Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies

OBJECTIVE

To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users.

METHOD

Review instrument completed by pharmacist interviewing drug users and other pharmacy users.

SETTING

Community pharmacists

SAMPLING

All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129.

KEY FINDINGS

The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users.

CONCLUSIONS

Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.

Community nurses' contribution to oral health

Oral health is an important component of general health and well-being. Although oral health has improved dramatically in children and young adults, oral diseases remain common, particularly among disadvantaged and vulnerable groups. Many patients seen by community nurses will fall into these categories and are less likely to have sought treatment. This article presents the epidemiology of oral diseases and conditions for specific groups in society that community nurses will be caring for. It looks at prescribing principles and describes treatment and advice for common oral conditions, including those where prescription may be appropriate. Community nurses play an important role in the oral health care of society, particularly among those least likely to access dental services.

[Adult cutaneous periarteritis nodosa and dental infections. Role of streptococci]

INTRODUCTION

Periarteritis nodosa can be associated with streptococcal infections in children. We report two cases of adult cutaneous periarteritis nodosa that disappeared after the treatment of dental infection.

EXEGESIS

A 23-year-old woman presented with necrotic ulceration on the legs for 6 months, with a histology of necrotizing vasculitis. Many sites of dental infections could be noted. Immunological data were negative and so were serologies of hepatitis. Corticosteroid therapy failed. The teeth removal with antibiotic therapy allowed the disappearance of cutaneous lesions in a month. A 26-year-old woman was hospitalized for growing thin, fever, diffuse arthralgia and myalgia and cutaneous nodules on the legs with necrotizing vasculitis on dermal vessels at histological analysis. The biology showed no pecularity. Radiography of the teeth showed many dental infection sites. The removal of six teeth with antibiotic therapy led to the disappearance of vasculitis in 6 weeks.

CONCLUSION

The search for an infectious problem is important when vasculitis is diagnosed, in particular periarteritis nodosa. The treatment of dental infection could occasionally mean avoiding immunosuppressive therapy in certain cases.

[Dental treatment of handicapped children under general anesthesia]

Complex dental treatment of a 15-year-old mentally retarded boy was presented by the authors. Oral surgical, restorative dental, and prosthetic intervention (upper and lower bridge) was done partly with intravenous narcotic agent (Propofol) and partly under intubation narcosis.

[Complications of dental infections]

Infectious dental complications are quite frequent given the high incidence of tooth decay. Other pathologies not related to dental decay can cause mouth infectious such as periodontal infections, alveolitis, peri-coronitis of impacted wisdom tooth and secondary infection of dental fragments. Dental infection can be localised to apex (top of the root) or progress to soft and bony tissues surrounding the teeth. The most frequent germs involved in these infections are generally the same as saprophyte buccal flora but are often associated to other anaerobic germs. The following complications will be described in what concerns their etiology, pathology and treatment: abcess, fistula, phlegmon and cellulitis, odontogenic cysts, actinomycosis, craniofacial thrombophlebitis, osteitis and osteomyelitis, maxillary sinusitis, septicemia and local odontogenic infections. The consequences of these infections can vary according to immunologic resistance of the patient as well as the resistance of some germs to the most common antibiotics. Several factors should be taken in consideration in the treatment; patient history factors, germ virulence, maintaining or suppression of etiologic factors and drainage possibilities.

Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system

BACKGROUND

Little is known about the use of dental services during pregnancy. Yet research suggests that a pregnant woman's oral health and her pregnancy outcome may be associated.

METHODS

Four states collected oral health data a part of the Pregnancy Risk Assessment Monitoring System, or PRAMS, in 1998. PRAMS is an ongoing, population-based survey designed to obtain information from mothers who recently delivered live-born infants about their experiences and behaviors before, during and immediately after pregnancy.

RESULTS

Reports of dental care use during pregnancy ranged from 22.7 to 34.7 percent. In three states, 12.2 percent to 25.4 percent of respondents reported having a dental problem and of these, 44.7 percent to 54.9 percent went for care. Among mothers reporting a dental problem, prenatal care, or PNC, insurance through public funding and late PNC entry were significantly associated with their not getting dental care.

CONCLUSIONS

Most mothers did not go for dental care during their pregnancy; among those who reported having problems, one-half did not get dental care.

PRACTICE IMPLICATIONS

Attention toward the oral health needs of pregnant women is warranted. A coordinated effort from the dental and obstetric communities to establish guidelines could benefit maternal oral health and perinatal outcomes.

