek biting being more prevalent in Group 1 10.1% versus 1.9% (P<0.001), plicated tongue 19.0% in Group 2 versus 3.8% in Group 1 (P<0.001). Conclusions: The present study has shown prevalence to be comparable to other relevant Western European studies. Since the spectrum of oral mucosal lesions changes with age and increases with general morbidity, routine examinations of oral cavities of the aging are mandatory particularly to detect early precancerous and other mucosal lesions.
Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow‐up study
Authors: Aartman Irene H. A. , De Jongh Ad , Makkes Peter C. , Hoogstraten Johan
Published: March 2003

Abstract – Objectives: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post‐treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. Methods: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (Tl) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S‐DAI); the Symptom Checklist 90 (SCL‐90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). Results: ANOVA showed that the DAS and S‐DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow‐up. Conclusions: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.
Factors associated with dental anxiety and attendance in middle‐aged and elderly women
Authors: Hägglin Catharina , Hakeberg Magnus , Ahlqwist Margareta , Sullivan Marianne , Berggren Ulf
Published: March 2003

Abstract – The aim of this study was to analyze the association between dental anxiety, dental attendance, health status and social factors. Our previous studies have shown that dental anxiety declines with age and is associated with poor oral health. In addition, correlations between dental anxiety, dental utilization and dental status have been revealed. However, the association of these factors with general health and social factors has not been analyzed in our previous studies. In a study of women's health in Göteborg, Sweden in 1992, 1017 urban women aged 38 to 84 years took part in a series of investigations including clinical examinations, interviews and questionnaires. In addition to descriptive and simple inference statistics, a two‐part multiple logistic regression model was utilized to investigate dental anxiety and dental utilization. Dental fear was less prevalent among older women, dentate or not, although 10% of females 62 years of age and older still reported high dental anxiety (DAS≥12). 94% of the younger (≤62 yr) and 76% of the older (≥70 yr) women reported regular dental attendance. When separating all women into dentate and edentulous groups, 94% of the dentate and 11% of the edentulous respondents reported regular dental care. Due to the large difference in dental attendance between dentate and edentulous women, these groups were analyzed separately. Multiple logistic regression analyses showed that the following factors were associated with irregular dental utilization among dentate women: high dental anxiety, fewer teeth and restorations, more caries, poorer chewing ability and dissatisfaction with dental esthetics. In the multiple regression for dental anxiety, high fear was shown to be associated with irregular dental care, age (younger), fewer teeth, dissatisfaction with dental esthetics and lower scores on the SF‐36 mental health scale. A separate analysis showed that individuals with high fear and regular, as opposed to irregular, dental attendance had more teeth at a statistically significant level, which were less often decayed and more often restored. In spite of the group with high fear and irregular attendance having fewer teeth, their level of decay was seven times higher. Overall, the results indicate a strong association between dental fear and dental attendance. Weak associations were found among socio‐economic, dental health and general health factors.
Outlining the morphological characteristics of acceptable occlusion
Authors: Svedström‐Oristo Anna‐Liisa , Pietilä Terttu , Pietilä Ilpo , Alanen Pentti , Varrela Juha
Published: March 2003

Abstract – Objectives: The aim of this study was to outline the definitions of a morphologically acceptable occlusion in young adults that could be applied to assess the outcome and effectiveness of orthodontic treatment. The opinions of Finnish orthodontists and general practitioners were investigated for this purpose. Methods: A semi‐structured questionnaire was sent to all health centres where at least one orthodontist was employed (n=37), to health centres without any orthodontist (n=31), to private orthodontists working as consultants (n=12) and to orthodontists working at university dental clinics (n=13). The criteria for moderate and little orthodontic treatment need in the Need of Orthodontic Treatment Index (NOTI) and the Index of Orthodontic Treatment Need (IOTN) were chosen to describe the basic characteristics of occlusal acceptability. Results: The questionnaire was returned by 76 subjects (82%). The respondents’ views on an acceptable occlusion in young adults were not totally in line with the chosen definitions. Only 16% of the respondents accepted the definitions of both indices as such; the criteria in NOTI were accepted by 25% and those in IOTN by 21% of the respondents. Functional considerations of the occlusion were the main reasons for the desire for further details in the description of an acceptable occlusion. Crossbites with a discrepancy between retruded contact position and intercuspal position were the least accepted anomalies. The opinions were statistically significantly associated with the level of the respondents’ orthodontic education and their type of employment. Conclusions: We conclude that the selected definitions of NOTI and IOTN can serve as a basis for the characteristics of a morphologically acceptable occlusion in young Finnish adults, but measures of the functional aspects of occlusion must be added for studies on the outcome of orthodontic services.
A clinical index for evaluating and monitoring dental erosion
Authors: Larsen Inge Birk , Westergaard Jytte , Stoltze Kaj , Larsen Anders Ingemann , Gyntelberg Finn , Holmstrup Palle
Published: March 2003

