bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta‐analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss
Authors: Hung Hsin‐Chia , Douglass Chester W.
Published: March 2003

Objective: This paper reports a meta‐analysis of studies that have investigated the effect of scaling and root planing on periodontal probing depth and attachment loss.

Material and methods: The criteria used for inclusion of studies were as follows: root planing and scaling alone was one of the primary treatment arms; patients or quadrants of each patient were randomly assigned to study groups; 80% of patients enrolled were included in first year follow‐up examinations; periodontal probing depth and attachment loss were reported in mm; the sample size of each study and substudy was reported. Sample size was used to weight the relative contribution of each study since standard errors were not reported by many studies and sample size is highly correlated with standard error and therefore statistically able to explain a substantial portion of the standard error on studies that use similar measures.

Results: The meta‐analysis results show that periodontal probing depth and gain of attachment level do not improve significantly following root planing and scaling for patients with shallow initial periodontal probing depths. However, there was about a 1‐mm reduction for medium initial periodontal probing depths and a 2‐mm reduction for deep initial periodontal probing depths. Similarly, there was about a 0.50‐mm gain in attachment for medium initial periodontal probing depth measurements and slightly more than a l‐mm gain in attachment for deep initial periodontal probing depth measurements. Surgical therapy for patients with deep initial probing depths showed better results than scaling and root planing in reducing probing depths. When patients were followed up over 3 years or more, these differences were reduced to less than 0.4 mm. Antibiotic therapy showed similar results to scaling and root planing. However, a consistent improvement in periodontal probing depth and gain of attachment is demonstrated when local antibiotic therapy is combined with root planing and scaling.
Residual periodontal defects distal to the mandibular second molar 6–36 months after impacted third molar extraction
Authors: Kan Kwok Wing , Liu Jerry K. S. , Lo Edward C. M. , Corbet Esmonde F. , Leung W. Keung
Published: March 2003

Aim: This retrospective study investigated the periodontal conditions distal to mandibular second molars 6–36 months after routine surgical extraction of adjacent impacted third molars.

Method: Subjects were randomly selected by systematic sampling from computer records of 3211 surgical mandibular third molar extractions in the Hong Kong dental teaching hospital. Records and pre‐extraction radiographs of the selected cases were retrieved. Selected subjects (n = 283) were invited for an interview followed by a clinical examination. Community Periodontal Index (CPI) protocol was used for the assessment of the general periodontal status (excluding the mandibular second molar of interest, i.e. the subject tooth) followed by a detailed periodontal examination of the subject tooth.

Results: In all, 158 subjects, aged 29 ± 7 years, were examined with only 6% (nine subjects) having a highest CPI score of 4 (excluding the subject tooth), but local periodontal defects were prevalent at the distal surface of subject mandibular second molars: mean probing pocket depth (PPD) was 5.4 ± 1.9 mm with 67% (106 subjects) exhibiting PPD ≥ 5 mm and 23% (36 subjects) exhibiting PPD ≥ 7 mm; mean recession was 0.8 ± 1.0 mm; bleeding on probing 96% and suppuration on probing 5%. Multiple linear regression analysis was used to analyse the effects of 12 independent variables on the PPD at the distal surface of the involved mandibular second molar. Three possible risk indicators (P < 0.001, R2 = 0.27) associated with localised increased PPD at the distal surface of the mandibular second molars were identified: 1) third molar ‘mesio‐angular’ impaction; 2) pre‐extraction crestal radiolucency and 3) inadequate post‐extraction local plaque control.

Conclusion: The results suggest that periodontal breakdown initiated and established on the distal surface of a mandibular second molar in the vicinity of a ‘mesio‐angular’ impacted third molar evidenced by pre‐extraction crestal radiolucency in association with inadequate plaque control after extraction can predispose to a persistent localised periodontal problem.
Quantitative assessment of apoptotic and proliferative gingival keratinocytes in oral and sulcular epithelium in patients with gingivitis and periodontitis
Authors: Jarnbring F. , Somogyi E. , Dalton J. , Gustafsson A. , Klinge B.
Published: March 2003

Background:  Periodontal disease is caused by a chronic infection inducing an inflammatory reaction that leads to a breakdown of tooth‐supporting tissue. The maintenance of an equilibrium between the host defence and microorganisms in the sulcus is essential to preserve health. All multicellular organisms have mechanisms for killing their own cells, and use physiological cell death for defence, development, homeostasis and ageing. Apoptosis and proliferation are very important phenomena in regulating this and a disturbance is often associated with disease e.g. cancer, AIDS, Alzheimer's disease, rheumatoid arthritis.

