Third Molar Surgical Removal: A Possible Model of Human Systemic Inflammation? A Preliminary Investigation

Accumulating evidence suggests that dental treatment is associated with systemic inflammation. We aimed to preliminarily study the impact of third molar removal on biomarkers of inflammation and oxidative stress. Ten consecutive subjects underwent the removal of third molars under local anaesthesia and provided blood samples before and 1, 7 and 60 days following therapy assessed for high-sensitivity serum concentrations of C-Reactive Protein (CRP), fibrinogen, white cell counts and a number of measures of oxidative stress (MDA, LOOH and FRAP). One week inflammatory response ensued with acute increases after 24 h of CRP (P<0.01), Fibrinogen (P<0.05) and white cell counts (P<0.05). Third molar removal may represent a useful model to investigate inflammation in humans.

[Analysis of violence against health care workers through medical surveillance at the workplace in a 8-yr period]

Physical and moral violence against the workers of a local public health unit is perspectively studied in the period 2005-2011. Data were collected during periodic medical surveillance of all workers exposed to risk and with more than one year of seniority. The prevalence of the phenomenon is constant in the period under review. On average, each year a worker in ten is physically assaulted, and one in five is subjected to verbal abuse. The professional groups most exposed to violence are nurses (OR 2.67 IC95% 1.63-4.39) and doctors (OR 2.44 IC95% 1.34-4.46). The areas at greatest risk are the psychiatric care (OR 25.7, IC95% 11.1-59.6) and emergency and first aid (OR 8.8, CI95% 3.8-20.5). The workplace violence against health workers requires urgent preventive interventions.

Reduced human beta defensin 3 in individuals with periodontal disease

The human beta defensin 3 (hBD3) is widely expressed in the oral cavity and exerts strong antibacterial and immunomodulatory activities. Hence, we hypothesized that hBD3 could play a protective role in the maintenance of periodontal homeostasis, and that it could be found in gingival crevicular fluid (GCF) of healthy individuals and those with periodontitis at levels correlating with the degree of periodontal health. By using an ELISA assay to quantify hBD3 in GCF, we demonstrated that the peptide is present at levels easily detectable in the majority of healthy individuals, but it is drastically reduced in GCF from those with periodontitis. Furthermore, hBD3 levels inversely correlate with the severity of the disease and the degree of colonization by combinations of bacterial species with elevated periodontopathogenic potential. Both genetic factors and host/bacterial proteases released in diseased sites may be responsible for the observed low/null hBD3 levels in GCF from individuals with periodontitis.

Sources of longitudinal variability in optical coherence tomography nerve-fibre layer measurements

AIMS

The purpose of this study was to compare the day-to-day reproducibility of optical coherence tomography (OCT; StratusOCT, Carl Zeiss Meditec, Dublin, CA) measurements of retinal nerve-fibre layer (RNFL) measurements at time points 1 year apart.

METHODS

One eye in each of 11 healthy subjects was examined using the StratusOCT fast RNFL scan protocol. Three fast RNFL scans with signal strength > or =7 were obtained on each of 3 days within a month. This protocol was repeated after 12 months. A linear mixed effects model fitted to the nested data was used to compute the variance components.

RESULTS

The square root of the variance component that was attributed to the differences between subjects was 7.17 microm in 2005 and 7.28 microm in 2006. The square roots of the variance component due to differences between days within a single subject were 1.95 microm and 1.50 microm, respectively, and for within day within a single subject were 2.51 microm and 2.55 microm, respectively. There were no statistically significant differences for any variance component between the two testing occasions.

CONCLUSIONS

Measurement error variance remains similar from year to year. Day and scan variance component values obtained in a cohort study may be safely applied for prediction of long-term reproducibility.

[Assaults and nuisances in health care environment]

A descriptive exploratory survey was used to investigate the occurrence of physical workplace violence among health care workers as well as the complaints and responses to such violence. The questionnaire was used for collecting data from a sample of 355 workers. Results showed that 25.6% of hospital workers reported physical aggression at any time of the working life, 8.5% in the last year. Injured workers showed significantly higher environmental complaint score than other workers. The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence.