Abstract – This study describes a new fine‐scaled system for classifying initial and advanced dental erosions. The system includes the use of study casts of the teeth in an epoxy resin with an accurate surface reproduction. The severity of erosion on each tooth surface is scored according to six grades of severity. In addition, the presence of a Class V restoration and dental erosion on the same surface increases the erosion score, as it is assumed that the need for restorative treatment can be caused by the erosion. A high inter‐examiner agreement was found when the present scoring system was used by two examiners on the same sample. With this prerequisite it is proposed that an index value for facial, oral, incisal/occlusal and cervical surfaces is calculated as the mean value of scores for the respective surfaces. The index values represent the severity of tooth substance loss in various locations of the oral cavity and are furthermore suitable for data analysis. The system is thereby well‐suited for determining etiologic factors and monitoring the progression of erosion over time.
Xylitol candies in caries prevention: results of a field study in Estonian children
Authors: Alanen Pentti , Isokangas Pauli , Gutmann Kristjan
Published: March 2003

Abstract – All field studies have unequivocally reported significant reductions in dental caries occurrence associated with the use of chewing gum containing xylitol. No other xylitol products besides chewing gum have so far been tested in field trials. A 5‐year follow‐up study with 2‐ or 3‐year xylitol consumption periods began in Estonia in 1994 with 740 10‐year‐old children in 12 schools at baseline examinations. For the study, 3 clusters each including 3–5 schools were formed on the basis of baseline caries experience. The products were used under the supervision of the teachers 3 times per day during school days but not during weekends or during the 3‐month summer holiday. The daily dose of xylitol was 5 g in all groups. The children were examined every year in September by two experienced clinicians. Dental caries was recorded according to WHO criteria. After 3 years, all xylitol groups showed a highly significant 35%–60% reduction in caries incident, compared with the corresponding control groups. The differences between candies, between candies and chewing gum, and between 2‐ and 3‐year users in the xylitol groups were non‐systematic, indicating no trends between the groups. The results suggest that not only xylitol chewing gum but also xylitol candies are effective in caries prevention, and that a school‐based delivery system seems to offer a practical way to distribute and control the use of the xylitol products.
Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6‐ to 36‐month‐old children
Authors: Milgrom P. , Riedy C. A. , Weinstein P. , Tanner A. C. R. , Manibusan L. , Bruss J.
Published: March 2003

Abstract – Caufield et al. (1) have suggested that the acquisition of mutans streptococci in young children most likely takes place during a “window of infectivity” from 19 to 31 months of age. Objectives and Methods: This study determined the prevalence of dental caries and bacterial infection in a randomly selected sample of 199 children 6 to 36 months old from the island of Saipan in the Commonwealth of the Northern Mariana Islands, USA. The relationships between caries and Streptococcus mutans infection, hypoplasia, diet and oral hygiene behavior were investigated. Results and Conclusions: The overall estimated prevalence of caries was high: 46.8% of the children had white spot lesions and 39.1% had enamel cavitation. Colonization was seen in very young children; S. mutans was detected in 25% of the predentate children. The results of multi‐variable modeling support the hypothesis that bacterial infection, diet, and hypoplasia are important in the etiology of dental caries in this population. Adjusted for age and ethnicity, children with a high level of S. mutans detected were 5 times more likely to have dental caries than children with a lower level of S. mutans detected. Hypoplasia and a high cariogenicity score (diet) were also significant independent predictors. The odds of having any white spot lesions or enamel cavitation were 9.6 times greater for children with any hypoplasia, and 7.8 times greater for children with high cariogenicity scores relative to those with lower scores after adjusting for level of S. mutans, age and ethnicity. Sleeping with a bottle, maternal sharing of utensils, and high snacking frequency were not significant predictors of caries in this population.
Social inequality in oral health and use of dental care in Sweden
Authors: Hjern Anders , Grindefjord Margaret , Sundberg Hans , Rosén Måns
Published: March 2003

