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Objective To provide an update on tray bleaching for various tooth discoloration conditions, including a complete examination form as well as an information and consent form. Clinical considerations Since the bleaching process was first documented in 1989, it has become a safe, successful, and conservative treatment for consistently whitening the color of patients' natural teeth. Though initially used on a limited basis, the process has expanded to include bleaching nicotine and tetracycline stains, single dark teeth, brown spots, reducing white spots, caries control as well as color change from aging. Ten percent carbamide peroxide is the material most used in research and has shown to be the most effective with the least amount of adverse side effects, including sensitivity or gingival irritation. Bleaching overnight using a smooth nonscalloped, nonreservoir vacuum-formed tray has been shown to be the method of choice for most clinicians, leading to greater patient compliance and an overall successful treatment. When possible, conservative bleaching treatment should be considered prior to more invasive, irreversible procedures such as veneers, or crowns to meet patients' esthetic requirements. Because of its basic pH, and potential for caries inhibition, complete restorative treatment does not have to be performed prior to initiating bleaching, making it an extremely flexible treatment. Conclusion With a thorough bleaching analysis, proper treatment of appropriate discolorations over an ideal timeframe, tray bleaching is a powerfully predictable tool in restorative dentistry. Clinical significance Tray bleaching with 10% carbamide peroxide should be the first consideration for treatment of discolorations of any type, with varying times of treatment, even in the presence of mild decay.

Background and Study Aims The recognition of suggestive endoscopic markers in the duodenum during open access endoscopy can help identifying patients who are likely to develop coeliac disease (CD). This study aims to determine the diagnostic accuracy of duodenal endoscopic markers for the diagnosis of CD. Patients and methods All children (0–15 years) who underwent oesophagogastroduodenoscopy (EGD) for any reason suggestive of CD at the paediatric department of Al-Assad University Hospital in Latakia, Syria during a 4-year period (from January 2010 to December 2013) were retrospectively included, in the study; this yielded a consecutive cohort without selection bias. The relevant data were obtained from the patients’ files. Four duodenal endoscopic markers, including scalloping, reduction of duodenal folds, nodular mucosal pattern, and scattered white spots, were evaluated. Results During the study period, 504 children underwent EGD of whom 123 (24.4%) were ultimately diagnosed with CD. At least one marker was observed in 200/504 children (39.6%) and the diagnostic values were as follows: Sensitivity (91%), specificity (76%), positive predictive value (56%), and negative predictive value (97%). Scalloping had the highest sensitivity and specificity of 89% and 96%, respectively. Conclusion Careful examination of the second and third parts of the duodenum during endoscopy can be helpful in identifying CD. Scalloping is the most common endoscopic marker, and the high NPV values of endoscopic markers should be interpreted cautiously, as the diagnosis of CD can be missed.

This clinical report describes a chemical abrasive protocol and whitening techniques to quantify modifications to the color and volume produced when eliminating white spots associated with developmental defects in enamel. Chemical (oxidative-erosive) abrasive treatment (whitening + 6.6% hydrochloric acid) resolves white spots up to a depth of 0.2 mm. At greater depths, infiltration with 16% hydrochloric acid followed by composite resin infiltration is recommended.

For patients with fixed orthodontic appliances, adequate daily dental plaque removal is more difficult. As a result, dental plaque accumulates more quickly and gingivitis and white spots develop more often. In non-orthodontic patients, electric toothbrushing is more effective in dental plaque removal than a manual toothbrush. This structured literature review shows that there is limited evidence that electric toothbrushes are more effective in plaque removal than a manual toothbrush in patients with fixed orthodontic appliances.Bij patiënten met vaste orthodontische apparatuur is adequate dagelijkse plaqueverwijdering moeilijker dan zonder deze apparatuur, waardoor plaque sneller accumuleert en vaker gingivitis en witte vlekken ontstaan. Bij niet-orthodontische patiënten is elektrisch tandenpoetsen effectiever in plaqueverwijdering dan met een handtandenborstel. Uit dit gestructureerde literatuuronderzoek blijkt dat er beperkte evidentie is dat elektrische tandenborstels effectiever zijn in plaqueverwijdering dan een handtandenborstel bij patiënten met een vaste orthodontische apparatuur.

BACKGROUND Children with molar incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly few studies have evaluated the clinical success of such interventions. AIM To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH. DESIGN This in-vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for management of incisor opacities. Standard images were taken pre- and six-months post-treatment. Image software (Image-Pro Plus®V7) was employed to convert 24-bit RGB images to 16-bit grey-scale and 45% magnification. Measurement repeatability was assessed using Intra-class Correlation Coefficients (ICC). Post-treatment changes in visible opacity area (mm2 ) and brightness (greyscale value) were tested using Wilcoxon Signed Rank Test for Related-Samples. RESULTS Mean total opacity surface area significantly reduced from 14.3mm2 (SD=7.5) to 9.4mm2 (SD=9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD=10.5) to 14.7% (SD=12.7). Mean maximum opacity brightness significantly reduced from 53066 greyscale value (SD=4740) to 49040 (SD=3796). ICC was good/excellent (0.75-1.0). CONCLUSION Minimally invasive treatment is effective in reducing size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