[Chikungunya infection in pregnancy: Evidence for intrauterine infection in pregnant women and vertical transmission in the parturient. Survey of the Reunion Island outbreak]

PURPOSE

Since February 2005, an outbreak of Chikungunya virus (CHIKV) infections occurred in Reunion Island. It is transmitted by the Aedes albopictus mosquito. Neonatal cases observations suggest possible fetal transmission during pregnancy. MATERIAL [corrected] AND METHODS. Observations made in 160 pregnant mothers infected by CHIKV between June 1, 2005 and February 28, 2006, in the south of Reunion island were recorded.

RESULTS

Three of nine miscarriages before 22 weeks of gestation could be attributed to the virus. 3,829 births took place during this time. Among the 151 infected women, 118 were viremia negative at delivery, and none of the newborns showed any damage. Among the 33 with positive viremia at delivery, 16 newborns (48.5%) presented neonatal Chikungunya.

DISCUSSION

Though fetal contamination risks appear to be rare before 22 weeks of gestation, they are potentially dangerous. After 22 weeks gestation, newborns infection occurs if the mother is viremia positive at delivery. Transplacental transmission is suspected, but the pathogenic mechanism remains unknown.

Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial

The effect of endo-alveolar and sub-mucosal administration of dexamethasone sodium phosphate to prevent inflammatory sequelae after surgical removal of lower third molars was studied. Forty-three patients underwent bilateral extractions of lower third molars and were randomly assigned to receive either dexamethasone 4 mg (group A) or 10 mg (group B) as endo-alveolar powder or 10 mg as sub-mucosal injection (group C) unilaterally. The controlateral site served as control and did not receive any steroid administration. Facial edema, trismus and pain perception were evaluated at the 2nd and 7th postoperative day. A multivariate analysis revealed that treatment and ostectomy time were both significantly positively associated with the degree of postoperative trismus and edema. Other baseline classification variables (e.g., molar classification) were also predictive of the degree of change in all clinical parameters. Test sites treated (any steroid application) showed greater reductions in all clinical parameters recorded compared to control. No statistically significant differences were observed between the three test groups. Both sub-mucosal and endo-alveolar administration of dexamethasone are effective in reducing postoperative sequelae of surgical removal of lower wisdom teeth.

The adhesion between fibre posts and composite resin cores: the evaluation of microtensile bond strength following various surface chemical treatments to posts

AIM

To evaluate the influence of various surface treatments to fibre posts on the microtensile bond strength with different composite resins.

METHODOLOGY

A total of 110 fibre posts were randomly divided into five groups, according to the surface pre-treatment performed. Group 1: immersion in 24% H(2)O(2) for 10 min and silanization for 60 s; group 2: immersion in 10% H(2)O(2) for 20 min and silanization for 60 s; group 3: immersion in 4% hydrofluoric acid gel for 60 s and silanization for 60 s; group 4: silanization of the post surface for 60 s and application of the bonding agent G-Bond; group 5: silanization of the post surface for 60 s (control group). After treatment, two posts were randomly selected from each group to evaluate the morphological aspect of the post surface with scanning electron microscopy. The remaining posts in each group were divided into five subgroups of five posts each, which differed in the type of composite resin used for the core build-up. Post-core strength were calculated and the differences among experimental groups were analysed with two-way anova and the Tukey test (alpha = 0.05).

RESULTS

The post-core strengths achieved in groups 1 and 2 were significantly higher (P < 0.05), than those of groups 3, 4 and 5. The post-core strength in the control group was significantly lower (P < 0.05) than all other groups.

CONCLUSIONS

Hydrogen peroxide and hydrofluoric acid both modified the surface morphology of fibre posts and with silane, significantly enhanced the interfacial strength between them and core materials.

