Anya P. G. F. Vieira

Despite some studies correlating dental fluorosis (DF) and fluoride (F) concentration in dental enamel, no information is available about DF and dentin F concentration. Our objective was to determine the correlation between teeth F concentration and DF severity in unerupted human 3rd molars, and the correlation between dentin and enamel F concentrations in the same tooth. Ninety-nine 3rd molars were studied-53 from Fortaleza, Brazil (F water, 0.7 ppm), 22 from Toronto (1.0 ppm), and 24 from Montreal (0.2 ppm). DF severity was evaluated according to the Thylstrup-Fejerskov Index, while F concentration was analyzed by Instrumental Neutron Activation Analysis. DF severity varied between TF0 and TF4, while F concentration ranged between 39 and 550 ppm in enamel and 101 and 860 ppm in dentin. Our results showed correlation between dentin F concentration and DF (r(S) = 0.316, p = 0.001), but no correlation between enamel F concentration and DF (r(S) = 0.154, p = 0.133). No correlation was observed between dentin and enamel F concentrations in the same tooth (r(S) = 0.064, p = 0.536).

The assessment of Health-Related Quality of Life (HRQoL) has been increasingly used to measure the overall impact of diseases in people's life. Diabetes mellitus (DM) is a chronic disease associated with high morbidity, mortality, and HRQoL impairment in patients. In longitudinal studies, the psychosocial impact of DM predicts mortality. The objective of this review is to describe and to analyze the main instruments used for the HRQoL evaluation in patients with DM. Generic instruments such, as the Quality of Well-Being Scale (QWB), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), EuroQol (EQ-5D) and specific instruments as the Diabetes Care Profile (DCP), Diabetes Quality of Life Measure (DQOL), Diabetes Impact Measurement Scales (DIMS), Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1 and DHP-18), Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R), Well-Being Enquiry goes Diabetics (WED), Diabetes-Specific Quality-of-life Scale (DSQOLS), Diabetes 39 (D-39) Problems Areas in Diabetes (PAID) were analyzed. PAID is the only translated and validated instrument available in Brazil. The generic and specific instruments have their stregths and shortcomings for evaluation of HRQL in patients with DM. The combined use of both generic (such as the SF-36) and specific (such as the PAID) appears to be a consistent way to evaluate HRQoL as a construct in Brazilian patients with DM. The present article reviews a variety of instruments and emphasizes the urgent need for validation studies of such instruments to be used in Brazilian subjects with DM.

This review focuses on the interaction of fluoride with the material properties of bone and teeth, which is of clinical, scientific, and public health interest. These tissues are composed primarily of collagen (protein) and hydroxyapatite (mineral), and their mechanical function depends on the properties of the constituents, their proportions, the interface, and the three-dimensional structure. Changing any of these may have clinical consequences. Fluoride interacts with mineralized tissues in a number of ways. At low doses, the fluoride may be passively incorporated into the mineral, stabilizing it against dissolution; this is one of the mechanisms by which municipally fluoridated water reduces the incidence of dental caries. At higher doses, such as those used for treatment of osteoporosis, the fluoride may alter the amount and structure of tissue present, including altering the interface between the collagen and mineral. At very high doses, skeletal and dental fluorosis occurs, characterized by debilitating changes in the skeleton and by marked mottling and discoloration of teeth, which may be accompanied by increased wear of the enamel. These effects have been observed in communities where the local drinking water has naturally high fluoride levels. Understanding the influence of fluoride on mineralized tissues is, therefore, of considerable significance.