The objective was to use two ultrasound image and signal processing techniques (MicroPure and superb microvascular imaging [SMI]; Toshiba Medical, Tokyo, Japan) to investigate carotid plaque calcification and intraplaque neovascularity flow as biomarkers for plaque vulnerability in patients before endarterectomy.Thirty patients, with preoperative computed tomography angiography and scheduled for carotid endarterectomy, were enrolled in an institutional review board-approved study. Bilateral grayscale, power Doppler, SMI and MicroPure imaging of the carotids were performed using an Aplio 500 Platinum scanner (Toshiba). MicroPure combines nonlinear imaging and speckle suppression to mark calcifications as white spots in a blue overlay, and SMI uses clutter suppression to extract microvascular flow signals. Readers counted calcifications and scored them as present or absent; intraplaque neovascularity was scored on a 4-point scale by ultrasound imaging as well as by pathology (as the reference). MicroPure and SMI assessments were compared with conventional ultrasound examination and computed tomography angiography with pathology as the reference standard.Owing to technical difficulties and cancelled operations, 57 carotids were studied; endarterectomies yielded 28 specimens. Intraplaque neovascularization was detected by SMI in significantly more plagues than by power Doppler (41 vs 22 out 57 examined plaques or 72% vs 39%; P .0001). There was no statistical difference between either reader compared with pathology (P.37). Sensitivity specificity and accuracy for detecting intraplaque neovascularity based on color SMI and PDI were 84% (95% confidence interval [CI], 64%-96%), 33% (95% CI, 1%-91%), 79% (95% CI, 59%-92%), and 52% (95% CI, 31%-72%), 100% (95% CI, 23%-100%), and 57% (95% CI, 37%-76%), respectively. MicroPure did not correlate with any measures of intraplaque flow (P.13).SMI may have potential for providing evidence of plaque vulnerability. MicroPure appears less useful in carotid applications.

The review summarizes and analyzes the data of world scientific literature and the results of the own research con- cerning one of the main non-targeted effects of ionizing radiation - the radiation induced bystander effect (RIBE) - the ability of irradiated target cells to induce secondary biological changes in non-irradiated receptor cells. The his- tory of studies of this phenomenon is presented - it described under various names since 1905, began to study from the end of the twentieth century when named as RIBE and caused particular interest in the scientific community during recent decades. It is shown that the development of biological science and the improvement of research methods allowed to get new in-depth data on the development of RIBE not only at the level of the whole organism, but even at the genome level. The review highlights the key points of numerous RIBE investigations including mod- eling; methodological approaches to studying; classification; features of interaction between irradiated and intact cells; the role of the immune system, oxidative stress, cytogenetic disorders, changes in gene expression in the mechanism of development of RIBE; rescue effect, abscopal effect, persistence, modification, medical effects. It is emphasized that despite the considerable amount of research concerning the bystander response as the universal phenomenon and RIBE as one of its manifestations, there are still enough «white spots» in determining the mech- anisms of the RIBE formation and assessing the possible consequences of its development for human health.U statti uzagal'neni ta proanalizovani dani svitovoï naukovoï literatury i rezul'taty vlasnykh doslidzhen' shchodo odnogo z osnovnykh nemishenevykh efektiv diï ionizuiuchogo vyprominiuvannia – radiatsiy̆no-indukovanogo efektu svidka (radiation induced bystander effect – RIBE) – zdatnosti oprominenykh klityn-misheney̆ indukuvaty vtorynni biologichni zminy v neoprominenykh klitynakh-retsypiientakh. Vidobrazheno istoriiu doslidzhen' ts'ogo fenomenu, iakyy̆ pid riznymy nazvamy opysuvavsia shche z 1905 roku, pochav vyvchatysia z kintsia KhKh stolittia, koly y̆ oderzhav naz- vu RIBE, ta vyklykav osoblyvyy̆ interes u naukovoï spil'noty v ostanni desiatyrichchia. Pokazano, shcho rozvytok biologichnoï nauky i vdoskonalennia metodiv doslidzhen' dozvolyly otrymaty novi poglybleni dani shchodo rozvyt- ku RIBE ne til'ky na rivni tsilisnogo organizmu, ale y̆ na rivni genomu. Vysvitleno kliuchovi momenty chyslennykh doslidzhen' RIBE, zokrema – modeliuvannia; metodychni pidkhody do vyvchennia; klasyfikatsiia; osoblyvosti vzaiemodiï mizh oprominenymy ta intaktnymy klitynamy; rol' imunnoï systemy, oksydatyvnogo stresu, tsytogene- tychnykh porushen', zminy ekspresiï geniv v mekhanizmi rozvytku RIBE; zvorotnyy̆ efekt svidka (rescue effect), abs- kopal'nyy̆ efekt (abscopal effect), persystentsiia, modyfikatsiia, medychni naslidky. Pidkresleno, shcho, nezvazhaiuchy na znachnyy̆ obsiag doslidzhen' fenomenu bystander response iak universal'nogo iavyshcha ta RIBE iak odnogo iz y̆ogo proiaviv, shche isnuie dostatn'o «bilykh pliam» u vyznachenni mekhanizmiv stanovlennia RIBE ta otsintsi mozhlyvykh naslidkiv y̆ogo rozvytku dlia zdorov’ia liudyny.

Purpose: To investigate the ocular subclinical inflammatory response in two soft contact lens materials when used in combination with two different care systems (‘solutions’). Methods: Fifteen established soft contact lens wearers wore each of two lenses: Acuvue® 2 (CH) and Acuvue® Oasys® (SiH) or no lenses in random sequence for one week. Two care systems were used: a peroxide system: Oxysept 1 Step® (P) for the right lens and Opti-Free® Replenish® (MPS) for the left lens. After one week of lens/no lens wear, in vivo confocal microscopy (IVCM) of corneal and conjunctival regions was carried out. Density of presumed dendritic cells (DC) and ‘white spots’ (WS) were quantified. Impression cytology of the bulbar and upper eyelid margin conjunctivae was carried out and samples were analysed for CD45+, CD3+ and CD11c+ cells. Results: The SiH + MPS combination showed a greater inflammatory response compared to SiH + P in seven out of 12 parameters investigated (p < 0.05). The remaining five were not statistically different between the two solutions. The converse was found for the CH lens, with four of the 12 parameters showing a greater response with the P solution compared to the MPS (p < 0.05). Conclusion: This study suggests that the SiH lens investigated demonstrated an upregulated response when used with a MPS compared to a P solution whereas the converse is true for the CH lens which showed a reduced response when used with a MPS compared to a P solution. This finding aids in the understanding of the biological underpinnings of manifest corneal inflammatory events during contact lens wear.

