1. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 May;105(5):597-605. Epub 2008 Mar 4. A patient-administered Medical Risk Related History questionnaire (EMRRH) for use in 10 European countries (multicenter trial). Abraham-Inpijn L, Russell G, Abraham DA, Bäckman N, Baum E, Bullón-Fernández P, Declerck D, Fricain JC, Georgelin M, Karlsson KO, Lamey PJ, Link-Tsatsouli I, Rigo O. Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. L.Abraham.Inpijn@inter.nl.net OBJECTIVE: The objective of this study was to produce a standardized medical risk-related history (MRRH) in order to identify the medically compromised patient (MCP) attending the general dental practitioner for treatment, to develop such a history (EMRRH), and to validate it in dental practices in 10 European countries. STUDY DESIGN: The Dutch MRRH, adapted to allow for legal and cultural differences of the participating countries was introduced. After consensus and repeated testing, the questionnaire was validated. In this last phase, 1000 patients older than 18 attending dental practices were selected, 100 per country; 994 medical histories were suitable for statistical analysis. Validation was carried out by a physician accustomed to making preoperative assessments, including the ASA risk classification. RESULTS: Mean specificity per country was 99.1 and per EMRRH item was 99.0. Mean sensitivity per country was 93.2 and per item was 93.7. Cohen's kappa for the countries involved was 0.81 to 0.98 and for subsequent questions was 0.81 to 0.97. CONCLUSION: The EMRRH was found to be valid in the detection of medically compromised patients in 10 European countries. PMID: 18299219 [PubMed - indexed for MEDLINE] 2. Ned Tijdschr Tandheelkd. 2005 Mar;112(3):90-4. [Antibiotic prophylaxis for patients with joint prostheses] [Article in Dutch] Abraham-Inpijn L. L.Abraham.Inpijn@inter.nl.net In The Netherlands only patients with reduced defence mechanism are considered for antibiotic prophylaxis, and only in case of a total hip replacement. The extend to which the American indications will be applied in Europe, is at this moment unknown. It becomes more and more clear that the risk from providing prophylaxis is greater than the risk of a joint infection. PMID: 15792392 [PubMed - indexed for MEDLINE] 3. Ned Tijdschr Tandheelkd. 2000 Mar;107(3):114. [Question of the month: Antibiotic prophylaxis for dental patients with joint replacements] [Article in Dutch] Abraham-Inpijn L. PMID: 11409386 [PubMed - indexed for MEDLINE] 4. Rev Belge Med Dent. 2000;55(1):72-9. [Local anesthesia and patients presenting with medical pathologies; the use of anamnesis in the prevention of medical complications in the dental office] [Article in French] Abraham-Inpijn L. The treatment of medically compromised patients is becoming a frequent event in general dental practice as a consequence of the longer presence of natural teeth, an increase in life expectation and a shift towards more ambulatory medical treatment of patients with chronic diseases. Since the dentist is responsible for a correct approach of these patients, it is important that he has knowledge of interactions between medical conditions, compensating mechanisms and medical treatment and the impact of dental treatment on this. In this context, medical history taking is useful. The medical history should be taken as correct as possible, with careful interpretation of the information. Necessary preventive measures should be known. PMID: 11039285 [PubMed - indexed for MEDLINE] 5. Prev Med. 1999 May;28(5):481-7. Acute medical complications in 277 general dental practices. Smeets EC, Keur I, Oosting J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam, The Netherlands. BACKGROUND: Due to the aging of the population on one hand and both medical and dental innovations on the other, the number of medical complications which occur during dental treatment is expected to rise. In order to prevent such complications, dental practitioners have used a medical risk-related history which includes risk determination and preventive measures (together the MRRH system). In this study, the medical complications which occurred in their practice have been compared with those recorded by a control group. METHODS: First, a tested registration form was used. In addition, the group using the MRRH system had previously attended a 1-day introductory course de voted to the MRRH system. Furthermore, a power analysis was used to determine the group sizes. The registration period was set at 1 year, during which the dentists sent in monthly reports. Only patients over the age of 18 were included, after having given their oral consent. An independent diagnosis was given of all registered medical complications by two different internists. RESULTS: A total of 208 medical complications were reported: 45 complications were reported by the 62 dentists who used the MRRH system (reference group) and 163 by the 215 dentists of the control group. First, it should be noted that some reports did not register vital signs; this is reflected in categories such as "no diagnosis," "collapse eci," and "others." Second, the study has revealed that the reference group has registered the heart rate and the frequency of breathing of patients more frequently than the control group. Also, a relatively lower percentage of complications was recorded within the reference group due to the intravenous injection of local anesthetics. CONCLUSIONS: The number of medical complications recorded in the two groups shows little variation. There is a considerable difference, however, in the nature of these complications. Copyright 1999 American Health Foundation and Academic Press. PMID: 10329338 [PubMed - indexed for MEDLINE] 6. Br Dent J. 1998 Nov 14;185(9):445-8. Introductory notes regarding a European Medical Risk Related History questionnaire (EMMRH) designed for use in dental practice. Abraham-Inpijn L, Smeets EC, Russell JG, Abraham EA. Academic Centre for Dentistry, Department of General Pathology and Internal Medicine, Amsterdam, Holland. Comment in: Br Dent J. 1999 Apr 10;186(7):316. The Medical Risk Related History (MRRH) has been in use for several years in the Netherlands. Since 1994 the MRRH system has been subject to research in nine European countries. Legal and ethical demands in all participating countries have been listed, and a national epidemiological analysis of pathology interfering with dental treatment has been undertaken for every participant. PMID: 9854341 [PubMed - indexed for MEDLINE] 7. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Nov;86(5):508-10. Fainting in the dental chair. Palmer-Bouva C, Van R, de Vries R, Abraham RE, Groen H, Abraham-Inpijn L. PMID: 9830639 [PubMed - indexed for MEDLINE] 8. Clin Exp Immunol. 1998 Jul;113(1):105-10. Characteristics of Prevotella intermedia-specific CD4+ T cell clones from peripheral blood of a chronic adult periodontitis patient. Wassenaar A, Reinhardus C, Abraham-Inpijn L, Snijders A, Kievits F. Department of Cell Biology and Histology, Academic Medical Centre, University of Amsterdam, The Netherlands. Periodontitis is a chronic destructive inflammatory disease associated with periodontopathic bacteria. In addition, autoantigens such as collagen and heat shock proteins (hsp) have been suggested to play a role. Established periodontal lesions are characterized by dense infiltrations of immune cells such as cytokine-producing CD4+ and CD8+ T cells. CD4+ T cells specific for Prevotella intermedia can be isolated from lesional gingiva, suggesting an active role for CD4+ T cells in the response to this bacterium. We therefore investigated the characteristics of a panel of 13 P. intermedia-specific CD4+ T cells generated from the peripheral blood of a patient with chronic adult periodontitis. All 13 P. intermedia-specific CD4+ T cells recognized the antigens in the context of HLA-DR. The T cell clones were mainly classified as Th0, producing comparable amounts of interferon-gamma (IFN-gamma) and IL-4, and Th2, producing high amounts of IL-4 and almost no IFN-gamma. None of the P. intermedia-specific T cell clones recognized antigens of the periodontopathic bacteria Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis and of the autoantigens collagen and hsp. The reactivity profile of the T cell clones to size-fractionated cell envelope antigens of P. intermedia indicated that P. intermedia-specific CD4+ T cell clones recognize probably five different antigen specificities in the context of the MHC class II molecules, DR7 or DR15. These results suggest that a broad panel of cell-associated protein antigens play a role in the induction of P. intermedia-specific CD4+ T cell response. PMCID: PMC1905014 PMID: 9697992 [PubMed - indexed for MEDLINE] 9. Gen Dent. 1998 Jul-Aug;46(4):356-60. Stress in elective dental treatment: epinephrine, norepinephrine, the VAS, and CDAS in four different procedures. Palmer-Bouva C, Oosting J, deVries R, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, ACTA, Amsterdam, The Netherlands. This study focuses on progressive stress during defined, elective dental treatments, expressed in VAS, CDAS, and catecholamine