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

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

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

European Organization for Caries Research Workshop: Methodology for Determination of Potentially Available Fluoride in Toothpastes

Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done

Timing of Favorable Conditions, Competition and Fertility Interact to Govern Recruitment of Invasive Chinese Tallow Tree in Stressful Environments

The rate of new exotic recruitment following removal of adult invaders (reinvasion pressure) influences restoration outcomes and costs but is highly variable and poorly understood. We hypothesize that broad variation in average reinvasion pressure of Triadica sebifera (Chinese tallow tree, a major invader) arises from differences among habitats in spatiotemporal availability of realized recruitment windows. These windows are periods of variable duration long enough to permit establishment given local environmental conditions. We tested this hypothesis via a greenhouse mesocosm experiment that quantified how the duration of favorable moisture conditions prior to flood or drought stress (window duration), competition and nutrient availability influenced Triadica success in high stress environments. Window duration influenced pre-stress seedling abundance and size, growth during stress and final abundance; it interacted with other factors to affect final biomass and germination during stress. Stress type and competition impacted final size and biomass, plus germination, mortality and changes in size during stress. Final abundance also depended on competition and the interaction of window duration, stress type and competition. Fertilization interacted with competition and stress to influence biomass and changes in height, respectively, but did not affect Triadica abundance. Overall, longer window durations promoted Triadica establishment, competition and drought (relative to flood) suppressed establishment, and fertilization had weak effects. Interactions among factors frequently produced different effects in specific contexts. Results support our ‘outgrow the stress’ hypothesis and show that temporal availability of abiotic windows and factors that influence growth rates govern Triadica recruitment in stressful environments. These findings suggest that native seed addition can effectively suppress superior competitors in stressful environments. We also describe environmental scenarios where specific management methods may be more or less effective. Our results enable better niche-based estimates of local reinvasion pressure, which can improve restoration efficacy and efficiency by informing site selection and optimal Management

Quantitative High-Throughput Screen Identifies Inhibitors of the Schistosoma mansoni Redox Cascade

Schistosomiasis is a tropical disease associated with high morbidity and mortality, currently affecting over 200 million people worldwide. Praziquantel is the only drug used to treat the disease, and with its increased use the probability of developing drug resistance has grown significantly. The Schistosoma parasites can survive for up to decades in the human host due in part to a unique set of antioxidant enzymes that continuously degrade the reactive oxygen species produced by the host's innate immune response. Two principal components of this defense system have been recently identified in S. mansoni as thioredoxin/glutathione reductase (TGR) and peroxiredoxin (Prx) and as such these enzymes present attractive new targets for anti-schistosomiasis drug development. Inhibition of TGR/Prx activity was screened in a dual-enzyme format with reducing equivalents being transferred from NADPH to glutathione via a TGR-catalyzed reaction and then to hydrogen peroxide via a Prx-catalyzed step. A fully automated quantitative high-throughput (qHTS) experiment was performed against a collection of 71,028 compounds tested as 7- to 15-point concentration series at 5 µL reaction volume in 1536-well plate format. In order to generate a robust data set and to minimize the effect of compound autofluorescence, apparent reaction rates derived from a kinetic read were utilized instead of end-point measurements. Actives identified from the screen, along with previously untested analogues, were subjected to confirmatory experiments using the screening assay and subsequently against the individual targets in secondary assays. Several novel active series were identified which inhibited TGR at a range of potencies, with IC50s ranging from micromolar to the assay response limit (∼25 nM). This is, to our knowledge, the first report of a large-scale HTS to identify lead compounds for a helminthic disease, and provides a paradigm that can be used to jump-start development of novel therapeutics for other neglected tropical diseases

Healthy ageing and depletion of intracellular glutathione influences T cell membrane thioredoxin-1 levels and cytokine secretion

Background: During ageing an altered redox balance has been observed in both intracellular and extracellular compartments, primarily due to glutathione depletion and metabolic stress. Maintaining redox homeostasis is important for controlling proliferation and apoptosis in response to specific stimuli for a variety of cells. For T cells, the ability to generate specific response to antigen is dependent on the oxidation state of cell surface and cytoplasmic protein-thiols. Intracellular thiols are maintained in their reduced state by a network of redox regulating peptides, proteins and enzymes such as glutathione, thioredoxins and thioredoxin reductase. Here we have investigated whether any relationship exists between age and secreted or cell surface thioredoxin-1, intracellular glutathione concentration and T cell surface thioredoxin 1 (Trx-1) and how this is related to interleukin (IL)-2 production.Results: Healthy older adults have reduced lymphocyte surface expression and lower circulating plasma Trx-1 concentrations. Using buthionine sulfoximine to deplete intracellular glutathione in Jurkat T cells we show that cell surface Trx-1 is lowered, secretion of Trx-1 is decreased and the response to the lectin phytohaemagglutinin measured as IL-2 production is also affected. These effects are recapitulated by another glutathione depleting agent, diethylmaleate.Conclusion: Together these data suggest that a relationship exists between the intracellular redox compartment and Trx-1 proteins. Loss of lymphocyte surface Trx-1 may be a useful biomarker of healthy ageing. © 2013 Carilho Torrao et al.; licensee Chemistry Central Ltd