Abstract – Objective: To describe oral health and use of dental care in relation to socio‐economic determinants over time in Sweden. Methods: Cross‐sectional study based on interview data on two randomly sampled sequential populations consisting of 7610 Swedish adult (25–64 years) residents and 4315 children (3–15 years) in their households from the Survey of Living Conditions 1996–97, and 7649 adult Swedish residents (25–64 years) from the survey of 1988–89. Results: Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996–97 survey in the adult study population (adjusted odds ratios 1.6–2.9). The same socio‐economic determinants were associated with caries in children (adjusted odds ratios 1.2–1.5). The socio‐economic differences in dental treatment and problems with chewing were greater in the age group 45–64 years compared to 25–44‐year‐olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5–8.1) in the 1988–89 survey to 9.1% (8.4–9.8) in the 1996–97 survey. A similar increase, from 2.4% (2.2–2.6) to 4.4% (3.9–4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio‐economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. Conclusion: This study demonstrates that socio‐economic differences in oral health and use of dental care are most marked in older (45–64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.
Adolescents’ sense of coherence, oral health status, and oral health‐related behaviours
Authors: Do Carmo Matias Freire Maria , Sheiham Aubrey , Hardy Rebecca
Published: March 2003

Abstract – Objective: To investigate the relationship between sense of coherence (SOC) and oral health. It was hypothesised that subjects with better oral health status and better oral health‐related behaviours have higher levels of SOC. Methods: A cross‐sectional study was conducted in Goiânia‐GO, Middle‐West Brazil, on a sample of 664 15‐year‐olds randomly selected from schools. Data were collected through questionnaires, the short version of Antonovsky’s SOC Scale (13‐item) and clinical dental examinations. Multiple logistic regression and polytomous ordered regression were used in the data analysis. Two sets of outcome variables were selected for the analyses: oral health status (dental caries, oral cleanliness, and periodontal disease), and oral health‐related behaviours (frequency of sugar intake, toothbrushing frequency, and pattern of dental attendance). Results: Adolescents’ SOC was associated with their caries experience in anterior teeth (OR=0.81 for 10 units increase in SOC scale; 95% CI=0.66–0.98), but the relationship did not remain significant after controlling for other factors. Adolescents with higher SOC were less likely to visit the dentist mainly when in trouble, compared with those with lower SOC (OR=0.83, 95% CI=0.71–0.98), or equivalently more likely to visit for mainly check‐ups. Other measures of oral health status and behaviours were not significantly associated with SOC. Conclusion: SOC was identified as a psychosocial determinant of adolescents’ oral health‐related behaviour, particularly affecting their pattern of dental attendance.
Evaluation of oral health promotion in the workplace: the effects on dental care costs and frequency of dental visits
Authors: Ide Reiko , Mizoue Tetsuya , Tsukiyama Yuji , Ikeda Masato , Yoshimura Takesumi
Published: March 2003

Abstract – An oral health promotion program has been conducted since 1989 at a shipyard in Japan. Aims: The purpose of the present study was to assess the impact of oral health promotion in the workplace in terms of dental care costs and frequency of dental visits. Methods: This program consisted of orientation, an initial regimen, and group counseling. The initial regimen included an evaluation of each participant’s oral health status, and instruction concerning oral hygiene, and prevention of oral disease. The participants were selected with each unit being a preexisting peer group. Eighty‐seven participants were compared with 216 control subjects in terms of annual dental care costs and frequency of dental visits in four periods: the 1‐year period before the program, the 1st year after the program, the 2nd year after, and the 3rd year after. Results: The annual mean dental care cost in the participant group for the year prior to the program was higher than that in the control group (21 317 vs. 17 116 yen). In the 1st year after the program, the difference increased (26 642 vs. 19 481 yen). In the 2nd and 3rd years after the program, dental care costs in the participant group were lower than those in the control group (2nd year: 18 305 vs. 22 841 yen, 3rd year: 16 911 vs. 21 920 yen). Conclusions: It can be concluded that this oral health promotion program in the workplace contributed to saving of costs associated with dental care. The workplace can be regarded as a key area for implementation of an oral health care system to make good use of limited resources.
Longitudinal study on periodontal conditions in healthy elderly people in Japan
Authors: Hirotomi Toshinobu , Yoshihara Akihiro , Yano Masatoshi , Ando Yuichi , Miyazaki Hideo
Published: March 2003

Abstract –

Objectives: A strategy for the control of periodontal disease progression is required to prevent tooth loss in older people. However, detailed epidemiological data on periodontal conditions in elderly people is limited. The purpose of the present study is to describe the natural history of periodontal disease and to evaluate the intraoral factors relating to the disease progression in systemically healthy elderly people.

Methods: In the cross‐sectional study, 599 and 162 subjects aged 70 and 80 years, respectively, were examined. Of those subjects aged 70 years, 436 (73%) participated in the 2‐year longitudinal study. Pocket depth (PD) and attachment level (AL) were measured for all functioning teeth at six sites per tooth. In the cross‐sectional study, AL of 4 mm or greater and 7 mm or greater were defined as moderate and severe disease, respectively. In the longitudinal study, a change in AL of 3 mm or greater at each site was defined as periodontal disease progression.