excretion in urine. Fourteen male patients had avoided dental treatment for years; all were classified as ASA risk score I. The different dental sessions were: first visit after many years; check-up (nonpainful and nontraumatic); drilling and restoring under local anesthetics; drilling and restoring without local anesthesia; and extractions. Urine collection was performed directly before and after the sessions to measure epinephrine and norepinephrine concentrations. Anticipation stress was registered in the VAS, CDAS, and epinephrine excretion. Progressive stress was reflected in epinephrine increase, which discriminated between the different elective dental treatments. PMID: 9758981 [PubMed - indexed for MEDLINE] 10. Prev Med. 1998 Jul-Aug;27(4):530-5. Detecting the medically compromised patient in dentistry by means of the medical risk-related history. A survey of 29,424 dental patients in The Netherlands. Smeets EC, de Jong KJ, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, ACTA, Amsterdam, The Netherlands. BACKGROUND: This study focuses on the detection of medically compromised dental patients in the Netherlands by means of a validated patient-administered medical risk-related history (MRRH). Due to social changes and scientific innovations in the past decade, more medically compromised patients will be needing special dental treatment. METHODS: The medical problems of 29,424 dental patients (age 18 years and over) from 50 dental practices in the Netherlands were registered by means of the MRRH. The patients were classified according to the ASA risk-score system, which was modified for dental treatment. An inventory of the number and nature of medical problems and the modified ASA risk score was drawn up in relation to dental treatment and age. RESULTS: The average age of the patients was 37.1 +/- 13.5 years. According to the current guidelines, dental treatment must be modified if the patient has an ASA score of III or IV. A relatively high percentage of patients ages 65-74 (23.9%) and 75 or over (34.9%) did have an ASA score of III or IV. Furthermore, the medical problems were classified into 10 categories, and the relationship to age was examined. The conditions that increased with age were hypertension and cardiovascular, neurological, endocrinological, infectious, and blood diseases. CONCLUSIONS: For the dental practice, these results mean that the MRRH can play an important role in adapting dental treatment to the specific needs of patients. This is especially important in the case of elderly patients. PMID: 9672946 [PubMed - indexed for MEDLINE] 11. Ned Tijdschr Tandheelkd. 1998 May;105(5):162-5. [Medical accidents in the dental practice. Survey of 471 dentists in the Netherlands] [Article in Dutch] Keur I, Smeets EC, de Jong KJ, Abraham-Inpijn L. Divisie Inwendige Geneeskunde van de Universiteit van Amsterdam. OBJECTIVE: To determine frequency and nature of medical accidents in Dutch dental practice in relation to type and time of treatment, with and without the use of the MRRH; frequency and nature of the professional assistance. METHOD: Dentists MRRH-users (n = 51) and control dentists (n = 420) recorded medical accidents by name, using a registration form, followed by an anonymous survey. RESULTS: 91 accidents were reported by name by 471 dentists. This contrasted with 300 accidents recorded by 380 dentists in an anonymous survey. No life threatening accidents were reported. Syncope and hyperventilation were frequent. Most of the accidents occurred during local anaesthesia or during treatment, as the procedure became more stressful. Two-third of the accidents could possibly have been prevented by means of a medical history. Medical assistance was requested in 6% of the cases. CONCLUSION: Life threatening disorders were not reported, possible because in the Netherlands no intravenous sedation or general anaesthetic is used in general dental practice. PMID: 11928418 [PubMed - indexed for MEDLINE] 12. Clin Exp Immunol. 1997 Nov;110(2):277-84. Antigen-presenting properties of gingival fibroblasts in chronic adult periodontitis. Wassenaar A, Snijders A, Abraham-Inpijn L, Kapsenberg ML, Kievits F. Laboratory of Cell Biology and Histology, Academic Medical Centre, University of Amsterdam, The Netherlands. Chronic periodontitis is characterized by dense infiltrations of T lymphocytes in the connective tissue, which consists mainly of gingival fibroblasts. It is becoming increasingly clear that T lymphocytes and gingival fibroblasts are capable of influencing each other. For example, the T cell cytokine interferon-gamma (IFN-gamma) is able to induce MHC class II molecules on the surface of several cell types, including gingival fibroblasts. Histological sections of chronically inflamed gingival tissue showed a great number of CD4+ and CD8+ T cells that produced IFN-gamma, and in addition showed abundant expression of MHC class II molecules on gingival fibroblasts. Therefore, we investigated whether these gingival fibroblasts acquire the capacity to carry out MHC class II-restricted functions such as antigen presentation to local T cells. In this study, we show that IFN-gamma-treated gingival fibroblasts were able to function as antigen-presenting cells (APC) for superantigen-mediated T cell proliferation. However, these fibroblasts failed to present whole-cell antigens of periodontitis-associated bacteria. Moreover, gingival fibroblasts inhibited the presentation of the whole-cell antigens of these bacteria by professional APC. This inhibition could be overcome by the addition of IL-2. These results suggest that gingival fibroblasts play an important role in the local specific immune response in chronic inflammatory periodontal lesions by regulating the response of infiltrating T cells. PMCID: PMC2265508 PMID: 9367413 [PubMed - indexed for MEDLINE] 13. Clin Chim Acta. 1997 Aug 8;264(1):37-47. Effect of a protein-rich meal on urinary and salivary free amino acid concentrations in human subjects. Brand HS, Jörning GG, Chamuleau RA, Abraham-Inpijn L. Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam (ACTA), The Netherlands. The aim of the present study was to investigate whether in healthy volunteers acute changes in plasma free amino acid composition after a protein-rich test meal are reflected in the urinary and salivary concentrations of the corresponding amino acids. The ingestion of a protein-rich meal elicited a significant increase of plasma and urine amino acid concentrations. The postprandial salivary amino acid excretion showed only minor changes. For several amino acids (alanine, arginine, asparagine, glycine, threonine and valine) significant relations were observed between the increase in concentration of these amino acids in venous plasma and urine. In whole saliva, only threonine and valine showed a significant relationship with the corresponding plasma concentration. Our data suggest that the urinary amino acid excretion of several amino acids has the potential for estimating short-term changes in plasma concentrations. Determination of salivary amino acid concentrations seems less appropriate for this purpose. PMID: 9267701 [PubMed - indexed for MEDLINE] 14. Int Dent J. 1997 Feb;47(1):16-20. The validity of a medical risk-related history for dental patients in Belgium. de Jong KJ, Abraham-Inpijn L, Vinckier F, Declerck D. Department of General Pathology and Internal Medicine, Academic Centre Dentistry Amsterdam (ACTA), The Netherlands. The aim of this study was to establish whether a patient-administered medical risk-related history (MRRH) for dental patients was valid. The MRRH, which was developed in the Netherlands, has now been tested in Belgium, where it was completed by total of 99 patients. Their answers were compared with the results of a verbal history, taken by a physician experienced in pre-assessment control. This verbal history was considered the 'gold standard'. The sensitivity and specificity of the medical questionnaire proved to be sufficiently high (88 per cent and 98 per cent respectively) and Cohen's Kappa displayed close agreement (0.87). These figures were only slightly lower than those obtained in Holland. The MRRH is valid for the registration of medical problems in dental patients but the answers need to be checked personally by the dental practitioner. Since the present trial was a limited one, the study will be expanded to nine countries in Europe. PMID: 9448784 [PubMed - indexed for MEDLINE] 15. Eur J Oral Sci. 1996 Jun;104(3):245-52. Cardiovascular responses induced by dental treatment. Brand HS, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. H.Brand@acta.nl Changes in mean heart rate and mean systolic and diastolic blood pressure are induced in both the patient's anticipation of scheduled treatment and the actual dental treatment itself. Significant changes have been observed before application of a local anesthetic, during restorative treatment, during extractions, and when epinephrine-impregnated retraction cords were used. These cardiovascular responses may vary according to the local anesthetic used and the choice of vasoconstrictor. The individual changes in heart rate and blood pressure are affected by pain and such individual factors as age, gender, hypertension, dental experience, and psychological responses. Although for the most part the cardiovascular changes induced by dental treatment are limited and within the normal physiological variation, this review stresses the importance of eliminating pain and minimizing patient anxiety. PMID: 8831058 [PubMed - indexed for MEDLINE] 16. Ned Tijdschr Tandheelkd. 