Derangement of warfarin anticoagulation by miconazole oral gel.
Pemberton MN. Sloan P. Ariyaratnam S. Thakker NS. Thornhill MH.
Clinical Academic Group of Oral Medicine and Dental Diagnostic Science, University Dental Hospital of Manchester.
The potentiation of the anticoagulant effects of warfarin by miconazole, when used in oral gel form, is described in three patients. The associated morbidity is examined, emphasising the importance of considering this potentially serious interaction when prescribing antifungal agents to patients on oral anticoagulants.
The prevalence of tooth wear in a cluster sample of adolescent schoolchildren and its relationship with potential explanatory factors.
Bartlett DW. Coward PY. Nikkah C. Wilson RF.
Department of Conservative Dentistry, UMDS, Guy's Dental Hospital, London Bridge.
OBJECTIVE: To assess the prevalence of tooth wear in adolescents and its relationship with diet, saliva and gastro-oesophageal reflux. DESIGN: Single centre cluster sample epidemiological study. SETTING: A school in London in the summer of 1996. SUBJECTS: 11-14-year-old schoolchildren. MAIN OUTCOME MEASURES: The Smith and Knight tooth wear index (TWI), salivary factors, diet and symptoms of gastro-oesophageal reflux were recorded for all subjects. RESULTS: Results were obtained from 210 subjects. One subject refused to provide a saliva sample and 11 subjects provided insufficient saliva for analysis of buffering power (n = 198). 57% (95% confidence intervals 50.3-63.7%) of subjects had tooth wear on more than ten teeth and a median 12% (interquartile range 6-18%, 95% confidence intervals 8-14%) of surfaces were affected. However, dentine involvement was rare. The median intake of carbonated drinks was 2 cans (interquartile range 1-3) a day. However, there was no correlation with TWI (r = -0.09, P = 0.19). There was no relationship between tooth wear index (TWI) and salivary flow rate (r = -0.02, P = 0.78) or buffering capacity (r = -0.02, P = 0.76). A trend was observed for those with a reported history of regurgitation (n = 27) to have a higher maxillary TWI (median 8, interquartile range 2-13) compared with those who did not (5, 2-9, P = 0.06). CONCLUSIONS: Tooth wear is common in adolescents and the relationship with dietary acid, salivary buffering and symptoms of gastro-oesophageal reflux is complex and requires further investigation.