Dental disease indices and caries related oral microflora in children with phenylketonuria

The purpose of this study was to investigate the dental caries, plaque and gingivitis indices and caries related oral flora in children with classic phenylketonuria. Forty-one children at The Great Ormond Street Hospital for Children and controls were included in the study. The main findings were: No significant difference in the decayed, missing and filled surfaces of the primary and permanent teeth between the phenylketonuria children and the controls. A significantly greater mean plaque score for the control children compared with the phenylketonuria children (p < 0.01) for the permanent teeth only. A significantly greater number of white opacities in the permanent teeth of the phenylketonuria group compared with the control group (p < 0.02). No significant differences in the caries related microflora.

Dental infections masquerading as skin lesions

Dental infection is a common cause of facial sinus; the external opening can masquerade as a variety of lesions. Surgical excision of the skin component alone fails to address the underlying problem and results in recurrence. Recognition and treatment of the underlying dental infection is required to allow the resolution of the associated skin lesion. Two illustrative cases are presented.

Delayed tooth eruption: association with severity of HIV infection

PURPOSE

HIV status is monitored by expression of clinical symptoms as well as CD4 lymphocyte counts. The purpose of this study is to assess the relationship between delayed dental eruption (DDE) and the progression of pediatric HIV infection to AIDS.

METHODS

A population of 70 perinatally HIV-infected children, aged 5 months to 13 years at their time of entry into the study, received dental examinations. Regression analysis between dental age and chronological age was performed. Subject CDC classification, adjusted for age, was used to determine an association between eruptive delay and severity of disease progression.

RESULTS

Data revealed no significant difference in timing of eruption based on severity of CD4 depletion alone (P = 0.09). However, clinical symptom status was strongly associated with DDE (P = 0.003). The relationship between symptoms and DDE persisted after controlling for CD4 depletion.

CONCLUSIONS

Our study indicates that there is a correlation between the progression from HIV infection to Pediatric AIDS and DDE and that this delay is most closely linked to severity of symptoms and not CD4 depletion.

Successful aging--the case for prosthetic therapy

Reduced chewing ability in community-dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long-term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.

Purulent pansinusitis, orbital cellulitis and rhinogenic intracranial complications

OBJECTIVES

Acute pansinusitis is rarely seen in the maxillofacial surgery field, but often occurs in combination with orbital and intracranial involvement. Clinically this entity is of great importance, since it represents a severe disease with possibly disastrous consequences.

PATIENTS

Aetiology, diagnosis and therapy of acute pansinusitis and its complications were analysed in 36 patients treated surgically from 1987 to 1996.

RESULTS

Eighteen patients were aged between 3 and 21-years-old. Only eight suffered from pure pansinusitis, and three of an isolated purulent orbital infection. Of these 25 patients 20 had (pan-)sinusitis with orbital, three with intracranial, and two with both orbital and intracranial complications. Intracranial involvement included meningitis, empyema and brain abscess. Aetiology was rhinogenic in 26, odontogenic in six patients, and traumatic in two cases. Radiological work-up included conventional radiographs and CT in most cases, MRI was only used with special indications. Microbiological examination detected single or multiple species of micro-organisms with equal frequency. If multiple species were found, infection was mostly aerobic/anaerobic in combination.

CONCLUSION

These purulent processes, frequently seen in young patients, require immediate surgical intervention and drainage with elimination of the cause of the disease if possible. Cooperation with other specialities is essential depending on the spread of the disease. In spite of the threatening acute symptoms, severe courses of disease or permanent defects should be avoidable.

[Odontogenic chronic maxillary sinusitis: regenerative possibilities of oro-antral defect]

Odontogenic maxillary sinusitis often develops into a chronic picture of unilateral inflammation, progressively interesting the whole antrum mucosa. The only decisive therapy of this pathology is a surgical one that, by completely removing pathologic tissues, starts sinus restoration by a healthy respiratory mucous membrane. This tissue grows from the nasal cavity after the radical surgery (according to Caldwell-Luc), presupposing an antrum drainage through that same cavity. Nevertheless, if the inflamed area is just limited in the central and posterior recesses, and the hiatus semilunaris of the medial wall remains open, it is possible to avoid a surgical access to the nasal cavity. In this way, an alternative surgery is proposed for chronic sinusitis which, using principles of Guided Bone Regeneration, permits to completely remove pathologic tissues and to start bone reformation in the damaged alveolar.

Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures

OBJECTIVE

To estimate the cumulative exposure to bacteraemia from dental procedures currently recommended for antibiotic prophylaxis and compare this with cumulative exposure from dental procedures not recommended for prophylaxis.

DESIGN

Retrospective analysis.

SETTING

University and teaching hospital maxillofacial and dental department.

PATIENTS

136 children with severe congenital cardiac disease attending for dental treatment between 1993 and 1998 and for whom full records were available. Each dental procedure was tallied.

MAIN OUTCOME MEASURES

Cumulative exposure per annum to "non-prophylaxis procedures"; cumulative exposure per annum to "prophylaxis procedures".

RESULTS

Cumulative exposure to bacteraemia from prophylaxis procedures was not significantly greater than from non-prophylaxis procedures.