1996 Mar;103(3):94-5. [How much feedback is provided by the 'feedback post'? Four years of medical information provision to dental practitioners] [Article in Dutch] van Diermen DE, Abraham-Inpijn L. Vakgroep Algemene Ziektenleer en Inwendige Geneeskunde, Academisch Centrum Tandheelkunde, Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam. This article describes the 'Feedback Post AZIG', an institute to which dentists can turn for advice on medical questions. The frequency as well as the content of these questions, posed between 1991 and 1994, are considered. Dentist clearly have a need for medical feedback and this need increases every year. Given the expected increase of the number of medically compromised patients in the dental practice, the importance of both medical training to dentists and feedback possibilities should not be underestimated. PMID: 11921955 [PubMed - indexed for MEDLINE] 17. Immunology. 1996 Jan;87(1):113-8. Type-1 and type-2 CD8+ T-cell subsets isolated from chronic adult periodontitis tissue differ in surface phenotype and biological functions. Wassenaar A, Reinhardus C, Abraham-Inpijn L, Kievits F. Department of General Pathology and Internal Medicine, University of Amsterdam, Netherlands. Cloning of CD8+ T cells expressing the alpha beta T-cell receptor from inflamed human gingiva revealed that at least two different subsets were found within the tissue and that these subsets were able to interact with each other. One subset produced high levels of interferon-gamma (IFN-gamma) and no interleukin-4 (IL-4) or IL-5, exhibited phytohaemagglutinin (PHA)- or anti-CD3-mediated cytolytic activity, and were CD28+. The other subset produced high levels of IL-4 in combination with IL-5, displayed no cytotoxicity and were CD28-. From the latter subset CD8+ T-cell clones were able to suppress the proliferative response of cytotoxic CD8+ T-cell clones. This suppression could be abolished by anti-IL-4 monoclonal antibodies. However, IL-4 alone was not able to induce the suppression. Our results indicate that CD8+ T cells might participate in local immune responses by the suppression of IFN-gamma-producing cells and by favouring humoral responses via the production of IL-4 and IL-5. PMCID: PMC1383976 PMID: 8666422 [PubMed - indexed for MEDLINE] 18. Stomatologiia (Mosk). 1996;75(3):15-8. [The significance of endocrine factors and microorganisms in the development of gingivitis in pregnant women] [Article in Russian] Abraham-Inpijn L, Polsacheva OV, Raber-Durlacher JE. 40-100% of pregnant women suffer from the co-called pregnancy gingivitis. The cause of pregnancy gingivitis is possible multicausal: increased plasma female sex-hormones, alteration in dental plague and perhaps Prevotella intermedia in the subgingival plague, together with alteration of immunoresponse. Increasing levels of progesterone in the gingiva as well as estrogens due to specific receptors affect vascular permeability and exudation, provoke stasis of microcirculation, increase prostaglandine E2 formation in human gingiva. Decreased gingival keratinization and capability of cell regeneration may affect the epithelial barrier. This can perhaps explain the direct dependence between progesterone and estrogens increasing and the intensification of gingivitis clinical manifestation. The experimental gingivitis model of women during pregnancy and post-partum showed identical amounts of dental plague, but clinical manifestations were more intense during pregnancy and they had a relation with increasing P. Intermedia, no statistical significance was shown in the proportion of P. gingivalis. Increasing steroid hormones can substitute for the naphtoquinone requirement of P. intermedia. Optimal oral hygiene performed during pregnancy reduced gingival swelling, redness and bleeding tendency to levels which can be considered as physiologic for the pregnant state. PMID: 9036576 [PubMed - indexed for MEDLINE] 19. Int Dent J. 1995 Dec;45(6):347-51. Anxiety and heart rate correlation prior to dental checkup. Brand HS, Gortzak RA, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. The aim of this study was to investigate the possible relationship between dental anxiety and heart rate prior to a dental checkup. Anxiety was determined in 44 patients using the Dental Anxiety Scale (DAS). Heart rate was measured 24 hours before, and immediately prior to, a dental checkup. The mean heart rate was higher immediately prior to the checkup than it had been 24 hours previously. The DAS score showed no relation to the heart rate immediately prior to the dental checkup, but showed a significant relation to the heart rate of women 24 hours before the checkup. In men, this relation did not reach significance. It is concluded that anticipation of a dental checkup increases heart rate. The average increase in heart rate is higher in patients with a low DAS score. PMID: 8666460 [PubMed - indexed for MEDLINE] 20. Am J Dent. 1995 Oct;8(5):242-4. Ambulant 24-hour blood pressure and heart rate of dentists. Gortzak RA, Stegeman A, Ten Brinke R, Peters G, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center for Dentistry Amsterdam (ACTA), The Netherlands. PURPOSE: To investigate blood pressure fluctuations in dentists during their daily activities, including dental procedures, in comparison with a non-dentist population. MATERIALS AND METHODS: A pilot study on blood pressure and heart rate fluctuations was performed which involved 26 dentists working at a university clinic. A 24-hour blood pressure registration was obtained using the Oxford Monitoring System. RESULTS: In the dentist group, both blood pressure and heart rate were found to be significantly higher during work than during leisure activities. In the control group, no significant difference in blood pressure was recorded between these periods. This study also showed the feasibility of ambulant 24-hour blood pressure registration on dentists during daily activity. Our results ethically justify a more intensive cardiovascular study involving a larger number of dentists working in private practice in order to establish whether our results are valid for the dental practitioner in general. PMID: 8634159 [PubMed - indexed for MEDLINE] 21. Ned Tijdschr Tandheelkd. 1995 Jul;102(7):263-5. [Alcoholism and dentistry] [Article in Dutch] Bemelman FJ, Stahl F, Abraham-Inpijn L. Vakgroep Algemene Ziekteleer en Inwendige Geneeskunde, Academisch Medisch Centrum, Academisch Centrum Tandheelkunde (ACTA) te Amsterdam, Louwesweg 1, 1066 EA Amsterdam. In this article the physical and psychological consequences of alcohol abuse are considered. In addition the interaction between alcohol abuse and oral health and dentistry is discussed. PMID: 11837110 [PubMed - indexed for MEDLINE] 22. Infect Immun. 1995 Jun;63(6):2147-53. Cloning, characterization, and antigen specificity of T-lymphocyte subsets extracted from gingival tissue of chronic adult periodontitis patients. Wassenaar A, Reinhardus C, Thepen T, Abraham-Inpijn L, Kievits F. Department of General Pathology and Internal Medicine, Academic Center for Dentistry Amsterdam (ACTA), The Netherlands. Chronic periodontitis is characterized by dense infiltrations of B and T lymphocytes within the gingival connective tissue. Distinct anaerobic gram-negative bacteria as well as autoimmunity to collagen have been reported to play a role in the etiology and the pathogenesis of this disease. Here we describe the cloning and characterization of CD4+ and CD8+ T lymphocytes isolated from inflamed gingival tissue obtained from four patients with chronic periodontitis. Clones were raised with phytohemagglutinin and interleukin-2 and tested for proliferation in response to whole-cell antigens of Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, human collagen type I, and two bacterial heat shock proteins. CD4+ T-cell clones reactive with collagen type I were obtained from all four patients. Eighty percent of these clones had phenotypes resembling the mouse type 2 T helper (Th) phenotype, i.e., they produced high levels of interleukin-4 and low levels of gamma interferon. No collagen-type-I-reactive CD8+ clones were obtained. Bacterial-antigen-reactive CD4+ and/or CD8+ T-cell clones were also obtained from each patient, and the majority of the clones showed a Th0-like cytokine pattern and produced equal amounts of interleukin-4 and gamma interferon. Although most clones were reactive with P. intermedia, it seems that the immune response is not strictly directed against this particular microorganism, as clones reactive with one of the other bacteria were also obtained from two patients. We propose that collagen-specific CD4+ Th2-like T cells contribute to the chronicity of periodontitis but that their modes of activation might be controlled by Th0-like T cells specific for periodontitis-associated bacteria. PMCID: PMC173279 PMID: 7539406 [PubMed - indexed for MEDLINE] 23. Gen Dent. 1995 May-Jun;43(3):274-6. Pain-induced hypertensive episode in the dental office. Gortzak RA, Abraham-Inpijn L. Department of Internal Medicine and General Pathology, Academic Center for Dentistry, University of Amsterdam, Netherlands. PMID: 8940586 [PubMed - indexed for MEDLINE] 24. Int Dent J. 1995 Feb;45(1):45-8. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam, The Netherlands. Patients demonstrate a physiological stress response during dental checkups and treatment. Local anesthesia and tooth extraction activate the adrenal cortex to produce cortisol. Changes in adrenaline or noradrenaline concentrations have been reported in plasma and urine after drilling and filling or extraction, and anticipation of a dental checkup increases blood pressure. Both diastolic and systolic blood pressure rise still further during restorative treatment without local anaesthesia and during extraction. In a study by the same authors, no significant changes in blood pressure were observed during restorative treatment with local anaesthesia, which suggests that the pain experienced by the patient contributes to the rise in blood pressure. Dentists must be aware that this increased blood pressure may induce cardiovascular complications during dental therapy. PMID: 7607744 [PubMed - indexed for MEDLINE] 25. Ned Tijdschr Tandheelkd. 1995 Feb;102(2):41-3. [Corticosteroids in dental practice] [Article in Dutch] Bemelman FJ, Donckers AM, Abraham-Inpijn L. Vakgroep Algemene Ziekteleer en Inwendige Geneeskunde, Academisch Centrum Tandheelkunde Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam. In this article some pharmacologic aspects of corticosteroids and their main medical indications are reviewed. In addition, the use of corticosteroids in dentistry and their interference with dental treatment are discussed. PMID: 11837068 [PubMed - indexed for MEDLINE] 26. Rev Belge Med Dent. 1995;50(1):9-18. [The medical history through a list of medical risks. Practical use in dental medicine] [Article in French] Abraham-Inpijn L, Parleviet KJ, Vinckier F, Declerck D. Vakgroep Algemene Ziektenleer & Inwendige Geneeskunde Academisch Centrum Tandheelkunde Amsterdam (ACTA), Amsterdam. A medical risk related patient-administered history (MRRH) was developed for use in routine dental treatment with or without local anesthesia by the general dental practitioner. The fixed guidelines of the ASA classification may be under discussion. Of course, there are other divisions and combinations conceivable and deviation of the standards may be inevitable. However, the present proposal is to be used for investigation purposes, which makes fixed guide-lines imperative. This MRRH, tested in Belgium, proved to be valid in comparison with the "gold standard", a verbal history taken by a physician experienced in pre-assessment control. The most reliable results can be obtained by a combination of the medical questionnaire and the additional verbal history. PMID: 7676087 [PubMed - indexed for MEDLINE] 27. Stomatologiia (Mosk). 1995;74(6):11-6. [Importance of proper implementation of the case history in the prevention of stomatological diseases] [Article in Russian] Abraham-Inpijn L, Polsacheva OV, de Jong KJ. In connection with ageing of population and an increasing number of older patients visiting the dental practice with multiple diseases, special prevention of possible medical complication during dental treatment is necessary. The advances in dentistry increase the chance of these complications. There is however no consensus about history taking in dental practice. For getting the maximum amount of information about the patient's health a Risk-Related Medical History (RRMH) patient-administered is proposed, that is checked by the dentist. The RRMH was composed in accordance with the modified ASA physical risk score. It allows to dyfine general patient's physical condition and to advise measures for prophylaxis of medical complication. The medical questionnaire showed a high sensitivity and specificity. In a study among 5000 patients the results of this history was analysed. The RRMH is simple and comfortable, it allows to obtain relible medical information in short time both for the dentist and for the patient. PMID: 8713392 [PubMed - indexed for MEDLINE] 28. Ned Tijdschr Tandheelkd. 1994 Nov;101(11):436-8. [Symptomatic bacteremia after periodontal treatment] [Article in Dutch] de Graaff J, Abbas F, Abraham-Inpijn L, Asscheman H, van Steenbergen TJ, Namavar F, Petit MD. Vakgroep Orale Microbiologie, Academisch Centrum Tandheelkunde Amsterdam (ACTA), Van der Boechorststraat 7, 1081 BT Amsterdam. Symptomatic bacteremia after dental treatment in an apparently healthy patient is an indication for preventive antibiotic treatment. This article describes the case of a patient with clinical symptoms of bacteremia after periodontal treatment, in whom the blood cultures remained positive after oral administration of amoxicillin (Chlamoxyl). Intramuscular administration of penicillin (Bicilline) was able to prevent the clinical symptoms as well as the bacteremia. PMID: 11831182 [PubMed - indexed for MEDLINE] 29. Clin Otolaryngol Allied Sci. 1994 Oct;19(5):415-21. Salivary flow rate and acute-phase proteins in Bell's palsy. Keur I, Abraham-Inpijn L, Nieuw Amerongen AV. Department of General Pathology and Internal Medicine, Academic Center for Dentistry, ACTA, Amsterdam, The Netherlands. The flow rate of extra-parotid and parotid saliva was compared in patients with Bell's palsy and in healthy volunteers. Samples were analysed for the concentration of total protein and seven acute-phase proteins. There was no difference between younger and older patients with regard to oral status, salivary flow rate, total protein or acute-phase proteins, in either extra-parotid or parotid saliva. No significant difference in flow rate for both extra-parotid and parotid saliva was found in the Bell's palsy patients in comparison with the controls. In the patients the salivary flow rate from the parotid gland on the paralysed side was slightly lower than on the healthy side, but not to a significant extent. The quantity of total protein was lower in the extra-parotid saliva in the patient group; there were no differences between the two groups with regard to parotid saliva. We were able to demonstrate small amounts of various acute-phase proteins in the control group. In the patients we found higher quantities per minute of acute-phase proteins in both extra-parotid saliva and parotid saliva than in the controls. In extra-parotid saliva there were significant differences in haptoglobulin, alpha 2-macroglobulin, C3-complement factor and ceruloplasmin; in parotid saliva the differences in haptoglobulin and ceruloplasmin were significant. However, there was a large inter individual variation in both groups studied. In the patient group no significant difference in the secretion of acute-phase proteins from the parotid gland could be demonstrated between the paralysed side and the healthy side.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7530609 [PubMed - indexed for MEDLINE] 30. Int Dent J. 1994 Oct;44(5):471-9. A risk-related patient-administered medical questionnaire for dental practice. de Jong KJ, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. This study deals with an improved medical questionnaire designed on the basis of the results of previous studies. The form consists of 27 items, each subdivided into a main question and one or more subquestions. The medical problems involved are categorised according to the risk-classification system of the American Society of Anaesthesiologists (ASA). An affirmative answer to the main question always results in ASA class II; the subquestions are designed to discriminate between ASA classes II, III and IV. For each of the 27 medical problems in the questionnaire, the implications for dental treatment are explained and an ASA risk classification proposed. The questionnaire can also be a useful tool in medical pre-assessment control. PMID: 7814118 [PubMed - indexed for MEDLINE] 31. J Clin Periodontol. 