Objective: The aim of this study was to determine whether the number of apoptotic and proliferative gingival keratinocytes differed between patients with gingivitis and those with periodontitis.

Material and methods: The distribution of neutrophil elastase, PCNA/cyclin, DNA fragmentation (apoptosis) and p53 was determined with immunocytochemical techniques. We used paraffin‐embedded sections from gingival biopsies and did quantitative analyses.

Results and conclusion: These showed that 5–12% of the keratinocytes in the basal layers of the epithelium proliferated in the two groups. Fewer apoptotic cells were seen in the oral epithelium than in the sulcus in all subjects in both groups. Only in the most apical part of the sulcus, close to the junctional epithelium, did the number of apoptotic keratinocytes exceed the proliferative ones in patients with periodontitis.
Periodontal treatment practices of Finnish dentists
Authors: Heinikainen Mia , Vehkalahti Miira , Murtomaa Heikki
Published: March 2003

Objectives: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery.

Material and methods: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8‐mm‐deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology.

Results: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%.

Conclusion: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.
Decision‐making for national programs of community fluoride use
Authors: Horowitz Herschel S.
Published: March 2003

Abstract – Every community, region or country with a high or rising prevalence of dental caries should implement a caries‐preventive program that automatically brings the benefits of systemic and topically applied fluoride to the entire population. The fluoridation of community water supplies or salt fulfills the requirements of providing safe, effective protection from dental caries at reasonable cost. The use of dietary fluoride supplements or fluoridated milk does not meet the requirements of a comprehensive national or community program because compliance is poor or only selected age groups are targeted. Water fluoridation is ideal for countries, regions or communities with many central water supplies or where salt production or distribution is not centralized or easy to control. Water fluoridation also has advantages where many areas exist with natural water fluoride concentrations at optimal or greater than optimal concentrations. Salt fluoridation is ideal for countries or regions with few, potable central water supplies in which salt production and distribution are centralized and easily controlled. Concentrations of fluoride for water fluoridation range from 0.5 to 1.2 parts per million (ppm) parts of water depending on climate and dietary practices. The concentration for fluoridation of salt is approximately 200 to 250 mg fluoride per kg of salt, also depending on dietary practices. Properly fluoridated salt should produce levels of urinary fluoride excretion similar to those found in communities with fluoridated water. Benefits of the two methods are similar. Salt fluoridation may be done more cheaply.
A study of dental staining among competitive swimmers
Authors: Escartin J. L. , Arnedo A. , Pinto V. , Vela M. J.
Published: March 2003

Abstract – Objective: To estimate the prevalence of dental stains (DS) in competitive swimmers and quantify the risk of these stains compared with sportsmen in a non‐swimmers group in Castellón, Spain. Methods: Cross‐sectional and case‐control designs. Between July 1996 and March 1997, 404 subjects, (171 enrolled in two clubs of competitive swimming and 233 sportsmen from two schools), were examined in order to detect and classify yellowish‐brown or dark‐brown stains on the facial surface of the eight incisors. Participation rates were 88.6% for swimmers, and 95.7% for sportsmen. Mean of participants’ age was 12 years, range 7–22 years. Castellón has three public competition swimming pools, two of which are indoors. Two of the pools used chloride products, and the third bromine for the disinfection of water. The recommended hygiene regulations were adhered to. Results: Prevalence of DS was 60.2% in swimmers and 12.9% in sportsmen (P=0.0001). Risk factors for DS included: use of competition swimming pools, age, gender, years of competition, daily consumption of coffee, red wine, and iron supplement during the last year. Professional dental cleanliness was a protective factor. In a logistic regression analysis, the use of competition swimming pools maintained a high risk of DS, odds ratio (OR)=9.28; 95% confidence interval (CI) 5.21–16.5, adjusted by the other variables. Amongst swimmers, more than 6 h of training a week increased the risk of these stains (OR=3.51; 95% CI 1.35–9.10). Conclusion: The study indicated a high risk of DS in competitive swimmers.
Type 1 diabetes mellitus and oral health: assessment of coronal and root caries
Authors: Moore Paul A. , Weyant Robert J. , Etzel Kenneth R. , Guggenheimer James , Mongelluzzo Mary Beth , Myers Daniel E. , Rossie Karen , Hubar Heidi , Block Harvey M. , Orchard Trevor
Published: March 2003

Abstract – Objectives: The oral health of a large cohort of adult insulin‐dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). Methods: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6–8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. Results: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age‐adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. Conclusions: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.
Dental erosion in children and adolescents – a cross‐sectional and longitudinal investigation using study models
Authors: Ganss Carolina , Klimek Joachim , Giese Katja
Published: March 2003

