Spectroscopic Investigation of Tooth Caries and Demineralization

Dental caries persists to be the most predominant oral disease in spite of remarkable progress made during the past half- century to reduce its prevalence. Early diagnosis of carious lesions is an important factor in the prevention and management of dental caries. Conventional procedures for caries detection involve visual-tactile and radiographic examination, which is considered as “gold standard”. These techniques are subjective and are unable to detect the lesions until they are well advanced and involve about one-third of the thickness of enamel. Therefore, all these factors necessitate the need for the development of new techniques for early diagnosis of carious lesions. Researchers have been trying to develop various instruments based on optical spectroscopic techniques for detection of dental caries during the last two decades. These optical spectroscopic techniques facilitate noninvasive and real-time tissue characterization with reduced radiation exposure to patient, thereby improving the management of dental caries. Nonetheless, a costeffective optical system with adequate sensitivity and specificity for clinical use is still not realized and development of such a system is a challenging task.Two key techniques based on the optical properties of dental hard tissues are discussed in this current thesis, namely laser-induced fluorescence (LIF) and diffuse reflectance (DR) spectroscopy for detection of tooth caries and demineralization. The work described in this thesis is mainly of applied nature, focusing on the analysis of data from in vitro tooth samples and extending these results to diagnose dental caries in a clinical environment. The work mainly aims to improve and contribute to the contemporary research on fluorescence and diffuse reflectance for discriminating different stages of carious lesions. Towards this, a portable and compact laser-induced fluorescence and reflectance spectroscopic system (LIFRS) was developed for point monitoring of fluorescence and diffuse reflectance spectra from tooth samples. The LIFRS system uses either a 337 nm nitrogen laser or a 404 nm diode laser for the excitation of tooth autofluorescence and a white light source (tungsten halogen lamp) for measuring diffuse reflectance.Extensive in vitro studies were carried out on extracted tooth samples to test the applicability of LIFRS system for detecting dental caries, before being tested in a clinical environment. Both LIF and DR studies were performed for diagnosis of dental caries, but special emphasis was given for early detection and also to discriminate between different stages of carious lesions. Further the potential of LIFRS system in detecting demineralization and remineralization were also assessed.In the clinical trial on 105 patients, fluorescence reference standard (FRS) criteria was developed based on LIF spectral ratios (F500/F635 and F500/F680) to discriminate different stages of caries and for early detection of dental caries. The FRS ratio scatter plots developed showed better sensitivity and specificity as compared to clinical and radiographic examination, and the results were validated with the blindtests. Moreover, the LIF spectra were analyzed by curve-fitting using Gaussian spectral functions and the derived curve-fitted parameters such as peak position, Gaussian curve area, amplitude and width were found to be useful for distinguishing different stages of caries. In DR studies, a novel method was established based on DR ratios (R500/R700, R600/R700 and R650/R700) to detect dental caries with improved accuracy. Further the diagnostic accuracy of LIFRS system was evaluated in terms of sensitivity, specificity and area under the ROC curve. On the basis of these results, the LIFRS system was found useful as a valuable adjunct to the clinicians for detecting carious lesions.

Concordancia entre citologia cervico vaginal anormal, colposcopia y biopsia de cervix de usuarias de la Clinica Colombia

El cáncer de cuello uterino, es una de las principales causas de morbimortalidad por cáncer a nivel mundial, el cual se perfila como un problema de salud pública; que gracias a la introducción de la toma de citología cervico vaginal como prueba de tamizaje, para detección temprana de cáncer de cuello uterino, ha venido en descenso. La sociedad Americana de Cáncer en estado Unidos, estima 11.270 casos nuevos para el 2009 y a nivel mundial, casi 500.000 casos nuevos (1,2). Actualmente, según las últimas estadísticas del Instituto Nacional de Cancerología 2009, comprende un 19,1% de casos nuevos. En el siguiente estudio se realizó un análisis descriptivo de concordancia, entre la citología cervico vaginal anormal, con el reporte de colposcopia y el estudio histológico (biopsia de cérvix); así como las principales alteraciones citológicas, según la clasificación de Bethesda que se presentan en las pacientes que son remitidas a la consulta de Ginecología Oncológica de la clínica Colombia. Los resultados obtenidos del estudio, nos mostró una concordancia kappa pobre a débil entre las variables: citología cervico vaginal anormal, colposcopia y biopsia de cérvix, en la Clínica Universitaria Colombia. Se recomienda realizar nuevos estudios de concordancia, previa modificación del informe de colposcopia de la CUC, para así poder unificar todos los conceptos, con el sistema de Bethesda, y el histológico y obtener un mejor resultado de concordancia.

