Effect of transcutaneous electrical nerve stimulation on pain perception threshold of human teeth: a double-blind, placebo-controlled study

In this double-blind, placebo-controlled study, we studied the effect of three different transcutaneous electrical nerve stimulation (TENS) devices with extra- and intraoral electrodes on the pain perception thresholds of 234 unrestored, caries-free human teeth of 66 healthy individuals subjected to stimulation with an electric pulp tester. A placebo control collective of 64 healthy subjects received no electrical stimulation, since an inactive TENS device was used. In all tooth types tested (maxillary and mandibular incisors and premolars), the use of the active TENS devices resulted in an increase of 16.3–32.5% versus baseline in the pain perception threshold. The differences between active TENS and baseline were statistically significant for both TENS devices using extraoral electrodes (P<0.05). No statistically significant differences were found between the different devices tested (P>0.05). In the placebo collective, the increase in the pain perception threshold ranged between 6.4% and 10.3% versus baseline. There were no significant differences between placebo TENS and baseline on the one hand and between placebo TENS and the active TENS devices on the other hand (P>0.05). The findings suggest that, as an alternative to local anesthetics, TENS seems not to be useful in the case of painful dental interventions, since it offered only minor advantages over a placebo. Received: 23 November 1999 / Accepted: 21 December 1999     

Effects of brinzolamide on ocular haemodynamics in healthy volunteers

AIM: A prospective, randomised study to evaluate effects of brinzolamide on ocular haemodynamics in healthy volunteers. METHODS: 30 volunteers (12 men, 18 women; 28.3 (SD 7.8) years) were prospectively randomised to either brinzolamide or placebo during a 2 week double masked treatment trial. Examinations were performed at baseline and after 2 weeks of treatment. Intraocular pressure was measured and automatic static perimetry (Humphrey field analyser, 24-2) and contrast sensitivity (CSV 1000, Vector Vision) were performed. Retrobulbar blood flow velocities (peak systolic and end diastolic velocity) and resistive indices (RI) of ophthalmic artery, central retinal artery and of temporal and nasal short posterior ciliary arteries were measured by colour Doppler imaging (Sonoline Sienna Siemens). In video fluorescein angiograms (scanning laser ophthalmoscope, Rodenstock) arteriovenous passage time (AVP, dilution curves) and peripapillary diameters of retinal arterioles and venules were measured by means of digital image analysis. RESULTS: Intraocular pressure was significantly decreased by brinzolamide (p<0.0001). Neither brinzolamide nor placebo changed visual field global indices after treatment. Contrast sensitivity at 3 cycles per degree was significantly higher in the placebo group (p<0.05). Apart from an increase of RI in ophthalmic artery under placebo treatment (p<0.05) there was no effect in retrobulbar haemodynamics in both groups. Brinzolamide therapy alone resulted in a significant reduction of AVP compared to baseline (p<0.05), while peripapillary retinal vessels diameters remained unaffected. CONCLUSIONS: Apart from the expected decrease of intraocular pressure brinzolamide showed no significant change in retrobulbar haemodynamics, but a significant shortening of AVP. Since in glaucoma AVP is prolonged indicating vascular dysfunction this effect might be beneficial in glaucoma therapy.     

Association of depression with agitation in elderly nursing home residents

Agitation is a serious problem for elderly individuals with dementia. It is often the major reason for admission to a restrictive environment such as a nursing home or hospital. The objectives of the current study were to (1) identify the components of agitation embedded in the Psychogeriatric Dependency Rating Scale (PGDRS) and (2) find race, gender, depression, and cognitive deficits associated with the factors extracted from the PGDRS in demographic variables and clinical variables. The study sample comprised 2285 subjects who were admitted to 59 nursing homes across Maryland. The factor analysis of the PGDRS confirmed that agitation is made up of a number of different elements ranging from physical and/or verbal aggression to wandering. Correlates of these elements varied, as did possible treatments. For example, physical and/or verbal aggression often accompanied severe depression, suggesting that treating the depression may alleviate this problem. However, wandering and psychotic behavior may be less amenable to existing treatments as these behaviors were associated with severe cognitive impairment.     

High concentrations of fluoride and boron in drinking water wells in the Muenster region--results of a preliminary investigation

In 1998, two cases of severe dental fluorosis in schoolchildren occurred in the Muenster region. These cases took place in one household, where fluoridated toothpaste, fluoridated salt, and fluoride tablets were consumed. Furthermore, the family used drinking water from its private well only. Analyses of the well water ordered by local health officials revealed very high amounts of fluoride, boron, and other electrolytes. This unusual combination of high amounts of fluoride and boron could also be found in the water of a great number of other private wells that are the only source for drinking water in this rural region of the Muensterland. Anthropogenic sources could be excluded. Because of this, the results of the water samples were collated to the specific geological situation in this area. In the Muenster region there are marl layers of the chalk era covered with quarternary sediments. The quarternary sediments are up to 10 to 20 metres thick and they usually conduct the groundwater. The marl contains high concentrations of fluoride and boron. In some places the groundwater has contact with these layers. To check the amount of fluoride and boron in the groundwater, indicator values were sought, which can give a hint of high contents of these trace elements. In this study the conductivity and acidity were identified as possible indicators of a high amount of fluoride and boron in the drinking water in this specific region. To work economically and efficiently, the drinking water should be checked for fluoride and boron on a regular basis only when these values are extraordinarily high. In the case of high concentrations, especially of fluoride, in the drinking water the persons concerned should be informed about their potential health risk, giving them the opportunity to optimise the total daily intake of fluoride.     

Cellular and humoral immune response in progressive multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is a fatal, demyelinating disease caused by JC virus (JCV) in patients with severe immunosuppression. We studied the JCV-specific cellular and humoral immune response in 7 healthy donors (HD), 6 human immunodeficiency virus-1 (HIV-1)-infected patients without PML (HIV), 4 HIV-1-negative patients with PML (PML), and 8 HIV-1-positive patients with PML (HIV/PML). As antigens, recombinant virus-like particles of the major structural protein VP1 (VP1-VLP) of JCV, tetanus toxoid (TT), or the mitogen phytohemagglutinin (PHA) were used. Proliferation of peripheral blood mononuclear cells (PBMC) after stimulation with the VP1-VLP was significantly suppressed in PML and HIV/PML patients compared to HD. After antigen stimulation the production of interferon-gamma (IFN-gamma) was reduced in PML, in HIV/PML, and in HIV patients. The production of interleukin-10 (IL-10), however, was elevated in HIV/PML patients. Neither proliferation nor cytokine production correlated with the presence of JCV DNA in PBMC. The immunoglobulin G serum antibody titer to the VP1-VLP was slightly elevated in HIV, elevated in PML, and highly elevated in HIV/PML patients compared to HD. The development of PML appears to coincide with a general impairment of the Th1-type T-helper cell function of cell-mediated immunity.