Vitiligo is a disease of the skin characterized by the appearance of white spots. Significant progress has been made in understanding vitiligo pathogenesis over the past 30 years, but only through perseverance, collaboration, and open-minded discussion. Early hypotheses considered roles for innervation, microvascular anomalies, oxidative stress, defects in melanocyte adhesion, autoimmunity, somatic mosaicism, and genetics. Because theories about pathogenesis drive experimental design, focus, and even therapeutic approach, it is important to consider their impact on our current understanding about vitiligo. Animal models allow researchers to perform mechanistic studies, and the development of improved patient sample collection methods provides a platform for translational studies in vitiligo that can also be applied to understand other autoimmune diseases that are more difficult to study in human samples. Here we discuss the history of vitiligo translational research, recent advances, and their implications for new treatment approaches.

Objective The present review systematically analyzed clinical studies investigating the efficacy of resin infiltration on post-orthodontic or non-post-orthodontic, white spot lesions (WSL), or fluorosis. Materials Five electronic databases (Central, PubMed, Ovid MEDLINE, Ovid EMBASE, LILACS) were screened. Article selection and data abstraction were done in duplicate. No language or time restrictions were applied. Outcomes were visual-tactile or DIAGNOdent measurements. Results Eleven studies with 1834 teeth being affected in 413 patients were included. Nine studies were randomized control trials, one a prospective cohort study, and one had an unclear study design. Meta-analysis could be performed for “resin infiltration vs. untreated control,” “resin infiltration vs. fluoride varnish,” and “resin infiltration without bleaching vs. resin infiltration with bleaching.” WSL being treated with resin infiltration showed a significantly higher optical improvement than WSL without any treatment (standard mean difference (SMD) [95% CI] = 1.24 [0.59, 1.88], moderate level of evidence [visual-tactile assessment]) and with fluoride varnish application (mean difference (MD) [95% CI] = 4.76 [0.74, 8.78], moderate level of evidence [DIAGNOdent reading]). In patients with fluorosis, bleaching prior to resin infiltration showed no difference in the masking effect compared to infiltration alone (MD [95% CI] = − 0.30 [− 0.98, 0.39], moderate level of evidence). Conclusion Resin infiltration has a significantly higher masking effect than natural remineralization or regular application of fluoride varnishes. However, although the evidence was graded as moderate, this conclusion is based on only very few well-conducted RCTs. Clinical relevance Resin infiltration seems to be a viable option to esthetically mask enamel white spot lesions and fluorosis.

Introduction: cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare illness. Capsule retention (CR) has been reported in a few cases of CMUSE. Methods: we present four cases of CMUSE with CR. None of the patients showed any symptoms or signs of small bowel obstruction before capsule endoscopy (CE). All patients denied a history of non-steroidal anti-inflammatory drugs intake, radiotherapy treatment or abdominal surgery. Results: CE disclosed circumferential stenosis with or without ulcers in the small bowel, some accompanied by mucosal edema, white spots and nodules. All patients underwent an elective surgery to remove the retained capsule and resect the lesions. Conclusion: CE plays a positive role in diagnosing CMUSE. CE findings are as important as CR to alert about the diagnosis of CMUSE

Objectives We aimed to apply deep learning to detect white spot lesions in dental photographs. Methods Using 434 photographic images of 51 patients, a dataset of 2781 cropped tooth segments was generated. Pixelwise annotations of sound enamel as well as fluorotic, carious or other types of hypomineralized lesions were generated by experts and assessed by an independent second reviewer. The union of the reviewed annotations were used to segment the hard tissues (region-of-interest, ROI) of each image. SqueezeNet was employed for modelling. We trained models to detect (1) any white spot lesions, (2) fluorotic lesions and (3) other-than-fluorotic lesions. Modeling was performed on both the cropped and the ROI images and using ten-times repeated five-fold cross-validation. Feature visualization was applied to visualize salient areas. Results Lesion prevalence was 37 %; the majority of lesions (24 %) were fluorotic. None of the metrics differed significantly between the models trained on cropped and ROI imagery (p > 0.05/t-test). Mean accuracies ranged between 0.81−0.84, without significant differences between models trained to detect any, fluorotic or other-than-fluorotic lesions (p > 0.05). Specificities were 0.85−0.86; sensitivities were lower (0.58−0.66). Models to detect any lesions showed positive/negative predictive values (PPV/NPV) between 0.77−0.80, those to detect fluorotic lesions 0.67 (PPV) to 0.86 (NPV), and those to detect other-than-fluorotic lesions 0.46 (PPV) to 0.93 (NPV). Light reflections were the main reason for false positive detections. Conclusions Deep learning showed satisfying accuracy to detect white spot lesions, particularly fluorosis. Some models showed limited stability given the small sample available. Clinical significance Deep learning is suitable for automated classification of retro- or prospectively collected imagery and may assist practitioners in discriminating white spot lesions. Future studies should expand the scope into more granular multi-class detections on a larger and more generalizable dataset.

