Continuous lumbar plexus and femoral blocks significantly reduce the need for opioids and decrease related side effects. Continuous lumbar plexus block is a more effective analgesic modality than is a continuous femoral block or patient-controlled intravenous administration of hydromorphone alone during physical therapy following primary unilateral total hip arthroplasty.

Blocks of bovine enamel covered with a layer of Streptococcus mutans cells were mounted in specially-designed holders in a prosthesis and carried intraorally for 2 h. Measurements of the iodide permeability (Ip) of the blocks before and after intra-oral exposure showed an increase in Ip (+ΔIp), suggesting demineralization when the mouth was rinsed with a 10% sucrose solution at 0 and 60 min, but a decrease in Ip (––ΔIp), suggesting remineralization, after interoral exposure without rinsing. Repeated tests with sucrose rinses in 5 subjects showed good within and between-subject reproducibility of ΔIp. Acid production in the S. mutans cells layer from sucrose caused a typical decrease and subsequent increase in pH (‘Stephan’ curve). S. mutans cells released from the appliance during the test became eliminated from the mouth within 1 to 2 weeks.

Streptococcus mutans strain IB-1600 was cultivated in Todd-Hewitt broth (THB) or THB supplemented with sucrose (S). Cell mass obtained from THB exhibited a high cell density and negligible glucan-rich extracellular matrix material (EMM), whereas cell mass from 2% S-supplemented THB exhibited widely-spaced cells separated by EMM. The pH-lowering potential of the different cell masses was studied in vivo with an intra-oral enamel demineralization test and rinsing with glucose solution, and in vitro with a model which permits vertical penetration of glucose through the cell mass and pH evaluation at different depths within the cell mass. In vivo, the pH profile of EMM-rich cell mass derived from 2% S-supplemented THB was characterized by a lower pH minimum and a slower return of the pH as compared with THB-derived cell mass. In vitro, an increase in cell mass EMM content was associated with a more rapid initiation and an increase in the rate of pH drop in the depth of the cell masses. Evaluation of the acidogenic potential of the cells in cell masses derived from THB and 2% S-supplemented THB with suspensions of dispersed cell mass and added glucose indicated no difference. The buffering capacity of cell mass derived from 2% S-supplemented THB within the pH range of 6.5-4.0 was greatly reduced as compared with that of THB-derived cell mass, due to the relatively low buffering capacity of EMM. The presence of EMM also appeared to enhance the porosity of the cell mass.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of extracellular matrix material (EMM) synthesized from sucrose (S) by Streptococcus mutans IB-1600 in altering the demineralizing potential of artificial plaque was evaluated with an intraoral enamel demineralization test (IEDT). The artificial plaque samples were prepared from cells cultivated in Todd-Hewitt broth (THB) supplemented with various S concentrations and by mixing THB-grown cells with increasing proportions of EMM (heat-killed THB + 2% S-cultivated cells). The samples were also evaluated for cell density (DNA content) and acidogenicity in vitro (pH-stat), as well as for in situ pH changes during a 45-minute intra-oral test following a 10% glucose rinse. An increase in the proportion of EMM relative to cell density was associated with an increase in enamel demineralization. This trend reversed when the ratio of cells to EMM was less than 1:19. Experiments involving strains of S. mitis, S. sanguis, and S. salivarius suggested a similar effect of EMM. The intra-oral pH data suggest that the presence of EMM may enhance demineralization by altering diffusion properties of plaque.

No abstract