[Differential radiodiagnosis of odontogenic mandibular osteomyelitis accompanied by trigeminal neuropathy]

This paper deals with the results of radiation examination in 43 patients with clinical manifestations of mandibular osteomyelitis. In 13 of them, the disease was accompanied by trigeminal neuropathy. The radiation semiotics of the changes occurring in the mandibular bone and its adjacent soft tissues in different phases of osteomyelitis is described. Comparative analysis of orthopantomograms and the images obtained by multislice spiral computed tomography has revealed the advantage of the latter in identifying insignificant changes in bone tissue and damages to the mandibular canal. Ultrasound study is of more informative value in detecting soft tissue changes in this area. High-technology radiodiagnostic techniques play a leading role in the differentiation of odontogenic and non-odontogenic trigeminal neuropathies.

Impact of oral problems on daily activities of HIV-infected children

AIM

Oral manifestations are common in HIV+ children, but the impact of these diseases on their daily life is unknown. So the aim of this study was to assess the impact of oral problems on the daily activities of HIV+ children.

METHODS

The Child-OIDP-B was used with 59 10-12 year-old HIV+ children, who were outpatients at two public hospitals for HIV treatment in Rio de Janeiro, Brazil. Caries, biofilm and gingival bleeding indexes were recorded. The Kruskall-Wallis and Mann-Whitney tests as well as the Spearman's correlation coefficient were used for analysis. Statistical evaluation: Replies were analysed using the Statgraphics ® Plus Version 5.0 statistics software system, in order to obtain comparative diagrams and graphs using the ANOVA multifactorial system.

RESULTS

The Child-OIDP-B scores ranged from 0 to 30, (mean=6.09) and 71.2% of the children were affected by oral problems. Association was found between oral impact and number of caries (p=0.009). Children receiving HAART therapy had a Child-OIDP-B score (4.87), much lower than those who were not (8.87) (p=0.038). The most reported oral impact of the disease was eating (55.6%), but oral wounds were the most prevalent type of lesions (76.3%). As regards the level of intensity of the impact, moderate severity was prevalent in all 59 children and 66.1% reported that oral impacts affected 1-4 daily activities, 50.8% of all children were not satisfied with their appearance and oral health; 23.7% perceived the impact of HIV-infection on general health.

CONCLUSION

Most children suffered the impact of oral problems on their daily activities, mainly functional impacts.

Diseases of the maxillary sinus: an overview for the dentists

Because of the intimate relationship between the upper dentition and the maxillary sinus, it is no surprise that inflammatory, cystic and neoplastic odontogenic diseases may extend into the maxillary sinus and, occasionally, into the nasal cavity. On the other hand, diseases of the maxillary sinus may extend into the oral cavity or may cause symptoms that mimic those of diseases of odontogenic origin. An overview is presented of the various odontogenic and nonodontogenic diseases that may involve the maxillary sinus.

The oral health of individuals with haemophilia: a review of the literature

This paper reviews the available evidence on the oral health of individuals with haemophilia and discusses the relevance of the findings for New Zealand. A comprehensive literature search was completed using the inclusion criteria that study participants were individuals with Haemophilia A or B and that a measure of their prevalence, severity or incidence of an oral condition or state was described. Eleven studies, all cross-sectional in design, were found to meet these criteria. Aspects of caries, periodontal health, enamel defects (including fluorosis), malocclusion, temporomandibular joint disorders and oral health-related quality of life were described in those papers. Seven papers compared the study sample with a comparison ("control") sample. No studies had been conducted in New Zealand. Generally, individuals with haemophilia were found to have worse oral health than controls. However, the quality of many of the papers was poor and their heterogeneous nature makes comparison of their findings difficult. The oral health of individuals with haemophilia in New Zealand is likely to be influenced by a complicated interaction of government policies, availability of care and personal prejudices. Better-quality research on the oral health of individuals with haemophilia and their barriers to oral healthcare is needed.

[Stomatological help delivery perfection for patients with hematological problems]

Complex examination of dentistry status of the hematologic patients organized in condition of many profile hospitals. From 35 examined light degree of gravity of hemophilia A was revealed in 9 (25,7%) patients, average - in 11 (31,4%), heavy - in 15 (42,9%). Undertaking, complex integrated action within the framework of primary preventive maintenance of oral cavities in patients with hemophilia have allowed for two years to perfect of the dentistry status: reduce average hygienic index on 12,6%, index PMA on 15,5%, intensities of caries on 8,1% in the absence for this period of the development of the complicated forms of caries.

[Experience in diagnostics and treatment of patients with odontogenous maxillary sinusitis]

210 sick dontogenous maxillary sinusitis were studied. To 150 patients surgical treatment with use of a method of a osteo-plastic sinusotomy of a genyantrum is lead. Patients have been taken on a dispensary observation. According to the lead postoperative computer tomography of additional sinuses of a nose in two projections, and also ortopantomography, rentgenographies of sinuses in semiaxial projection, the pneumatization of the operated genyantrums has not been disturbed, the osteal forward wall has been kept on all extent, was absent retraction soft tissues of infraorbital area, that as a whole speaks about efficiency and not so traumaticaly the lead surgical treatment. The offered way of surgical treatment promotes to the greatest degree to conservation of anatomic structures of maxillofacial area, possessing the least traumatism in comparison with other ways. This technique is simple, effective and does not demand application of the expensive equipment.