Although lanthanum deposition in the stomach has been most frequently reported to occur as white lesions, no study has investigated whether the white lesions observed during esophagogastroduodenoscopy are truly lanthanum-related. Here, we retrospectively investigated the amount of lanthanum in endoscopic biopsy specimens.We reviewed four patients showing gastric white spots or annular whitish mucosa in the gastric white lesions (Bw) and peripheral mucosa where the white substance was not endoscopically observed (Bp) during biopsy. We also reviewed three patients with diffuse whitish mucosa and three patients with no whitish lesions. We performed scanning electron microscopy and energy dispersive X-ray spectrometry to quantify the lanthanum elements (wt%) in the biopsy specimens.The amount of lanthanum in the Bw ranged from 0.15-0.31 wt%, whereas that of Bp was 0.00-0.13 wt%. The difference was statistically significant (P 0.05). The amount of lanthanum in the Bw, endoscopically presented with white spots or annular whitish mucosa, was significantly higher than that of no whitish lesions (0.05-0.14 wt%, P 0.05). The amount of lanthanum was also higher in the diffuse whitish mucosa (0.21-0.23 wt%) compared with no whitish lesions (P 0.01).This study is the first to reveal that pathological lanthanum deposition corresponds to the endoscopically observed white lesions in the gastric mucosa. Therefore, during esophagogastroduodenoscopy, physicians should pay attention to possible presence of white lesions in patients treated with oral lanthanum carbonate to ensure prompt identification of associated issues.

Dental fluorosis changes the colour and/or structure of enamel, leading to an unaesthetic appearance. One of the main goals in the treatment is aesthetic improvement of the affected teeth. Two clinical cases of patients with white spot fluorosis lesions on frontal teeth are presented. All treated teeth are infiltrated with low-viscous light-curing resin (ICON, DMG). A significant improvement in the aesthetic appearance of all the treated tooth surfaces is visible immediately after resin infiltration, and in most of the teeth - a complete disappearance of the white spots. Resin infiltration is an alternative micro-invasive approach for treatment of white spot lesions of different origin. It allows a quick and natural recovery of the affected teeth.

Background: Vitiligo is a hypopigmentation disorder that affects 1% of the world's population. Vitiligo causes white spots on the skin, mucous membranes, or white hair by destroying skin melanocytes. The pathogenesis of vitiligo is unknown but autoimmune, autocytotoxic, and neural mechanisms are suggested. According to the autoimmune theory, in people with vitiligo, immune cells invade and damage melanocytes. T cells are more commonly present in vitiligo patients' skin and remain in the lesion site, which is composed of CD8 and CD4 T cells. Many studies have been conducted on the presence and role of cytokines such as interleukins and interferongamma (IFN-γ) in the vitiligo process. Aim: This study aimed to introduce herbs effective against vitiligo from the perspective of Persian medicine and to investigate their possible therapeutic mechanisms with the possible effects of herbs on autoimmune mechanisms. Methods: For this purpose, keywords were used to extract data from Persian medicine textbooks, and then relevant scientific databases, including Google Scholar, PubMed, Web of Science, and Scopus were examined. Results: It was found that Persian medicine scholars used 50 different medicinal plants to treat and reduce the complications of vitiligo, and recent scientific studies have proven immune-regulating properties and reducing the effect of many of them on cytokines. Conclusion: According to scientific evidence on immunomodulatory effects, new research into the effects of these plants on vitiligo can lead to the discovery of new drugs and approaches for treating this disease.

This study aimed to investigate if the semi-rapid maxillary expansion (SRME) can cause white spot lesion (WSL) formation using quantitative light-induced fluorescence digital (QLF-D).The SRME group comprised 15 patients (9 girls, 6 boys; 13.5 ± 1 years) who had transverse maxillary deficiency and underwent expansion with full-coverage expanders. The screw of the expanders in the SRME group was activated twice a day for the first week. After decementation at the end of the first week, the screw activation protocol was changed to 3 turns/ week. In the SRME group, the QLF-D images were captured before starting treatment and 3.18 ± 0.32 months later when the expansion treatment was completed. The control group consisted of 15 subjects (8 girls, 7 boys; mean age 14.2 ± 1.9 years) who never had orthodontic treatment. The images of the control group were obtained with 3 months interval. The images were analyzed in terms of demineralization using analysis software.The left central incisor was the only tooth that was affected by WSL formation in the SRME group after expansion. The left central incisor tooth's fluorescence levels were decreased and the lesion area increased significantly (p 0.05). No significant mineralization changes occurred in the control group (p 0.05).SRME resulted in WSL formation in the left central incisor, while other teeth were not affected by demineralization. Although providing adequate oral hygiene is easier during SRME due to the removable appliance, the orthodontist should still be aware that it may cause demineralization.

Introduction Our objective was to evaluate the efficacy of a fluoridated varnish in preventing white spot lesions in patients with fixed appliances. A laser-induced fluorescence device was used to determine any correlations between the degree of demineralization and the length of the observation period, the arch sector, the frequency of varnish application, and the specific tooth site. Methods A split-mouth study design was used for 24 orthodontic patients, allocated randomly to 2 subgroups with differing frequencies of Duraphat varnish (Colgate-Palmolive, New York, NY) application. Repeated measures of the degree of demineralization were taken on the vestibular surfaces of 12 teeth (6 varnished and 6 unvarnished controls). Measurements were taken at 4 sites using a DIAGNOdent Pen 2190 laser (KaVo, Biberach an der Riss, Germany) and then subjected to statistical analysis. Results Generalized linear model and coefficient model analysis showed differences in the degrees of demineralization between treated and untreated teeth, but this was not statistically significant in terms of time point, frequency of application, or specific tooth site. However, when we analyzed the position of the teeth, the varnished anterior teeth showed a statistically significant reduction in demineralization compared with their unvarnished counterparts. Conclusions Periodic application of fluoride varnish can offer some protection against white spots, but not to a statistically significant degree if the patients have excellent oral hygiene.

Background To report a case of uveitis and neuroretinal detachment in a patient treated with Trametinib and Dabrafenib due to metastatic cutaneous melanoma stage IV. Case presentation We evaluated slit lamp examination, fundoscopy, optical coherence tomography, fluorescein and indocyanine green angiography in a 66 years old man suffering visual loss. Fundoscopy showed serous neuroretinal detachment of the fovea accompanied with white spots surrounding the fovea in both eyes. Although therapy with Trametinib and Dabrafenib was stopped uveitis anterior was seen 2 weeks later. After a year, the therapy was started again and the serous neuroretinal detachment appeared once more, however without inflammatory reaction of the anterior chamber. Conclusion Patients treated with Trametinib and Dabrafenib should undergo consecutive eye examinations from the beginning of the therapy.