Abstract – Objective: To investigate the prevalence and incidence of dental erosion in children and adolescents. Methods: Lesions were registered for all tooth surfaces of primary and permanent teeth using pre‐orthodontic study models. A total of 1000 individuals (mean age 11.4±3.3 years) were included; 265 of them were followed over a 5‐year period using their final orthodontic casts. Results: In the primary teeth, 26.4% of the individuals had no erosive lesions, 70.6% had at least one tooth with grade 1 erosion and 26.4% had grade 2 erosion. Grade 1 erosion was found in 44% of the occlusal surfaces of molars (36% of the incisal surfaces of the canines) and grade 2 erosion in 11% (9%). Lesions affecting oral or vestibular surfaces were negligible. In the permanent teeth, 11.6% of individuals had at least one tooth with grade 1 erosion but only 0.2% had at least one tooth with grade 2 erosion. The most affected teeth were the mandibular first molars (7% with grade 1 lesions). Lesions affecting oral or vestibular surfaces were negligible. Mandibular first molars were identified as possible marker teeth for the onset of erosive lesions. Within the last two decades, the percentage of subjects with at least one tooth with a grade 1 or 2 erosive lesion significantly increased for primary and with grade 1 for permanent teeth (P≤0.001). The longitudinal observation revealed that subjects with erosive lesions in their primary dentition had a significantly increased risk for erosion in their permanent teeth (P≤0.001). Conclusion: In Germany, dental erosion seems to be a significant, but not a serious, problem for dental health in adolescents.
Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial
Authors: Frenkel Heather , Harvey Ian , Newcombe Robert G.
Published: March 2003

Abstract – Objectives: This cluster‐randomised controlled trial assessed whether oral health care education (OHCE) for nursing home caregivers would achieve improvements in clients’ oral health. Methods: Twenty‐two nursing homes were randomly allocated to intervention or control group. Clients were examined at baseline and at follow‐up visits 1‐ and 6‐months after caregivers received OHCE. Main outcome measures were denture plaque, denture‐induced stomatitis, dental plaque and gingivitis. Differences in group means/medians were compared with adjustment for cluster randomisation. Results: Clients’ baseline oral health was poor. After OHCE, the intervention group’s oral health scores improved significantly. Reductions in denture plaque scores (0–4 scale) exceeded those of the control group by 1.15 (95%CI=0.83, 1.47) at 1 month and by 1.47 (95%CI=1.13, 1.80) at 6 months. Denture‐induced stomatitis prevalence reduced significantly over 6 months compared to the control group (P<0.0001). Group differences in favour of the intervention group were 0.41 (95%CI=0.18, 0.65) at 1 month and 0.34 (95%CI=0.14, 0.53) at 6 months for dental plaque (0–3 scale), and 0.17 (95%CI=−0.01, 0.35) at 1 month and 0.28 (95%CI 0.15, 0.42) at 6 months for gingivitis (0–2 scale). Key differences remained significant after adjustment for clustering effects. The provider’s costs would currently be approximately £6700 per year to deliver the intervention to a Health Authority with 100 homes. Conclusions: Although final levels of residents’ oral health were still short of ideal, this study clearly shows that, for a modest cost, OHCE can improve caregivers’ knowledge, attitudes and oral health care performance for elderly, functionally dependent clients.
Reported bruxism and stress experience
Authors: Ahlberg J. , Rantala M. , Savolainen A. , Suvinen T. , Nissinen M. , Sarna S. , Lindholm H. , Könönen M.
Published: March 2003

Abstract –  The aim of the study was to analyze whether perceived bruxism was associated with stress experience, age, gender, work role, and occupational health care use among a nonpatient multiprofessional population. Altogether, 1784 (age 30–55 years) employees of the Finnish Broadcasting Company were mailed a self‐administered questionnaire covering demographics, perceived bruxism, total stress experience and the use of health care services provided by the company. The response rate was 75% (n = 1339, 51% men) and mean age was 46 years (SD = 6) in both genders. There were no significant differences in demographic status by age and gender. Bruxism and stress experiences did not significantly vary with regard to category of work, but both were significantly more frequent among women (P < 0.05). In all work categories frequent bruxers reported more stress, and the perceptions were significantly differently polarized between the groups (P < 0.001). According to logistic regression, frequent bruxism was significantly positively associated with severe stress experience (Odds ratio = 5.00; 95% CI = 2.84–8.82) and female gender (Odds ratio = 2.26; 95% CI = 1.43–3.55). Frequent bruxism was also significantly positively associated with the numbers of occupational health care and dental visits (P < 0.01), and slightly negatively associated with increasing age and work in administration (P < 0.05). It was concluded that bruxism may reveal ongoing stress in normal work life.
Directed acyclic graphs (DAGs): an aid to assess confounding in dental research
Authors: Merchant Anwar T. , Pitiphat Waranuch
Published: March 2003

