Viable periodontal ligament (PL) cells are required for PL healing of avulsed teeth following replantation. If immediate replantation cannot be accomplished, the ability of PL progenitor cells to reproduce (clonogenic capacity) and recolonize the wound may be extended by prevention of desiccation and storage in physiological media. This investigation examined the effects of storage in saliva, milk, Hank's balanced salt solution (HBSS) and Eagle's medium (alpha MEM) on the clonogenic capacity of human PL progenitor cells at 30 and 60 min extra-alveolar time. Twenty erupted human premolar teeth extracted as atraumatically as possible for orthodontic purposes were used in the present study. Fifteen premolars were placed immediately in freshly collected autologous saliva at room temperature, (+ 23 degrees C) for 15 min. These 15 premolars were next divided into three groups of five and stored in either saliva, milk or HBSS at + 4 degrees C in plastic cups surrounded by ice. The remaining five teeth served as positive controls and were immediately placed in alpha MEM at + 4 degrees C. PL tissue was scraped from one-half of the root surface with a scalpel at 30 and 60 min total extra-alveolar duration. Cells were released from the tissue sample with a 30 min enzymatic digestion procedure and the cells from the tissue samples analyzed for clonogenic capacity. There was a reduction in clonogenic capacity with time for all protocols. Periodontal ligament cells stored in alpha MEM showed the least reduction between 30 and 60 min and the greatest reduction was observed for PL cells stored in saliva. The difference in clonogenic capacity following transfer from saliva to milk or HBSS was not significant at 30 min. At 60 min, cells transferred from saliva to HBSS had a statistically higher percentage of clonogenic cells than those transferred to milk (5.9% vs. 3.5%; P < 0.05). We conclude that immediate storage of avulsed teeth in autologous saliva, followed by transfer to chilled milk, preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.

There is increasing policy interest in the consideration of frailty measures (rather than chronological age alone) to inform a more equitable allocation of health and social care resources in the community. The Clinical Frailty Scale (CFS) has attracted interest for its simplicity and consideration of multiple relevant geriatric dimensions. However, a criticism of the CFS has been the possible subjectivity in the scoring, bringing the possible danger of lack of scoring consistency across agencies. For that reason, the authors of the CFS published a classification tree method to assist with routine scoring of the CFS.The aim of the present study was to apply the CFS classification tree to data from adults aged 65 and over from The Irish Longitudinal Study on Ageing (TILDA) and correlate derived CFS categories with patterns of health and social care utilisation in Irish older people assessed in Wave 5 of the study (year 2018). In addition, we explored how CFS categories and states changed over 8 years in TILDA between Wave 1 (2010) and Wave 5.Results showed the following prevalence of CFS categories in Wave 5: 6% ‘very fit’ (CFS1), 36% ‘fit’ (CFS2), 31% ‘managing well’ (CFS3), 16% ‘vulnerable’ (CFS4), 6% ‘mildly frail’ (CFS5), 4% ‘moderately frail’ (CFS6) and 1% ‘severely frail’ (CFS7). No participants were ‘very severely frail’ or ‘terminally ill’. In wave 5, increasing CFS categories had an association with increasing utilisation of hospital and community health services, and increasing hours of formal and informal social care provision. The transitions analyses from Wave 1 to 5 suggested a dynamic picture of CFS transitions, with 2-year probability of transitioning from ‘fit’ (CFS1-3) to ‘vulnerable’ (CFS4), and ‘fit’ to ‘frail’ (CFS5+) at 34% and 6%, respectively. ‘Vulnerable’ and ‘frail’ had a 22% and 17% probability of reversal to ‘fit’ and ‘vulnerable’, respectively.Our results suggest that the CFS classification tree was able to stratify the TILDA population aged 65 and over into subgroups with increasing health and social care needs. The CFS classification tree could be used to aid the allocation of health and social care resources in older people in Ireland, but given the frequency of CFS transitions in the population, it is recommended that CFS status in individuals is reviewed at least every 2 years.