CONCLUSIONS

The data raise important questions about the appropriateness of current guidelines for antibiotic prophylaxis of bacterial endocarditis.

Oral health management implications in patients with tuberous sclerosis

We report 6 cases of patients with tuberous sclerosis and concomitant dental pathosis. The multiple manifestations in tuberous sclerosis determine its impact on dental therapy. A lack of awareness of this condition may compound the possible side effects of dental treatment. Possible preventive measures by dentists are highlighted in this presentation. Medical evaluation and the control of risk factors in relation to general anesthesia and sedation are key considerations for the management of patients with tuberous sclerosis.

[A handbook project designed to sensitize the illiterate population to orodental preventive care]

In many poor countries, the number of "illiterate people" is often very high. In order to sensibilize these populations to dental caring, the authors propose a series of frames based on the mental association with their traditional lifestyles. With only ten series of drawings they deal with: morphology, hygiene, cares, smile, functional and aesthetic importance of mouths and teeth. To conclude, the authors insist on the fact that this way of sensibilisation is all the more efficient that it is beyond dialects, ethnic groups and boundaries.

[Large cysts of dental origin in the maxilla]

The authors give a common survey of clinical and pathological appearance of cysts of maxillary sinuses, especially their dental origin. They review the possibilities of diagnosis and show the treatment technic they used the past 4 years on 11 cases. They emphasise the importance of radiological controlling the root canal treated teeth and the role of the dentist in instructing the patient about this.

Hepatitis C infection and associated oral health problems

Hepatitis C infection is widespread throughout the community. This study aimed to assess the status of oral health of persons infected with hepatitis C. DMFT and CPITN indices were recorded at a clinic providing priority dental care for people with hepatitis C infection. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using a modified Oral Health Impact Profile questionnaire. The DMFT index differed significantly between hepatitis C and general patients. The number of decayed and missing teeth was greater in those infected with hepatitis C for all patients aged between 25 and 50 years. Although there was no significant difference in CPITN categories for subjects evaluated, a marked trend for poor periodontal health was noted for those individuals with hepatitis C. Salivary flow was reduced in 50 per cent of hepatitis C infected subjects. Social impact was significantly affected with 71 per cent of hepatitis C subjects reporting painful aching in the mouth and 56 per cent having difficulty in relaxing. In conclusion, the results from the project strongly indicate an urgent need for priority delivery of dental care for people with hepatitis C infection.

[Clinical classification of chronic odontogenic maxillary sinusitis]

Examination of 248 patients with odontogenic maxillary sinusitis (OMS) has shown that most of OMS forms run a chronic course. Their clinical classification is outlined with a special emphasis on the latent form which occurs in 16.5% of the examinees. An open form of OMS was diagnosed in 51.6% of the patients. Treatment of chronic OMS is surgical in many cases: maxillary sinusotomy with upper jaw teeth examination and treatment.

Oral health of patients scheduled for elective abdominal aortic correction with prosthesis

OBJECTIVE

to evaluate the frequency of potential oral foci of infection in patients scheduled for elective abdominal aortic surgery.

DESIGN

prospective clinical study.

MATERIALS

oral health and dentures of 50 patients (33 males and 17 females, mean age 65 years) were examined before aortic surgery.

CHIEF OUTCOME MEASURES

radiographic and clinical examination with special emphasis on identifying acute and chronic oral and ontogenic conditions which may contribute to aortic prosthesis infection.

RESULTS

eighty-two per cent of the patients had some oral infection foci. The mean number of remaining teeth in the cohort was 9.3, and 21% of these were potential infectious foci (62% in the patients). Twenty-six per cent of the patients suffered from oral Candida infection. Seventy-four per cent of the patients had total or partial dentures, 45% of which were ill-fitting and needed repair.

CONCLUSIONS

oral infectious foci occur frequently in patients needing aortic surgery. Untreated foci may contribute to aortic prosthesis infection. Preoperative oral evaluation and elimination of intraoral infection is recommended for patients scheduled for abdominal aortic repair.

Tooth-related issues

Several conditions exist around teeth that may predispose the periodontium to disease. These situations may occur as a result of the condition or position of teeth or as a result of tooth treatment. In certain cases these tooth-related factors may contribute to the initiation of periodontal disease. While the etiology of periodontal disease is bacterial, factors that enhance bacterial accumulation or allow the ingress of bacteria into the periodontium should be considered in the classification and diagnosis of periodontal diseases. This is because many times these tooth-related issues can cause site-specific problems that require treatment in an otherwise intact periodontium. Several factors related to tooth/root anatomy, restorative, and endodontic considerations have been associated with gingival inflammation, attachment loss, and bone loss. These factors will be reviewed as they relate to their potential to promote damage to the periodontium.