Results: In the cross‐sectional study, 97.1% of the subjects had at least one site of AL of 4 mm or greater (4+ mm). The prevalence of AL of 7 mm or greater (7+ mm) was 47.9%, with 2.8 affected teeth per person in those with AL 7+ mm. These findings reveal that periodontal disease is extremely widespread in the elderly population. However, very few had many teeth with severe periodontal conditions. In the longitudinal study, 75.1% experienced attachment loss of 3 mm or greater (3+ mm) during the 2‐year study period. Of those subjects who experienced attachment loss, a mean of 4.7 teeth exhibited attachment loss. Multivariate logistic regression showed that both the highest AL in each tooth at baseline and abutment teeth for removable partial dentures were significantly related to periodontal disease progression as well as tooth loss incidence.

Conclusions: These results suggest that teeth with poor periodontal conditions as well as abutment teeth for removable partial dentures were significant intraoral factors relating to periodontal disease progression as well as tooth loss.
Do young adults demand more dental services as their income increases?
Authors: Grytten Jostein , Holst Dorthe
Published: March 2003

Abstract  – Several studies from the USA have shown that there is a positive and strong relationship between income and demand for dental care. All these studies have been performed on populations where treatment needs were high. Today, young adults represent one group of the population where treatment needs are low. But young adults will not necessarily demand or utilize more dental services as their income increases. As we do not know the extent to which demand will increase when income increases among young adults, future needs for dental manpower could be less than predicted from previous studies. The aim of the present study was to examine the relationship between income and demand/utilization for dental services among young adults in Norway. The analyses were performed on two large sets of survey data, collected in 1985 and 1995, which were representative of the Norwegian population aged 20 years and above. The main finding was that the increase in demand with an increase in income was less for young adults than for older adults. In particular, there was a marked fall in the income elasticities among young adults from 1985 to 1995. The fall in the income elasticity corresponds to a marked decrease in the prevalence of dental diseases among young adults during that period. Our results imply that future policies for dental manpower should take into account the lower income elasticity for young adults compared to for older adults, and that future needs for dental personnel should be planned accordingly.
Development of clinical practice guidelines for dentists: methods for topic selection
Authors: Van Der Sanden Wil J. M. , Mettes Dirk G. , Grol Richard P. T. M. , Plasschaert Alphons J. M. , Verdonschot Emiel H.
Published: March 2003

Abstract –

Objectives: The aim of this study was to compare four methods for assessing the preferences of the dental profession for topics to be considered for the development of clinical practice guidelines.

Methods:  The methods were: (1) a survey among dentists, (2) an analysis of topics discussed in dental peer groups, and (3) screening of dental journals. A fourth method was obtained from method number 3. The frequencies of the reported topics were calculated for each of the methods. For the fourth method, the number of publications per topic were plotted against the year of publication, and the slope of the linear regression line was used as an indicator. Within each of the four methods, the topics were ranked according to the frequency in which they were reported, and to the slope value. The reliability of the methods was tested by the “item‐rest sum correlation”, which is the correlation of the rank positions of one method with the sum of the rank positions obtained by the remaining three methods.

Results:  In using all methods, a total of 1027 topics were obtained. Reclassification resulted in 34 topics. Moderate item‐rest sum correlations ranging from 0.34 to 0.48 were found for all methods, indicating that the rank order of every method moderately predicts the sum of the rank orders obtained by all other methods. The topic ‘prevention of cross‐infection’ had the highest overall rank position.

Conclusion:  It is concluded that the four applied methods appeared to provide a consistent ranking of potential topics. In view of the fact that the questionnaire method is generally applicable, this method should be preferred for assessing dentists' preferences for topics to be considered for the development of clinical practice guidelines.
Dentistry between pathology and cosmetics
Authors: Marthaler Thomas M.
Published: March 2003

In ancient and medieval times, the prevalence of caries and periodontal disease varied. There were no treatments for dental hard tissue, but dental cosmetics played an important role. In the late 19th century, caries levels reached a maximum in Europe and North America after refined sugar became a cheap staple food. Toothlessness became frequent even in young adults. Caries prevention, effective on a public health scale, began with the introduction of water fluoridation in the 1940s. By 1985, dental academia had acknowledged that substantial declines could also be obtained in entire populations through topical fluorides, mainly in toothpastes. While decreasing caries prevalence is irrefutable in affluent countries, the specific reasons of the decline are still a matter of debate.

