Kinetics of salivary pH after acidic beverage intake by patients undergoing orthodontic treatment

The saliva of patients undergoing orthodontic treatment with fixed appliances can potentially present a delay in the diluting, clearing, and buffering of dietary acids due to an increased number of retention areas. The aim of this clinical trial was to compare salivary pH kinetics of patients with and without orthodontic treatment, following the intake of an acidic beverage. Twenty participants undergoing orthodontic treatment and 20 control counterparts had their saliva assessed for flow rate, pH, and buffering capacity. There was no significant difference between salivary parameters in participants with or without an orthodontic appliance. Salivary pH recovery following acidic beverage intake was slower in the orthodontic subjects compared to controls. Patients with fixed orthodontic appliances, therefore, seem to be at higher risk of dental erosion, suggesting that dietary advice and preventive care need to be implemented during orthodontic treatment.

[Ileus due to oranges in Meckel's diverticulum]

BACKGROUND

A Meckel's diverticulum is a remnant of the primitive bowel and the yolk sac which occurs in 1-5% of the population. It causes problems in only very few people.

CASE DESCRIPTION

A 39-year-old man developed acute abdominal pain after eating two oranges. The cause of the pain was found during a lower abdominal laparotomy - the small bowel was obstructed by a Meckel's diverticulum and a phytobezoar composed of orange fibres. Both were removed surgically.

CONCLUSION

A symptomatic Meckel's diverticulum should be removed; however, in an asymptomatic Meckel's diverticulum this approach is controversial. One of the problems that can arise is an obstructive ileus. Patients who in the past have had an obstructive ileus resulting from a phytobezoar are advised to avoid eating large quantities of fruit rich in fibre and to chew very well.

Radionuclide concentration in tea, cabbage, orange, kiwi and soil and lifetime cancer risk due to gamma radioactivity in Rize, Turkey

BACKGROUND

In this study, the activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were measured in tea, cabbage, orange, kiwi and soil samples collected from different stations using gamma spectrometry with a high-purity germanium detector.

RESULTS

The average activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were found to be 8.2 ± 1.8, 17.3 ± 3.3, 465.8 ± 11.8 and 20.9 ± 3.8 Bq kg(-1) in food samples, and 72.4 ± 9.8, 51.1 ± 8.3, 229.3 ± 14.7 and 312.9 ± 11.5 Bq kg(-1) in farm soils, respectively. The internal effective dose to individuals and excess lifetime cancer risk from the consumption of the food type radioactivity ranged between 11.7 and 53.6 µSv y(-1) and between 0.05 × 10(-3) and 0.24 × 10(-3) , respectively. The annual external gamma effective dose and excess lifetime cancer risk in the farms due to soil radioactivity ranged between 94.1 and 139.8 µSv y(-1) and between 0.43 × 10(-3) and 0.64 × 10(-3) , respectively. The mean transfer factors of (232) Th, (238) U, (40) K and (137) Cs, from the soil to vegetables and fruit were 0.57, 0.32, 2.12 and 0.04, respectively.

CONCLUSION

Annual effective gamma doses were found to be higher than the world's average in soil samples. The excess lifetime cancer risks were only found higher than the world's average in soil samples.

Feasibility of using sodium bicarbonate solution as a damage-limiting strategy for erosion lesions

PURPOSE

One of the recommended measures to prevent and control dental erosion is the oral rinse with sodium bicarbonate solution, which would neutralise the dietary acids. However, the prescription of this aqueous suspension has been made on an empirical basis. The aim of this in vitro study was to evaluate whether the demineralisation caused by erosive episodes could be controlled by the potential neutralising effect exerted by a sodium bicarbonate solution.

MATERIALS AND METHODS

Bovine enamel slabs were embedded in epoxy resin, ground/polished and tested for initial surface microhardness. Twice daily for 2 days, specimens were subjected to an erosive challenge with orange juice in an orbital shaker. Following each erosive episode, specimens (n = 15) were immersed for either 30 or 60 seconds in a sodium bicarbonate solution or deionised water. The negative control group was left untreated. For the remaining daily time, specimens were kept in artificial saliva. New microhardness indentations were then made as described for the initial measurements.