1994 Sep;21(8):549-58. Experimental gingivitis during pregnancy and post-partum: clinical, endocrinological, and microbiological aspects. Raber-Durlacher JE, van Steenbergen TJ, Van der Velden U, de Graaff J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam, The Netherlands. The purpose of this study was to assess whether an intensive oral hygiene regimen practised during pregnancy results in a clinically healthy gingival state, and to assess whether experimentally-induced gingivitis differs in severity during pregnancy as compared to post-partum. In addition, levels of black-pigmented Gram negative anaerobes at subgingival and oral mucosal sites and plasma concentrations of free estrogens and prosterone were determined. These parameters were studied during a 14-day episode of experimental gingivitis induced in the 25th week of pregnancy, and again 6 months post-partum. The subjects were selected on shallow pockets < or = 4 mm and interproximal loss of attachment not exceeding 2 mm. As a result of controlled oral hygiene, the gingival condition improved both during pregnancy and post-partum. At day 0 during pregnancy, however, gingival swelling, redness, and bleeding on probing were found to be higher than post-partum. Free plasma levels of estrogens and progesterone were found to be normal throughout the study. It was hypothesized that the increase in severity of gingival symptoms during pregnancy reflect microvascular physiologic effects of increased levels of these hormones. During pregnancy, more swelling, redness and bleeding on probing developed during experimental gingivitis than post-partum, whereas the amount of plaque was similar in both phases. This suggests that as a result of dental plaque accumulation, gingival inflammation develops superimposed on pregnancy-associated physiologic alterations. Microbiological evaluation showed that the mean proportions of Prevotella intermedia in subgingival plaque increased during experimental gingivitis performed during pregnancy, whereas no increase of this micro-organism was found post-partum. PMID: 7989619 [PubMed - indexed for MEDLINE] 32. Ned Tijdschr Tandheelkd. 1994 Mar;101(3):86-9. [Midazolam sedation in the general dental practice] [Article in Dutch] Bertens J, Abraham-Inpijn L, Meuwissen PJ. Vakgroep Algemene Ziekteieer en Inwendige Geneeskunde, Academisch Centrum Tandheelkunde Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam. The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment. PMID: 11830956 [PubMed - indexed for MEDLINE] 33. Ned Tijdschr Tandheelkd. 1994 Jan;101(1):10-4; quiz 15, 22. [Halitosis (fetor ex ore). A review] [Article in Dutch] van Nieuw Amerongen A, Veerman EC, Abraham-Inpijn L, van Steenbergen TJ, van Winkelhoff AJ. Vakgroep Orale Biochemie, Academisch Centrum Tandheelkunde Amsterdam (ACTA). About 15% of the Dutch population has, in a more or lesser degree, complaints about bad breath. This is caused particularly by the anaerobic metabolism of a number of oral microorganisms, in which putrefaction occurs and volatile sulfur compounds will be formed. Some of these compounds are also possibly involved in the pathogenesis of periodontitis. A good oral hygiene is of primary importance to prevent halitosis and to reduce bad breath. Antiseptic mouth-waters can be helpful in the reduction of the bacterial metabolism. In addition, stimulation of the salivary secretion has a dual favourable effect, firstly because of its antimicrobial salivary proteins, and secondly by reduction of the retention of nutrients in the oral cavity. PMID: 11830981 [PubMed - indexed for MEDLINE] 34. J Public Health Dent. 1993 Fall;53(4):219-22. Medical risk classification of dental patients in The Netherlands. de Jong KJ, Oosting J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam, The Netherlands. This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician. PMID: 8258783 [PubMed - indexed for MEDLINE] 35. Gen Dent. 1993 May-Jun;41(3):246-51. High blood pressure screening in the dental office: a survey among Dutch dentists. Gortzak RA, Abraham-Inpijn L, ter Horst G, Peters G. Academic Center for Dentistry, Department of General Pathology and Internal Medicine, University of Amsterdam, Netherlands. PMID: 8243963 [PubMed - indexed for MEDLINE] 36. J Periodontol. 1993 Mar;64(3):211-8. Experimental gingivitis during pregnancy and post-partum: immunohistochemical aspects. Raber-Durlacher JE, Leene W, Palmer-Bouva CC, Raber J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center for Dentistry Amsterdam, (ACTA), The Netherlands. The histoimmunological response of 8 individuals was studied longitudinally in relation to the development of experimental gingivitis during pregnancy and post-partum. At day 0 as well as at day 14 of experimental gingivitis the mean periodontal pocket bleeding index (PPBI) was higher during pregnancy than post-partum, whereas the amount of plaque that accumulated was similar. The number of CD1 positive cells (mainly Langerhans) in the oral epithelium was found to be higher during pregnancy. In the sulcular epithelium, however, the number of these cells tended to decrease during pregnancy as compared to post-partum. The number of CD4 positive cells in oral and sulcular epithelium was increased during pregnancy (P < 0.05). It was speculated that this increase in the number of CD4 positive cells is confined to the Th-1 subset, since the number of CD14 positive cells (mainly macrophages and granulocytes) together with the number of B cells was found to be decreased during pregnancy. Th-1 cells are known to be cytotoxic against these HLA class II antigen bearing cells. Consequently, cytotoxicity directed against B cells and macrophages may result in diminished immunoresponsiveness in pregnancy gingivitis. PMID: 8463944 [PubMed - indexed for MEDLINE] 37. Cancer Nurs. 1992 Oct;15(5):313-21. Nursing care for oral complications associated with chemotherapy. A survey among members of the Dutch Oncology Nursing Society. Nieweg R, van Tinteren H, Poelhuis EK, Abraham-Inpijn L. Comprehensive Cancer Center, Amsterdam, The Netherlands. The incidence of oral complications among adult cancer patients undergoing chemotherapy varies from 12% to 80%. Adequate oral hygiene has been shown to be important in prevention, and an essential role is reserved for the nursing staff. These considerations prompted the decision to survey, by means of a questionnaire, the nurses who give care to cancer patients. The questions were concerned with multidisciplinary treatment, inspection methods, nursing interventions, and nursing education. Data emerged regarding a shortage of dentists and dental hygienists, and knowledge of oral inspection and the appropriate interventions by nurses are insufficient. Extra attention to oral hygiene during training is warranted. PMID: 1423250 [PubMed - indexed for MEDLINE] 38. Clin Prev Dent. 1992 Sep-Oct;14(5):5-10. Non-invasive 27-hour blood pressure registration including dental checkups in some dental practices. Gortzak RA, Abraham-Inpijn L, Peters G. Academic Center for Dentistry Amsterdam, Netherlands. The study involved 53 patients aged 18 to 67 (mean age 38.8, SD 13.6), 26 male and 27 female, who were monitored by means of a 27-hour non-invasive ambulant blood pressure registration, using the Oxford Monitoring System. All patients had been under dental supervision by the same dentist for more than one year, and were familiar with the procedure during checkups. This study showed a significant rise in systolic blood pressure (8.6 mmHg) and a tendency towards increased diastolic pressure (2.9 mmHg) during dental checkups in comparison with the values recorded 24 hours earlier during normal daily activity. These results were independent of the blood pressure classification (normotensive, borderline or hypertensive) of the patients and are comparable to the increases measured during a visit to the GP. Neither the sex nor the manner of the dentist had any significant influence on either the systolic or diastolic pressure values during the checkup. Nor did the phobic level of the patients significantly influence blood pressure values during the dental checkup. On the basis of the results of this study, it may be concluded that regardless of whether the patient is phobic or non-phobic, and regardless of the sex and manner of the dentist, blood pressure measurements taken during dental checkups are reliable and can be used for referral decisions. PMID: 1291186 [PubMed - indexed for MEDLINE] 39. Oral Surg Oral Med Oral Pathol. 1992 Jun;73(6):677-81. Blood pressure response to routine restorative dental treatment with and without local anesthesia. Continuous noninvasive blood pressure registration with a finger manometer. Gortzak RA, Oosting J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center of Dentistry Amsterdam, The Netherlands. A continuous noninvasive blood pressure registration with the Finapres finger manometer was carried out during routine dental treatment, with and without local anesthesia. Forty patients (21 male), 21 to 64 years of age, were studied. Blood pressure was recorded continuously from 10 minutes before dental treatment to 10 minutes after treatment was completed. No local anesthetic was used in 25 patients. In 15 patients (seven men) local anesthetic was used. All patients showed a considerable blood pressure variation. During treatment a significant mean blood pressure increase was registered in the patients treated without local anesthesia. In the patients treated with local anesthesia no significant mean blood pressure changes during dental treatment could be established. However, during the actual administration of the local anesthetic solution a transient blood pressure increase was found, followed by a decrease shortly after removal of the needle from the mouth. After treatment of both groups of patients, a mean blood pressure decrease was established. PMID: 1437035 [PubMed - indexed for MEDLINE] 40. Eur J Med. 1992 Apr;1(1):23-9. Detecting medical problems in dentistry: a survey of 4,087 patients in The Netherlands. de Jong KJ, Oosting J, Peters GJ, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. OBJECTIVES: This study was conducted to determine whether a medical history could be an effective means of detecting medical problems in dental patients. METHODS: A risk-related patient-administered medical questionnaire was completed by 4,087 patients in 47 dental practices. The data collected were summarized by means of descriptive statistics; the number of medical problems and the relationship between these problems and the age of the patient were analyzed. RESULTS: In all, 37.2% of these patients reported at least one medical problem. Hypertension, chronic bronchitis, allergies and medication were the items most frequently mentioned. The frequencies of heart disease, hypertension, endocrinologic and neurologic disorders increased with age, while allergies and chronic obstructive pulmonary disease were evenly distributed over the different age groups. The differences between the health of the patients in the various dental practices were not significant. CONCLUSIONS: On the basis of these results, it can be concluded that taking a medical history by means of a patient-administered questionnaire is an effective method of detecting medical problems of dental patients. PMID: 1341973 [PubMed - indexed for MEDLINE] 41. J Periodontol. 1991 Nov;62(11):663-7. CD4 to CD8 ratio and in vitro lymphoproliferative responses during experimental gingivitis in pregnancy and post-partum. Raber-Durlacher JE, Zeijlemaker WP, Meinesz AA, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center for Dentistry Amsterdam, The Netherlands. The absolute numbers and percentages of peripheral T, B, and NK cells were assessed in 7 women, both during the second trimester of pregnancy and 6 months post-partum. Furthermore, the in vitro responses of peripheral blood lymphocytes (PBL) to several mitogens and a preparation of Prevotella intermedia were compared in a period of experimentally-induced gingivitis during pregnancy and post-partum. Clinically, the periodontal pocket bleeding index (PPBI) was found to be higher during pregnancy than post-partum. The absolute numbers of CD3, CD4, and CD19 positive cells appeared to be decreased during pregnancy as compared to post-partum. However, the results did not indicate any evidence for a reduced in vitro PBL response to several mitogens and a preparation of P. intermedia during pregnancy. PMID: 1836497 [PubMed - indexed for MEDLINE] 42. Oral Surg Oral Med Oral Pathol. 1991 Nov;72(5):527-33. Validity of a risk-related patient-administered medical questionnaire for dental patients. de Jong KJ, Borgmeijer-Hoelen A, Abraham-Inpijn L. Department of General Pathology and Internal Medicines, Academic Centre Dentistry Amsterdam, The Netherlands. In this study the validity of a patient-administered risk-related medical questionnaire for dental patients was tested. The answers given on the questionnaire were compared with the results of a verbal history taken by a physician. This verbal history was considered the "gold standard." The sensitivity and specificity of the medical questionnaire appeared to be sufficiently high, and the kappa values of the separate questions were satisfactory. The questionnaire was found to be valid in the registration of medical problems in dental patients, but combination of the two methods is recommended. PMID: 1745509 [PubMed - indexed for MEDLINE] 43. Community Dent Oral Epidemiol. 1991 Oct;19(5):310-1. Clinical relevance of a medical history in dental practice: comparison between a questionnaire and a dialogue. de Jong KJ, Abraham-Inpijn L, Oomen HA, Oosting J. Department of General Pathology and Internal Medicine, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. PMID: 1743001 [PubMed - indexed for MEDLINE] 44. Gen Dent. 1991 Sep-Oct;39(5):339-42. Blood pressure response to dental checkup: a continuous, noninvasive registration. Gortzak RA, Abraham-Inpijn L, Oosting J. Academic Center for Dentistry, Department of General Pathology and Internal Medicine, University of Amsterdam. PMID: 1812051 [PubMed - indexed for MEDLINE] 45. Oral Surg Oral Med Oral Pathol. 1990 Dec;70(6):734-7. Lack of evidence for link between intradental lesions and chronic renal failure. Abraham-Inpijn L, Schuurs AH. Academic Center for Dentistry, Amsterdam, The Netherlands. In at least three publications, radiographic intradental changes have been mentioned in connection with end-stage renal failure with and without renal osteodystrophy. The influence of immunosuppressive therapy has been suggested. In 63 patients with one or a combination of the above-mentioned criteria, no evidence was found on intradental radiolucencies or of extreme narrowing (obliteration) of the dental pulp cavity. PMID: 2263331 [PubMed - indexed for MEDLINE] 46. Oral Surg Oral Med Oral Pathol. 1990 Dec;70(6):730-3. Blood pressure measurements during dental checkups representative of 26-hour registration. Gortzak RA, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center Dentistry, Amsterdam. The effect of dental checkups on blood pressure was investigated. In 27 normotensive patients (13 men and 14 women) aged 22 to 64 years (mean 39.75 +/- 10.5 years), a 26-hour continuous, noninvasive blood pressure registration was carried out. Of each patient at least 175 blood pressure measurements were registered during these 26 hours, giving a total amount of 4725 blood pressure measurements. A dental checkup appointment with the family dentist was included. Blood pressure values displayed the well-known diurnal variation, but the visit to the dental surgeon was not accompanied by a rise in blood pressure. There was no significant difference between the blood pressure values during the 26-hour period and those during the checkup period. During a rest period after the dental checkup, neither the systolic nor the diastolic pressure fell to any degree in relation to the 26-hour values or the visit to the surgeon. PMID: 2263330 [PubMed - indexed for MEDLINE] 47. Ned Tijdschr Tandheelkd. 1990 Nov;97(11):452-4. [Medical history. Risk factors and prevention in dental practice] [Article in Dutch] Abraham-Inpijn L, de Jong KJ, Oomen HA. ACTA, Amsterdam. The need for the taking of a medical history when dealing with dental patients, is discussed from two different points of view. The medically compromised patient, according to article 9 part 3 of the regulation 'Special dentistry' in The Netherlands must be recognized by a medical history so adequate preventive treatment will avoid unnecessary medical intervention. As part of the EC proposals on the education of dental practitioners, the prevention of medical emergencies in the dental practice is important as well. A structured medical history based on risk classification and preventive measures meets both options. PMID: 2151528 [PubMed - indexed for MEDLINE] 48. J Clin Periodontol. 1990 Apr;17(4):233-42. Improved metabolic control, clinical periodontal status and subgingival microbiology in insulin-dependent diabetes mellitus. A prospective study. Sastrowijoto SH, van der Velden U, van Steenbergen TJ, Hillemans P, Hart AA, de Graaff J, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center for Dentistry, Amsterdam, The Netherlands. The effect of improved metabolic control on the clinical periodontal condition and the subgingival microflora of diseased and healthy periodontal pockets in 6 ambulatory insulin-dependent diabetes mellitus (IDDM) patients was prospectively studied. Duplicate measurements with a time-interval of 3 days were made every 4 moths for assessment of the metabolic status, the clinical periodontal condition and the subgingival microflora. During the study, patients maintained personal oral hygiene measures as they usually did before the study. Neither supplementary dental prophylaxis nor oral hygiene measures were applied during the investigation. Long-term metabolic control (HbAlc) improved significantly with intensive conventional insulin treatment. Gingival redness decreased significantly whereas gingival swelling showed a not significant trend to decrease. It is suggested that microvascular changes associated with improved metabolic control in diabetes mellitus may mediate the observed change in gingival redness. No effect could be demonstrated for probing pocket depth, probing attachment level, bleeding on probing and the plaque index. Statistical analysis of the effect of improved metabolic control on the subgingival microflora revealed that only the % of streptococci increased significantly in diseased periodontal pockets. In general, no significant changes were found in either healthy or diseased pockets with regard to the bacterial flora associated with periodontal disease. The results of the present study indicate that improved metabolic control in IDDM patients may have no potential impetus for an improved clinical periodontal condition nor on the subgingival bacterial flora. It is concluded that the periodontal condition in IDDM patients may only ameliorate when local oral hygiene measures are applied. PMID: 2189897 [PubMed - indexed for MEDLINE] 49. J Periodontol. 