In countries where caries has declined substantially, activities of dentists are shifting towards cosmetic dentistry. However, caries continues to be a problem for the lower socioeconomic strata, even in affluent countries, and is a serious problem in developing countries. Thus, water fluoridation is still important, and salt fluoridation should be considered where water fluoridation is not feasible. Both measures are extremely cheap to implement. Controlled fluoridation has a great potential for developing countries and low social strata of affluent countries. Its reduced effectiveness in high socioeconomic strata of affluent countries, due to the widespread usage of fluoride in toothpastes and other oral care products, should not detract from the public health value of fluoridation.
Psychological factors and perceptions of pain associated with dental treatment
Authors: Maggirias J. , Locker D.
Published: March 2003

Although pain during dental treatment has been identified as playing a major role in the onset of dental anxiety and is a major concern of patients when seeking dental care, there have been very few studies of the prevalence of pain during dental treatment and the factors associated with patients' perceptions of pain. This study used data from a longitudinal population‐based study to assess the proportion of dental attenders who experienced pain while having dental treatment and the psychological characteristics which predisposed them to experience pain. Of 1422 subjects who completed questionnaires at baseline and five‐year follow‐up, 96.4% had visited a dentist over the observation period. Two fifths, 42.5%, reported having pain during treatment and one‐fifth, 19.1%, had pain that was moderate to severe in intensity. Reports of pain were associated with the types of treatment received, and a number of baseline sociodemographic and psychological factors. In a logistic regression analysis predicting the probability of pain, a variable documenting the number of types of invasive treatment received (restorations, extractions, crowns/bridges, root canal therapy and periodontal treatment/surgery) had the strongest independent effect. Pain was also more likely to be reported by those with previous painful experiences and those who were anxious about dental treatment, expected treatment to be painful and felt that they had little control over the treatment process. Pain was less likely to be reported by those who said they were unwilling to accept or tolerate pain. Younger subjects and those with higher levels of education were more likely to report pain than older subjects and those with a lower educational level. These results indicate that pain is as much a cognitive and emotional construct as a physiological experience. They also have implications for dentists' behaviour when providing dental care.
The emergence of permanent teeth in Flemish children
Authors: Leroy Roos , Bogaerts Kris , Lesaffre Emmanuel , Declerck Dominique
Published: March 2003

Abstract – The aim of the present study was to investigate the timing of emergence of permanent teeth in Flanders (Belgium). Data were obtained in the Signal‐Tandmobiel® projecta, a longitudinal study in a sample of 4468 Flemish children. Survival analysis with a log‐logistic distribution was performed to calculate median (and mean) values and 95% CI's for all permanent teeth. The analysis indicated significantly earlier emergence ages in girls than in boys. The emergence pattern turned out to be symmetric in both sexes. Most mandibular teeth emerged significantly before their antagonists, in boys as well as in girls. These findings are in agreement with other studies on the emergence of permanent teeth.
Activation and cross‐reactivity pattern of a new allergen in adhesive plaster
Authors: Bergendorff O. , Hansson C.
Published: March 2003

N,N′‐disalicylidene‐1,2‐diaminopropane is a copper inhibitor present in some adhesive plasters, rubber products and gasoline. Upon contact with water it is hydrolyzed to salicylaldehyde and 1,2‐diaminopropane. All patients in this study showed positive patch‐test reactions to N,N′‐disalicylidene‐1,2‐diaminopropane, and also to 1,2‐diaminopropane and ethylenediamine. None reacted to salicylaldehyde. Patch testing with different N,N′‐disalicylidene‐derivatives showed localization of the amino groups in positions 1 and 2 to be a prerequisite of cross‐reactivity to 1,2‐diaminopropane and ethylenediamine. An extraction procedure and a high‐performance liquid chromatography (HPLC) method for the analysis of adhesive plasters is described. Studies of the hydrolysis of the copper inhibitor at physiological pH showed rapid formation of 1,2‐diaminopropane under biomimetic conditions.
Severe dermographism after topical therapy with diphenylcyclopropenone for alopecia universalis
Authors: Skrebova Natalja , Nameda Yumiko , Takiwaki Hirotsugu , Arase Seiji
Published: March 2003

We describe here a 19‐year‐old Japanese man with an 11‐year history of alopecia universalis, who, after the 1st application of a 0.003% diphenylcyclopropenone (DPCP) solution to the whole scalp, developed acute contact dermatitis at the test site, together with widespread severe dermographism. Every 3 weeks, persistence of the severe urticarial reaction and efficacy of treatment were monitored by constant pressure stimuli in a series of pressure tests, and subsequently evaluated by laser Doppler flowmetry (LDF). Although, on pressure tests, the urticarial response was found to significantly improve after starting treatment, erythematous responses continued to appear for nearly 3 months. The persistent course of these side‐effects in our patient strongly suggests that precautions must currently be taken in the therapeutic use of potent sensitizers such as DPCP.
The importance of exposure estimation in the assessment of skin sensitization risk
Authors: Robinson Michael K. , Gerberick G. Frank , Ryan Cindy A. , McNamee Pauline , White Ian R. , Basketter David A.
Published: March 2003