A refined sampling strategy for intra-tooth stable isotope analysis of mammalian enamel

Serial sampling and stable isotope analysis performed along the growth axis of vertebrate tooth enamel records differences attributed to seasonal variation in diet, climate or animal movement. Because several months are required to obtain mature enamel in large mammals, modifications in the isotopic composition of environmental parameters are not instantaneously recorded, and stable isotope analysis of tooth enamel returns a time-averaged signal attenuated in its amplitude relative to the input signal. For convenience, stable isotope profiles are usually determined on the side of the tooth where enamel is thickest. Here we investigate the possibility of improving the time resolution by targeting the side of the tooth where enamel is thinnest. Observation of developing third molars (M3) in sheep shows that the tooth growth rate is not constant but decreases exponentially, while the angle between the first layer of enamel deposited and the enamel–dentine junction increases as a tooth approaches its maximal length. We also noted differences in thickness and geometry of enamel growth between the mesial side (i.e., the side facing the M2) and the buccal side (i.e., the side facing the cheek) of the M3. Carbon and oxygen isotope variations were measured along the M3 teeth from eight sheep raised under controlled conditions. Intra-tooth variability was systematically larger along the mesial side and the difference in amplitude between the two sides was proportional to the time of exposure to the input signal. Although attenuated, the mesial side records variations in the environmental signal more faithfully than the buccal side. This approach can be adapted to other mammals whose teeth show lateral variation in enamel thickness and could potentially be used as an internal check for diagenesis.

Season of birth and sheep husbandry in late Roman and Medieval coastal Flanders: a pilot study using tooth enamel d18O analysis

From the early Roman period, there is archaeological evidence for the exploitation of the Flemish coastal plain (Belgium) for a range of activities, such as sheep herding on the then developing salt-marshes and salt-meadows for the production of wool. During the early Middle Ages, this culminated in the establishment of dedicated ‘sheep estates’. This phase of exploitation was followed by extensive drainage and land reclamation measures in the high Medieval period, transforming areas into grassland, suited for cattle breeding. As part of a larger project investigating the onset, intensification and final decline of sheep management in coastal Flanders in the historical period, this pilot study presents the results of sequential sampling and oxygen isotope analysis of a number of sheep teeth (M2, n = 8) from four late Roman and Medieval sites (dating from 4th to 15th century AD), in order to assess potential variations in season of birth between the different sites and through time. In comparison with published data from herds of known birth season, incremental enamel data from the Flemish sites are consistent with late winter/spring births, with the possibility of some instances of slightly earlier parturition. These findings suggest that manipulation of season of birth was not a feature of the sheep husbandry-based economies of early historic Flanders, further evidencing that wool production was the main purpose of contemporary sheep rearing in the region. Manipulation of season of birth is not likely to have afforded economic advantage in wool-centred economies, unlike in some milk- or meat-based regimes.

Ridge Preservation With Acellular Dermal Matrix and Anorganic Bone Matrix Cell-Binding Peptide P-15 After Tooth Extraction in Humans

Background: Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several regenerative techniques are available and are used for socket preservation. The aim of this study is to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. Methods: Eighteen patients in need of extraction of maxillary anterior teeth were selected and randomly assigned to the test group (ADM plus ABM/P-15) or the control group (ADM only). Clinical measurements were recorded initially and at 6 months after ridge-preservation procedures. Results: In the clinical measurements (external vertical palatal measurement [EVPM], external vertical buccal measurement [EVBM], and alveolar horizontal measurement [AHM]) the statistical analysis showed no difference between test and control groups initially and at 6 months. The intragroup analysis, after 6 months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the two groups, the differences in the test group were as follows: EVPM = 0.83 +/- 1.53 mm; EVBM = 1.20 +/- 2.02 mm; and AHM = 2.53 +/- 1.81 mm. The differences in the control group were as follows: EVPM = 0.87 +/- 1.13 mm; EVBM = 1.50 +/- 1.15 mm; and AHM = 3.40 +/- 1.39 mm. The differences in EVPM and EVBM were not statistically significant; however, in horizontal measurement (AHM), there was a statistically significant difference (P<0.05). Conclusion: The results of this study show that ADM used as membrane associated with ABM/P-15 can be used to reduce buccal-palatal dimensions compared to ADM alone for preservation of the alveolar ridge after extraction of anterior maxillary teeth. J Periodontol 2011;82:72-79.