1990 Apr;61(4):217-23. Stimulation of lymphocytes in vitro by Bacteroides intermedius and Bacteroides (Porphyromonas) gingivalis sonicates. Raber-Durlacher JE, Zeijlemaker WP, Meinesz AA, Abraham-Inpijn L. Department of General Pathology and Internal Medicine, Academic Center for Dentistry Amsterdam, The Netherlands. The present study was designed to assess whether the in vitro stimulation of lymphocytes by sonicates of Bacteroides intermedius and Bacteroides (Porphyromonas) gingivalis is antigen specific or non-specific. In addition, the role of T and B lymphocytes in these responses was assessed. Peripheral blood lymphocytes obtained from healthy volunteers were cultured in the presence of these bacterial preparations and the proliferative response was measured. In similar experiments the response of umbilical cord blood lymphocytes did not exceed background values. In limiting dilution experiments only 1:4000, 1:6800, and 1:8200 of the lymphocytes initially reacted to B. intermedius, which strongly argues for the antigen-specificity of the response. Purified T cells, in the presence of monocytes, proliferated when stimulated with B. intermedius and B. gingivalis. As for B cell stimulation, the bacterial extracts were capable of inducing IgM production, which appeared to be T cell dependent. These findings support the notion that B. intermedius and B. gingivalis induce specific T cell activation; secondarily, a T cell dependent, polyclonal B cell activation may occur. PMID: 1691286 [PubMed - indexed for MEDLINE] 50. J Clin Periodontol. 1990 Jan;17(1):55-60. Relationship between bleeding/plaque ratio, family history of diabetes mellitus and impaired glucose tolerance. Sastrowijoto SH, Abbas F, Abraham-Inpijn L, van der Velden U. Department of General Pathology, Academic Center for Dentistry Amsterdam, The Netherlands. In the present study, the relationship between bleeding/plaque ratio, family history of diabetes mellitus and oral glucose tolerance pattern were investigated in 85 non-diabetic individuals without periodontal breakdown. In this group, no relationship between bleeding/plaque ratio, family history of diabetes mellitus and impaired glucose tolerance was found. The results of the present study suggest that the observed variation in bleeding/plaque ratio cannot be explained by impaired glucose tolerance or family history of diabetes mellitus. It is hypothesized that in subjects with impaired glucose tolerance, the periods of elevated blood glucose values may be too short to introduce tissue changes. PMID: 2295709 [PubMed - indexed for MEDLINE] 51. Ned Tijdschr Tandheelkd. 1989 Dec;96(12):561-3. [Orbital cellulitis after a dental infection] [Article in Dutch] van der Borden J Jr, Steinmetz PA, Abraham-Inpijn L, Visser CE, Westerbeek HA. Blindness as a complication of a dental infection is rare. A nineteen-year-old male is presented with an apical abscess, leading to a maxillary sinusitis, orbital cellulitis and an imminent cavernous sinus thrombosis. PMID: 2639265 [PubMed - indexed for MEDLINE] 52. J Clin Periodontol. 1989 May;16(5):316-22. Periodontal condition and microbiology of healthy and diseased periodontal pockets in type 1 diabetes mellitus patients. Sastrowijoto SH, Hillemans P, van Steenbergen TJ, Abraham-Inpijn L, de Graaff J. Department of Internal Medicine, Academic Center for Dentistry, Amsterdam, The Netherlands. On the basis of glycosylated hemoglobin (HbA1c) values, 22 type 1 (insulin-dependent) diabetic adults were grouped into patients with near normal (HbA1c less than or equal to 7.7%) and poor (HbA1c greater than or equal to 9.9%) metabolic control. A total of 44 subgingival sites were examined for Actinobacillus actinomycetemcomitans, black-pigmented Bacteroides species and Capnocytophaga species. No significant difference could be demonstrated between patients in the 2 test groups with regard to periodontal condition. Neither age of diabetic patients nor duration of diabetes mellitus influenced the periodontal parameters. In both test groups, pocket depth of 4 mm or more (greater than or equal to 4 mm) was found to be significantly associated with increased swelling, bleeding after probing and amount of marginal plaque. Proportionally high %s of cultivable A. actinomycetemcomitans (mean 4.3%; range 2.8-5.8%), Bacteroides gingivalis (33.2% and 34.6%) and Bacteroides intermedius (mean 4.2%; range 0.001-13.5%) were isolated from diseased periodontal pockets. In diabetic patients with poor metabolic control, B. intermedius was isolated from diseased periodontal pockets with a mean % of 7.2%, range 0.3-12.5%. Independent of the degree of metabolic control, low %s of Capnocytophaga species were isolated from diseased and healthy periodontal pockets, mean 0.9% (range 0.003-3.9%) and mean 1.4% (range 0.04-4.9%), respectively. It was concluded from this study that metabolic control seems to have no direct effect on the periodontium. Furthermore, the rôle of Capnocytophaga species in the pathogenesis of infectious periodontal disease in type 1 diabetic patients seems to be overestimated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 2723104 [PubMed - indexed for MEDLINE] 53. Ned Tijdschr Tandheelkd. 1989 May;96(5):189-92. [Do dentists agree on dental anaesthesia?] [Article in Dutch] Oomen HA, de Jong KJ, Abraham-Inpijn L. Hundred-and-ten dentists, both practitioners and teachers, attending a postgraduate course in medical emergencies, were unanimous in their choice of anaesthetics and medical anamnesis, the importance of avoiding toxicity and also in the unpredictability and infrequency of allergic reactions. There was no consensus on the importance of the aspiration test to avoid intravascular injection. PMID: 2635270 [PubMed - indexed for MEDLINE] 54. Ned Tijdschr Geneeskd. 1989 Mar 25;133(12):604-6. [Screening for hypertension by the dentist] [Article in Dutch] Abraham-Inpijn L, Gortzak RA. PMID: 2716875 [PubMed - indexed for MEDLINE] 55. Ned Tijdschr Tandheelkd. 1989 Feb;96(2):49-52. [Prevention of oral side effects in children receiving chemotherapy] [Article in Dutch] Raber-Durlacher JE, Abraham-Inpijn L, Lustig KH, Behrendt H. Especially in children the frequency of oral complications associated with cancer chemotherapy is high. The dentist plays an important role in preventing or reducing these sometimes life-threatening problems. Oral symptoms of the underlying disease, oral sequelae from chemotherapy, patient-related factors and a preventive oral care program will be discussed. PMID: 2622498 [PubMed - indexed for MEDLINE] 56. Neth J Med. 1989 Feb;34(1-2):98-108. The prevention of oral complications in bone-marrow transplantations by means of oral hygiene and dental intervention. Raber-Durlacher JE, Abraham-Inpijn L, van Leeuwen EF, Lustig KH, van Winkelhoff AJ. Oral complications cause morbidity and mortality in patients, undergoing allogeneic or autologous bone-marrow transplantation. The clinical features and the pathogenesis of the oral sequelae of bone marrow ablative therapy and graft-versus-host disease are discussed. In addition, a preventive oral care procedure before, during and after bone-marrow transplantation is proposed. PMID: 2644559 [PubMed - indexed for MEDLINE] 57. Ned Tijdschr Tandheelkd. 1988 Oct;95(10):369-71. [The use of lasers on dental hard tissues] [Article in Dutch] Leunisse M, Abraham-Inpijn L, Roodenburg JL. PMID: 3077793 [PubMed - indexed for MEDLINE] 58. J Am Dent Assoc. 1988 Apr;116(4):531-6. Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia. Abraham-Inpijn L, Borgmeijer-Hoelen A, Gortzak RA. Department of General Pathology and Internal Medicine, Academical Medical Center, University of Amsterdam, The Netherlands. Cardiovascular complications caused by hypertension need to be anticipated during routine dental therapy. Changes in the cardiovascular system before, during, and after treatment were studied for 40 patients undergoing extractions. PMID: 3164019 [PubMed - indexed for MEDLINE] 59. Clin Otolaryngol Allied Sci. 1987 Oct;12(5):349-55. Bell's palsy: factors affecting the prognosis in 200 patients with reference to hypertension and diabetes mellitus. Abraham-Inpijn L, Oosting J, Hart AA. Department of Internal Medicine and Otolaryngology, University Hospital, Amsterdam, Holland. In an effort to refine and amplify the basis for clinical prognosis in Bell's palsy, 14 factors in a clinical study were analysed. From the results, it is still impossible to make a certain prognosis of recovery in the individual patient. However, it is obvious that, based on degree of paresis on assessment, and to a lesser degree the MAP value, at least a quantitative statement can be made. PMID: 2827919 [PubMed - indexed for MEDLINE] 60. Oral Surg Oral Med Oral Pathol. 1987 Oct;64(4):427-31. An unusual case of black teeth. Schuurs AH, Abraham-Inpijn L, van Straalen JP, Sastrowijoto SH. The Netherlands, Academic Center for dentistry, Amsterdam. Loss of enamel and a deep black stain of the teeth in a 40-year-old diabetic patient are strongly suggested to be caused by the daily consumption of a cheap white wine and, possibly, by the chewing of cayenne. The wine proved to be rather acid, thereby promoting abrasion as a result of gnashing, and to contain a high concentration of tannin. The exact role of the tannins is described. PMID: 3477763 [PubMed - indexed for MEDLINE] 61. Ned Tijdschr Tandheelkd. 