Abstract –Confounding, a special type of bias, occurs when an extraneous factor is associated with the exposure and independently affects the outcome. In order to get an unbiased estimate of the exposure–outcome relationship, we need to identify potential confounders, collect information on them, design appropriate studies, and adjust for confounding in data analysis. However, it is not always clear which variables to collect information on and adjust for in the analyses. Inappropriate adjustment for confounding can even introduce bias where none existed. Directed acyclic graphs (DAGs) provide a method to select potential confounders and minimize bias in the design and analysis of epidemiological studies. DAGs have been used extensively in expert systems and robotics. Robins (1987) introduced the application of DAGs in epidemiology to overcome shortcomings of traditional methods to control for confounding, especially as they related to unmeasured confounding. DAGs provide a quick and visual way to assess confounding without making parametric assumptions. We introduce DAGs, starting with definitions and rules for basic manipulation, stressing more on applications than theory. We then demonstrate their application in the control of confounding through examples of observational and cross‐sectional epidemiological studies.
Effectiveness of chlorhexidine–thymol varnish for caries reduction in permanent first molars of 6–7‐year‐old children: 24‐month clinical trial
Authors: Baca Pilar , Muñoz M. José , Bravo Manuel , Junco Pilar , Baca Adela P.
Published: March 2003

Objectives: To determine the effect of chlorhexidine varnish on the prevention of caries in permanent first molars.

Methods: Two groups of 6–7‐year‐old school children were followed up in a clinical trial, a group of 86 children whose teeth were treated with a chlorhexidine–thymol varnish (Cervitec®) and a control group of 95 children. The varnish was reapplied every 3 months and the caries increments were compared at 24 months.

Results: The DFS (decayed and filled surfaces in permanent first molars) increment in the control group (mean = 1.85; SD = 2.27) was higher than in the test group (mean = 0.95; SD = 1.38), resulting in a 48.6% caries reduction. This difference was statistically significant (P = 0.032).

Conclusions: Chlorhexidine–thymol varnish is effective in preventing caries in permanent first molars.
Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial
Authors: Frenkel Heather , Harvey Ian , Needs Kathy
Published: March 2003

Objectives: The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial. Methods: A self‐administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re‐administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open‐ended questions solicited qualitative data. Results: Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two‐thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group significantly improved their scores over the control group at times 2 and 3 for knowledge (P<0.003) and attitude (P<0.001). Analysed across both arms at baseline, the main predictors for knowledge and attitude scores were age and dental attendance pattern. Qualitative responses showed an acceptance of caregivers' roles in oral health care and criticism of existing provision within homes. Conclusions: The OHCE was well received and resulted in improved oral health care knowledge and attitudes. When viewed with separately reported trial results of clients' oral health status, knowledge and attitude score improvements coincided with improved delivery of oral health care.
Dental fluorosis decline after changes to supplement and toothpaste regimens
Authors: Riordan Paul J.
Published: March 2003

In 1989/90, in 659 12‐year‐olds in Perth (F 0.8 mg/L) and the Bunbury region of Western Australia (WA) (F ∼0.25 mg/L), dental fluorosis prevalences were 40.2% and 33.0%. Fluoride supplements (OR 4.63) and extended residence in a fluoridated area (OR 4.06) were significant risk factors; toothpaste ingestion variables had ORs greater than unity; in 1990, DMFT for this age group was 0.84. School Dental Service took steps to discourage supplement and toothpaste ingestion and to promote low fluoride toothpaste for children < 6 years of age.

Objectives: To evaluate the effect of this campaign on fluorosis and caries.

Methods: Between May–July 2000, 582 10‐year‐olds were examined for dental fluorosis (TF index) and dental caries (DMFT) in school dental clinics.

Results: Fluorosis prevalence was 22.2% in Perth and 10.8% in the Bunbury region. Overall prevalence was 18.0% and of this, 80.2% was TF 1, 17.9% was TF 2 and just 1.9% was TF 3. In 1989/90, 79 children had used supplements before the age of 4 year; in 2000 only 40 had done so (P < 0.001). Mean DMFT values in Perth and Bunbury were 0.32 and 0.28 (P > 0.05). Low F toothpaste, unavailable in 1989/90, had been used by 24.5%. The only significant risk factor was residence, OR 2.0.