The development of new ingredients and products for the consumer market requires a thorough assessment of their potential for skin sensitization and the possible clinical manifestation of allergic contact dermatitis. The process by which low molecular weight chemicals induce and elicit skin sensitization reactions is complex and dependent on many factors relevant to the ability of the chemical to penetrate the skin, react with protein, and trigger the cell‐mediated immune response. These major factors include inherent potency, chemical dose, duration and frequency of exposure, vehicle or product matrix, and occlusion. The fact that a chemical is a contact allergen does not mean that it cannot be formulated into a consumer product at levels well tolerated by most individuals. Many common ingredients (e.g., fragrances, preservatives) are known skin allergens. However, all allergens show dose‐response and threshold characteristics. Therefore, one should be able to incorporate these chemicals into products at levels that produce acceptably low incidences of skin sensitization under foreseeable conditions of exposure. The critical exposure determinant for evaluating skin sensitization risk is dose per unit area of skin exposed. Use of this parameter allows for comparative assessments from different types of skin sensitization tests (including cross‐species comparisons), and, at least for known potent allergens, there is remarkable similarity in threshold dose/unit area determinations across species. The dose/unit area calculation enables a judgment of the sensitization risk for different product types. This is illustrated using the chemical preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) as a case study.
Metal‐induced generalized pruriginous dermatitis and endovascular surgery
Authors: Giménez‐Arnau Ana , Riambau Vicente , Serra‐Baldrich Esther , Camarasa José G.
Published: March 2003

Metal contact allergy is a common problem in the general population. Diagnostic and therapeutic medical‐surgical procedures in which metals can be responsible for eczema are diverse. Endovascular aortic surgery is still an experimental but less invasive technique. A generalized eczematous dermatitis elicited by metal of an endovascular prosthesis is presented. An abdominal aortic aneurysm was diagnosed in a 79‐year‐old woman. Endoluminal repair with a straight Vanguard® endograft was successful. 3 weeks later, she suffered a severe episode of erythema and eczema on the legs. Since then, she complained of continuous pruritus with eczema and excoriated papules. The dermatitis and also the patch test pathology showed eczema. Patch testing was positive to nickel sulfate and cobalt chloride. An endograft semi‐quantitative metal analysis was performed with plasma‐induction joint mass‐spectrometry. The self‐expanding metal stent was mainly composed of nickel (∼55%) and titanium (21%) with reinforcing thread of platinum. Antimony was detected only in the polyester textile. These results are consistent with Nitinol® composition. The need for preoperative patch testing for metals is controversial. Enquiry about metal allergy is recommended before endoluminal surgical procedures. In the near future, the design of endografts must take into account the possibility of this sort of reaction.
Reduced nickel sensitivity in young Danish women following regulation of nickel exposure
Authors: Veien Niels K. , Hattel Thais , Laurberg Grete
Published: March 2003

In most western countries, nickel is the most common contact allergen among young women. In 1991, Denmark implemented a statutory order calling for the reduction of exposure to nickel in nickel‐plated items in close contact with the skin. In a retrospective analysis, a comparison is made of the number of positive patch tests to nickel seen in a private practice of dermatology before and after this statutory order was implemented. From 1 January 1986 to 31 December 1989, 35 of 1135 (3.1%) men patch tested and 628 of 3024 (20.8%) women patch tested had positive reactions to nickel. From 1 January 1996 to 31 December 1999, 48 of 1104 (4.3%) men and 424 of 2193 (19.3%) women had positive patch tests to nickel. During the 1st period, 155 of 702 women under the age of 20 (22.1%) had positive patch tests to nickel, compared to 54 of 324 (16.7%) during the second period (p<0.05). The most likely explanations of this decrease in nickel sensitivity are reduced exposure to nickel and increased public awareness of the risk of nickel sensitization.
Tixocortol pivalate contact allergy in the GPMT: frequency and cross‐reactivity
Authors: Frankild S. , Lepoittevin J.‐P. , Kreilgaard B. , Andersen K. E.
Published: March 2003