RESULTS

ANOVA applied to the percentage of surface microhardness change (%deltaSMH) showed no statistically significant difference among treatments (P = 0.5810).

CONCLUSION

The use of sodium bicarbonate solution, at least under in vitro conditions, may not be a feasible strategy for managing enamel erosion.

Life-threatening hyperkalaemia developing following excessive ingestion of orange juice in a patient with baseline normal renal function

Hyperkalaemia is a less-recognised life-threatening cause of paralysis. We describe a 51-year-old African-American man, who suffered from muscle weakness progressing to ascending symmetric paralysis, and inability to masticate. Physical examination revealed flaccid paralysis with areflexia of the four limbs. Computed tomography of the brain and cervical spine did not demonstrate any organic lesions. Laboratory investigations revealed serum potassium 9.0 mEq/L (not haemolysed), blood urea nitrogen 34 mg/dL, and serum creatinine 2.0 mg/dL. Electrocardiography showed typical features of hyperkalaemia. After emergent treatment for hyperkalaemia was initiated, serum potassium was rapidly-normalised to 5 mEq/L and all neuromuscular symptoms reversed within one hour. Upon reviewing his food and medication history, he admitted drinking 2.5 litres of orange juice (which contains about 450 mg of potassium in 1,000 ml) per day for the past three weeks to quench his thirst. Hyperkalaemia should be borne in mind in the differential diagnosis of acute paralysis. Hidden sources of potassium intake, such as orange juice, should not be overlooked, even in patients with baseline normal renal function.

Tongue erosions and diet cola

We report the case of a 38-year-old woman who presented with a 10-year history of painful ulcerations on her tongue. She reported that she drank large quantities of diet cola and some orange juice daily and that she used cinnamon-flavored toothpaste and mouthwash nightly. Patch testing elicited positive reactions to balsam of Peru (a fragrance as well as a flavoring agent put in cola drinks that cross-reacts with orange juice) and cinnamic aldehyde. She was diagnosed with allergic contact dermatitis. She was put on a restricted diet and a fragrance-free regimen, and her condition resolved.

Does Low Acid Orange Juice Equal Low Erosion?

This paper compares the erosive potential of standard Tropicana smooth orange juice with a new low acid orange juice. Three parameters are compared in the laboratory; pH, neutralizable acidity and the ability to erode enamel. The pH of the standard orange juice is 3.88 compared with the low acid orange juice which has a pH of 4.18. The neutralizable acidity of the low acid juice is lower (16.96 ml of 0.1 M NaOH) than the standard juice (28.46 ml of 0.1 M NaOH). The low acid orange juice produces less enamel erosion (2.49 microm) than the standard juice (5.23 pm). Ideally, these laboratory findings need to be confirmed in a randomized controlled clinical trial before this product could be recommended unreservedly for patients that are clinically susceptible to erosion.

CLINICAL RELEVANCE

As dietary advice forms a cornerstone in the clinical management of erosion, the introduction of a commercially available low acid orange is most welcome.

Allergic reaction after ingestion of orange blossom pollen

A 31-year-old atopic subject with allergic rhinoconjunctivitis with sensitization to several pollens, presented with urticaria and angioedema after ingestion of orange blossom pollen (Citrus sinensis). A positive skin prick test for orange blossom pollen extract (BIAL-Aristegui, Bilbao, Spain) at a concentration of 1.2 mg/ml was obtained. Serum specific IgE antibodies to orange blossom pollen were shown (Unicap Pharmacia System, Uppsala, Sweeden). A conjunctival provocation test was negative with orange blossom pollen extract dilutions of 1:1000, 1:100 and 1:10 w/v. We describe a patient with an IgE-mediated reaction caused by hypersensitivity to orange blossom pollen. Although the pollen is an aeroallergen and the way of sensitization and entrance is the airway, and therefore the symptoms appear in this location, when contact is through some other route such as the digestive tract, it is also able to sensitize reporting urticaria and angioedema like in our case, instead of respiratory symptoms.

