Oral management of the patient with end-stage liver disease and the liver transplant patient

The patient with end-stage liver disease who is in need of a liver transplant should have a pretransplant dental evaluation. Such a patient faces lifelong immunosuppression with an increased risk of infection. This article discusses both the need for control of oral diseases before liver transplantation and guidelines for oral care in the immediately postoperative and long-term transplant patient. Specific indications for antibiotic prophylaxis and antibiotic regimens are presented; in addition, adverse reactions and side effects of immunosuppressant drugs are discussed. Pertinent drug interactions salient to the dental management of patients with end-stage liver disease are reviewed, and specific management recommendations for these patients are presented.

Effect of a traditional Chinese medicine, Bu-zhong-yi-qi-tang on the protection against an oral infection with Listeria monocytogenes

The protective effect against an oral infection with Listeria monocytogenes was observed in BALB/c mice who were orally administered a traditional Chinese medicine, Bu-zhong-yi-qi-tang (Japanese name: Hochu-ekki-to, HOT) daily for 7 days. Bacterial numbers in the Peyer's patch (PP) at 18 h, in the mesenteric lymph nodes (MLN) at 18 h, 1 day and 3 days and in the liver at 3 days after infection were significantly suppressed in HOT-treated mice, although there was no difference in the bacterial number in the small intestinal contents. The enhanced bactericidal activities of PP and liver macrophages by pretreatments of HOT were observed. The protective effect of HOT was not observed in athymic nu/nu and IFN-gamma deficient mice. The administration of HOT increased IFN-gamma-producing cells in the intestinal intraepithelial lymphocytes (IEL) but did not in the PP, MLN and liver. HOT exerts effects mainly on CD8alphabeta+ IEL which are thymus-dependent, and induced IFN-gamma production from their cells. These results suggest that HOT acts on the gut-associated lymphoid tissues and induces IFN-gamma from CD8alphabeta+ IEL, which activates PP and liver macrophages and consequently the resistance to L. monocytogenes is augmented in the mice.

Promoting oral health in institutionalised older adults: a nursing perspective

Current demographic trends necessitate that increased attention be paid to problems arising in the older population. One such area relates to the oral cavity, which may be affected by both the effects of aging and the effects of disease and illness. Yet the evidence shows a significant lack of adequate oral care, which may create major problems for affected individuals, causing oral and dental problems that may, in turn, predispose to nutritional deficiencies, communication difficulties and devastating dental disease (Ogle, 1982). This paper reviews the literature pertaining to this complex subject, concluding that although nurses have an important role in providing effective oral care for the institutionalised patient, it is difficult to identify appropriate techniques, agents and tools with which to provide such care. Further research in this field is undoubtedly needed.

Long-term supplementation with alpha-tocopherol and beta-carotene and prevalence of oral mucosal lesions in smokers

OBJECTIVE

To assess the effect of alpha-tocopherol and beta-carotene supplementation on the prevalence of oral mucosal lesions in smokers.

DESIGN

An end-point examination of a random sample of participants in a controlled trial for 5-7 years (Alpha-Tocopherol Beta-Carotene Cancer Prevention Study) in Helsinki, Finland.

SUBJECTS

A total of 409 white male cigarette smokers, aged 55-74 years who received either alpha-tocopherol (50 mg per day) or beta-carotene (20 mg per day) supplementation, both of these or placebo capsules.

METHODS

Clinical examination of oral mucosae, histological examination of lesions showing leukoplakia and cytological examination of buccal epithelium. Statistical analysis using Fisher's exact test.

RESULTS

No statistically significant differences were found between the study groups either in the prevalence of oral mucosal lesions or in the cells of unkeratinized epithelium. Leukoplakia was present in 24 (5.9%) of the subjects. Seven lesions showed dysplasia.

CONCLUSION

The present study on oral health does not support the hypothesis that alpha-tocopherol or beta-carotene supplementation plays an essential role in preventing oral mucosal changes in smokers.

The impact of WIC dental screenings and referrals on utilization of dental services among low-income children

PURPOSE

This cross-sectional study examined whether referrals from nondental health professionals impacted utilization of dental services by low-income populations.

METHODS

A sample of 309 mothers enrolled in the Women, Infant, and Children (WIC) clinic in Jackson County, Missouri, completed a self-administered, 32-item questionnaire to assess the mother and child's oral health behavior and past use of dental services. Dental utilization, the primary dependent variable, was defined as whether or not the child had ever been to a dentist.

RESULTS

Findings showed 27% of the children in the sample had been referred for dental care. Bivariate analysis indicated that a dental referral, age of the child, age of the mother, mother's perceived dental need for the child, household size, number of children in the household, and dental insurance for the child were associated with a child having a dental visit. Logistic regression, however, indicated that only age was significantly related to utilization.

CONCLUSION

The results showed a strong effect of increasing age being related to dental utilization, while additional research is needed to clarify the importance of WIC referrals.