Conclusions: Fluorosis prevalence seems to have fallen in parallel with a reduction in discretionary intake from supplements and toothpaste. No increase in dental caries experience was recorded. Because the teeth examined in this study were at risk of fluorosis in 1992–95, very soon after policies changed, and because people are slow to change health habits, it seems reasonable to expect a further improvement when teeth mineralised in the late 1990s become visible.
Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments
Authors: Schriks M. C. M. , Van Amerongen W. E.
Published: March 2003

Abstract –  Atraumatic Restorative Treatment, ART, is a method of minimal caries intervention that uses only hand instruments. The aim of the present study was to explore a possible difference between the extent of discomfort experienced during dental treatment according to the ART approach and a method using rotary instruments. The study was performed in Indonesia. A total of 403 children were randomly divided in two groups. In each child, one class II restoration in a deciduous molar was made. One group received treatment using rotary instruments (750 r.p.m.). The other group was treated according to the ART approach. Glass ionomer cement was used for restoration in both groups. Discomfort scores were determined using both physiological measurements (heart rate) and behavioral observations (Venham) on specific moments during the treatment. Venham scores showed a marked difference between the two groups at most time points. Heart rate measurements were different at deep excavation. Also, a clear relation between Venham scores and heart rate measurements could be found at all time points. Confounding could be shown for operating dentist, gender of the patient and initial anxiety, not for age. No effect modification could be shown. It can be concluded that children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instruments.
Strontium nitrate suppresses chemically‐induced sensory irritation in humans
Authors: Zhai Hongbo , Hannon Whitney , Hahn Gary S. , Pelosi Alessandra , Harper Robert A. , Maibach Howard I.
Published: March 2003

Skin care products are complex formulations that may cause sensory irritation symptoms, characterized by stinging, burning, and itching. Substances capable of counteracting sensory irritation are of great practical interest. Strontium salts have been demonstrated to inhibit sensory irritation and inflammation when applied topically. In this double‐blind study, we evaluated the efficacy of strontium nitrate in reducing chemically‐induced skin sensory irritation in 8 subjects. In a random order, 20% strontium nitrate in 70% glycolic acid (pH=0.6) (mixture) was applied to the volar aspect of the forearm and a positive control (70% glycolic acid, pH=0.6) to the contralateral forearm. The irritation sensation was evaluated each min for the first 20 min after topical application using a scale from 0–4. The duration of the irritation sensation in min was also recorded. Strontium nitrate mixed with glycolic acid, in comparison with glycolic acid alone, markedly (p<0.01) shortened the duration of the irritation sensation from 24.4±4.1 (mean±SEM) min to 8.9±3.7 (mean±SEM) min, and significantly (p<0.05) reduced the mean magnitude of the irritation sensation at all time points (overall). The study demonstrated that strontium nitrate potently suppresses the sensation of chemically‐induced irritation.
Ascertainment of hand dermatitis using a symptom‐based questionnaire; applicability in an industrial population
Authors: Vermeulen Roel , Kromhout Hans , Bruynzeel Derk P. , De Boer Edith M.
Published: March 2003

In this study, the applicability of a symptom‐based questionnaire on hand dermatitis was assessed in a population of rubber workers. The questionnaire was previously validated in a study among nurses. 224 subjects employed in 9 different companies completed a questionnaire on skin complaints. Subsequently, 202 workers attended the physical examination of the skin by a dermatologist. The ascertainment of skin complaints according to the questionnaire was compared to the medical evaluation. The 2 different diagnostic tools used for assessing dermatitis resulted in dissimilar estimates of the prevalence of active hand dermatitis, ranging from 6.9% to 38.1% of all workers. Using the medical evaluation as ‘gold standard’ we observed a moderate sensitivity and specificity (respectively 71.4%; 95% CI: 47.7–95.1 and 76.1%; 95% CI: 70.0 – 82.2), a low positive predictive value (18.2%; 95% CI: 8.0 –28.4) and a high negative predictive value (97.3%; 95% CI: 94.7 –99.9) for the classification based on the self‐administered questionnaire. When evaluated against ‘first symptoms of dermatitis’ the sensitivity decreased, while the specificity remained almost the same. The deviant findings between the present and the original validation study of the same questionnaire among nurses hamper its applicability in populations with different occupations. Therefore, if questionnaires are to be used, validity studies have to be carried out to evaluate differences in perception of skin diseases between different (occupational) populations.
The spectrum of inflammatory cell response to dimethyl sulfoxide
Authors: Sjögren Florence , Anderson Chris
Published: March 2003