The acidic and erosive potential of five sports drinks

Sports drinks are becoming increasingly popular as we are all being encouraged to adopt a healthier lifestyle with regular exercise. However, many of these products are based on acidic fruits and may contribute to erosion. The aim of this study was to screen a number of these products for their potential to cause enamel erosion in vitro. The erosive potential of a number of readily available sports drinks was assessed in the laboratory by measuring their pH, neutralisable acidity and their ability to erode enamel. These were compared to a positive control, orange juice and a negative control, water. The pH of the sports drinks ranged from 3.16-3.70 with their neutralisable acidity ranging from 9.74-13.44 mls of 0.1M NaOH. The amount of enamel removed following 1-hour immersion in the sports drinks ranged from 1.18-5.36 microns. In comparison, the orange juice control had a pH of 3.68, a neutralisable acidity of 19.68 mls of 0.1 M NaOH and removed 3.24 microns of enamel. Many of the sports drinks tested were found to be erosive. This information will be of use to clinicians when counselling patients with tooth surface loss who use fruit based sports drinks regularly.

Isolation, cloning and allergenic reactivity of natural profilin Cit s 2, a major orange allergen

BACKGROUND

Orange is among the most widely consumed fruits, and among the plant food sources causing allergic reactions according to popular perception. However, its relevant allergenic components are virtually unknown. Profilin is a well-defined minor plant panallergen, showing prevalences around 30% in fruits and vegetables.

METHODS

Twenty-three orange-allergic patients were studied. Natural orange profilin, named Cit s 2, was purified by affinity chromatography and characterized by N-terminal amino acid sequencing, matrix-assisted laser desorption/ionization mass spectrometry analysis and isolation of its coding cDNA. Reactivity to Cit s 2 was analyzed in vivo by skin prick tests (SPT) and in vitro by IgE immunodetection, specific IgE determination in individual sera and enzyme-linked immunosorbent assay-inhibition assays.

RESULTS

The N-terminal amino acid sequence and molecular mass of natural Cit s 2, both fully in agreement with the complete amino acid sequence deduced from its coding cDNA, demonstrated its profilin nature. An unexpectedly high reactivity to Cit s 2 was found in vivo (78% of positive SPT responses) and in vitro (87% of sera from orange allergic patients had specific IgE to Cit s 2). The purified allergen inhibited around 50% of the IgE binding to an orange pulp extract.

CONCLUSION

Orange profilin Cit s 2, unlike other plant food profilins, is a major and highly prevalent allergen.

Antigenicity and immunocrossreactivity of orange tree pollen and orange fruit allergenic extracts

BACKGROUND

It is important to study the crossreactivity between orange tree pollen (OTPE) and orange fruit (OFE) due to the high incidence of pollen/food-related allergies worldwide. The aim of the present study was to determine the antigenic relationship between OTPE and OFE.

METHODS

OTPE and OFErabbit antisera as well as sera from patients allergic to OTPE and OFE were comparatively applied in IgG- and/or IgE-specific ELISA inhibition, crossover or inhibition immunoblotting assays using OTPE and OFE allergenic extracts as solid phase. Periodate and proteinase K treatments were used for carbohydrate and protein depletion, respectively.

RESULTS

The antigenicity of OTPE and the presence of common structures between OTPE and OFE extracts were demonstrated by rabbit IgG-specific ELISA inhibition and crossover immunoblotting assays. A 30-kDa protein, common target of the IgE response on OTPE, OFE and mandarin extract, but absent in lemon extract, was identified by ELISA and immunoblot inhibition assays in patients suffering from primary sensitization to OTPE in the context of occupational exposure. Moreover, biochemical treatments showed that antigenic epitopes on the 30-kDa protein contain polypeptidic but no carbohydrate moieties.

CONCLUSIONS

The antigenicity of OTPE, the presence of common antigenic determinants between pollen and citrus fruits and an IgE-specific crossreactive protein band of 30 kDa sharing carbohydrate-free epitopes were described. After isolation and purification, this common antigen might be useful for allergen immunotherapy in pollen/fruit-related allergic patients.

