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Co-replication of several isotypes of foot-and-mouth disease virus.

Genome segments of the foot-and-mouth disease virus isolates O1Lombardy and O3 Venezuela that encode, among other products, capsid protein VP1 were amplified using PCR, and the products were cloned and sequenced. The alignment of up to 11 O3-specific sequences revealed six silent nucleotide changes a well as six changes that cause amino acid substitutions in capsid protein VP1 at positions 45, 83, 141, 145, 170 and 178. The heterogeneity of three O1-specific sequences consisted of seven silent exchanges and amino acid changes at positions 85 and 134 on VP1. Amplification, subclonning and sequencing of cloned O3-specific cDNA was performed to examine the nature of the sequence heterogeneity. As no difference was found among five subcloned sequences, we conclude that the Taq polymerase copied the DNA correctly. The sequence heterogeneity observed with both virus isolates is, therefore, consistent with the quasispecies structure of foot-and-mouth disease virus. Furthermore, amino acid changes at a number of sites have been found to be involved in the formation or modulation of neutralizing epitopes. The novel aspect of this study is the ability to estimate, by cloning of PCR products, the number of virus isotypes, possibly varying in antigenicity, that are able to co-propagate. Seven isotypes of O3 Venezuela were identified. Some are of particular interest because they exhibit a change at VP1 codon 145 that causes the replacement of arginine, possibly essential for virus attachment to cells, by isoleucine.

Amino Acid Sequence↗

Identification of a fifth neutralizable site on type O foot-and-mouth disease virus following characterization of single and quintuple monoclonal antibody escape mutants.

A monoclonal antibody (C3) produced against foot-and-mouth disease virus type O1Caseros was found to neutralize quadrivalent monoclonal antibody escape mutant (G67) of foot-and-mouth disease virus type O1Kaufbeuren. This mutant had been characterized at the sequence level as having distinct changes affecting four non-overlapping neutralizable sites. The C3 monoclonal antibody was used to prepare a quintuple escape mutant from the G67 and a single escape mutant from the parental O1Kaufbeuren viruses. Polyclonal post-vaccinated and infected cattle sera as well as polyclonal mouse and guinea-pig sera, which neutralized the quadrivalent mutant, no longer neutralized the quintuple mutant, indicating that a fifth site had been identified and that changing the fifth site eliminated all neutralization. The site was characterized using serological techniques and found to be conformationally dependent, trypsin-sensitive and independent of sites previously characterized by monoclonal antibodies. Amino acid sequencing comparing parental, single C3 and quintuple mutants showed that a single change from a glutamine to a histidine, at amino acid 149 in the structural protein VP1, (1D) characterized the C3 mutation. The fifth site probably represents a conformational epitope which is formed due to the interaction of the VP1 loop region with other surface amino acids.

Amino Acid Sequence↗

A randomized clinical trial on the short-term clinical and microbiological effects of the adjunctive use of a 0.05% chlorhexidine mouth rinse for patients in supportive periodontal care.

OBJECTIVE: To evaluate the clinical and microbiological activity of a new mouth rinse formulation, used as an adjunct to oral hygiene, for patients in supportive periodontal care. PATIENTS AND METHODS: This was a randomized, placebo-controlled clinical trial with two groups: test group, rinsing twice per day with the test product (with 0.05% chlorhexidine and 0.05% cetylpyridinium chloride); and control group, rinsing with a placebo. Treated chronic periodontitis patients were included, and two visits were rendered, baseline, and after 15 days. Clinical outcome variables included plaque and gingival indices, and probing pocket depth. Subgingival samples were processed by culturing. Patient-based variables and adverse effects were also assessed. Outcome variables were compared by t-test, chi2, and Mann-Whitney test. RESULTS: The results belonged to 33 patients. Plaque and gingival indices, and the log of bacterial total counts were reduced in the test group (p < or = 0.01), but differences between groups were only statistically significant (p < 0.05) for plaque and bacterial counts. A significant reduction in the proportions of flora (p < 0.05) and frequency of detection (p = 0.01) of Porphyromonas gingivalis was observed in the test group. CONCLUSIONS: The newly formulated mouth rinse demonstrated short-term plaque-inhibitory activity. This was associated with a reduction in the total load of anaerobic subgingival microflora.

Adult↗

Quadrant root planing versus same-day full-mouth root planing. II. Microbiological findings.