[Prevention and therapy of acute radiation-related morbidity of the skin and mucosa. II, Recommendations of the literature]

BACKGROUND

In a German multicenter questionnaire, answered by 89 departments, we had examined the strategies to prevent or to treat the acute morbidity of the skin and mucosa associated to radiation therapy. In this work, the recommendations from the literature are compared to the results of the questionnaire.

METHODS

An extensive research on common data information systems (Medline, Cancerlit, DIMDI and others) was performed. The criteria included the organ related morbidity and therapeutic strategies for its reduction. The obtained data were compared to the results from the questionnaire.

RESULTS

The study data found by the research often demonstrate small patient numbers and little convincing results. However, as in the questionnaire, the joint principle seems to be the reduction of acute inflammatory tissue reaction by evasion of bacterial and mycotic overgrowth and reduction of exo- and endogenous toxins.

CONCLUSIONS

Further studies with more convincing results are required.

Filling the gap: equity and access to oral health services for minorities and the underserved

BACKGROUND AND OBJECTIVES

Family physicians and other primary care providers play a pivotal role in preventing oral disease, especially among minority and underserved populations who have limited access to dental services and poorer oral health status. Oral diseases/conditions, such as caries, baby bottle tooth decay, gingivitis, periodontitis, oral pharyngeal malignancies, and orofacial trauma, are prevalent and costly, yet largely preventable. Given their role in promoting and protecting overall health and their historical role in serving minority and underserved families, family physicians occupy a unique position to assure equity, access, and improvement in oral health for all Americans.

Oral management of the cancer patient. Part II: chemotherapy

This second of a three-part series reviews chemotherapy treatment and the responsibilities dental care providers have for patients in all phases of this type of cancer treatment. The goals of dental care are to maintain the integrity of the oral mucosa, prevent secondary infection, provide relief, and assist in maintaining dietary intake. The dental hygienist plays a key role in the recognition, treatment or monitoring of dental conditions that could cause complications to the patient during and post chemotherapy, as well as in educating and motivating the patient in optimal oral self-care.

The effect of locally applied gauze drain impregnated with chlortetracycline ointment in mandibular third-molar surgery

A prospective randomized crossover, within-patient, controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline (Aureomycin 3%, Lederle) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted mandibular third molars. The teeth were removed on two separate occasions; on one side drain was inserted in the socket, and on the other side no drain treatment was used for control. The influence on postoperative pain, swelling, and mouth opening ability was investigated. The results indicated a statistically significant reduction (P = 0.02) in the incidence of postoperative inflammatory complications, defined as postoperative alveolitis, from 35% in the no-drain group to 4% in the drain group. No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction. There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method. It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain, swelling, and mouth opening reduction after impacted mandibular third-molar surgery.

An audit of oral and dental health regimens practised in the management of oropharyngeal cancer

The purpose of the present study was to find out what preventive care was offered to patients after radiotherapy, particularly if they were dentate. As the mean age of the population increases and the number of people who retain at least some of their teeth into old age also rises, it is likely that more and more people with a diagnosis of oral cancer will be dentate. The incidence of oropharyngeal cancer has also started to increase recently and is affecting more young and dentate people. It is of paramount importance to provide comprehensive management for these patients, not only to remove the disease and reconstruct the defect, but also to provide the patient with the opportunity of experiencing a good quality of life by having a comfortable mouth after treatment. A questionnaire was sent to all senior fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the results analyzed. The results of this survey show that improvements could be made if some simple preventive measures were instigated in the early stages of treatment.

Dental considerations and treatment of the oncology patient receiving radiation therapy

As many as 400,000 out of 1 million patients newly diagnosed with cancer may develop oral complications. The trend toward people's maintaining their teeth longer coupled with the rising age of the population suggest that dentists frequently may be treating patients with cancer, and should be informed about aspects of their oncologic care that will affect their oral health. This article highlights some of the important clinical considerations and offers guidelines for treating patients receiving radiation therapy.

When children put their fingers in their mouths. Should parents and dentists care?

We have heard mothers tell their children not to stick their fingers in their mouths because they will get sick. Medical and dental professionals know this is true. Oral habits like thumb sucking and nail biting can damage the structure of the mouth and can lead to the spread of infectious diseases.

Minocycline and oral pigmentation

Minocycline is a semisynthetic tetracycline used in the treatment of inflammatory acne because of its broad spectrum of activity, less common development of resistant organisms, and its anti-inflammatory effects. A number of adverse reactions are reported, including skin and oral pigmentation. This paper details the pharmacology of minocycline and describes the pigmentation and likely mechanisms active in both hard and soft tissues. Oral pigmentation usually involves the hard tissues only and presents typically as a discrete band occupying the central zone of the alveolar mucosa and palate. As with other sites, it may persist following withdrawal of the drug. Early recognition by the dental practitioner may allow an alternative form of therapy to be sought, minimizing the likelihood of a long-term aesthetic problem.

Nutrition and oral health guidelines for pregnant women, infants, and children

Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime.