Introduction The complex designs of fixed orthodontic appliances hinder proper access for cleaning, favouring the development of gingival inflammation and white spot lesions around brackets. The aim of this study was to evaluate the effectiveness to avoid these undesirable effects by using two prophylactic methods: Photodynamic Therapy (PDT) and conventional ultrasonic scaler (US), in patients during fixed orthodontic treatment. Materials and methods Twenty patients under orthodontic treatment for at least 15 months were randomly divided into two groups: PDT mediated by methylene blue (MB) and US. Both treatments were applied in repeated doses (four times in intervals of 2 weeks in the beginning of the study (T0), with booster doses at 3, 6 and 9 months, T1, T2 and T3, respectively). Periodontal clinical parameters (full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and probing depth (PD)) were recorded as well as the International Caries Detection and Assessment System (ICDAS) index. Samples of subgingival plaque and saliva (for determination of 4 periodontopathogens and mutans streptococci, respectively), were collected at T0 and at the follow-ups of T1, T2 and T3. Results The evolution of FMPS, FMBS, PD, ICDAS scores as well as the counts of periodontopathogens and salivary mutans streptococci was similar after US or PDT implementation. Greatest periodontal scores reduction took place at T1 for FMBS and PD and at T2 for FMPS. Main microbial reduction took place at T1. ICDAS index began to increase from T2. No statistically significant intergroup differences were observed. Conclusions Additional treatment of PDT or US in repeated doses delayed undesired side effects during fixed orthodontic treatment in young patients with low caries risk and signs of gingival inflammation.

International audience; Plasminogen deficiency is a rare congenital condition that leads to pseudomembraneous lesions, such as ligneous conjunctivitis and ligneous gingivitis. Because of its rarity, ligneous gingivitis is not a pathology one may easily suspect from its clinical symptoms. We report the case of a 35-year-old Caucasian woman who experienced gum masses with white spots, but no pain. Based on the clinical picture, one could refute a diagnosis of necrotizing ulcerative periodontitis. Several biopsies were taken. The last ones showed an amorphous eosinophilic substance that could be fibrin. Plasmatic dosage of plasminogen (activity level 44%) confirmed the hypothesis of ligneous gingivitis. This report appears to be a very rare diagnosis of a ligneous gingivitis without major conjunctivitis, associated with a moderate plasminogen deficiency.

Objective To use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients.Materials and Methods: An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment.Results: Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3−3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times).Conclusions: There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.

Unmet medical needs are a priority for organizations such as the WHO and major public-private initiatives, such as Innovative Medicines Initiative, were established to speed up the development of better and safer medicines for patients. To assist such projects, the EMA in its 'Road Map to 2015' considered the mapping of unmet medical needs as a priority. This study has identified medical conditions for which the EMA could not identify developments in the pharmaceutical pipelines, that is, 'white spots'. Our analysis was made using external data sources as well as mining data of the EMA. The main areas for white spots were oncology, infectious diseases and certain psychiatric conditions. According to our data and a review of literature, in a number of these white spots, diagnostic tools may even be missing. The identification of those conditions will benefit stakeholders, including regulators, research funding bodies and patients' organizations.

The clinical feasibility of a novel device called a Cariotester was investigated by measuring the Knoop hardness (KHN) of white spot lesions diagnosed as ICDAS code 1, 2 or 3. To obtain an equation for converting the Cariotester indentation depth into the KHN, a regression analysis was performed between the depth and measured KHN for human enamel. The Cariotester was then used to measure the indentation depth for white spots (ICDAS code 1, 2 or 3) in extracted teeth, and the KHN values were determined using the above equation. The KHN was 219.9±19.7, 162.4±24.0 and 31.7±17.5 for code 1, 2 and 3 lesions, respectively, which was 30, 49 and 90% lower than that for healthy enamel. Using the formula reported in the literature, the mineral density was calculated to be 87.7 vol.% for healthy enamel, and 75.1, 66.1 and 35.5 vol.% for code 1, 2 and 3 lesions, respectively.

Background Bier spots are asymptomatic white anemic macules with irregular shape located on the upper limbs and less often on the lower limbs and trunkus. They are observed predominantly in youg males and may be idiopathic or associated with other conditions. Objective We report two cases with Bier spots in which videodermatoscopy and nailfold capillaroscopy were performed. Results Patient 1 was a 34-year-old otherwise healthy male who presented with white spots on his upper limbs for 10 years. Dermoscopy revealed marked narrowing of skin capillaries within the borders of white macules whereas capillaroscopy pattern was normal. Patient 2 was a 20-year-old female with symptoms of Raynaud's phenomenon who presented with white spots on the volar aspects of her hands for 2 years. The capillaroscopy showed abnormal findings with presence of homogenous enlarged capillaries. Conclusion Bier spots do not require any treatment. The associated conditions found should be monitored.