Information for the diagnosis and treatment of root resorption due to tooth replantation

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications.

Menopausal status: A possible predictive factor for recurrence in women with cancer of the uterine cervix without pelvic lymph node metastasis

Objectives: To evaluate risk factors for recurrence of carcinoma of the uterine cervix among women who had undergone radical hysterectomy without pelvic lymph node metastasis, while taking into consideration not only the classical histopathological factors but also sociodemographic, clinical and treatment-related factors. Study design: This was an exploratory analysis on 233 women with carcinoma of the uterine cervix (stages IB and IIA) who were treated by means of radical hysterectomy and pelvic lymphadenectomy, with free surgical margins and without lymph node metastases on conventional histopathological examination. Women with histologically normal lymph nodes but with micrometastases in the immunohistochemical analysis (AE1/AE3) were excluded. Disease-free survival for sociodemographic, clinical and histopathological variables was calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to identify the independent risk factors for recurrence. Results: Twenty-seven recurrences were recorded (11.6%), of which 18 were pelvic, four were distant, four were pelvic + distant and one was of unknown location. The five-year disease-free survival rate among the study population was 88.4%. The independent risk factors for recurrence in the multivariate analysis were: postmenopausal status (HR 14.1; 95% CI: 3.7-53.6; P < 0.001), absence of or slight inflammatory reaction (HR 7.9; 95% CI: 1.7-36.5; P = 0.008) and invasion of the deepest third of the cervix (FIR 6.1; 95% CI: 1.3-29.1; P = 0.021). Postoperative radiotherapy was identified as a protective factor against recurrence (HR 0.02; 95% CI: 0.001-0.25; P = 0.003). Conclusion: Postmenopausal status is a possible independent risk factor for recurrence even when adjusted for classical prognostic factors (such as tumour size, depth of turnout invasion, capillary embolisation) and treatment-related factors (period of treatment and postoperative radiotherapy status). (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Comparison of biological behavior between early-stage adenocarcinoma and squamous cell carcinoma of the uterine cervix

Objectives: (1) To compare the anatomopathological variables and recurrence rates in patients with early-stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix; (2) to identify the independent risk factors for recurrence. Study design: This historical cohort study assessed 238 patients with carcinoma of the uterine cervix (113 and IIA), who underwent radical hysterectomy with pelvic lymph node dissection between 1980 and 1999. Comparison of category variables between the two histological types was carried out using the Pearson`s X-2 test or Fisher exact test. Disease-free survival rates for AC and SCC were calculated using the Kaplan-Meier method and the curves were compared using the log-rank test. The Cox proportional hazards model was used to identify the independent risk factors for recurrence. Results: There were 35 cases of AC (14.7%) and 203 of SCC (85.3%). AC presented lower histological grade than did SCC (grade 1: 68.6% versus 9.4%; p < 0.001), lower rate of lymphovascular space involvement (25.7% versus 53.7%; p = 0.002), lower rate of invasion into the middle or deep thirds of the uterine cervix (40.0% versus 80.8%; p < 0.001) and lower rate of lymph node metastasis (2.9% versus 16.3%; p = 0.036). Although the recurrence rate was lower for AC than for SCC (11.4% versus 15.8%), this difference was not statistically significant (p = 0.509). Multivariate analysis identified three independent risk factors for recurrence: presence of metastases in the pelvic lymph nodes, invasion of the deep third of the uterine cervix and absence of or slight inflammatory reaction in the cervix. When these variables were adjusted for the histological type and radiotherapy status, they remained in the model as independent risk factors. Conclusion: The AC group showed less aggressive histological behavior than did the SCC group, but no difference in the disease-free survival rates was noted. (C) 2006 Elsevier Ireland Ltd. All rights reserved.

