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Biomedical subjects

N Tinanoff

Publications and source records attributed to N Tinanoff.

At least 55 records · Page 3Linked to original sources

Treatment of the periodontal component of Papillon-Lefèvre syndrome.

A 9-year-old girl was treated for the periodontal component of Papillon-Lefèvre syndrome, an autosomal recessive disease characterized by palmarplantar hyperkeratosis and premature loss of teeth. Initially, the patient was found to have a polymorphonuclear leukocyte chemotactic dysfunction, defective leukocyte adherence, and deep periodontal pockets harboring presumptive periodontopathic bacteria. After unsuccessful treatment with combined mechanical therapy and 2 different antibiotics, all of the patient's erupted teeth were extracted in an attempt to minimize the chance of infection of teeth yet to erupt. At age 16 years, the now-erupted teeth have normal gingiva and crevice depths, radiographs show no evidence of periodontal pathology, no periodontopathic bacteria are detected in gingival crevices, and leukocyte function is normal.

Bacteria↗

Comparison of effect of SnF2 and NaF mouthrinses on caries incidence, salivary S. mutans and gingivitis in high caries prevalent adults.

The effect of SnF2 and NaF mouthrinses were compared in subjects initially selected because of their high caries prevalence and high levels of salivary S. mutans. Subjects rinsed twice a day with either SnF2 or NaF (200 ppm F-). Subjects in both groups continued to be caries active during the course of the study. However, at the first year examination subjects rinsing with SnF2 had less S. mutans/ml saliva, a lower caries incidence and less gingivitis. After 2 yr the S. mutans levels in the SnF2 rinsing group remained significantly less. Both caries incidence and gingivitis were lower in the SnF2 group after 2 yr but the difference was not significant.

Adolescent↗

Diagnosis and treatment of acute fluoride toxicity.

The literature has shown overwhelmingly that fluoride used for dental prophylaxis presents minimal risks if used appropriately. However, there is an increasing potential for ingestion of toxic doses of fluoride because of the increasing use of pleasant-tasting fluoride products. The ADA has recommended that no more than 120 mg fluoride (264 mg NaF) be dispensed at any one time. As with any medication, fluoride preparations should be prescribed in child-resistant containers, and patients or parents (or both) should be instructed as to the proper daily treatment regimens and the potential for toxic overdoses. Possibly the greatest risk of fluoride intoxication relates to the concentrated fluoride preparations used for professionally applied fluoride treatment (Table 3). Therefore, patients receiving professional topical fluoride treatments should have well-fitting trays with the minimal amount of fluoride necessary to contact the teeth. These patients should be provided with a saliva ejection system, and they should never be left unobserved during the topical application. Health professionals should be aware of the potential toxic effects of fluoride in addition to the well-known caries preventive effects. It is necessary to know how to calculate the amount of fluoride ingested and the emergency treatment recommended to prevent toxic effects in suspected overdose cases.

Child↗

Changes of subgingival total colony forming units and black pigmented bacteroides after a single irrigation of periodontal pockets with 1.64% SnF2.

Periodontal pockets of 11 subjects were irrigated once with either 1.64% SnF2 or saline applied by syringe. Changes on the total anaerobic colony forming units (CFU) and black pigmented bacteroides (BPBs) of the irrigated pockets were assessed for 31 days. The results showed little change of the CFUs by either single application of SnF2 or saline. However, SnF2 irrigation produced a decrease in the BPBs for 1 week with the greatest effect (1/2 log reduction) being seen at 3 days after the irrigation. Some subjects had more impressive reductions in BPBs, yet four of the 11 subjects showed no reductions in BPBs in those sites irrigated with SnF2. Further studies with frequent irrigation intervals are necessary to evaluate the potential usefulness of SnF2 for subgingival irrigation.

Adult↗

Antiplaque properties of sustained release SnF2: pilot studies.