Radiography and computed tomography in the diagnosis of nonneoplastic equine mandibular disease

We compared the information gained from computed tomography (CT) vs. radiography in horses with nonneoplastic disease of the mandible. We hypothesized that CT would provide additional diagnostic information. Medical records, radiographs, and CT images of horses with nonneoplastic mandibular disease evaluated between 1994 and 2008 were reviewed. Nineteen horses were identified; 11 had a tooth root abscess and related disease, four had a fracture of the teeth and/or mandible, and four had a nonneoplastic mass. Both CT images and radiographs allowed identification of diseased teeth that appeared clinically normal otherwise. CT allowed identification of teeth that were clinically affected but appeared normal radiographically. Parameters such as tooth pulp involvement, lamina dura destruction, presence of bone fragments, lingual and buccal mandibular bone periosteal reaction, and cortical bone destruction were more conspicuous with CT. Performing radiography and CT in horses with nonneoplastic mandibular disease provides a more complete evaluation than either technique alone. CT contributes additional information that could otherwise be overlooked with radiographs alone in horses with a mandibular fracture. CT provides ancillary information to radiographs in horses with dental infection or a nonneoplastic mass of the mandible.

[Can dental problems have influence on difficulties in treating paranasal sinusitis in children?]

Paranasal sinusitis is a condition that is treated by a General Practitioner and in case it fails it requires specialistic therapy. In most cases the inflammation is connected with nasal mucosa infection. However, in older children and adolescents sinusitis caused by spreading of tooth and gingiva inflammatory process can be an essential therapeutic and diagnostic problem. It is most often connected with periapical lesions, complications following dental procedures and oroantral fistula inflammation. Inflammatory process originally concerns maxillary sinus, however, it often undergoes generalization and it affects all or most of sinuses unilaterally or bilaterally. In microbiology of odontogenic sinusitis the dominant bacteria are the bacteria typical for peridental lesions (Streptococcus sanguis, Streptococcus salivarius, Streptococcus mutans and anaerobic bacteria). Odontogenic sinusitis frequently causes life threatening complications that require heroic drug and surgical treatment. Therapeutic and diagnostic problems are presented in case studies of 5 children aged from 10 to 17, who are treated in Children's Otolaryngology, Audiology and Phoniatrics Clinic in Łódź. There seems to be the need to emphasize the importance of thorough examination of oral cavity in all the children suffering from sinusitis, especially unilateral sinusitis. It is so essential on account of the gravity of the problem and serious complications that accompany the conditions.

Diabetes mellitus and its relevance to the practice of dentistry

Diabetes mellitus is a syndrome of abnormal carbohydrate, fat and protein metabolism that results in acute and chronic complications due to the absolute or relative lack of insulin. Globally, it is expected that the number of people with diabetes will increase, and as a result dental practitioners will encounter an increasing number of patients affected by this chronic condition, which may have implications for the provision of safe and appropriate dental treatment. This article aims to provide an overview of diabetes and to discuss aspects of the condition relevant to dentistry. The article also discusses the management of diabetic emergencies in a dental practice setting.

Management of descending mediastinal infections with an unusual cause: a report of 3 cases

Mediastinal infections are a life-threatening and distinctly rare event, especially when they are caused by a dental abscess or by a foreign body that has not perforated the esophagus. We evaluated how best to treat descending mediastinal infections occurring from an unusual cause. We report 3 female patients with mediastinal infections: two aged 45 and 80 years, each with a dental abscess, and one 62 with a foreign-body injury of the retropharyngeal wall. A retropharyngeal abscess and descending necrotizing mediastinitis developed in two of these patients. The mediastinal abscess was detected by computed tomographic scanning. All patients were successfully treated by drainage of their abscesses via cervicotomy or thoracotomy. A mediastinal abscess can be a serious complication. Mediastinitis is associated with a high mortality rate if the diagnosis is not quickly established and adequate therapy is not provided. In this report, we discuss the management and possible pathophysiological mechanisms of descending mediastinal infections that have an unusual cause. Clinicians should be aware of the possibility of descending mediastinal infections in patients with a retropharyngeal abscess or a dental abscess associated with persistent signs, such as fever. Imaging modalities must be used as soon as possible to enable early diagnosis. Aggressive treatment includes surgical drainage, and medical management in an intensive care unit may prevent a catastrophic outcome.

Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis

INTRODUCTION

Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endodontic treatment.

METHODS

Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate.

RESULTS

Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity.

CONCLUSIONS

The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.

Prevalence of psychiatric disorders in a group of adult patients seeking general dental care

OBJECTIVES

To determine the prevalence of psychiatric disorders in adult patients seeking general dental care because their presence can have a significant impact on how these patients should be managed.