A 13-year-old girl presented to us with difficulty with night vision and whitish spots in both eyes. Parents first noticed the white spots 6 months ago that were gradually increasing in size. For the past 3 months, she struggled to see in the dark and preferred to stay indoors after sunset. She was otherwise previously well. The family was vegetarian and hailed from a rural village. The child had a normal systemic examination. Ocular examination revealed bilateral, triangular chalky white plaques on bulbar conjunctivae that were not wet by the tear film (figure 1). Slit lamp examination showed that these lesions had a foamy appearance (figure 2). The child’s visual acuity and the rest of the ocular examination were normal. Figure 1 Bilateral …

ObjectivesThis study evaluated the effect of fluoride and non-fluoride sealants on hardness decrease (HD) and marginal adaptation (MA) on enamel substrates after cariogenic challenge.MethodsOcclusal enamel blocks, from human third molars, were randomly divided into six groups (n=12), according to occlusal fissures condition (S – sound; C – caries-like lesion; CF – caries-like lesion+topical fluoride) and sealants (F – FluroShield; H – Helioseal Clear Chroma). Lesion depths were 79.3±33.9 and 61.3±23.9 for C and CF groups, respectively. Sealants were placed on occlusal surface and stored at 100% humidity (37°C; 24h/d). HD was measured by cross-sectional microhardness analysis at the sealant margin distances: −1 (under sealant), 0 (sealant margin), 1, 2 (outer sealant). Sealant MA was observed by polarized light microscopy and scored according to: 0 – failure (no sealant MA or total sealant loss); 1 – success (sealant MA present). MA and HD were analysed by ANOVA-R and mixed model analysis, respectively.ResultsFor HD (ΔS), F values (6900.5±3686.6) were significantly lower than H values (8534.6±5375.3) regardless of enamel substrates and sealant margin distances. Significant differences were observed among sealant margin distances: −1 (5934.0±3282.6)

Ocular involvement of rhinosporidiosis is seen in about 15% of cases and clinically appears as a freely mobile, granular, pink, fleshy sessile or pedunculated mass. The conjunctiva is the most common site of origin. A 25-year-old male presented with a painless mass in the lower part of the left eye for 6 months which was gradually progressive. Examination revealed a pedunculated mass of 15 mm x 15 mm arising from the lower palpebrae of the left eye retracting the lower lid. It appeared to be vascular with few white spots at the apex. Rest of the ocular examinations was within the normal limit. The presentations of ocular rhinosporidiosis vary. Though the conjunctival origin is very common, it may not have a classic pink fleshy appearance at all times. A vascular/cystic painless conjunctival mass should also be considered as a case of rhinosporidiosis in prone areas.

SUMMARY The aim of this study was to report a clinical case of moderate fluorosis spots treated with infiltration of low-viscosity resin. A commercial resin was applied to the facial surfaces on the anterior teeth in both the maxillary and mandibular arches. The white spots of fluorosis lost their whitish appearance and appeared similar to sound enamel. This technique, which might constitute an alternative to white-masking of fluorosis spots, showed optimal esthetic results.

Objective: To evaluate the influence of an app-based approach in a protocol for domestic oral hygiene maintenance in a group of adolescent patients wearing fixed multibracket appliances. Materials and Methods: Eighty adolescent patients scheduled to start an orthodontic multibracket treatment were randomly divided into two groups of 40. Plaque index (PI), gingival index (GI), white spots (WS), and caries presence were recorded in all patients, and they were instructed regarding domestic oral hygiene maintenance on the day of braces application (t0) and every 3 months (t1, t2, t3, t4) during the first year of treatment. Study group (SG) patients were enrolled in a WhatsApp chat room–based competition and instructed to share monthly with the other participants two self-photographs (selfies) showing their oral hygiene status. Results: SG patient participation in the chat room was regular and active throughout the observation period. At t2, t3, and t4, SG patients had significantly lower values of both PI and GI and a lower incidence of new WS and caries, compared with the control group. Conclusion: Integration of new “social” technologies in a standard oral hygiene motivation protocol is effective in improving compliance of adolescent patients and in improving their oral health status during orthodontic multibracket treatment.

The aim of the present study was to describe a clinical protocol for the treatment of white spots with the use of an abrasive material. A four-year-old patient presented with a white spot on tooth 51 and a white spot associated with a carious lesion in the cervical region of tooth 52. Treatment was planned with microabrasion and restoration of the upper right lateral incisor. Prophylaxis was first performed, followed by protection with a dental dam and the application of the abrasive material (silicon carbide and hydrochloric acid 6%). Five applications were needed to remove the spots. The restoration of the upper right lateral incisor was then performed with a resin composite. A good esthetic outcome was achieved and both the patient and her guardians were satisfied with the results. Microabrasion is a conservative treatment option that achieves satisfactory results with regard to tooth color.

White spot lesions are defined as enamel surface and sub surface demineralisation, although these lesions can be reversed and do not form cavities. Infiltration using fluid resin proved to be a valid micro-invasive alternative compared with traditional conservative therapy. This has allowed treatment without any trauma (no use of local anaesthesia and cavity preparation) of numerous lesions in only one session with stable clinical (mechanical stability, enamel hardness, conservation of sound tissue) and aesthetic results (disappearance of lesions) over the time. The present report evaluates the effectiveness of Icon infiltration resin on postorthodontic white spots at 6 months, 1 and 4 years.

Diffuse anterior retinoblastoma is an infrequent presentation in which the tumor is confined to the anterior segment, and there is no retinal mass. An 18-month-old Asian Indian boy presented with white spots in the left eye. There were extensive anterior segment seeds without a retinal tumor. Fine-needle aspiration biopsy confirmed the diagnosis of retinoblastoma, and the patient received intravenous chemotherapy with a combination of vincristine-carboplatin-etoposide, periocular topotecan, and intravitreal topotecan to achieve complete tumor regression.

OBJECTIVE: To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. METHODS: Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 ± 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. RESULTS: The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. CONCLUSION: Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology. © 2009 The Authors. Journal compilation © 2009 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology and Blackwell Publishing Asia Pty Ltd.