OBJECTIVES: The aim of this study was to test the hypothesis that over a period of 6 months, same-day full-mouth scaling and root planing (FM-SRP) resulted in greater reductions in the detection frequency of five putative periodontal pathogens compared with quadrant scaling and root planing (Q-SRP) in chronic periodontitis patients. MATERIALS AND METHODS: Forty patients were recruited into this study. Subjects were randomised into two groups. The FM-SRP group received full-mouth scaling and root planing completed within the same day, while the Q-SRP group received quadrant root planing at 2-weekly intervals over four consecutive sessions. Selected-site analyses were performed on the deepest site in each quadrant before and after therapy, at approximately 3 and 6 months from baseline (R1 and R2) and clinical indices were recorded with an electronic pressure-sensitive probe. In addition, subgingival plaque samples were collected from these sites at baseline (BAS), at reassessment 1 (R1), approximately 6 weeks after the completion of therapy and at reassessment 2 (R2), 6 months from baseline. Polymerase chain reaction (PCR) was used to determine the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Treponema denticola and Bacteroides forsythus in plaque. RESULTS: Both therapies resulted in significant improvements in all clinical indices both at R1 and R2. A marked reduction in the presence of all candidate periodontal pathogens was noted after both treatment modalities, reaching statistical significance for the majority of the test organisms. These improvements were maintained over a period of 6 months. When the two treatment groups were compared, a significantly higher percentage of Q-SRP patients was positive for P. intermedia at R1 compared with FM-SRP patients (p<0.05). In addition, a greater reduction in the patient prevalence for T. denticola was found for the FM-SRP group than the Q-SRP group at R1 and R2 from baseline (p<0.005), but the significance of this is questionable given the skewed detection frequency of this organism at baseline between the two treatments (p<0.01). CONCLUSION: This study failed to confirm that same-day FM-SRP resulted in greater microbiological improvements compared with Q-SRP at 2-weekly intervals over a 6-month period, as determined by PCR.

Adult↗

Quadrant root planing versus same-day full-mouth root planing.

OBJECTIVES: The aim of this study was to determine whether same-day full-mouth scaling and root planing (FM-SRP) and quadrant scaling and root planing (Q-SRP) resulted in variations in the systemic humoral immune response dynamics (antibody titres and avidity) during active treatment and 3 and 6 months post-therapy. MATERIALS AND METHODS: Forty patients with chronic periodontitis were recruited into this study. Subjects were randomised into two groups and received either scaling and root planing quadrant by quadrant at 2-weekly intervals (Q-SRP group) or same-day full-mouth scaling and root planing (FM-SRP group). Clinical measurements and serum samples were obtained at baseline and approximately 6 weeks after the last clinical intervention (R1) and 6 months after the initiation of therapy (R2). Furthermore, serum samples were obtained from each patient undergoing therapy (Q-SRP and FM-SRP) at 3 bi-weekly instances so as to determine the short-term effects of each session of scaling and root planing on the dynamics of the humoral immune response. Serum antibody titre was assayed by enzyme-linked immunosorbent assay (ELISA) and antibody avidity was measured by thiocyanate dissociation against five putative periodontal pathogens: Porphyromonas gingivalis; Actinobacillus actinomycetemcomitans; Prevotella intermedia; Treponema denticola and Bacteroides forsythus. RESULTS: Both therapies resulted in similar antibody titre reductions against the majority of the organisms tested and although there was a distinct trend for antibody avidity to increase following therapy, this was not found to be statistically significant, reflecting marked inter-individual variation. In addition, no evidence emerged from this study to support increased antibody titres following the active phases of both treatment approaches due to an inoculation effect. Nevertheless, significant short-term increases in antibody avidity to most test bacteria were noted for both treatment strategies. CONCLUSION: Both therapies were associated with a reduction in antibody titres and an increase in the binding ability or avidity of antibodies, but there was a marked inter-subject variability and statistical significance was reached for only some of the test bacteria. No significant differences in the humoral antibody dynamics were found between the two treatment approaches.

Adult↗

The effect of maximal mouth opening on dimension discrimination.

The ability of twenty-five young persons to discriminate dimensions was tested. A reference stick of 10 mm was placed between the teeth, alternating with test sticks of different heights. After application of the reference stick the subjects were asked to open the mouth maximally. A test stick was placed on the lower incisors and the subjects closed the mouth slowly, until their upper incisors contacted the test stick. The subjects were then asked to assess whether a test stick felt higher or lower than the reference stick. Using this experimental method, it was found that incorrect assessments were symmetrically distributed around the 10 mm reference stick. A receptor mechanism is proposed, and applied to explain the results of the present and a previous experiment.