METHOD AND MATERIALS

Medical history questionnaires from 442 randomly selected patients who presented for examination at the Virginia Commonwealth University School of Dentistry were reviewed for a positive history of psychiatric conditions, whether they were being treated for their condition, and what medications were prescribed.

RESULTS

Twenty percent of the patients had a positive history of a psychiatric disorder. The most common disorder for both sexes was depression. Other disorders included anxiety, bipolar disorder, eating disorder, claustrophobia, attention deficit disorder, seasonal affective disorder, and schizophrenia. More than one disorder was reported by 50% of men and 37% of women, the most common combination being depression and anxiety. Seventy-seven percent of women and 69% of men were under active treatment. Commonly prescribed medications, which can have important adverse effects, included selective serotonin uptake inhibitors, benzodiazepines, lithium, and tricyclic antidepressants. Twenty patients reported taking more than one medication for their disorder.

CONCLUSION

A significant number of dental patients have a psychiatric disorder. Because such disorders can affect the patient's response to dental treatment and require treatment modifications, and the adverse effects of the medications being used can alter the oral environment, clinicians need to be aware of their presence and the proper way to manage these patients.

Primary failure of eruption and PTH1R: the importance of a genetic diagnosis for orthodontic treatment planning

INTRODUCTION

Primary failure of eruption (PFE) is characterized by nonsyndromic eruption failure of permanent teeth in the absence of mechanical obstruction. Recent studies support that this dental phenotype is inherited and that mutations in PTH1R genes explain several familial cases of PFE. The objective of our study was to investigate how genetic analysis can be used with clinical diagnostic information for improved orthodontic management of PFE.

METHODS

We evaluated a family (n = 12) that segregated an autosomal dominant form of PFE with 5 affected and 7 unaffected persons. Nine available family members (5 male, 4 female) were enrolled and subsequently characterized clinically and genetically.

RESULTS

In this family, PFE segregated with a novel mutation in the PTH1R gene. A heterozygous c.1353-1 G>A sequence alteration caused a putative splice-site mutation and skipping of exon 15 that segregated with the PFE phenotype in all affected family members.

CONCLUSIONS

A PTH1R mutation is strongly associated with failure of orthodontically assisted eruption or tooth movement and should therefore alert clinicians to treat PFE and ankylosed teeth with similar caution-ie, avoid orthodontic treatment with a continuous archwire.

Equine idiopathic cheek teeth fractures: Part 3: A hospital-based survey of 68 referred horses (1999-2005)

REASONS FOR PERFORMING STUDY

There is limited information available on the more serious sequellae of idiopathic cheek teeth (CT) fractures.

OBJECTIVES

To obtain information on clinical and ancillary diagnostic findings in referred horses with idiopathic CT fractures.

METHODS

Details of all horses suffering from idiopathic CT fractures referred to the Equine Hospital at the University of Edinburgh 1999-2005 were examined, and information concerning fracture patterns, clinical and ancillary diagnostic findings, treatments and long-term response to treatments were obtained and analysed.

RESULTS

A total of 60 maxillary and 17 mandibular idiopathic CT fractures were diagnosed in 68 horses. Fracture patterns included maxillary CT lateral slab fractures (45%), maxillary CT midline sagittal fractures (16%) and various other patterns of maxillary CT fractures (17%). In the mandibular CT, lateral slab fractures were found (12%) and various other CT fracture patterns were present in 10%. The more centrally positioned CT (maxillary and mandibular Triadan 08s and 09) were preferentially fractured. Clinical signs included quidding in 47% of cases; bitting and behavioural problems (28%); signs of apical infection, including bony swellings and nasal discharge (21%); anorexia/weight loss (15%); halitosis (13%); and buccal food impaction (12%). The treatment of all cases was conservative whenever possible and included corrective rasping of the remaining tooth (46% of cases); oral extraction of the smaller and loose dental fragment (32%) and extraction of the entire fractured tooth by oral extraction (28%) or by repulsion (13%). Prophylactic treatment of adjacent, nonfractured CT with carious infundibula was possibly of value in preventing further midline sagittal maxillary CT fractures.

CONCLUSIONS

Horses referred with idiopathic CT fractures frequently have clinical signs of apical infection of the fractured CT and these teeth require extraction, orally if possible. More conservative treatment of idiopathic CT fractures without signs of gross apical infection can resolve clinical signs in most cases.

POTENTIAL RELEVANCE

In the absence of apical infection, extraction of only the loose dental fragments of CT with idiopathic fractures is usually successful.

[Elderly people and removable partial dentures]

The most frequently reported disadvantages of removable partial dentures are the more demanding daily oral hygiene self-care, especially for people who already experience difficulties in self-care, and the possible harmful influence on the remaining dentition. These disadvantages can be expressed in an extreme form in (frail) elderly people. The elderly show relatively large amounts of oral plaque, (root) caries, and periodontal disease. Considerations which may or may not indicate a partial denture for a (frail) elderly person are: the expressed problem and demand for treatment, the general health condition ofthe patient, oral mucosal health, the condition of the opposing jaw, the possible contribution to function and/or aesthetics, the possibilities of oral self-care and/or volunteer aid, the patient's personal adaptability, and possible hazards. Extreme care in subsequent, decisions should be the rule. Key concepts are: explicit demand for treatment, appropriateness, safety, and oral self-care/volunteer aid.

Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins

Epidemiologic studies suggest positive associations between poor oral health and cardiovascular disease. The authors undertook a prospective study among 15,273 Swedish twins (1963-2000) to examine whether genetic factors underlying the 2 diseases could explain previous associations. They estimated hazard ratios and 95% confidence intervals controlling for individual factors and stratifying on twin pairs to control for familial effects. Quantitative genetic analyses estimated genetic correlations between oral diseases and cardiovascular disease outcomes. Tooth loss (hazard ratio (HR) = 1.2, 95% confidence interval (CI): 1.1, 1.4) and periodontal disease (HR = 1.3, 95% CI: 1.0, 1.4) were associated with small excess risks of cardiovascular disease; periodontal disease was also associated with coronary heart disease (HR = 1.4, 95% CI: 1.1, 1.6). Adjustment for genetic factors in co-twin analyses did not appreciably change estimates. In contrast, tooth loss was more strongly associated with coronary heart disease in twin models (HR = 2.1, 95% CI: 1.2, 3.8) compared with adjusting for individual factors alone (HR = 1.3, 95% CI: 1.1, 1.4). There was evidence of shared genetic factors between cardiovascular disease and tooth loss (r(G) = 0.18) and periodontal disease (r(G) = 0.29). Oral disease was associated with excess cardiovascular disease risk, independent of genetic factors. There appear to be common pathogenetic mechanisms between poor oral health and cardiovascular disease.

Oral health and nutritional status of semi-institutionalized persons with mental retardation in Brazil

Association between oral health status and nutritional status was investigated in 200 semi-institutionalized persons with mental retardation aged 5-53 years, 45.5% female, in the cities of Florianópolis and São José, province of Santa Catarina, Brazil. In this cross-sectional study, clinical-odontological examination revealed a high percentage of individuals (68%) with heavily compromised dentition. The index of decayed, missing and filled deciduous and permanent teeth, which increased from 2.85+/-2.87 in children to 20.5+/-6.86 units in adults, was used to classify the individuals' oral health status. Anthropometric evaluation revealed the prevalence of suboptimal nutritional status in 52% of children and adolescents [22% underweight, 30% at risk of overweight or overweight], and in 60% of adults [7% underweight, 53% overweight or obese]. Significant association was found between unsatisfactory oral health status and overweight in children (chi(2)=4.627; p=0.031). Findings evidenced the existence of a relationship between oral health status and nutritional status in persons with mental retardation.

Dental and periodontal health status in children affected by cystic fibrosis in a southern Italian region

AIM

The aim of this study was to record the oral health status through the mean value of the DMFT/dmft index, the CPITN values and the DDE modified index in children affected by cystic fibrosis (CF).

STUDY DESIGN

Observational study.

METHODS

A group of 54 CF patients, aged 7 to 12 years, was selected and their data were compared to those of the same age healthy control group of 101 children.

RESULTS AND STATISTICS

CF patients showed a mean DMFT (1.5 +/- 2.17) and dmft (0.42 +/- 0.9) significantly lower than control subjects (respectively 3.70 +/- 3.92 and 2.96 +/- 3.30). Moreover, in the CF subjects a high prevalence (55.6%) of enamel defects and a better periodontal health were found, despite the low presence of calculus in both groups.

CONCLUSION

The low caries experience and the high prevalence of enamel defects in CF patients could be due to the metabolic disease, and above all to the long-term pharmacological therapies (antibiotics and pancreatic enzymes) that they take.

Prevalence of medically compromised conditions in dental patients

OBJECTIVES

To study the prevalence of medically compromised conditions in patients seeking dental treatment at the Faculty of Dentistry, Chulalongkorn University.

STUDY DESIGN

The files of 58,317 patients seeking dental treatments at the Faculty of Dentistry, Chulalongkorn University from 2002-2004 were retrieved and reviewed for medically compromised conditions.

RESULTS

From a total of 58,317 patients, 7,167 patients (12.2%) had medically compromised conditions. The five most prevalent conditions in descending order were allergy, hypertension, diabetes mellitus, heart diseases and thyroid diseases.

CONCLUSIONS

Even though the prevalence of medically compromised conditions in dental patients is not high, dentists should bear in mind that some of the patients may harbor such conditions which are contraindicated for certain dental procedures or medication or require special attention when treating these patients. Therefore, a thorough history taking and careful clinical examinations are mandatory before commencing any dental treatment.

[Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation]

Necrotizing fasciitis of the head and neck is a rare polymicrobial infection, rapidly progressing with a potentially fatal outcome, without early recognition and treatment. Odontogenic infection spreading to the lower neck or anterior chest is an important clinical feature. CT-scan and MRI can be useful in case of doubt. As the relative mild external clinical signs can mask the severe underlying necrosis, the difference in outcome is due to the rapidity of diagnosis and surgical intervention. Surgery consists of complete debridement of all necrotic tissues, repeated as needed and associated with an early tracheotomy. Antibiotherapy is based on the organisms most frequently involved. Hyperbaric oxygen therapy and vacuum-assisted closure could have a role after initiation of intravenous antibiotics and surgical debridement. We report a case of a 23-year old man with a necrotizing fasciitis from a dental origin, necessitating an extensive and repeated surgery, a tracheotomy and antibiotherapy; he developed severe complications such as multisystem organ failure, pericardial effusion and cardiorespiratory arrest.

Prevention of infective endocarditis: a review of the American Heart Association guidelines

Ever since the last American Heart Association (AHA) publication on prevention of infective endocarditis (IE) many medical societies and physicians have questioned the efficacy of prophylaxis in patients that undergo a dental, genitourinary (GU) or gastrointestinal (GI) procedures. In 1997 AHA recognize that most cases of IE were not related to invasive procedures but as a result of arbitrarily occurring bacteremia from routine daily activities as well as recognition of the possibility of IE prophylaxis failure. This assumptions as well as review of numerous published studies over the past two decades caused that AHA to revise the guidelines of 1997. Based on published series this new guidelines identify the following underlying cardiac conditions with an increase risk of IE and are the ones in which prophylaxis is recommended. They include (1) prosthetic cardiac valve or prosthetic material used for cardiac valve repair, (2) previous IE, (3) Congenital Heart Disease (CHD) including unrepaired cyanotic as well as palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired CHD with residual defects and (4) cardiac transplantation recipients who develop cardiac valvulopathy. All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa will require IE prophylaxis. Patients that undergo respiratory tract procedure that involves incision or biopsy of the respiratory mucosa will also required IE prophylaxis. In contrast to previous AHA guidelines, antibiotic prophylaxis to prevent IE is not recommended for GU or GI procedures. First line therapy recommended includes amoxicillin or ampicillin and if allergic to penicillin, clindamycin 600 mg or azithromycin 500 mg. Antibiotics should be administered in a single dose before the procedure, but the dosage may be administered up to two hours after procedure. This new AHA recommendation are more clear for healthcare providers regarding to which patient should undergo prophylaxis in comparison with previous ones and are expected to reduce antibiotic resistance that increased during the past years as a result of previous antibiotic prophylaxis for IE.

Dental inflammation and central retinitis--it is important to protect the retina from the harmful sunlight

During 3-year study of 73 patients with dental inflammation, sinusitis, otitis and 5 cases with granuloma, in 9 cases we observed the development of central retinitis. All patients were medicated with the same antibiotics and parabulbar depo of Prednisolonacetate. To 50% of these patients, we suggested eye protection with Yellow Medical filters during two months. In the first group with medication we observed better vision in 69%, but in the second group with eye protection with Yellow Medical filters we observed normalization of vision in 100%.

[General anesthesia in mentally disabled patients undergoing dental surgery]

OBJECTIVE

To describe the anesthetic technique used, the evaluation of airway patency, and the perioperative complications in patients with lower than average intelligence (mentally disabled) who are administered general anesthesia for dental surgery.

MATERIAL AND METHODS

We carried out a prospective, descriptive, comparative study of mentally disabled ASA 2-3 patients. The patients were distributed in 2 groups: mild to moderate mental disability and severe to very severe mental disability. Induction was via intravenous or inhaled anesthesia depending on availability of venous access. Maintenance was with sevoflurane in oxygen and air at variable concentrations in order to maintain a bispectral index (BIS) between 40 and 60. Statistical comparisons were based on the chi2 test, the log-rank test and the t test.

RESULTS

Forty-seven patients were enrolled. The anesthetic technique maintained hemodynamic stability in both groups. No statistically significant differences were found in Mallampati classification, Cormack-Lehane classification, or level of disability. The incidence of complications was higher in the group with more severe disability; the most common complication was difficult tracheal intubation. Bradycardia was the most common complication in the group with mild to moderate mental disability.

CONCLUSIONS

The anesthetic technique used in this study proved to be safe and effective in this type of patient. A higher degree of mental disability led to less effective examination of the airway and more difficult direct laryngoscopy. BIS was as effective for monitoring in this population as it is in the general population.

Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006)

CONCLUSIONS

Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h.

OBJECTIVES

Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (> 40%).

PATIENTS AND METHODS

We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006.

RESULTS

The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures.

Gardner's syndrome presenting with dental complaints

Dental professionals play an important role in discovering the early signs of many illnesses. Gardner's syndrome, which affects one in 7500 births in the United States, is an inherited autosomal dominant disorder. There are three distinctive features associated with this syndrome: familial intestinal polyposis or adenomatosis, surface tumors of hard tissues particularly osteoma in the skull, maxillae, and mandible, and finally surface tumors of the soft tissue. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated. Consequently, early identification of the disease is critical. In this article an 18-year-old male patient with previously undiagnosed Gardner's syndrome who presented for removal of multiple impacted and unerupted teeth is reported to illustrate the importance of early detection and proper referral. This report describes an unusual presentation of a patient seeking extraction of teeth only, while he was totally unaware of potentially deadly situation.

Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients

AIMS

To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.

METHODS

A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.

RESULTS

Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.

CONCLUSION

This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.

Medical causes of headache in children

Headache may be considered primary or secondary, and secondary headaches may be caused by intracranial disorders or medical/systemic disorders. In many cases, headache may be a presenting symptom of the medical disorder, and accurate diagnosis will lead to specific treatment. In other cases, the headache may be a known complication of the disorder, but the underlying disorder must be considered in management plans. Medical causes of headache are so diverse that uniform screening tests are not useful. History and examination must guide the differential diagnosis, and management plans must be individualized.

Lemierre Syndrome associated with dental infections. Report of one case and review of the literature

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an "oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism". In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it's clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It's necessary to administer the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if necessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar.

Dental otalgia

BACKGROUND

Secondary or referred otalgia can represent a diagnostic challenge to the otolaryngologist. Collectively, dental disorders are the most common causes of secondary otalgia presenting to the ENT clinic, and may account for up to 50 per cent of referred otalgia. Temporomandibular joint dysfunction syndrome represents the most common dental cause of referred otalgia. Decay and pulpal inflammation of posterior teeth can also frequently present as otalgia. The common embryological developmental origin of both oral and dental structures and the ear is responsible for their overlapping sensory nerve supplies, and this explains referred otalgia secondary to dental and temporomandibular joint disorders. These disorders can be easily overlooked, resulting in unnecessary and costly investigations.

AIMS

This review aims to give a succinct overview of common dental causes of otalgia, and to provide ENT clinicians with guidelines for performing a rapid and simple dental and temporomandibular joint examination, which will reliably diagnose or exclude dental otalgia.

Oral manifestations of gastrointestinal diseases

The present paper offers a detailed review of the oral manifestations of various gastrointestinal diseases or conditions, with suggestions on how they may be relevant to the practice of gastroenterology. The review includes Crohn's disease, ulcerative colitis, Gardner syndrome, Peutz-Jeghers syndrome, malabsorption conditions related to hematopoesis, gastrointestinal malignancy metastatic to the jaws, jaundice and gastric reflux diseases.

Temporomandibular disorders and other causes of facial pain

Temporomandibular disorders and facial pain cause significant discomfort and disability for affected patients. Understanding the clinical presentation, pathogenesis, and therapy is essential in helping patients who have these problems. This article critically reviews these aspects, with an emphasis on their relationship to headache.

Clindamycin versus Unasyn in the treatment of facial cellulitis of odontogenic origin in children

The study was undertaken to characterize the microbiology of dental abscesses in children and to compare clindamycin and ampicillin/sulbactam in the treatment of facial cellulitis of odontogenic origin. Sixty children with acute facial cellulitis of dental origin underwent surgery (extraction or root canal procedure) within 24 hours of presentation. Pus samples were cultured aerobically and anaerobically. Patients were randomized (1:1) to receive intravenous ampicillin/sulbactam or clindamycin for 48 hours followed by oral amoxicillin/clavulanate or clindamycin for 7 days. A total of 211 bacterial isolates were recovered from 54 samples. The most common aerobic and facultative organisms were viridans streptococci, Neisseria, and Eikenella species. Among anaerobes, Prevotella and Peptostreptococcus species were the most frequent. No treatment failure occurred in either group. Dental abscesses in children are polymicrobial aerobic/anaerobic infections. Treatment of complicated dental infections with ampicillin plus a beta-lactamase inhibitor or clindamycin in combination with surgical drainage is very effective.

Dental health status of liver transplant candidates

A prerequisite dental evaluation is usually recommended for potential organ transplant candidates. This is based on the premise that untreated dental disease may pose a risk for infection and sepsis, although there is no evidence that this has occurred in organ transplant candidates or recipients. The purpose of this study was to assess the prevalence of dental disease and oral health behaviors in a sample of liver transplant candidates (LTCs). Oral examinations were conducted on 300 LTCs for the presence of gingivitis, dental plaque, dental caries, periodontal disease, edentulism, and xerostomia. The prevalence of these conditions was compared with oral health data from national health surveys and examined for possible associations with most recent dental visit, smoking, and type of liver disease. Significant risk factors for plaque-related gingivitis included intervals of more than 1 yr since the last dental visit (P = 0.004), smoking (P = 0.03), and diuretic therapy (P = 0.005). Dental caries and periodontal disease were also significantly associated with intervals of more than 1 yr since the last dental visit (P = 0.004). LTCs with viral hepatitis or alcoholic cirrhosis had the highest smoking rate (78.8%). Higher rates of edentulism occurred among older LTCs who were less likely to have had a recent dental evaluation (mean 88 months). In conclusion, intervals of more than 1 yr since the last dental visit, smoking, and diuretic therapy appear to be the most significant determinants of dental disease and the need for a pretransplantation dental screening evaluation in LTCs. Edentulous patients should have periodic examinations for oral cancer.