Tooth Abnormalities of Number and Position in the Permanent Dentition of Patients With Complete Bilateral Cleft Lip and Palate

Objective: To radiographically evaluate the prevalence of tooth abnormalities of number and position in the permanent dentition of individuals with complete bilateral cleft lip and palate. Design: Cross-sectional retrospective. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil. Patients: Two hundred five individuals with complete bilateral cleft lip and palate. Interventions: Analysis of patient records and panoramic radiographs. Main outcome measures: Evaluation of hypodontia and supernumerary teeth and analysis of the position of the permanent maxillary lateral incisor in relation to the alveolar cleft. Results: Hypodontia was observed in 144 patients (70.2%), and the highest prevalence was observed for the maxillary lateral incisor. When both lateral incisors were present (43%), they were primarily located on the distal side of the cleft (25%). Supernumerary teeth were observed in 11.7% of individuals. Conclusion: Patients with cleft lip and palate presented high prevalence of hypodontia and supernumerary teeth. The prevailing characteristics of their location may suggest the presence of a similar genetic component for the occurrence of hypodontia and cleft.

In vitro analysis of human tooth pulp chamber temperature after low-intensity laser therapy at different power outputs

In vitro studies have provided conflicting evidence of temperature changes in the tooth pulp chamber after low-level laser irradiation of the tooth surface. The present study was an in vitro evaluation of temperature increases in the human tooth pulp chamber after diode laser irradiation (GaAlAs, lambda = 808 nm) using different power densities. Twelve human teeth (three incisors, three canines, three premolars and three molars) were sectioned in the cervical third of the root and enlarged for the introduction of a thermocouple into the pulp chamber. The teeth were irradiated with 417 mW, 207 mW and 78 mW power outputs for 30 s on the vestibular surface approximately 2 mm from the cervical line of the crown. The highest average increase in temperature (5.6A degrees C) was observed in incisors irradiated with 417 mW. None of the teeth (incisors, canines, premolars or molars) irradiated with 207 mW showed temperature increases higher than 5.5A degrees C that could potentially be harmful to pulp tissue. Teeth irradiated with 78 mW showed lower temperature increases. The study showed that diode laser irradiation with a wavelength of 808 nm at 417 mW power output increased the pulp chamber temperature of certain groups of teeth, especially incisors and premolars, to critical threshold values for the dental pulp (5.5A degrees C). Thus, this study serves as a warning to clinicians that ""more"" is not necessarily ""better"".

Primary non-gestational choriocarcinoma of the uterine cervix: A case report

Background. Primary non-gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites.Case. Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug-resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non-gestational choriocarcinoma.Conclusion. Primary non-gestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue. (c) 2005 Elsevier B.V. All rights reserved.

Association between CD31 expression and histopathologic features in stage IB squamous cell carcinoma of the cervix

This study was undertaken to evaluate the association between the expression of CD31 in the tumor and the histopathologic findings in patients with carcinoma of the cervix. This study included prospectively 30 women, aged 46.6 +/- 10.7 years, with stage IB squamous cell carcinoma of the cervix submitted to radical hysterectomy from November 2001 to September 2002. Samples from the tumor were taken and immunohistochemically evaluated by a monoclonal antibody for CD31. Clinicopathologic characteristics such as stage, tumor size, grade of differentiation, lymphatic vascular space invasion (LVSI), parametrial involvement, and status of pelvic lymph nodes were also recorded. The clinical stage (FIGO) was IB1 in 22 patients (73.3%) and IB2 in 8 patients (26.7%). The expression of CD31 was significantly associated with tumor size and the presence of LVSI, but not with grade of differentiation and vaginal or parametrial involvement (P= 0.03, P= 0.032, P= 0.352, P= 0.208, and P= 0.242, respectively). on univariate analysis, the presence of pelvic lymph node metastasis was influenced by LVSI (P= 0.003) and CD31 expression (P= 0.032). However, on multivariate analysis, the presence of LVSI (P= 0.007) was the only independent predictor of pelvic lymph node metastasis. The CD31 expression in tumor is significantly associated with LVSI and tumor size in patients with early-stage squamous cell carcinoma of the cervix.