A study in vitro of the combined effects of soft drinks and tooth brushing with fluoride toothpaste on the wear of dentine

The aim of this study was to measure loss of dentine produced by soft drinks alone and combined with tooth brushing with and without toothpastes. Groups of flat human dentine specimens were exposed for 10 min and then 30 min to orange juice (OJ), carbonated cola (CC) or modified blackcurrant (MB) drinks alone or after the exposures brushed with a fluoride toothpaste for 10 s. Further groups were exposed to OJ as before but brushed with water or non-fluoride toothpaste or placed in slurries of fluoride paste. Five cycles of each regimen were carried out. Tissue loss was determined by profilometry. Water immersion/brushing and brushing controls were included. OJ and CC produced similar erosion and significantly more than MB. Compared with drinks alone, dentine loss was reduced by fluoride toothpaste brushing but increased by water and non-fluoride toothpaste brushing. Fluoride toothpaste slurry had no significant effect on soft drink erosion. Very little abrasion with brushing alone was recorded over the time frame of these experiments. It is concluded that fluoride toothpaste could provide protection, albeit small, against erosion. The data again support the concept of brushing before meals.

Orange-induced skin lesions in patients with atopic eczema: evidence for a non-IgE-mediated mechanism

Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic protein and urinary methylhistamine were measured. No allergic reactions were found to orange in skin prick or patch tests. However, 23 patients (74%) had specific serum IgE to orange. Oral provocation testing resulted in pruritic eczematous or maculopapular skin lesions predominantly at the predilection sites in 16 patients (52%). The SCORAD increased significantly in patients positive to the oral provocation test (p <0.05). Specific IgE to orange did not correlate with the clinical outcome of the oral provocation test. No significant changes were found in serum mast cell tryptase, eosinophil cationic protein or in urinary methylhistamine excretion. The negative results in the skin tests and a lack of correlation between specific IgE and oral provocation tests indicate that non-IgE-mediated mechanisms are involved in cutaneous adverse reactions to oranges in patients with atopic eczema.

The erosive potential of some herbal teas

OBJECTIVES

Many epidemiological studies show a high prevalence of tooth wear, even in young patients. One factor that may be contributing to this problem is the consumption of herbal teas that are often considered to be 'healthy' alternatives to other beverages. The aim of this study was to screen a number of these products for their potential to cause erosion.

METHODS

The erosive potential of a variety of herbal teas was assessed in the laboratory by measuring their pH, neutralisable acidity and their ability to erode enamel and these were compared to a positive control, orange juice.

RESULTS

The pH of the herbal teas ranged from 3.1 to 7.1 and the neutralisable acidity ranged from 3.5 to 60.3 ml of 0.1M NaOH. The amount of enamel removed following 1h immersion in the herbal teas ranged from 0.00 to 9.6 microm. In comparison, the orange juice control had a pH of 3.7 a neutralisable acidity of 21.4 ml and removed 3.3 microm of enamel.

CONCLUSIONS

Many of the herbal teas tested were found to be more erosive than orange juice. This information will be of use to clinicians when counseling patients with tooth surface loss.

An in vitro assessment of the erosive potential of conventional and white ciders

The aim of this in vitro study was to investigate the erosive potential of a range of traditional and white ciders using standard laboratory tests. It measured the pH, 'neutralisable acidity' and the amount of surface enamel lost following immersion over a period of 4 hours. The pH was measured with a digital pH meter and the 'neutralisable acidity' was measured as the volume of 0.1 M sodium hydroxide required to increase the pH to neutrality. Surface enamel loss was measured at 1, 2, 3 and 4 hours using profilometry. The pH on opening ranged from 2.96 to 4.04 and the 'neutralisable acidity' ranged from 14.54 to 21.47 mls. The amount of surface enamel lost following four hours immersion ranged from 8.60-23.95 microns, compared to 12.85 microns for an orange juice control. All the ciders tested were acidic and had considerable erosive potential in vitro which was broadly similar to that of orange juice. A wide variation was found between different commercial brands and this information should be useful when counselling patients with tooth surface loss.