Fever of Unknown Origin due to Dental Infections: Cases Report and Review

Persistent undiagnosed fever remains a common problem in clinical practice. In a variable number of cases, no definitive diagnosis is made. This lack of a clear etiology indicates that certain disorders are not being detected despite the recently developed technology usually applied in this situation. On occasion, dental disease is one potential cause of persistent fever. Oral symptoms usually are not present, thus allowing the oral cavity to be overlooked during physical examination. We describe three patients with persistent fever due to dental disease and discuss the pathogenesis of this disease.

[Concentration of proinflammatory and antiinflammatory cytokines in blood and wound of patients with odontogenic phlegmons]

Levels of IL-1beta, IL-6, TNFalpha, IL-10 and TGF-beta in blood and wound of 56 patients with odontogenic phlegmons in dynamic of infection process were expected. In accordance with known facts production of proinflammatory cytokines (IL-1beta, IL-6, TNFalpha in blood in acute phase of the inflammation process was much more intensive than in normal conditions. Increased proinflammatory cytokines generation led to significant raising of IL-10 concentration, but elevation of its level in blood was only at the 10-14 the days of therapy. The dynamic of these cytokines concentrations in wound were similar. On other side the negative role in regeneration of wound plays TGFbeta. Minimal concentration of this cytokine in blood was found at 1-3 from treatment beginning. On the background of the intensive therapy the level of TGFbeta raised fastly and at 10-14 days was much more than in control conditions. Wound level of TGFbeta was more than in normal conditions from the third day. These changes may be one of the reason of hyper proliferation of keratinocytes, that led rough scars.

The impact of oral disease and nonsurgical treatment on bacteremia in children

BACKGROUND

The authors examine the role of dental disease and nonsurgical dental procedures in the incidence and duration of bacteremia in children.

METHODS

The authors randomized a group of children to receive amoxicillin or a placebo before dental rehabilitation in an operating room setting. They collected eight blood draws at the following times: two minutes after intubation (draw 1); after dental restorations, pulp therapy and cleaning (draw 2); 10 minutes later (draw 3); and five draws during and after dental extractions (draws 4-8). The authors compared dental disease parameters and the type of dental procedures performed with the incidence and duration of bacteremia.

RESULTS

The authors enrolled 100 children (aged 1-8 years) in the study. The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07), and the incidence from draw 3 was 16 percent in the placebo group and zero percent in the amoxicillin group (P = .03). Subjects with higher gingival scores were more likely to have a bacteremia for draw 2 (P = .01). The authors found that subjects in the group with bacteremia for draw 3 had undergone more pulpotomies than did subjects in the group without bacteremia for draw 3 (3 +/- 2.5 standard deviation [SD] versus 1.5 +/- 1.6 SD, P = .04), while they found almost no differences for draw 2.

CONCLUSIONS

This study suggests that gingival disease has an impact on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia altogether.

Health habits, attitudes and behavior towards oral health of children with epilepsy

Introduction: Children suffering from epilepsy are high at risk of oral diseases primarily due to their underlying medical condition which can have an impact on the maintenance level of oral hygiene, but also due to adverse effects of antiepileptic drugs. Objective. The aim of this paper was to identify habits, attitudes and behavior of children with epilepsy and parents in respect to oral health. Method. The experimental group consisted of 50 children with epilepsy, 24 boys and 26 girls, 7-14 years old, mean age 11.2?2.2 years. The control group consisted of healthy children, matched by age and gender. The instruments of investigation consisted of the structured interview of children and parents concerning oral health habits, attitudes and behavior. We used medical records of children with epilepsy as a source of information on their diagnosis, duration of the illness and current therapy. Statistical analysis was performed by chi-squared test, nonparametric correlation, Wilcoxon?s signed rank test and logistic regression. Results. Results showed that more children with epilepsy and their parents had inappropriate habits and attitudes towards oral health, as well as nutrition habits (p<0.001). Compared to healthy controls, children with epilepsy washed their teeth less often and shorter, they had less knowledge about causes of oral diseases and about influence of oral diseases on general health, and they had worse self-rating of teeth and gum condition. In addition, significantly more children with epilepsy used an incorrect technique of teeth brushing (p<0.001). Characteristics of children?s epilepsy and educational degree of parents had no influence on these differences. Conclusion. Study results showed that children with epilepsy and their parents had worse habits, attitudes and behavior towards oral health than healthy controls and their parents. This difference can be explained primarily by worse parental estimation of oral health and behavior towards oral health in comparison to parents of healthy controls. .

Oral assessment of children with an autism spectrum disorder

PURPOSE

The study assessed the oral health status of children with an autism spectrum disorder (ASD) to help establish the oral health needs of this population.

METHODS

Oral assessments were conducted on 39 children with an ASD and 16 children with other developmental disabilities (DD), solicited from 3 different schools. Conditions assessed were bacterial plaque, gingivitis, dental caries, restorations, bruxism, delayed eruption/missing teeth, oral infection, developmental anomalies, injuries, occlusion, salivary flow, and oral defensiveness.