Dimethyl sulfoxide (DMSO), depending upon the concentration and mode of application to the skin, can induce either a non‐immunological immediate contact urticaria or an irritant reaction. The dermal cellular infiltrate after open application of varying concentrations of DMSO has been studied in an experimental guinea pig model. The composition of the dermal cellular infiltrate showed a spectrum dependent on the concentration and number of applications of DMSO. The immediate reaction infiltrate 3 h after application of 100% DMSO consisted of 50% granulocytes, basophils being predominant. On the other hand, 12% DMSO applied 3 × daily for 3 days (cumulative insult) caused histologically a cellular reaction in which 80% of the infiltrate consisted of mononuclear cells. The present findings are compared to the microscopic findings in 3 other cutaneous reactions previously studied in this animal model, namely, the Type I immediate hypersensitivity reaction, the Type IV delayed hypersensitivity reaction, and the irritant reaction. Differing cellular infiltrate patterns are discernible at the same time points. The study illustrates the spectrum of inflammatory reactions seen in the skin and provides background information for future clinical studies, for instance, on the role of the basophil granulocyte in immediate contact reactions.
Allergologically relevant rubber accelerators in single‐use medical gloves
Authors: Knudsen B. B. , Hametner C. , Seycek O. , Heese A. , Koch H.‐U. , Peters K.‐P.
Published: March 2003

To prevent contact with specific rubber accelerators, sensitized patients have to know in which glove brands these accelerators are present. Additionally, quantitative measurements of the bioavailable amounts of accelerators are needed to assist consumers in selecting gloves with the lowest possible amount of residual rubber accelerators. The aim of the study was to develop an analytical method by which residuals of rubber accelerators in single‐use medical gloves could be determined qualitatively and quantitatively. 19 different glove brands were analysed for content of accelerators, and the results were compared to manufacturers' ingredient claims of the identical gloves. ZDEC, ZDBC, ZMBT and ZPC were the most frequently detected chemicals. In 9 of 15 gloves discrepancies were found, usually minor, between content of accelerators declared by manufacturers to be present and accelerators detected by analysis. Both phosphate buffer and acetone were tested as extraction media. No accelerators were detectable with the described chemical analysis in phosphate extracts, whereas acetone was demonstrated to be a technically suitable medium for extraction. However, more kinetic studies of the extraction procedure and studies of skin penetration are needed to document that the extraction procedure simulates the clinical situation.
The trend of nickel allergy from a Scottish tertiary referral centre
Authors: Dawn G. , Gupta G. , Forsyth A.
Published: March 2003

The aims of this study were to analyze the change in trend of allergic contact dermatitis (ACD) from nickel in a single tertiary referral centre. In 1982 and 1997, 800 and 860 patients were patch tested, respectively. The frequency of positive reactions to nickel from our centre was 16% in 1982 and 22% in 1997. In both years, the vast majority of patients developed the eruption below 30 years of age. However, the commonest age of onset in 1982 was in the 11–20 year age group, while in 1997, this was 1 decade later, in the 21–30 year age group. In 1997, we noted a much higher female preponderance (F:M=13:1) than in 1982 (F:M=6:1). There was no change in male prevalence but a slight increase in female prevalence in 1997. The rate of atopy in patients with nickel ACD showed an increase from 23% in 1982 to 33% in 1997. Nickel was thought to be a contributory factor in causing occupational dermatitis in 27% of patients in 1982 and 24% patients in 1997. Of these, hairdressing in 1982 and nursing in 1997 were the commonest occupations. In 1982 and 1997, respectively, 40 (5%) and 37 (4%) patients were positive to nickel alone, while 89 (11%) and 150 (18%) patients showed positive reactions to other allergens in addition to nickel. In both the years, the hands were the main sites of involvement. However, in 1997 there was an increase in the number of patients presenting with face and neck involvement.
Epidemiology of occupational skin disease in Singapore 1989–1998
Authors: Goon Anthony Teik‐Jin , Goh Chee‐Leok
Published: March 2003

This is an epidemiologic study of occupational skin disease in Singapore. All patients diagnosed with occupational dermatoses in the National Skin Centre, Singapore, over the 10‐year period 1989–1998 were studied retrospectively. Irritant contact dermatitis was found to be more common than allergic contact dermatitis. The major sources of occupational dermatitis in Singapore were the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were detergents/wet work, solvent and oil/grease. The main allergens were chromate, rubber chemicals and nickel. We concluded that the main sources of occupational skin disease and main allergens in Singapore had remained the same compared to a similar study of occupational skin diseases in 1984–85. Weak irritants are still the predominant causes of occupational irritant contact dermatitis, though the main irritants have changed compared to the previous study, where cutting fluids, cement and solvent were the most common irritants.
Multicentre study of allergic contact cheilitis from toothpastes
Authors: Francalanci Stefano , Sertoli Achille , Giorgini Simonetta , Pigatto Paolo , Santucci Baldassarre , Valsecchi Rossano
Published: March 2003

