Two decades of ART: improving on success through further research

Since the introduction of the Atraumatic Restorative Treatment (ART) approach over twenty years ago, more than 190 research publications have appeared. The last research agenda defining research priorities for ART was published in 1999. The objective of the present work was to review existing research in the context of future research priorities for ART. MATERIAL AND METHODS: An internet survey was conducted amongst those who had published on ART or were known to be working on the ART approach, to solicit their views as to areas of future ART research. Three broad categories were defined, namely: 1. Basic and laboratory research; 2. Clinical research, and, 3. Community, Public Health, Health Services Research. RESULTS: A 31% response rate was achieved. The study identified a number of new areas of research as well as areas where additional research is required. These are expressed as recommendations for future ART research. CONCLUSIONS: The ART approach is based on a robust, reliable and ever-growing evidence base concerning its clinical applications which indicates that it is a reliable and quality treatment approach. In common with all other oral health care procedures, targeted applied research is required to improve the oral health care offered

Conclusions from the symposium: Two decades of ART: success through research

Two decades of ART research has served as the catalyst for a new way of thinking about oral health care. It is now necessary to build on the success of ART research by educating existing and future oral health professionals and health decision makers about the benefits of the ART approach. It is also important to build upon the sound research base that already exists on ART even though enough is known about ART to consider it is a reliable and quality approach to control caries. While oral health promotion through prevention remains the essential foundation of oral health, the ART approach is an important corner stone in the building of global oral health

Global affordability of fluoride toothpaste

<p>Abstract</p> <p>Objective</p> <p>Dental caries remains the most common disease worldwide and the use of fluoride toothpaste is a most effective preventive public health measure to prevent it. Changes in diets following globalization contribute to the development of dental caries in emerging economies. The aim of this paper is to compare the cost and relative affordability of fluoride toothpaste in high-, middle- and low-income countries. The hypothesis is that fluoride toothpaste is not equally affordable in high-, middle- and low-income countries.</p> <p>Methods</p> <p>Data on consumer prices of fluoride toothpastes were obtained from a self-completion questionnaire from 48 countries. The cost of fluoride toothpaste in high-, middle- and low-income countries was compared and related to annual household expenditure as well as to days of work needed to purchase the average annual usage of toothpaste per head.</p> <p>Results</p> <p>The general trend seems to be that the proportion of household expenditure required to purchase the annual dosage of toothpaste increases as the country's per capita household expenditure decreases. While in the UK for the poorest 30% of the population only 0.037 days of household expenditure is needed to purchase the annual average dosage (182.5 g) of the lowest cost toothpaste, 10.75 days are needed in Kenya. The proportion of annual household expenditure ranged from 0.02% in the UK to 4% in Zambia to buy the annual average amount of lowest cost toothpaste per head.</p> <p>Conclusion</p> <p>Significant inequalities in the affordability of this essential preventive care product indicate the necessity for action to make it more affordable. Various measures to improve affordability based on experiences from essential pharmaceuticals are proposed.</p

Reversible Silencing of CFTR Chloride Channels by Glutathionylation

The cystic fibrosis transmembrane conductance regulator (CFTR) is a phosphorylation- and ATP-dependent chloride channel that modulates salt and water transport across lung and gut epithelia. The relationship between CFTR and oxidized forms of glutathione is of potential interest because reactive glutathione species are produced in inflamed epithelia where they may be modulators or substrates of CFTR. Here we show that CFTR channel activity in excised membrane patches is markedly inhibited by several oxidized forms of glutathione (i.e., GSSG, GSNO, and glutathione treated with diamide, a strong thiol oxidizer). Three lines of evidence indicate that the likely mechanism for this inhibitory effect is glutathionylation of a CFTR cysteine (i.e., formation of a mixed disulfide with glutathione): (a) channels could be protected from inhibition by pretreating the patch with NEM (a thiol alkylating agent) or by lowering the bath pH; (b) inhibited channels could be rescued by reducing agents (e.g., DTT) or by purified glutaredoxins (Grxs; thiol disulfide oxidoreductases) including a mutant Grx that specifically reduces mixed disulfides between glutathione and cysteines within proteins; and (c) reversible glutathionylation of CFTR polypeptides in microsomes could be detected biochemically under the same conditions. At the single channel level, the primary effect of reactive glutathione species was to markedly inhibit the opening rates of individual CFTR channels. CFTR channel inhibition was not obviously dependent on phosphorylation state but was markedly slowed when channels were first “locked open” by a poorly hydrolyzable ATP analogue (AMP-PNP). Consistent with the latter finding, we show that the major site of inhibition is cys-1344, a poorly conserved cysteine that lies proximal to the signature sequence in the second nucleotide binding domain (NBD2) of human CFTR. This region is predicted to participate in ATP-dependent channel opening and to be occluded in the nucleotide-bound state of the channel based on structural comparisons to related ATP binding cassette transporters. Our results demonstrate that human CFTR channels are reversibly inhibited by reactive glutathione species, and support an important role of the region proximal to the NBD2 signature sequence in ATP-dependent channel opening