1987 May;94(5):195-203. [AIDS and dentistry. Aspects of medical history, diagnosis and prevention further illustrated] [Article in Dutch] Abraham-Inpijn L. PMID: 2955232 [PubMed - indexed for MEDLINE] 62. Ned Tijdschr Tandheelkd. 1987 Mar;94(3):93-6. [The hemophiliac patient in the general dental practice] [Article in Dutch] Kouijzer PW, Sjamsoedin DA, Abraham-Inpijn L. PMID: 2952892 [PubMed - indexed for MEDLINE] 63. Ned Tijdschr Tandheelkd. 1985 May;92(5):173-5. [AIDS (acquired immunodeficiency syndrome)] [Article in Dutch] Abraham-Inpijn L, Hulsebosch HJ. PMID: 3862970 [PubMed - indexed for MEDLINE] 64. Ned Tijdschr Tandheelkd. 1985;92 Spec No:422-5. [Focal infection] [Article in Dutch] Thoden van Velzen SK, Abraham-Inpijn L, Moorer WR. PMID: 3867828 [PubMed - indexed for MEDLINE] 65. Ned Tijdschr Tandheelkd. 1985;92 Spec No:418-22. [Medical emergencies in dental practice] [Article in Dutch] Abraham-Inpijn L. PMID: 3867827 [PubMed - indexed for MEDLINE] 66. Ned Tijdschr Tandheelkd. 1984 Sep;91(9):319-22. [Recent developments with respect to diabetes mellitus] [Article in Dutch] Abraham-Inpijn L. PMID: 6390226 [PubMed - indexed for MEDLINE] 67. J Clin Periodontol. 1984 Apr;11(4):209-20. Plaque and systemic disease: a reappraisal of the focal infection concept. Thoden van Velzen SK, Abraham-Inpijn L, Moorer WR. The review presented here covers metastatic local and systemic disease secondary to the accumulation of plaque or the formation of other pathogenic microbial depots in the mouth. At least 3 pathways may link oral infection to secondary disease, to wit metastatic infection due to transient bacteremia, metastatic immunological injury, and metastatic toxic injury. The available evidence is presented and examples are provided. They concern among others such divergent diseases as acute bacterial myocarditis, infective endocarditis, brain abscess, uveitis and iridocyclitis, trigeminal and atypical facial neuralgia, unilateral facial paralysis, fever of "unknown' origin, and neutrophil dysfunction. PMID: 6368612 [PubMed - indexed for MEDLINE] 68. Ned Tijdschr Geneeskd. 1983 Aug 27;127(35):1578-84. [Renal osteodystrophy. II. Pathology and roentgen diagnosis] [Article in Dutch] Raber-Durlacher JE, Schächter ME, Abraham-Inpijn L, Bras J, van Ooij CP, Wilmink JM. PMID: 6633697 [PubMed - indexed for MEDLINE] 69. Ned Tijdschr Geneeskd. 1983 Aug 20;127(34):1542-6. [Renal osteodystrophy. I. Calcium and phosphate metabolism; normal status] [Article in Dutch] Raber-Durlacher JE, Schächter ME, Abraham-Inpijn L, Bras J, van Ooij CP. PMID: 6314159 [PubMed - indexed for MEDLINE] 70. Ned Tijdschr Tandheelkd. 1983 Jul-Aug;90(7-8):329-32. [Late results of irradiation of the head and neck region] [Article in Dutch] Abraham-Inpijn L. PMID: 6579382 [PubMed - indexed for MEDLINE] 71. Ned Tijdschr Tandheelkd. 1983 May;90(5):221-7. [Endocarditis. The role of the dental profession in prevention] [Article in Dutch] Abraham-Inpijn L, Mackay A. PMID: 6577302 [PubMed - indexed for MEDLINE] 72. Oral Surg Oral Med Oral Pathol. 1982 Jun;53(6):647-50. Radiographic interpretation of the mandibular angular cortex: a diagnostic tool in metabolic bone loss. Part II. Renal osteodystrophy. Bras J, van Ooij CP, Abraham-Inpijn L, Wilmink JM, Kusen GJ. Panoramic radiographs of patients with chronic renal failure showed a loss of cortical bone at the mandibular angle; the loss of cortical bone correlated very well with the degree of renal osteodystrophy, established by biopsy of the undecalcified iliac crest. The value of using the cortical thickness at the mandibular angle as a parameter in diagnosing metabolic bone loss is discussed. PMID: 6954448 [PubMed - indexed for MEDLINE] 73. Ned Tijdschr Tandheelkd. 1982 May;89(5):224-8. [Medical in the dental curriculum] [Article in Dutch] Abraham-Inpijn L. PMID: 6955626 [PubMed - indexed for MEDLINE] 74. Oral Surg Oral Med Oral Pathol. 1982 May;53(5):541-5. Radiographic interpretation of the mandibular angular cortex: A diagnostic tool in metabolic bone loss. Part I. Normal state. Bras J, van Ooij CP, Abraham-Inpijn L, Kusen GJ, Wilmink JM. PMID: 6954430 [PubMed - indexed for MEDLINE] 75. Clin Otolaryngol Allied Sci. 1982 Apr;7(2):99-105. Predisposing factors in Bell's palsy: a clinical study with reference to diabetes mellitus, hypertension, clotting mechanism and lipid disturbance. Abraham-Inpijn L, Devriese PP, Hart AA. The purpose of this study was to assess the frequency of risk factors for vascular disease like hypertension, lipid disturbances and diabetes mellitus in a group of patients with Bell's palsy. These patients were compared to patients with a peripheral facial paralysis of known origin. We did find a statistically significant difference between the Bell's palsy patients and their controls for cardio-vascular variables only. Hypertension proved to be by far the most important single discriminating variable. PMID: 7094388 [PubMed - indexed for MEDLINE] 76. Ned Tijdschr Tandheelkd. 1981 May;88(5):178-80. [The disturbed elderly; a sometimes reversible process] [Article in Dutch] Abraham-Inpijn L. PMID: 6943434 [PubMed - indexed for MEDLINE] 77. J Laryngol Otol. 1980 Jul;94(7):785-8. Wegener's granulomatosis, serous otitis media and sinusitis. Abraham-Inpijn L. A description is given of two patients suffering from Wegener's granulomatosis. The first manifestations were an acute sinusitis and an acute otitis media, with sterile granulomatosis tissue in the diseased organs, high fever and joint complaints. Thereafter the general symptoms of the disease showed themselves. The immediate response to treatment with cytotoxic and corticosteroid drugs was encouraging. PMID: 7191871 [PubMed - indexed for MEDLINE] 78. Ned Tijdschr Tandheelkd. 1979 Jul-Aug;86(7-8):266-9. [Latent forms of diabetes mellitus: snake in the grass] [Article in Dutch] Abraham-Inpijn L. PMID: 298608 [PubMed - indexed for MEDLINE] 79. Arch Chir Neerl. 1979;31(1):9-15. Critical evaluation of low-dose heparin in laryngectomy. Abraham-Inpijn L. In a clinical trial thromboembolic prophylaxis with subcutaneous low-dose heparin was given to 20 patients admitted for surgery on the larynx. All patients (40 totally) had a malignancy. The study was not primarily directed on the antithrombotic effect, but on complication factors. In the control group pulmonary embolism was found four times, but not in the group of patients receiving heparin. No increase of blood loss in the heparin group appeared, although this group included very difficult operations. No complications were seen to arise from the injections of the heparin. PMID: 443830 [PubMed - indexed for MEDLINE] 80. Ned Tijdschr Tandheelkd. 1978 Nov;85(11):430-4. [Recent developments with respect to serum hepatitis] [Article in Dutch] Abraham-Inpijn L, Lacunes RJ, Tan TL. PMID: 295433 [PubMed - indexed for MEDLINE] 81. Trop Geogr Med. 1978 Jun;30(2):227-34. Alpha-foetoprotein during chemically induced hepatocellular carcinoma in rats. Abraham-Inpijn L. During induction of hepatocellular carcinoma (HCC) in rats with 3'MeDAB (3'methyl-dimethyl-aminoazobenzene) and Aflatoxin B1 alpha-foetoprotein (AFP) could already be demonstrated in the serum in the early phase of carcinogen administration. In this period the liver showed livercell necrosis but no tumour formation. The AFP level in the induction phase was correlated with the degree of livercell necrosis. The detection of AFP during the induction period is of importance as it is followed by a high frequency of liver tumours in later phases. The AFP concentration in the tumour phase was not related in any histological feature of the tumour; however, the mean AFP concentration in cases of HCC combined with cirrhosis was much higher than in cases of HCC without cirrhosis. Some rats with HCC showed AFP-negative sera, but AFP-positive bile. PMID: 83043 [PubMed - indexed for MEDLINE] 82. Tijdschr Ziekenverpl. 1978 May 23;31(11):502-4. [Preventive treatment of surgical patients with low dose heparin] [Article in Dutch] Abraham-Inpijn L. PMID: 248253 [PubMed - indexed for MEDLINE] 83. Ned Tijdschr Geneeskd. 1977 Aug 6;121(32):1257-9. [Menière's disease? The drug that did not work] [Article in Dutch] Abraham-Inpijn L. PMID: 895909 [PubMed - indexed for MEDLINE] 84. Arch Chir Neerl. 1975;27(1):63-8. Effect of low-dose heparin on incidence of postoperative thrombosis in orthopaedic patients. Abraham-Inpijn L, Vreeken J. In a double-blind study, using matched controls, thrombo-embolic prophylaxis with subcutaneous low-dose heparin was studied in 25 patients admitted for orthopaedic surgery. Deep vein thrombosis (DVT) was detected by clinical assessment and by the 125I-fibrinogen leg-scanning technique. As a control the T-1/2 of the 125I-fibrinogen was measured. Six of the 13 patients in the control group and one in the heparin-treated group developed deep vein thrombosis within the first eight postoperative days. PMID: 1098580 [PubMed - indexed for MEDLINE]