In spite of their intrinsic anti‐inflammatory properties, corticosteroids can induce contact allergy. When studying the allergenic properties of corticosteroids it has to be considered that both the allergenic and anti‐inflammatory effect may influence the induction phase as well as the elicitation phase and that such effects may be dose‐dependent. A multiple dose guinea pig maximization test (GPMT) was therefore used to study the dose‐response relationship of tixocortol pivalate. The GPMT was conducted according to OECD guideline #406, using a multiple‐dose design and test results were analysed with logistic regression analysis. There was a significant tixocortol pivalate sensitization of the test animals compared to the control group (p<0.05), after both challenge and re‐challenge. The challenge with 1% tixocortol pivalate gave more positive reactions than the challenge with 3%. The highest frequency of positive animals was observed when the animals were treated with low to intermediate induction concentrations and intermediate to high challenge concentrations with tixocortol pivalate in the TRUE TestTM. Cross‐reactivity was found between tixocortol pivalate and hydrocortisone, which was expected from their close molecular resemblance, whereas no cross‐reactivity was seen between tixocortol pivalate and the 3 other corticosteroids: amcinonide, budesonide, and hydrocortisone‐17‐butyrate.
Ethnic variation in the skin irritation response
Authors: Foy V , Weinkauf R , Whittle E , Basketter D. A
Published: March 2003

There is a widespread, but largely unsubstantiated, view that certain skin types may be more susceptible to the effect of skin irritants than others. One expression of this would be that certain ethnic groups may also be more likely to experience skin irritation. As a consequence, when evaluating the skin compatibility of substances/preparations, these differences may need to be taken into account. However, other evidence indicates that, within any particular group, inter‐individual variation is likely to be much larger than the differences between means for distinct groups. In this study, we have investigated 2 carefully matched panels of Caucasian and Japanese women volunteers to determine their topical irritant reaction, both acute and cumulative, to a range of materials. The results indicated that the acute irritant response tended to be greater in the Japanese panel and this reached statistical significance with the stronger irritants. Cumulative irritation was investigated only with the weaker irritants and, although again the trend was to a higher response in Japanese compared to Caucasian panelists, this rarely reached significance. Nevertheless, where risk assessment for skin irritation was critical, then at the population level, these differences might be relevant, both for safety in use of substances and products and for skin acceptability.
Allergenicity of natural rubber latex gloves
Authors: Brehler Randolf , Rütter Anita , Kütting Birgitta
Published: March 2003

The concentrations of proteins, allergens and rubber chemicals are essential parameters of the allergenicity of NRL gloves. To date, a standardized method has been given only for analysis of the protein concentration (DIN EN 455‐3), and not for the concentrations of allergens and rubber chemicals. In the present study, we investigated 11 brands of surgical gloves currently available on the German market. Additionally 1 glove, not subjected to final leaching procedures, was added for comparison purposes. Protein concentrations were analysed by different methods in different laboratories. Allergen concentrations were assayed by prick tests in NRL‐allergic volunteers and by RAST inhibition methods. Rubber chemicals were analysed by HPTLC and GC. The protein concentrations analysed by the Lowry method in the 2 laboratories gave concordant results, but the correlations between protein and allergen concentrations were low. The protein concentration analysed by HPLC correlated with the allergen concentration, and gave better information on the allergenicity of the gloves. The development of standardized methods for allergen analysis in the assessment routine is necessary, due to significant discrepancy between protein and allergen levels of some gloves. Thiurams were not found in any of the gloves, though carbamates were present in all gloves tested. Our data indicate that washing procedures have little or no effect on the concentration of rubber chemicals.
Skin protection in bakers' apprentices
Authors: Bauer Andrea , Kelterer Daniela , Bartsch Reinhard , Pearson James , Stadeler Martina , Kleesz Peter , Elsner Peter , Williams Hywel
Published: March 2003

Skin protection measures − barrier creams, protective gloves – and skin care are widely recommended for the prevention of occupational hand dermatitis (HD) in skin risk professions, but there is hardly anything known about uptake levels of the measures. The objective of this controlled intervention study was to quantify the uptake and maintenance of skin protection and skin care measures in first‐year bakers' apprentices. A total of 94 first‐year bakers' apprentices were included in the study in September 2000. The apprentices were assigned to the skin protection and control group class‐wise to reduce contamination. The skin protection group comprised 39 apprentices who were trained in skin protection measures at the beginning and after 4 weeks of training. 55 apprentices were assigned to the control group representing no skin protection intervention. Standardized interviews took place at the beginning of the training and at 4 monthly follow‐ups (FU). The uptake of skin protection measures differed significantly between the groups (barrier cream p < 0.0001, protective gloves p = 0.046, skin care p = 0.025). Barrier cream use in the skin protection group was incorporated in the daily routine very well from the start and reached 100% at the end of the examination period (4th FU). At this time, only 3.2% of the controls used barrier creams. The level of acceptance of protective gloves (4th FU: skin protection group 43.3%; controls 32.3%) was considerably lower than that of barrier creams. The initial level of regular skin care was high in both groups (skin protection group 67.6%, controls 61.7%). After the intervention the acceptance of skin care rose to 88.9% in the skin protection group compared to 68.1% in the controls (4th FU). The present study has shown that skin protection and skin care measures can be introduced successfully in the daily routine of a skin risk occupation and high uptake and maintenance rates can be achieved.
Fragrance contact dermatitis – a worldwide multicenter investigation (Part III)
Authors: Larsen Walter , Nakayama Hideo , Fischer Torkil , Elsner Peter , Frosch Peter , Burrows Desmond , Jordan William , Shaw Stephanie , Wilkinson John , Marks James , Sugawara M. , Nethercott Marc , Nethercott James
Published: March 2003