Humans↗

Salivary flow, saliva, pH and buffering capacity in 70-year-old men and women. Correlation to dental health, dryness in the mouth, disease and drug treatment.

A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P less than 0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P less than 0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P less than 0.05 and women P less than 0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P less than 0.01). In a consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18 ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04 ml/min (sex. diff. P less than 0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P less than 0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P less than 0.05 and women P less than 0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P less than 0.01). Diseases of the circulatory system were correlated to subjective dryness (P less than 0.01).

Aged↗

Assessment of mouth-to-mask ventilation in resuscitation of asphyxic newborn babies. A pilot study.

The aim of the study was to compare the effectiveness of mouth-to-mask ventilation (MM) in neonatal asphyxia with bag-and-mask ventilation (BM). A new mouth-to-mask infant resuscitation system was constructed. The study was performed in two university clinics with different resources. The KEM Hospital in Bombay was well equipped and neonatologists took part in all resuscitations; Muhimbili Medical Centre in Dar es Salaam was understaffed and had no physicians available at resuscitation. Therefore, different protocols had to be used. In Bombay, the study period was limited to 5 minutes. If needed, mask ventilation was then replaced by intubation. In Dar es Salaam, MM ventilation was continued for up to 10 minutes, the inspiratory pressure was adjusted to 30 cmH2O and the ventilation was slow (8-10 breaths/min). In Bombay, 30 babies were allocated to the BM and 24 to the MM groups. In Dar es Salaam 56 were in the BM and 64 in the MM groups. The results for term babies in Bombay and both term and pre-term babies in Dar es Salaam showed no significant differences between the two groups of treatment, as determined by Apgar score > or = 4 at 5 and 10 minutes, number of babies with their first gasp, heart rate > 130 beats/min or pulse oximeter values above 75%, all at 5 minutes. An Apgar score > or = 4 at 5 minutes was achieved in more than 75% of all infants, irrespective of treatment. The rates of early neonatal mortality and neonatal convulsions did not differ between the two methods of resuscitation. In Dar es Salaam, the low respiratory frequency used in both groups was associated with a slow increase in heart rate above 130 beats per min. This result indicates that further studies will be needed before such slow respiratory frequencies are used. We conclude that, if adequate training is provided and the respiratory frequency is kept within the normal range, MM ventilation is an alternative to assisted ventilation when no bag and mask is available. However, further studies are necessary, since this method has proved to be tiring and uncomfortable for the resuscitating health personnel.

Apgar Score↗

Neonatal imitation of tongue protrusion and mouth opening: methodological aspects and evidence of early individual differences.

The present work examines imitation of mouth opening and tongue protrusion in 32 full-term infants at three different occasions: When the infants are two to three days, three weeks, and three months old. The analysis focuses (1) on individual differences in imitative behaviour and (2) on how to operationalize the infants' responses. The overall group analysis revealed that imitation of tongue protrusion was statistically significant for both two- to three-day-old and three-week-old infants but not when the children had become three months old. No statistically significant effect was observed for imitation of mouth opening. Two different imitation indexes were constructed in order to assess individual differences in early imitative behaviour. Results show that short-term stability in imitative tendencies exists between the first and second observation. The results further reveal that methodological factors must be seriously considered when studying neonatal imitation: the overall imitation found for tongue protrusion is demonstrated to be dependent on how the infants' responses are coded.

Female↗

Lung volumes measured by helium dilution and by body plethysmography with mouth and oesophageal pressures: a comparative study in patients with lung disease.

A comparison was made between the helium dilution technique and body plethysmography--using both mouth pressure and oesophageal pressure against box pressure--for measuring functional residual capacity (FRC). In patients with restrictive lung disease (n = 9) no major differences in FRC were noted between the techniques. In patients with obstructive lung disease (n = 17), helium dilution underestimated FRC by a mean of 0.9 l and conventional body plethysmography (mouth-box pressure) overestimated it by 0.4 l in comparison with FRC obtained by oesophageal pressure against box pressure. The difference between the techniques increased with increasing lung volumes. It is concluded that conventional body plethysmography measures FRC more accurately than the helium dilution technique in patients with obstructive lung disease.