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially‐targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop‐restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.
Quenching: fact or fiction?
Authors: Basketter David
Published: March 2003

Fragrance chemicals are a frequently reported cause of allergic contact dermatitis (ACD), a matter which has recently come into considerable prominence, to the point that legislation in Europe is under serious consideration. Certain skin‐sensitizing fragrance chemicals have been reported by the producing industry to be rendered safe (quenched), at least in terms of ACD, when they are used in the presence of a specific quenching agent. Accordingly, it seemed timely to review this apparent quenching phenomenon, considering the available data and potential mechanistic hypotheses that might be used to explain it. If it is correct, it should be a phenomenon of potentially enormous value in the elimination of the allergenic properties of at least a proportion of common skin sensitizers. Whilst there is some evidence in man for the occurrence of quenching during the induction of skin sensitization, a much more substantial body of work has failed to find supportive evidence in various animals models, at a chemical level or at elicitation in human subjects with existing allergy. On balance, it is concluded that quenching of fragrance allergens is a phenomenon still awaiting positive evidence of existence.
Patch testing with neomycin sulfate
Authors: Bjarnason Bolli , Flosadóttir Ellen
Published: March 2003

The recommended patch test concentration of neomycin sulfate is 20% in petrolatum applied occluded for 48 h (2 days [D]). In the current study, the efficiency of such a test is compared to results with other techniques using lower allergen dose than obtained by approximately 20 μl of the 20% substance. Efficiency of petrolatum and demineralized water as vehicles are compared. 16 neomycin‐sulfate positive subjects were retested with serial doses ranging from 0.4 to 0.0085 mg/cm2 neomycin sulfate in cellulose printed on polyester squares and applied by both tapes and plastic foils. Additionally, tests were performed with the 20% petrolatum substance in Finn Chambers®. Tests containing the 20% substance in petrolatum and in water were applied directly with transparent foils. Readings ranged from 3 to 264 h (11D) following applications. Results show that foil applications of a polyester square dose, that is 7% of the dose obtained with the 20% substance, distinguished between perfusion of subjects who were visually positive and not with any test in the study. With the same test technique and visual assessments, 2 subjects were false‐negative but developed doubtful test responses with the Finn Chambers®.
Another look at seasonal variation in patch test results
Authors: Uter W. , Geier J. , Land M. , Pfahlberg A. , Gefeller O. , Schnuch A.
Published: March 2003

There is conflicting evidence concerning seasonal variability of patch test results and no evidence concerning the influence of season on weak‐positive, possibly false‐positive, irritant reactions, which was analysed in the present study. Data collected in the German Information Network of Departments of Dermatology (IVDK) 1992 to 1997 were combined with external environmental data on temperature and absolute humidity in Germany, and bivariate as well as logistic regression analyses performed concerning the association between reactivity to selected allergens and air temperature and absolute humidity on the respective days of patch testing. Between 39,239 and 41,629 patients had been tested with the 4 allergens considered here. Only formaldehyde exhibited a distinct increase in questionable or irritant as well as weak‐positive reactions associated with dry, cold weather. Methylchloroisothiazolinone/methylisothiazolinone and lanolin alcohol showed only a weak, and epoxy resin no, association with climatic conditions. The results indicate that weak‐positive reactions, at least to formaldehyde as a prototype of an allergen which is at the same time a marginal irritant, may sometimes be irritant rather than allergic. Patients showing these should be re‐tested to improve the poor reproducibilty observed with this allergen.
Incidence of work‐related hand eczema during apprenticeship: first results of a prospective cohort study in the car industry
Authors: Funke Ulrich , Fartasch Manigé , Diepgen Thomas L.
Published: March 2003