Clinical evaluation of piroxicam-FDDF and azithromycin in the prevention of complications associated with impacted lower third molar extraction

Combined treatments with non-steroidal anti-inflammatory drugs and antibiotics may offer significant benefits in the prevention of pain and infections associated with oral surgery. In this study, piroxicam and azithromycin were administered to patients undergoing dental extraction to examine the efficacy of piroxicam in the prevention of post-operative pain and inflammatory complications, either in the absence or in the presence of a concomitant antibiotic treatment. Thirty patients were randomly assigned to three groups and treated for 3 days, before impacted lower third molar removal, as follows: (1) sublingual piroxicam-FDDF (fast dissolving dosage formulation) 20 mg/day; (2) oral azithromycin 500 mg/day; (3) piroxicam-FDDF 20 mg/day plus azithromycin 500 mg/day. Oral acetaminophen (500 mg tablets) was allowed as rescue analgesic medication. Pain intensity was evaluated on a 100-mm visual-analogue scale after dental extraction (day 1), and at days 2, 3, 7 after surgery. Edema and trismus were estimated at days 2 and 7. At days 1 and 2, pain intensity was significantly lower in patients treated with piroxicam-FDDF, either alone (p < 0.05) or in combination with azithromycin (p < 0.05), than in patients administered with azithromycin alone. A higher acetaminophen consumption was also recorded in the latter group (p < 0.01). Pain intensity values did not differ among treatment groups at days 3 and 7. At day 2, the facial edema was significantly less intense in patients exposed to piroxicam-FDDF alone, as compared to patients treated with azithromycin, either alone (p < 0.05) or in combination with piroxicam-FDDF (p < 0.05). No significant differences were detected when comparing groups for trismus at days 2 and 7. The present results indicate that, when given alone in the pre-operative period, piroxicam-FDDF effectively counteracts post-surgical pain and inflammatory reactions in oral tissues. Upon combined treatment with piroxicam-FDDF and azithromycin, the macrolide antibiotic may reduce the influence of piroxicam on post-operative inflammation, without affecting its beneficial effect on surgical pain.

Endométriose avec ascite et épanchement pleural : à propos d'un cas

Massive ascites associated with pelvic endometriosis is an uncommon combination. Pleural effusion may rarely occur. Fourteen cases are reported in the literature. We report the case of a black nulligravida woman followed for a primary infertility. Endometriosis was suspected in presence of increasing dysmenorrhea, cystic adnexal masse, umbilical nodes and ascites. The diagnosis was confirmed at exploratory laparoscopy. The patient had been followed for assisted procreation for six years and had undergone a conservative laparoscopic surgery never described. After several ascites recurrences, the pathology was resolved by Gonadotropin-releasing hormone agonist therapy. But a right pleural effusion with ascites occurred following a bad therapeutic observance. This complication reveals an early pregnancy never reported for this exceptional pathology. A conservative management allowed this unique case of well outcoming pregnancy. The possible pathogenesis of ascites and pleural effusion are explored and recommendations for diagnosis and treatment options are discussed.

Periodontitis: from local infection to systemic diseases

Periodontitis is a chronic infectious disease, characterized by the progressive loss of the teeth's supporting tissues, affecting almost 40% of the entire adult population. An imbalance between a localized gram-negative infection and an exaggerated host inflammatory response plays a pivotal role in determining gingival tissue damage. Recent evidence suggests that the effect of periodontitis might not be limited just to the oral cavity but it might have systemic consequences. Indeed periodontitis has also been associated with a moderate systemic inflammatory response. Although the mechanisms behind this association remain unclear, periodontitis might represent one distant source of low-grade systemic inflammation. This association could explain the increased risk of future cardiovascular diseases observed, the impaired metabolic control in diabetes subjects and the adverse pregnancy outcomes observed in populations suffering from periodontitis. In this review we describe the pathophysiological processes involved in periodontitis and briefly review the evidence produced to support an association between periodontitis and systemic diseases.