Female↗

Mouth to pouch transit after restorative proctocolectomy: hydrogen breath analysis correlates with scintigraphy.

OBJECTIVES: Fast intestinal transit may be responsible for slow adaptation and unacceptable steady-state function after restorative proctocolectomy. Investigation of GI transit time may be valuable in such a setting. We hypothesized that postprandial hydrogen breath tests may yield transit data that correlate with technetium-labeled meal scintigrams. METHODS: This study compared intestinal transit after a lactulose and bean meal via the breath hydrogen and scintigraphy methods in 21 ileoanal pouch subjects. The meal consisted of baked beans (425 g), 30 ml (20 g) lactulose syrup, 1 mCi 99mtechnetium sulfur colloid in finely chopped liver and 170 ml tap water. The meal contained 120 Kcal (70% carbohydrate, 18% protein and 12% fat). RESULTS: Of 21 pouch subjects, 11 (53%) had breath tests and scintigraphy transit studies that differed by 5-21 min. Three of 21 (14%) scintigraphy mouth to pouch transit times were faster than breath test transits by 43-107 min. Seven of 21 (33%) subjects did not have breath test peaks >10 ppm. Mouth to pouch transit for breath hydrogen (104+/-16 min) and scintigraphy (98+/-7 min) tests had significant correlation (r = 0.96, p < 0.0001) among subjects with alveolar hydrogen peaks and accurate scintigrams (n = 11). Scintigrams were five times more expensive than breath tests. CONCLUSIONS: A peaking hydrogen breath test provides an alternative to scintigraphy for estimating intestinal transit after ileoanal pouch.

Adult↗

Biosensor characterization of antigenic site A of foot-and-mouth disease virus presented in different vector systems.

The region 141-160 of the VP1 protein of foot-and-mouth disease virus known as site A is an immunodominant region that has been extensively studied for the purpose of developing a synthetic vaccine. In the present study, site A of foot-and-mouth disease virus was inserted in three different loops of the maltose-binding protein and its antigenicity was compared with site A presented as a conjugated synthetic peptide or inserted in beta-galactosidase. The affinity of antibodies elicited against the site A synthetic peptide was also compared with that of antibodies raised against the site A inserted within the two carrier proteins. Using biosensor technology it was possible to estimate the concentration of site A antibodies present in the various antisera and to show that site A fused to maltose-binding protein was a slightly better mimic of the epitope present in the virus particle than the synthetic peptide or the beta-galactosidase recombinant construct.

Animals↗

Comparison of plaque accumulation after topical application and mouth rinsing with chlorhexidine gluconate.

This study measured plaque accumulation on anterior teeth after topical or mouth rinse application of 0.2% chlorhexidine gluconate. Compared with water plaque scores were highly significantly reduced. There was no significant difference in plaque scores between topical application or mouth rinsing. The importance of locally adsorbed chlorhexidine is emphasised and the relevance of an oral reservoir effect questioned.

Administration, Topical↗

Clinical and radiographical split-mouth-study on resorbable versus non-resorbable GTR-membranes.

The aim of this prospective split-mouth-study was to compare the 5-months-healing results after implantation of resorbable (Polyglactin-910) and non-resorbable (e-PTFE) GTR-membranes. 12 healthy patients with 41 periodontal defects were treated. Radiographical and clinical examinations (papillary bleeding index, gingival recession, probing pocket depth, probing attachment level, and furcation depth) were carried out under standardized conditions immediately before and 5 months after surgery. The vertical relative attachment gain (V-rAG) was calculated as a % of the bony defect depth (intra-operatively measured) at baseline, and the horizontal relative attachment gain (H-rAG) as a % of the furcation depth at baseline. The standardized radiographs were evaluated blind by 4 experienced examiners for changes of the alveolar bone. Furthermore, digital subtraction radiography was carried out using the standard deviation of the grey level histograms in the experimental region and in a control region as a test parameter for bone changes. Both types of membranes achieved an attachment gain. Using the split-mouth-design, no statistically significant (< or = 0.05) difference between the two membranes could be detected (number of defects/median) with regard to V-rAG (Polyglactin: 12/77.5%, e-PTFE: 12/73.2%) or to H-rAG of class-II-furcations (Polyglactin: 5/66.7%, e-PTFE: 5/66.7%), or to bone changes using conventional and subtraction radiographic evaluation. In conclusion based on this 5-months-study, the resorbable membranes provided attachment gain comparable to the e-PTFE-membranes.