Risk factors as determinants of dental neglect in children

Although neglect represents over a half of both reported and substantiated cases of child maltreatment each year, it is misunderstood and under-reported. Dental neglect, a form of physical neglect, is ignored to an even greater degree. Certain families appear to be more at risk for neglect, in some form, than others. Predisposing risk factors that may increase the incidence of neglect include characteristics of parents and children, family situations, socioeconomic and demographic circumstances, and parental beliefs and practices. Dentists, particularly pediatric dentists, are in unique positions to evaluate not only the dental needs of children, but also family situations and circumstances that might affect their dental well-being. Knowledge and understanding of the various risk factors discussed will enable dentists to address the problem of dental neglect from a preventive approach, rather than strictly treating is results. Further research is needed to develop effective methods for both the evaluation and, if necessary, the education of at-risk individuals on the importance of good oral hygiene and professional care.

Protection against oral and gastrointestinal diseases: importance of dietary nitrate intake, oral nitrate reduction and enterosalivary nitrate circulation

Over the last 20 years, dietary nitrate has been implicated in the formation of methemoglobin and carcinogenic nitrosamines in humans. This has led to restrictions of nitrate and nitrite levels in food and drinking water. However, there is no epidemiological evidence for an increased risk of gastric and intestinal cancer in population groups with high dietary vegetable or nitrate intake. A reevaluation of our currently very negative perception of dietary nitrates comes from recent research into the metabolism and enterosalivary circulation of nitrate in mammals. These studies showed that nitrate is converted to nitrite in the oral cavity that then "fuels" an important mammalian resistance mechanism against infectious diseases. Moreover, there is now evidence that the conversion of nitrate into oxides of nitrogen prevents the formation carcinogenic nitrosamines.

[Disorders of the oral mucosa in the elderly]

The oral mucosa of the elderly may be affected by a variety of diseases. The majority of such diseases are rather harmless and may occur in younger patients as well. Furthermore, a number of oral lesions may be the result of neglect of the dentition or the dentures. Particularly in the elderly, however, one should take into account the possibility of a malignant or premalignant lesion. Therefore, careful attention should be paid to any ulcerative lesion of the oral mucosa and to white or red changes that are not easily recognizable as a benign disease entity. Also pigmented lesions of the oral mucosa should be looked upon with suspicion. In elderly patients several oral and perioral complaints may be present of which the etiology is unknown. An example of such complaints is the so-called burning mouth syndrome.

Oral cavity complications of bone marrow transplantation

Bone marrow transplantation, once regarded as experimental, has evolved into a standard treatment for a variety of malignancies. Considerable advances have been made in histocompatibility typing, pretransplantation chemotherapy, and posttransplantation immunosuppressive therapy as well as prophylaxis and treatment of infections. Oral complications develop in almost all patients, and their early recognition may result in the institution of prompt treatment and prolonged survival. Mucositis, often severe and extremely painful, develops in more than three quarters of bone marrow transplant recipients, and its prevention, unfortunately, remains unsatisfactory. Herpes simplex virus and Candida albicans account for most oral infections, although their incidence has been dramatically reduced by the institution of prophylactic agents. Graft versus host disease continues to be a significant complication of marrow transplantation, and the detection of commonly occurring oral changes may support its diagnosis.

Dental infections and general health

The detrimental effect of focal infection on general health has been known for decades. Chronic dental infections may worsen the condition of medically compromised patients. Prophylactic antibiotics are therefore routinely prescribed before dental treatment to immunosuppressed and other at-risk patients to combat the spread of oral bacteria into the bloodstream. More recent studies have shown that dental infections may also be a risk factor for atherosclerosis and various other chronic diseases, emphasizing the need for frequent dental checkups among the diseased, in particular. The aim of this review article is to discuss some recent findings on the effect of dental infections on health in general. In many industrialized countries, there is an urgent need to focus on preventive dental care for the diseased and the elderly, whose oral health has been more or less neglected.

Effects of gastroesophageal reflux on the oral cavity

The effects of chronic exposure of the oral cavity to gastric acid can be many and varied. Soft tissue symptoms (nonspecific burning and sensitivity) have been mentioned in the literature, but pathognomonic soft tissue lesions have not been documented. Dental erosion can be considered to be the predominant oral manifestation of gastroesophageal reflux disease. Erosion begins with subtle changes in the surface enamel and can progress to severe loss of tooth substance. Because the causes of such tooth lesions may be multifactorial, combining the effects of erosion, attrition, and abrasion and because of the subtle changes present in the beginning stages of such lesions, diagnosis may be difficult. Although the basic mechanism of erosion in gastroesophageal reflux patients is the dissolution of enamel and dentin due to acid exposure, a multitude of other factors can modify the effects of gastric acid. Salivary parameters, in particular, may play an important role in affecting oral pH after reflux episodes. Once dental erosion is diagnosed, thorough evaluation is necessary to document the extent of damage and to detect a cause, which may have both intrinsic and extrinsic components. Treatment goals include eliminating the causes of acid exposure, preventing the effects of acid exposure when it is not controllable, treating symptoms of soft tissue irritation and dental erosion, and restoring the dentition to an esthetically and functionally acceptable level.