The implementation and preliminary evaluation of an ART strategy in Mexico: a country example

The massive use of preventive measures in Mexico including fluoride toothpaste, a national program of salt fluoridation and education on prevention has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means to address this. This included the development of training materials, the organization of training courses for existing dentists and the incorporation of ART into the undergraduate curriculum. RESULTS: Six years after the introduction of ART in the year 2000, it was estimated that over 2 million ART procedures had been provided. As part of the planning cycle, an evaluation was undertaken in 2008 to determine amongst Mexican dentists what were the perceived problems when implementing the ART approach. Such research identified that the scarcity of appropriate dental materials and the lack of suitable instruments were the major problems. In addition, a preliminary evaluation of ART restorations and sealants placed as part of this National Oral Health Program was undertaken. The survival outcomes after one year compared favorably with one other study conducted in Mexico but were somewhat lower than the results reported from a number of other countries. CONCLUSION: The ambitious and forward thinking policy for improving the oral health in Mexico is now showing dividends. One example is the ART strategy, which has been successful both in terms of the number of ART procedures provided and generally in terms of clinical outcomes

Dust in the Ionized Medium of the Galaxy: GHRS Measurements of Al III and S III

We present interstellar absorption line measurements of the ions S III and Al III towards six stars using archival Goddard High Resolution Spectrograph data. The ions Al III and S III trace heavily depleted and non-depleted elements, respectively, in ionized gas. We use the photoionization code CLOUDY to derive the ionization correction relating N(Al III)/N(S III) to the gas-phase abundance [Al/S]_i in the ionized gas. For spectral types considered here, the corrections are small and independent of the assumed ionization parameter. Using the results of these photoionization models, we find [Al/S]_i = -1.0 in the ionized gas towards three disk stars. These values of [Al/S]_i (=[Al/H]_i) imply that Al-bearing grains are present in the ionized nebulae around these stars. If the WIM of the Galaxy is photoionized by OB stars, our data for two halo stars imply [Al/S]_i = -0.4 to -0.5 in the WIM and thus the presence of dust grains containing Al in this important phase of the ISM. While photoionization appears to be the most likely origin of the ionization for Al III and S III, we cannot rule out confusion from the presence of hot, collisionally ionized gas along two sightlines. We find that [Al/S]_i in the ionized gas along the six sightlines is anti-correlated with the electron density and average sightline neutral density. The degree of grain destruction in the ionized medium of the Galaxy is not much higher than in the warm neutral medium. The existence of grains in the ionized regions studied here has important implications for the thermal balance of these regions. (Abstract Abridged)Comment: 30 pages including 8 embedded tables and 8 embedded figures. Accepted for publication in the Astrophysical Journa