Adult↗

A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial periodontal therapy.

BACKGROUND: Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations. METHODS: In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a "one-stage, full-mouth" disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva. RESULTS: Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p<0.001 and p<0.05, respectively), when compared with placebo. This was also reflected by additional reductions in the number of CFU/ml of aerobic and especially anaerobic species and by a suppression of Streptococcus mutans (versus an overgrowth for the placebo), in all niches. Differences between both CHX solutions were never encountered. The subjective ratings were slightly in favour of the new CHX-CPC formulation when compared with the other CHX-alcohol formulation, especially for taste of the product (p<0.05), but less impressive for the staining of teeth and tongue. CONCLUSIONS: The results of this study demonstrated the potential of a new CHX 0.05%+CPC 0.05% non-alcoholic formulation as an effective antiplaque agent for long-term use with reduced subjective side effects.

Anti-Infective Agents, Local↗

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis.

AIM: To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. METHODS: Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. RESULTS: The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). CONCLUSION: The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.

Adult↗

The effect of a mouth rinse containing phenolic compounds on plaque formation and developing gingivitis.

BACKGROUND: The clinical effect of Listerine, a mouth rinse containing a mixture of phenolic compounds, is ascribed to its bactericidal properties. However, phenolic compounds are also known to interfere with the inflammatory process. OBJECTIVE: The purpose of this clinical trial was to evaluate the effect of regular mouth rinsing with Listerine on plaque and gingivitis during a 2-week period of no mechanical oral hygiene. MATERIAL AND METHODS: Twenty-one subjects were recruited for the study. On Day 0 of each 2-week experimental period, the participants were told to abstain from all mechanical plaque-control measures but to rinse twice a day with 10 ml of the assigned solution (test: Listerine, positive control:0.1% chlorhexidine (CHX), negative control: saline) for 60 s. Each experimental period was preceded by a 2-week period including oral hygiene instruction, scaling and professional mechanical tooth cleaning. Examinations included assessments of plaque and gingivitis (Days 0 and 14), sampling of plaque and collection of gingival crevicular fluid (GCF) (Days 0, 7 and 14). From the supragingival plaque samples, six different morphotypes of bacteria were counted using dark-field microscopy. The GCF collected was analysed with respect to the content of lactoferrin and albumin. RESULTS: During the experimental periods, it was observed that significantly less plaque formed and less gingivitis developed when the participants rinsed with the Listerine mouthwash than with saline solution. However, significantly more plaque formed during the Listerine than during the CHX rinse period, while there was no significant difference in the development of gingival bleeding between the Listerine and the CHX rinse regimens. Significantly smaller proportions of motile rods and fusiforms were found in the List and CHX groups than in the control (Ctrl) group. The increase of the lactoferrin/albumin ratio in the List group was significantly smaller than that in the Ctrl group but significantly larger than in the CHX group. CONCLUSION: It was suggested that the effect of Listerine on gingivitis is more pronounced than on plaque formation. This indicates that the phenolic compound may have anti-inflammatory effects.

Adult↗

Pathways to full mouth extraction.

The process of not attending the dentist is a vicious cycle in which anxiety plays a crucial role. A research project concerning the disease and non-disease reasons for full mouth extraction provided an opportunity to describe the dental histories in terms of dental attendance pattern and related factors which resulted in full dentures. Three profiles of dental histories could be outlined: 1) The regular attenders (19%). Because of their age (means = 47 yr), their positive attitude towards dentistry together with their positive attitude towards full dentures, it is suggested that the possibilities of keeping the natural dentition were exhausted so that full mouth extraction was an acceptable solution. 2) The symptomatic attenders (38%). Because anxiety, which was widespread in this group, was not based on negative experiences, it is suggested that anxiety is caused by social learning. Together with their positive attitude towards full dentures, the high prevalence of full dentures in their social environment and their low socioeconomic status, the conclusion is drawn that these patients lived in a culture which supports behavior that leads to total tooth loss. 3) Once regular attenders (43%). In this group anxiety leads to a negative perception of dental visits and to a negative attitude towards dentists. As a consequence dental visits are deferred, which results in deterioration of the dentition. Experiences with dentists are distorted in a negative way, which increases dental anxiety. Facilitated by a positive attitude towards full dentures, their bad dental condition finally urges them to take full dentures at early age.

Adult↗