RESULTS

Chi-square and Fisher's exact test of significance were used to compare groups. Young children with an ASD who resided with parents showed significantly more signs of bruxism than the comparison groups. Likewise, older children who lived at the residential school manifested significantly more gingivitis. No other significant differences existed when age and residence were considered for children with an ASD. When comparing children with ASD to those with another DD, the latter group showed significantly more oral injuries, abnormal salivary flow, and developmental anomalies. Children with an ASD displayed the following percentages for clinically visible conditions: plaque (85%), gingivitis (62%), and caries (21%). Approximately half of the children with ASD were orally defensive.

CONCLUSIONS

Children with an ASD appear to have oral conditions that might increase the risk of developing dental disease. The extent of risk is unclear and needs further investigation.

Oral Health in Veterans Affairs Patients Diagnosed with Serious Mental Illness

OBJECTIVES

We evaluated patient and medication treatment factors associated with self-reported oral health status in patients diagnosed with serious mental illness (SMI) in a large, national sample of patients in the Veterans Affairs (VA) health system.

METHODS

4,769 patients (mean age = 55, 7.8 percent women) were included from the VA's 1999 National Psychosis Registry (NPR) for whom the oral health information gathered by the VA's Large Health Survey of Veterans was available. Current (1999) psychotropic medication data were ascertained from the NPR. Multivariable logistic regression analyses were used to determine the patient factors (e.g., sociodemographic, enabling, and treatment factors) associated with poor or fair overall dental health, and with having tooth or mouth problems that made it difficult to eat.

RESULTS

While 61.0 percent of persons with SMI self-reported fair to poor dental health, 34.1 percent reported that oral health problems made it difficult for them to eat. Patients who were not employed, experiencing financial strain, who smoked, who were prescribed tricyclic antidepressants, or prescribed selective serotonin reuptake inhibitors were more likely to report poor or fair dental health. These variables were also associated with having tooth or mouth problems.

CONCLUSIONS

Suboptimal oral health was self-reported with substantial prevalence among patients with SMI, a problematic finding given its consequences for general health, social functioning, and quality of life. Greater efforts are needed to improve oral health outcomes among patients with SMI by facilitating access to dental care and addressing mutable factors such as smoking and medication side effects.

Dental implications of some common movement disorders: a concise review

Movement disorders - or dyskinesias - are characterized by involuntary movements. Despite the major role for medical specialists in the diagnosis and treatment of dyskinesias, dentists are confronted with such disorders as well. Unfortunately, the literature regarding the dental implications of movement disorders is still scarce. This concise review describes the dental implications of some common dyskinesias, viz., Gilles de la Tourette's syndrome, Huntington's disease, idiopathic torsion dystonia, oral dyskinesias, and Parkinson's disease. It was concluded that these dyskinesias may have profound dental implications. Not only do generalized dyskinesias have focal manifestations in the orofacial region, but there are also dyskinesias that exclusively affect the orofacial area. The oral manifestations of dyskinesias are in part directly related to the disorder, and in part medicine-related. Dentists should be able to recognize the oral manifestations and, when properly trained, to manage them adequately. In most instances, a multidisciplinary approach upon referral is necessary, including the medical specialists involved. Unfortunately, the level of evidence of the selected papers was generally low. In our rapidly ageing population, it is a challenge for all of us to improve the quality of this emerging field, for the sake of this sometimes heavily infirmed category of patients.

Anaerobic bacteria in 118 patients with deep-space head and neck infections from the University Hospital of Maxillofacial Surgery, Sofia, Bulgaria

The aim of this study was to assess the incidence and susceptibility to antibacterial agents of anaerobic strains in 118 patients with head and neck abscesses (31) and cellulitis (87). Odontogenic infection was the most common identified source, occurring in 73 (77.7%) of 94 patients. The incidence of anaerobes in abscesses and cellulitis was 71 and 75.9%, respectively, and that in patients before (31 patients) and after (87) the start of empirical treatment was 80.6 and 72.4%, respectively. The detection rates of anaerobes in patients with odontogenic and other sources of infection were 82.2 and 71.4%, respectively. In total, 174 anaerobic strains were found. The predominant bacteria were Prevotella (49 strains), Fusobacterium species (22), Actinomyces spp. (21), anaerobic cocci (20) and Eubacterium spp. (18). Bacteroides fragilis strains were isolated from 7 (5.9%) specimens. The detection rate of Fusobacterium strains from non-treated patients (32.2%) was higher than that from treated patients (13.8%). Resistance rates to clindamycin and metronidazole of Gram-negative anaerobes were 5.4 and 2.5%, respectively, and those of Gram-positive species were 4.5 and 58.3%, respectively. One Prevotella strain was intermediately susceptible to ampicillin/sulbactam. In conclusion, the start of empirical treatment could influence the frequency or rate of isolation of Fusobacterium species. The involvement of the Bacteroides fragilis group in some head and neck infections should be considered.