Knowledge and Use of Caries Risk Assessment for Adult Patients Croatian Dentists

Svrha rada: Svrha istraživanja bila je evaluirati upotrebu procjene rizika za nastanak karijesa (PRK)kod hrvatskih općih stomatologa i procijeniti njihovo znanje i stajališta o PRK-u. Materijal i postupci: Poveznica za on-line upitnik poslana je na e-adrese 1500 stomatologa u Hrvatskoj. Dobiveni podatcianalizirani su s pomoću deskriptivne statistike, logističke regresije i Chi-kvradrat testa. Rezultati: Od257 ispitanika njih 47 % obavlja PRK rutinski, a samo se 4,5 % pritom koristi specifičnim formularima.Među ispitanicima znatno je varirala važnost različitih čimbenika pri pripremi plana terapije. Nadalje,77 % ispitanika temeljilo je individualnu prevenciju (IPK) karijesa na PRK-u. Veza između PRK i IPK tePRK i plana terapije bila je statistički značajna (p = 0,001). Praktičari koji primjenjuju PRK češće pla-niraju terapiju i provode IPK prema PRK-u. Na uporabu PRK-a nisu utjecali ni specijalizacija, ni iskustvo stomatologa. Zaključci: Velikom dijelu (53 %) hrvatskih općih stomatologa PRK nije dio rutinskeprakse i postoji značajna povezanost između njegove primjene i planiranja terapije te IPK. Potrebno je promicati uporabu PRK-a u svakodnevnoj dentalnoj praksi u Hrvatskoj.Objective: The aim of this study was to evaluate the usage of caries risk assessment (CRA) by Croatian general practitioners and evaluate their knowledge and attitudes towards CRA. Material and methods: A link to an online questionnaire was sent via e-mail to a sample of 1,500 general dentists in Croatia. The obtained data were analyzed using descriptive statistics, logistic regression analyses and chi-square tests. Results: Of 257 respondents, 47% performed CRA routinely, but only 4.5% of them used a specific CRA form. The significance of different actors in the development of a treat-ment plan varied considerably among respondents. Furthermore, in 77% of the respondents CRA was a basis for planning individual caries prevention (ICP). The association between CRA and ICP, and be-tween CRA and treatment planning was statistically significant (p=0.001). The practitioners doing CRA more often plan their treatment and ICP according to CRA. The use of CRA was not influenced by specialty and dentists’ experience. Conclusions: In a considerable percentage (53%) of Croatian general dentists, CRA is not part of their routine practice, and there is a strong association between the use of CRA and treatment plans and ICP. There is a need to promote the use of CRA in daily dental practice in Croatia

Food for Thought : Eastern Baltic cod in distress: biological changes and challenges for stock assessment

The eastern Baltic (EB) cod (Gadus morhua) stock was depleted and overexploited for decades until the mid-2000s, when fishing mortality rapidly declined and biomass started to increase, as shown by stock assessments. These positive developments were partly assigned to effective management measures, and the EB cod was considered one of the most successful stock recoveries in recent times. In contrast to this optimistic view, the analytical stock assessment failed in 2014, leaving the present stock status unclear. Deteriorated quality of some basic input data for stock assessment in combination with changes in environmental and ecological conditions has led to an unusual situation for cod in the Baltic Sea, which poses new challenges for stock assessment and management advice. A number of adverse developments such as low nutritional condition and disappearance of larger individuals indicate that the stock is in distress. In this study, we (i) summarize the knowledge of recent changes in cod biology and ecosystem conditions, (ii) describe the subsequent challenges for stock assessment, and (iii) highlight the key questions where answers are urgently needed to understand the present stock status and provide scientifically solid support for cod management in the Baltic Sea

Two decades of ART: improving on success through further research

Since the introduction of the Atraumatic Restorative Treatment (ART) approach over twenty years ago, more than 190 research publications have appeared. The last research agenda defining research priorities for ART was published in 1999. The objective of the present work was to review existing research in the context of future research priorities for ART. MATERIAL AND METHODS: An internet survey was conducted amongst those who had published on ART or were known to be working on the ART approach, to solicit their views as to areas of future ART research. Three broad categories were defined, namely: 1. Basic and laboratory research; 2. Clinical research, and, 3. Community, Public Health, Health Services Research. RESULTS: A 31% response rate was achieved. The study identified a number of new areas of research as well as areas where additional research is required. These are expressed as recommendations for future ART research. CONCLUSIONS: The ART approach is based on a robust, reliable and ever-growing evidence base concerning its clinical applications which indicates that it is a reliable and quality treatment approach. In common with all other oral health care procedures, targeted applied research is required to improve the oral health care offered