Ankyloglossia: a morphofunctional investigation in children

OBJECTIVES

To provide diagnostic criteria for ankyloglossia in children by anatomical measurements; to investigate the correlation between severity of ankyloglossia and a series of morphofunctional findings; to evaluate the potential mismatch between a clinical suspect of ankyloglossia and the authentic anatomical diagnosis.

DESIGN

Two different techniques of anatomical measurements and a clinical evaluation of a series of morphofunctional findings were performed.

SUBJECTS AND METHODS

In 200 children referred for evaluation and treatment of tongue-tie, the length of the frenulum and the interincisal distance were measured in maximum opening of the mouth and with the tip of the tongue touching the palatal papilla. Occlusion, type of bite, tongue resting position, swallowing mechanism, oral floor mobility, frenulum insertion modality and speech were investigated. Any correlation between these morphofunctional findings and anatomical measures was investigated.

RESULTS

Children with a frenulum length more than 2 cm and an interincisal distance of more than 2.3 cm were normal. In both measurements, significant correlations among mean values and other variables were observed. Moreover, three levels -- mild, moderate and severe -- of ankyloglossia were assessed.

CONCLUSIONS

Length of frenulum and interincisal distance allow an assessment of severity of ankyloglossia in children. Ankyloglossia was not associated with infantile swallowing.

[Pregnancy beyond age 40 in 382 women: a retrospective study in Reunion Island]

OBJECTIVE

To examine obstetrical and neonatal outcomes among women age 40 years and older.

MATERIAL AND METHODS

There was a retrospective study including 382 pregnant women at least 40 years of age and 7786 controls aged 20-34, stratified according to parity. Associations between maternal age and pregnancy outcomes were assessed using Pearson's chi(2) test, Fischer exact test, Student test or Mann and Whitney test, as appropriate.

RESULTS

Maternal age 40 and over was associated with an increased risk for gestational diabetes (multiparas: OR 3.2, 95%CI 2.2-4.8; grandmultiparas: 2.8, 1.6-5.0), chronic diabetes (multiparas: 3.5, 1.04-10.6), chronic hypertension (multiparas: 3.1, 1.5-6.1; grandmultiparas: 12.1, 3.3-53.2), pregnancy-induced hypertension (nulliparas: 4.6, 1.01-17.3; multiparas: 2.6, 1.3-5.4) and preclampsia (multiparas: 2.9, 1.1-7.2). The risk for cesarean section was 2-fold higher in older multiparas and grandmultiparas. The same was true for the rate of operative vaginal delivery. The rate of fetal chromosomal abnormalities was 7-fold higher in older gravidas. Rates of fetal death were significantly increased in the cohort of older pregnant women (nulliparas: 11.2, 2.9-44.0; multiparas: 3.9, 1.4-10.9).

CONCLUSION

Pregnancy at age 40 and over is associated with high rates of obstetrical complications, cesarean sections and operative vaginal deliveries, emphasizing the importance of rigorous antenatal care.

In vitro effects of different concentration of PRP on primary bone and gingival cell lines. Preliminary results

AIM

Platelet rich plasma (PRP) is utilized in oral surgery to enhance bone healing and it has been suggested to accelerate soft tissue healing. Nevertheless, there is no evidence on biological concentration of platelets needed to determine the higher biological response. Therefore, aim of this study is to evaluate the action of PRP in vitro on osteoblasts and fibroblasts and to evaluate which is the most effective concentration of PRP.

METHODS

PRP was obtained from volunteers donors by standard apheresis. Osteoblasts were growth for 72 hours in a medium added with platelet concentration of 230%. Fibroblasts were treated with different platelet density for 24 hours and 72 hours. Platelet density was increased of 230%, 350%, 460% and 700% the normal blood count. Cell proliferation was evaluated with MTT test. ANOVA test was used to assess cells proliferation data.