Previously, small defects in the retinal pigment epithelium appearing as depigmented spots in the fundus photographs have been observed in a high proportion of adult diabetic patients. In order to evaluate whether these changes already occur in children we examined the black-and-white and colour fundus photographs of 206 diabetic children aged 4.6-19.6 years (median 12.6), with the median duration of diabetes of 4.7 years (range 0.0-14.2). Early signs of retinopathy were observed in 27 (13.1%) of them. The control group was composed of 45 healthy children aged 8.1-16.6 years (median 11.8). One or more tiny white spots in the fundus of one or both eyes were observed in 97 diabetics (47.1%), more often in those with retinopathy than in those without (66.7% vs. 44.1%, p less than 0.001). In the control group similar spots were observed in 24 children (53.5%). Only in a small proportion of children (4.4% of both diabetic and control patients) were the spots numerous. In children most of the white spots in the fundus may represent drusen type deposits rather than defects in the pigment epithelium.

in this issue of SAMJ have shown survival rates in a region of South Africa (SA) of only 50%, reflecting the high frequency of late presentation, the simple reason for which is lack of effective screening. Early detection of suspected RB would significantly reduce this unacceptably high mortality rate. Early detection may be achieved by performing a simple clinical test on all newborns and toddlers: the red reflex. The red reflex or retinal reflex refers to the reddish-orange reflection of light from normal retina, and it is observed with a direct ophthalmoscope held close to the examiner’s eye, while observing the patient’s eyes from a distance of approximately 30 cm. Normally, the reflections of the two eyes are equivalent in colour, intensity and clarity. The examiner is looking for the presence of a whitening of the reflex, white spots in the reflex, an absent red reflex or asymmetry of the two red reflexes when viewed from various angles. [2,3] It is considered standard of care that all newborn babies are tested for a red reflex at discharge from the neonatal nursery. Parents are similarly able to detect a problem by noticing an abnormality in the red reflex in photographs taken when the ‘red eye reduction’ function happens to be switched off on their camera. It would not be too idealistic to suggest that all doctors attending to neonates and toddlers use this humble camera technique and digitally save the red reflex images to the patient’s file at each visit. In the not-too-distant future, neonatal screening will include universal digital retinal imaging. The roll-out of diabetic screening programmes using portable digital imaging systems is already established in many parts of the world, including the Cape Town metropole. These systems could be expanded to also serve as screening units for neonates. ‘Should eye imaging be part of a standard newborn examin a tion?’ was the theme of a session presented at the 2014 World Ophthalmol og y Congress of the International Council of Ophthalmology on 3 April 2014 in Tokyo, Japan. Speakers from the USA, Russia, India, China and Taiwan shared their experience with modern retinal imaging systems used in universal eye imaging programmes in their countries, convincing the audience about the value of such systems in neonates. The RetCam (Clarity Medical Systems, USA) is an example of a medical device utilising innovative 21st-century optical, electronic and information technologies to image the retina of neonates. Its ability to perform wide-field imaging on neonatal retinas has revolutionised neonatal retinal disease management in the developed world. It has been shown to be a safe screening tool when operated by trained technicians. [4]

We investigated the treatment effect of non-invasive infiltration on early caries caused by different degrees of enamel demineralization. Forty specimens of early enamel caries were prepared and divided into low and high demineralization groups. After treatment with non-invasive infiltration, the specimens were placed under cariogenic conditions. Color measurements were determined using a spectrophotometer 4 times to obtain chromatism values (ΔE1-ΔE4), including before and after production of artificial caries, and after infiltration treatment and re-demineralization. The effects of color change on early caries using non-invasive infiltration were compared between the 2 demineralization groups. Color differences before the production of artificial caries and after infiltration treatment and re-demineralization could not be distinguished by direct observation. Color differences after the production of artificial caries and after infiltration treatment and re-demineralization could be distinguished by direct observation. There were no significant differences in the 4 chromatism values (ΔE1-ΔE4) between the 2 groups. Non-invasive infiltration showed an excellent ability to mask white spot lesions and maintained high color stability. Treatment of high and low demineralization of enamel had the same masking effect.

International audience; In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.

The Pap smear has been used to test women for cervical cancer since its invention in 1928. With a simple swipe and smear, doctors have been able to use microscopic observation to detect cancerous activity. Because cervical cancer is one of the most preventable forms of cancer, the Pap smear revolutionized how we deal with the disease. Yet, worldwide, 275 000 women (1) still die from cervical cancer each year. That's because although the Pap is an efficient test, it requires elements such as facilities, follow-up visits, and trained cytology technicians, making it difficult to use in low- to middle-income neighborhoods. In these areas, some of which are right here in the US, visual inspection with acetic acid (VIA)3 has become the norm in cervical cancer screening. In this procedure, the cervix is washed with acetic acid, and a physician scans the cervix with his or her own eyes, without any magnification, looking for white spots, which might possibly be a clump of cancerous cells. The problem with VIA, however, is that it can offer an often imprecise and delayed picture. If a physician can actually see the cancer on the surface of the cervix, that would indicate the tumor has become large enough to burst through the skin's surface, from the deeper tissues below, meaning it is very advanced. And, white doesn't always mean cancer. So, although VIA has reduced cervical cancer mortality rates by some 30% (2), it has a false-positive rate that can hover near 83%. What would be ideal, says David Levitz, cofounder of MobileOCT, a technology company, is a different type of screening test that can enhance a physician's vision beyond 20/20. MobileOCT is working on just such an optical cervical cancer screening technology, optical coherence tomography (OCT). The team plans to start a …

Plaque control during the course of orthodontic treatment is not an easy task, and dental caries are not an unlikely complication. We examined the possibility of controlling dental caries with Nd-YAG laser irradiation in orthodontic patients. As a preliminary experiment, we used the Nd-YAG laser to irradiate an extracted tooth and then left it to soak in lactic acid. The decay of the tooth was evaluated with a scanning electron microscope (SEM); tooth decay was inhibited by the action of the laser. Twenty patients undergoing orthodontic treatment for early decalcification of the teeth (white spot lesions) were selected, and photographs were taken of their oral cavities. White spot lesions on the four incisors and two canines of the maxilla were traced on tracing paper, and their areas were calculated by computer. Ten of the patients received laser treatment and acidulated phosphate fluoride solution (APF); the other ten acted as the control group. Between 11 and 12 months later, we photographed the oral cavity as we had previously; the white spot lesions were again traced and their areas calculated. The changes in the areas of the white spots of the laser-irradiated and control groups showed the following increases: laser-irradiated group, 1.41 times; controls, 2.87 times. The difference was statistically significant. These results demonstrate that Nd-YAG laser irradiation with application of APF acts as an effective method of caries control during orthodontic treatment.