The purpose of this study was to determine the frequency of responses to selected fragrance materials in patients who were fragrance sensitive. 218 fragrance sensitive subjects were evaluated in eight centres worldwide with a fragrance mixture (FM) and 17 less well‐studied fragrance materials. Reaction to the fragrance mixture (FM) occurred in 76% of the subjects. The (FM) detected all reactions to nerol and hydroxycitronellol and 93% of the reactions to clove bud oil. Ten fragrance materials were not detected by the FM and deserve further study: benzenepropanol, beta, beta, 3‐trimethyl, hexyl‐salicylate, dl‐citronellol, synthetic ylang ylang oil, benzyl mixture, cyclohexyl‐acetate, eugenyl methyl ether, isoeugenyl methyl ether, 3‐phenyl‐1‐propanol, and 3, 7‐dimethyl‐7‐methoxyoctan‐2‐ol.
Dosage considerations in patch testing with liquid allergens
Authors: Shaw Daniel W. , Zhai Hongbo , Maibach Howard I. , Niklasson Bo
Published: March 2003

This study examines reproducibility of water and ethanol drop volumes from plastic squeeze dropper bottles, examines the difference in drop volumes between commonly used liquid patch test solutions, and evaluates the volumes of water and ethanol needed to saturate Finn and IQ Chamber filter papers. 2 plastic squeeze dropper bottles recommended for use in patch testing have poor reproducibility compared to other bottles tested. 3 aqueous allergens tested (formaldehyde 1%, methylchloroisothiazolinone/methylisothiazolinone 0.01%, and dimethylol dihydroxyethyleneurea 4.5%) have drop volumes equivalent to water. Smaller drop volumes are produced by ethanol, hydrocortisone butyrate 1% in ethanol, cocamidopropyl betaine 1% aq., and propylene glycol 30% aq. Filter paper saturation volumes using distilled water are 16–19 µL in standard Finn Chambers and 29–35 µL in IQ Chambers. Ethanol saturation volumes are slightly lower. Previously recommended volumes of application for aqueous allergens of 15 µL for standard Finn Chambers and 25 µL for IQ Chambers (slightly below the filter paper saturation points) are appropriate. Selection of dropper bottles should consider drop volume reproducibility, differing drop volumes for different allergens, and the patch test chamber system being used.
Contact allergy to the Asteraceae plant Ambrosia artemisiifolia L. (ragweed) in sesquiterpenelactone‐sensitive patients in southern Sweden
Authors: Möller Halvor , Spirén Anna , Svensson Åke , Gruvberger Birgitta , Hindsén Monica , Bruze Magnus
Published: March 2003

Ambrosia artemisiifolia L. a classical cause of ragweed dermatitis in North America, is also found in Europe. 17 patients with contact allergy to sesquiterpene lactone (SL) mix were recalled for patch testing with extracts of North American and Swedish ragweed, the latter harvested in summer and autumn. 8/17 patients were test‐positive to the American extract, 14/17 to the Swedish summer extract and 15/17 to the autumn extract. All patients except 1 were found to have a chronic hand eczema of the pompholyx type. 5/16 hand eczema patients had a flare‐up of their pompholyx at patch testing. We concluded that patients with SL mix allergy are allergic to American as well as to Swedish ragweed. Pompholyx seems to be a frequent clinical picture in patients with SL mix allergy.
Long‐term follow‐up of successful orthodontic‐periodontal treatment of localized aggressive periodontitis: a case report
Authors: Harpenau Lisa A. , Boyd Robert L.
Published: March 2003

This report describes a case of localized aggressive periodontitis (localized juvenile periodontitis) that was jointly treated with conventional periodontal therapy, selective extractions to eliminate localized areas of vertical bone loss, and orthodontic therapy. A 20‐year follow‐up is described in this report. The success of periodontal treatment in a case such as this depends on making an accurate diagnosis, providing periodontal treatment to control the disease, and providing regular periodontal maintenance during and after orthodontic treatment.