Pilot studies examining the physical and clinical properties of an intracoronal sustained release fluoride delivery system were performed. After testing various percentages of SnF2 incorporated into polycarboxylate, zinc phosphate, and zinc oxide cements, 70% SnF2 polycarboxylate cement was found to have adequate compressive strength while releasing the greatest amount of fluoride in vitro. A 30-day in vivo trial, in which this fluoride cement was used as a temporary intracoronal restoration, produced elevated salivary fluoride levels with only transient elevation in urinary fluoride levels. Plaque scores decreased during the experimental period, suggesting that the released SnF2 affected bacterial growth or attachment. The SnF2-polycarboxylate cement was an adequate temporary restorative material without significant side effects.

Delayed-Action Preparations↗

Anti-bacterial determinants of stannous fluoride.

The growth of bacteria on stainless steel wires was used as a model to investigate which properties of SnF2 produced anti-bacterial effects against S. mutans. Wire-adherent bacteria were exposed for one min, twice a day, to various fluoride or control compounds having similar ions, pH, valence, or atomic weights. After two days, the thickness of adherent bacteria was scored visually, and the decrease in pH of the growth medium was determined. Bacteria from each wire were then dried, weighed, and analyzed for metal content. Electron microscopy and electron microprobe were used to identify the location of heavy metal deposits in the bacteria. Only SnF2 dramatically altered S. mutans growth and metabolism, and this anti-bacterial effect was associated with a large uptake of tin into the bacterial cells. The fluoride salts of sodium, lead, zinc, and copper had little influence on S. mutans growth in this test system. The pH of the various fluoride salts or controls generally had no effect on the activity of the test compounds, except for the noted inactivation of SnF2 at elevated pH's. Since SnF4 did not alter the growth or metabolism of S. mutans, a unique property of SnF2--possibly the reactivity in an aqueous environment--may be responsible for its anti-bacterial properties.

Anti-Infective Agents, Local↗

Clinical study to compare the effect of stannous fluoride and chlorhexidine mouthrinses on plaque formation.

A clinical study was conducted on four adults to compare the relative efficacy of 0.2% chlorhexidine digluconate and 0.1% stannous fluoride (SnF2). Using a crossover experimental design, subjects rinsed twice daily for 5 days with SnF2 and then, after a 2-day interim recovery period, for 5 days with chlorhexidine. Statistically significant differences (P less than 0.05) in the relative efficacy of the two agents were found. Chlorhexidine was more effective in reducing Gingival and Plaque Indices, plaque wet weight and bacterial Colony Forming Units, calculated both per subject and per group.

Chlorhexidine↗

Preventing dental caries.

Since most children do not see a dentist until age three, family physicians have the opportunity to initiate proper dental care and thus reduce the incidence of dental caries. In addition to oral hygiene and dietary modification, optimal fluoride ingestion in the first few years of life produces lifelong resistance to dental caries. Knowledge of the pathology of dental caries and use of appropriate fluoride dosages enables the family physician to apply a highly effective preventive regimen in daily practice.

Child↗

Resident physician performance in a continuing education format. Does newly acquired knowledge improve patient care?

As part of an educational program in preventive dentistry for family medicine residents, we evaluated changes in systemic fluoride prescribing habits related to newly acquired knowledge. Residents, unaware of the study, were randomly assigned to one of two groups and shown a videotape describing preventive dental techniques. We supplemented the tape viewed by one group with specific instructions explaining the implementation of the information in patient care. Residents in both groups demonstrated the ability to learn and maintain their level of knowledge during a three-month period. Daily chart audits, however, revealed no substantial increase in correct prescribing of systemic fluoride to pediatric patients for either group. Only subsequent individual monitoring and reinforcement achieved the desired behavior. The acquisition of new knowledge by resident physicians under these circumstances did not lead to its application in daily patient care. This result parallels reported difficulties in altering physician behavior by continuing medical education, and suggests that residency programs are an appropriate setting to initiate improved physician performance in response to acquired knowledge.

Child↗