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Item Effect of a modified adhesive system with encapsulated arginine and calcium carbonate on dentin permeability(Wiley, 2023-08) AlShehri, Aram Mushabbab; Kamocki, Krzysztof; Viana, Ítallo Emídio Lira; Scaramucci, Taís; Hara, Anderson; Windsor, L. Jack; Platt, Jeffrey A.; Cook, Norman Blaine; Sochacki, Sabrina Feitosa; Biomedical and Applied Sciences, School of DentistryTo modify an adhesive system with halloysite clay nanotubes (HNTs) containing arginine and calcium carbonate and to evaluate their cytocompatibility, viscosity and efficacy in reducing dentin permeability. HNTs containing arginine and calcium carbonate were incorporated into the primer and adhesive of a three-step adhesive system (SBMP), and their viscosity was measured. Discs (n = 4/group) were prepared: SBMP (control), HNT-PR (modified primer), HNT-ADH (modified adhesive) and HNT-PR + ADH (modified primer and adhesive) were evaluated regarding cell death and viability. Dentin discs were prepared and randomly assigned into the following treatments (n = 10): NC (no treatment), SBMP, HNT-PR, HNT-ADH, HNT-PR + ADH and COL (Colgate® Sensitive Pro-relief™ prophylaxis paste). After, they were submitted to an erosive-abrasive cycling. Dentin permeability (hydraulic conductance) was evaluated at baseline, 24 h after treatment and after cycling. Both the modified primer and adhesive showed significantly higher viscosity than their controls. Group HNT-PR resulted in significantly higher cytotoxicity when compared to SBMP and HNT-PR + ADH groups. Group HNT-ADH resulted in the highest cell viability compared to all other groups. All groups showed significantly lower dentin permeability when compared to the NC group. Post-cycling, SBMP and HNT-ADH groups showed significantly lower permeability when compared to COL group. The addition of encapsulated arginine and calcium carbonate did not affect the cytocompatibility of the materials nor their ability to reduce dentin permeability.Item More Is Not Always Better: A Case Report of Excess Calcium Carbonate Ingestion Causing Milk-Alkali Syndrome(2021-03-25) Waller, Sydney; Luster, Taylor; Collins, Angela J.; Raymond-Guillen, LukeCASE DESCRIPTION: A 54-year-old female with a medical history significant for CKD stage 4 and alcohol use disorder presented to the Emergency Department with altered mental status. Labs were significant for hyponatremia, hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis, and Cr 9.3. Lorazepam was given due to concern for alcohol withdrawal. Ultimately, her symptoms were discovered to be due to excessive ingestion of calcium carbonate (aka: Tums), and she was diagnosed with milk-alkali syndrome (MAS). Pt was treated with IV KCl and normal saline, and her labs and mental status normalized over the subsequent 48 hours. | CLINICAL SIGNIFICANCE: MAS is constituted by metabolic alkalosis, acute kidney injury, and hypercalcemia. It is a result of a large intake of calcium and absorbable alkali. The syndrome was first recognized in the early twentieth century, and it essentially disappeared when histamine blockers began being used to treat peptic ulcers in the 1980s. Recently, the syndrome is becoming more common with the increased use of calcium-carbonate in antacids and osteoporosis prevention medications. MAS is the third most common cause of hypercalcemia, after malignancy and hyperparathyroidism. Management involves holding calcium and vitamin D supplements and administering aggressive intravenous hydration. Bisphosphonates and dialysis may be useful in severe cases. Prognosis of MAS is typically good as the condition is reversible. | CONCLUSION: The prevalence of MAS is increasing due to the wide availability of calcium-containing supplements and antacids. In order to counteract this, increased awareness amongst at risk patient populations, such as the elderly and those with renal disease, is vital. Furthermore, increased awareness amongst healthcare professionals may help prevent complications that can arise from untreated MAS.