Data on the incidence and prevalence of occupational contact dermatitis (OCD) are scarce, and most of our knowledge about OCD is derived from clinical case reports or clinical studies of in‐ and out‐patients. Therefore, we investigated in the epidemiological, prospective Audi cohort study (PACO study) the incidences of work‐related hand eczema in different apprenticeships of Audi AG. In total, 2078 apprentices were investigated at the start of their apprenticeship and systematically followed up over a 3‐year period. At the end of the study, information on 2042 (98.2% follow‐up) apprentices was available. The 1‐year cumulative incidences of hand eczema were 9.2% (95%‐confidence interval 7.8–10.7) in metalworkers, 8.8% (95%‐CI 7.0–10.7) in other blue‐collar workers, and 4.6% (95%‐CI 2.3–8.1) in white‐collar apprentices. The 3‐year cumulative incidences of hand eczema were 15.3% (95%‐CI 13.6–17.2) in metalworkers, 14.1% (95%‐CI 11.8–16.5) in other blue‐collar workers, and 6.9% (95%‐CI 4.0–10.9) in white‐collar apprentices. In females, the cumulative incidence of hand eczema was higher compared to men (1‐year incidence 10.1%, 95%‐CI 7.7–13.0, versus 8.3%, 95%‐CI 7.1–9.5; 3‐year incidence 16.1%, 95%‐CI 13.1–19.5 versus 13.6%, 95%‐CI 12.2–15.2). In some occupations, like cooks, tool mechanics, milling cutters and varnishers, the incidence of hand eczema was significantly increased. In those occupations, however, no job change was necessary, and no notifiable occupational contact dermatitis occurred. The incidence was not uniformly distributed over the 3‐year period. Within the first 6 months, a particularly high rate of hand eczema occurred, which then declined and remained steady at a lower rate over the 2nd and the 3rd years. The results of our study give important suggestions for preventive measures at the workplace and effective occupational pre‐employment advices.
Cement burns: a review 1960–2000
Authors: Spoo J. , Elsner P.
Published: March 2003

We review the literature on cement burns of the skin published during the last 4 decades. 51 case reports were analyzed with special regard to common modes of injury, localization of cement exposure, preventive measures taken and treatment. Cement burns are injuries concerning professionals at the workplace as well as amateurs during do‐it‐yourself work. In 49% of the cases, no attempt to protect the skin had been made. The majority of injuries were located on the lower legs and knees. Full‐thickness burns were reported in 66% of cases. Surgery had to be performed in 34%. Cement burns can be avoided by adequate skin protection. Although acute cement injuries may seem rare, prospective studies should be carried out for correct estimation of prevalence. The need for information on the harmful properties of cement in the occupational as well as the domestic environment is emphasized.
Human potency predictions for aldehydes using the local lymph node assay
Authors: Basketter David A. , Wright Zoe M. , Warbrick E. Vicky , Dearman Rebecca J. , Kimber Ian , Ryan Cindy A. , Gerberick G. Frank , White Ian R.
Published: March 2003

The murine local lymph node assay (LLNA) assesses skin sensitization potential as a function of proliferative responses induced in lymph nodes draining the site of topical exposure to test chemical. It has been shown that interpolation of LLNA dose‐response data to define the concentration of test chemical required to induce a 3‐fold stimulation of proliferation (EC3) offers the prospect of a quantitative index of the relative potency of a contact allergen. Initial studies have demonstrated that there exists a strong (inverse) correlation between EC3 values and contact allergenic potency in humans. Thus, materials with a low EC3 value were more potent contact allergens in humans. However, it is necessary to examine a wide range of allergens to demonstrate that such correlations are generally true. Thus, in the present study, 10 aldehydes of varying degrees of allergenicity in man were evaluated in the LLNA and their EC3 values derived. Formaldehyde was regarded as the strongest allergen in man and also had the lowest EC3 value, 0.35% (equivalent to 0.93% formalin). In contrast, the extremely weak allergen vanillin and the non‐sensitizer ethyl vanillin both had EC3 values of >50%. For the remaining 7 aldehydes, there was a close similarity between what is judged to be their rank order of allergenicity in humans and EC3 values derived from analysis of LLNA data. These results support further the utility of EC3 determinations in the LLNA as a measure of the relative potency of a contact allergen.
Contact dermatitis due to hardy primula species and their cultivars
Authors: Aplin C. G. , Lovell C. R.
Published: March 2003

For more than 100 years, it has been widely held that of all the Primula species to cause allergic contact dermatitis, P.obconica is the most likely culprit, particularly in Northern Europe. The main sensitizer is primin, but other sensitizers are reported. Other species are rarely implicated, but we suspect from our discussions with Primula growers that this is probably a consequence of under‐reporting. Moreover, cutaneous reactions to other hardy Primula species and cultivars would appear to be milder and may sometimes be associated with a state of tolerance after repeated handling. With the co‐operation of members of the Midland and West Section of the National Auricula and Primula Society of the UK, 462 questionnaires were sent out to members and 316 replies were returned (response rate 68.4%) with data on 320 growers. 84 out of a total of 320 (26.25%) attributed a cutaneous reaction to Primula species, whereas 236 (73.75%) reported no reaction. Of the 84 who reported reactions, 48 suspected P.auricula, 34 P.obconica, 10 P.vulgaris, 5 P.allionii, 3 P.marginata and 2 P.forrestii. 19 believed that they had reacted to 2 or more species of Primula. Our study suggests that Primula species other than P.obconica may elicit dermatitis more frequently than previously recorded.