International audience; Early-stage caries (white spots), fluoroses, traumatic hypomineralizations and molar incisive hypomineralization (MIH) all present, to differing degrees, clinical symptoms involving white marks on the enamel. This article shows that proper diagnosis leads to better understanding of the three-dimensional aspects of the lesion, thereby ensuring the appropriate choice of a specific treatment.

The aim of this study was to assess the diagnostic performance and accuracy of four plaque indices for orthodontic patients. The plaque accumulation of 140 maxillary incisors with bonded brackets was recorded using intra-oral photographs and assessed using four different plaque indices: the orthodontic plaque (OP) index, the modified orthodontic plaque (MOP) index, the Quigley and Hein (QHP) index and the modified Navy plaque (MNP) index. The assessment was performed twice within a time interval of 4 weeks by four different examiner groups: orthodontists, dentists, students and orthodontic assistants. No significant differences were detected for the OP and MOP indices among the examiner groups. A significant difference was found for the QHP and MNP indices. The inter- and intra-examiner reliability of the OP and MOP indices was good. In contrast, the reliability for the QHP and MNP indices was moderate to poor with few exceptions. The discrimination performance of the OP and MOP indices was excellent. The sum of the sensitivity and specificity was generally lower for the QHP and MNP indices compared with the OP and MOP indices. OP and MOP indices showed good performance. The QHP and MNP indices are not appropriate for orthodontic purposes. Traditional plaque indices reflect the typical pattern of plaque accumulation for patients without multi-bracket appliances. The performance of these indices for orthodontic patients has never been investigated. Orthodontic plaque indices that focus on the surface along the gingival margin and areas around the bracket exhibit higher diagnostic performance and accuracy compared with traditional indices.

Dental caries affects most adults worldwide; however, the risk factors for dental caries do not necessarily exert their effects uniformly across all tooth surfaces. Instead, the actions of some risk factors may be limited to a subset of teeth/surfaces. Therefore, we used hierarchical clustering on tooth surface-level caries data for 1,068 Appalachian adults (ages 18-75 yrs) to group surfaces based on co-occurrence of caries. Our cluster analysis yielded evidence of 5 distinct groups of tooth surfaces that differ with respect to caries: (C1) pit and fissure molar surfaces, (C2) mandibular anterior surfaces, (C3) posterior non-pit and fissure surfaces, (C4) maxillary anterior surfaces, and (C5) mid-dentition surfaces. These clusters were replicated in a national dataset (NHANES 1999-2000, N = 3,123). We created new caries outcomes defined as the number of carious tooth surfaces within each cluster. We show that some cluster-based caries outcomes are heritable ( i.e., under genetic regulation; p < 0.05), whereas others are not. Likewise, we demonstrate the association between some cluster-based caries outcomes and potential risk factors such as age, sex, educational attainment, and toothbrushing habits. Together, these results suggest that the permanent dentition can be subdivided into groups of tooth surfaces that are useful for understanding the factors influencing cariogenesis. Abbreviations: COHRA, Center for Oral Health in Appalachia, the principal study sample; C1-5, clusters 1-5, groups of similarly behaving tooth surfaces identified through hierarchical clustering; DMFS index, decayed, missing, or filled surfaces, a traditional caries measure representing the number of affected surfaces across the entire dentition; DMFS1-5, partial DMFS indices representing the number of affected surfaces within a hierarchical cluster; and NHANES, National Health and Nutrition Examination Survey, the secondary study sample.

White demineralized areas after the removal of orthodontic appliances remain a problem for clinicians and patients. The main objective of this study is to assess clinical photography as a method for the evaluation of caries and white spots and the in vivo study of remineralization of carious lesions. The secondary objective was to compare the effect of different levels of both experimental and commercial fluoride solutions on the remineralization of enamel carious lesions. White spot lesions were created with an acid solution on extracted permanent human teeth, and the lesions were remineralized in remineralizing solutions with or without fluoride ions. The changes in the enamel surface during the demineralization and the remineralization processes were recorded with a 35 mm clinical camera. Photographs were taken of the experimentally created white spots, the samples were sectioned for microradiography testing, and the actual mineral contents of the white spot lesions were calculated from the microradiographs. The enamel lesions were further analyzed by powder x-ray diffraction to confirm whether fluoride was incorporated into the lesions during the remineralization period. From this experiment it can be concluded: (1) clinical photography as currently practiced is not an adequate method of monitoring the remineralization of white spots with large lesion depths and (2) the experimental solution that contains 50 ppm fluoride had a higher efficacy for remineralization than the control solution or the commercial mouth rinse, which contained 225 ppm fluoride.

The prevalence of dental caries was determined clinically in 2.5-year-old Dutch cleft lip and/or palate children (n = 76) and in children without congenital malformation (n = 75). The parents were given a structured questionnaire regarding the child's dietary habits, oral hygiene, fluoride exposure and social economic background. The prevalence of dental caries was higher in children with oral cleft than in children without oral cleft. Initial caries (white spots) was diagnosed in 17.1% of the subjects with oral cleft compared with 4.0% of the control subjects. Manifest caries (cavities) was found in 26.3% of the children with oral cleft compared with 5.3% of the controls. The dft score (manifest caries) was significantly higher for the oral cleft group (0.59 +/- 1.35) than for the control group (0.11 +/- 0.54). 52% of the total number of initial and manifest lesions were localized to the maxillary incisors. A multivariate analysis yielded initial caries, oral hygiene and treatment with preoperative infant orthopaedics as the variables significantly associated with manifest caries.