RESULTS

Osteoblasts proliferation, at 72 hours, showed an increase of proliferation in PRP group compared to plasma (P < 0.001). Fibroblast proliferation after 24 hours increases when PRP is added (P < 0.05). However, no significant differences were detected among the various concentration of PRP. Yet, at 72 hours, MTT values increases when platelet concentrate is 230% and 350%. At 700% platelet density MTT values were lower than control group (P < 0.05).

CONCLUSIONS

Our results indicated that PRP has an enhancing effect on osteoblasts and fibroblasts proliferation when it is prepared only within certain ranges of concentrations. However, further experimental studies are needed to confirm our hypothesis.

The use of hydrogen peroxide in the experimental therapy of cysts. An in vitro analysis

AIM

Aim of the authors is to evaluate in vitro the histological alteration caused by hydrogen peroxide on a sample of radicular cysts.

METHODS

Twelve radicular cysts were divided into 2 portions. The control group was histologically evaluated whereas the other portion, test, was treated with 3% hydrogen peroxide before histological analysis. Test and control portions were compared for integrity of the epithelium, inflammatory state of the cystic walls, presence of necrosis, stromal vacuolization and microvessel density (MVD). MVD was evaluated by immunohistochemistry using anti-CD34 monoclonal antibodies.

RESULTS

Significantly lower epithelium integrity has been detected in the test group (p= or <0.007), (Wilcoxon test). Moreover, the test group presented a higher number of stromal vacuolization areas (p= or <0.004). However, necrosis and inflammation reported no significative differences. No significative differences were noticed for the MVD.

CONCLUSION

Hydrogen peroxide showed a cytopathic and cytolytic activity in vitro. Those effects have been shown on both cysts tissues: epithelium and connective tissue. The present study did not reveal any statistically significant difference between the number of vessels in the control and in the test group. However, further in vitro and human studies are needed to validate this substance in the treatment of cysts.

Continuation treatment of delusional depression in older adults

Delusional depression responds poorly to acute antidepressant monotherapy but appears to respond to intensive combination pharmacotherapy, however with poor short-term outcomes after initial improvement, particularly in later life. The authors compared the efficacy and safety of continuation combination therapy to monotherapy among older patients after remission from a delusional depression. Twenty-nine older adults with SCID-diagnosed major depression with delusions received continuation treatment with nortriptyline-plus-perphenazine or nortriptyline-plus-placebo under randomized double-blind conditions after achieving remission after ECT. Of the 28 subjects included in efficacy analyses, 25% suffered relapses. The relapse frequency was nonsignificantly greater in combination therapy than in monotherapy subjects. However, combination subjects had significantly more extrapyramidal symptoms, an increased incidence of tardive dyskinesia, and a greater number of falls. Continuation treatment with a conventional antipsychotic does not decrease relapse rates but is associated with significant untoward adverse events in older persons after recovery from a delusional depression.

Effect of removable orthodontic appliances on oral colonisation by mutans streptococci in children

Little is known about the effect of removable orthodontic appliances on oral colonisation by mutans streptococci (MS). In the present study, the frequency of isolation and serotype distribution of MS were evaluated in two groups of children, one undergoing therapy with removable appliances and the other not subjected to any kind of orthodontic treatment, respectively. Streptococci isolated from dental plaque samples from both groups of children were identified as mutans streptococci on the basis of their morphological and biochemical properties and were then serotyped in an enzyme immuno-assay using monoclonal antibodies. The number of subjects harbouring MS in their dental plaque was statistically higher in the group of orthodontic children without caries experience (CF) in comparison with CF children of the control group (10/12, 83.3% vs. 15/44, 34%). No clear difference was observed in the distribution of the different MS serotypes between the experimental and control group: S. mutans c,f serotype was the most frequently isolated in both groups of children followed by S. mutans serotype e and S. sobrinus serotype g. Such results suggest that the use of removable appliances may lead to the creation of new retentive areas and surfaces, which favour the local adherence and growth of MS. The data obtained stress the importance of a careful monitoring of patients treated orthodontically for risk of caries development.