[Disclosure of Behcet disease by concomitant dental infection]

BACKGROUND

Behçet's disease can be aggravated by chronic infection. Our case illustrates how the disease can be disclosed during an acute activation of a chronic infectious focus.

CASE REPORT

A 40-year-old man had Behçet's syndrome associating fever, bipolar aphtosis, cutaneous pseudo folliculitis, anterior uveitis, and meningitis following an acute episode of a dental infection, with periapical granuloma. Antibiotic therapy was ineffective in calming this first flare-up of Behçet's disease. Corticosteroid and colchicine therapy were effective.

DISCUSSION

Clinical and experimental work would implicat buccal streptococcal flora in the pathogenesis of Behçet's disease. Antibiotics offer interesting perspectives but further studies are needed to define their role in the treatment of Behçet's disease.

Clinical findings in Japanese children with obstructive sleep apnea syndrome: focus on dental findings

We evaluated clinical findings including those on dentistry and in the oral cavity of children with obstructive sleep apnea syndrome (OSA). This study examined twenty-seven OSA children, who were advised by otolaryngologists to be admitted for closer examination and showed an apnea index (AI) of 5 or more on polysomnographs. Their clinical history was obtained from their mothers, and oral findings were also evaluated. The patient consisted of 15 males (56%) and 12 females (44%). The mean body mass index (BMI) was 16.0 +/- 3.0. Of the clinical findings related to sleeping and the duration of sleeping, snoring was the most frequently observed finding (100%). The mean duration of sleep, calculated from the time they went to bed (9.2 +/- 0.8 p.m.) and the time they got up (7.1 +/- 0.8 a.m.), was 9.9 +/- 1.0 hours. Of the clinical findings obtained during the daytime, hyponasal speech was the most frequently observed finding (74%). In terms of dentistry, oral breathing was the most frequently observed finding (89%). The mean duration of meals was 31.7 +/- 13.8 minutes. Results of oral examination revealed that Hellman's dental age was most frequently IIA. According to the standardized grading classification, grade I was observed in 7%, II in 63%, and grade III in 30% of subjects.

Dental neglect: definition and prevention in the Louisiana Developmental Centers for patients with MRDD

When dental services and appropriate use of restraints are used for persons who are severely and profoundly mentally retarded and developmentally disabled (MRDD), oral health is enhanced and dental neglect is controlled or even reduced. This paper defines dental neglect and examines the consequences to persons who are MRDD when appropriate restraints and preventive dental home care are not used. Oral health outcome assessment data of this MRDD population indicate the presence or absence of dental neglect. The outcome assessment measures the level of oral health within the developmental center. The Louisiana Department of Health and Hospitals (DHH) operates nine developmental centers, where approximately 2000 individuals with severe to profound mental handicaps reside. Two-thirds (66%) of this population are resistive to the delivery of clinical and preventive dental services. The responsibilities and roles of dental health professionals, long-term-care facility administrators, and direct service staff are discussed to help reduce dental neglect in these centers. For these individuals to receive quality and comprehensive dental care, appropriate use of restraint/physical hold is necessary. The Dental Health Resource Program (DHRP) developed guidelines for delivering preventive and clinical dental services to reduce confusion and misinterpretation of the definition and use of restraint in the Louisiana Developmental Centers (LADCs).

Denture possibilities for patients with mental disorders

Patients with mental disorders, due to their specific physical and social status, often lack the possibility for appropriate dental treatment. The objective of our study aims at creating an adequate approach and prospective for currative plan casual. We represent two clinical cases, treated in a different way and we conclude, that every separate patient requires individual approach, from the first contact, through diagnosing and decision making for plan of treatment. Our experience implies that the mental status of the patients is not a reason for refusal of dental treatment.

High-altitude illness induced by tooth root infection

High-altitude illness may occur after recent pulmonary infection, but high-altitude illness after root canal therapy has not been described previously. A 44-year-old man is presented who skied to a 3333 m high peak in the Eastern Alps one day after he had undergone root canal therapy because of a tooth root infection. After 4 hours above 3000 m severe symptoms of high-altitude illness, including pulmonary oedema, developed. His condition improved after immediate descent. The next day he presented with local and general signs of infection which were successfully treated with gingival incisions and antibiotics. In conclusion, acute tooth root infection and root canal therapy may induce high-altitude illness at an altitude just above 3000 m.

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 2. Odontogenic sinus disease and elective clinical procedures involving the maxillary antrum: diagnosis and management

Although odontogenic sinusitis is a rare entity when compared to sinus disease of rhinogenic origin, it is extremely important to identify a dental aetiology when it occurs. The offending tooth or teeth would thus require endodontic treatment or extraction, and the sinus disease carefully assessed and appropriately managed. Aetiology and presentation of oro-antral fistulae are also discussed and guidelines for the management of this complication are recommended. Certain lesions such as cysts and tumours may involve the jaws and hence the maxillary antrum; some of these, such as a radicular cyst are quite common, but the rarer ones are included for completeness. Surgical techniques are continuously evolving to optimise form and function of the jaws, and when applied to the maxilla there may be some impact on nasal and sinus function. The advent, and now proven success, of osseointegrated jaw implants have brought with them innovations and refinements of bone grafting techniques, and more recently distraction osteogenesis for augmentation. Maxillary osteotomies for surgical orthodontics, and to facilitate prosthodontic treatment are briefly mentioned, as most of these inevitably involve the antrum and/or nose. This paper discusses, in summary form, important aspects of clinical dental practice which may involve the maxillary antrum. It is thus a broad overview of certain pathologic conditions and elective surgical procedures which have relevance to both medical and dental practitioners.

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 3. But doctor, my ear hurts

Temporomandibular disorders (TMD) can present as an array of symptoms that can mimic both odontogenic and ear, nose, and throat (ENT) disorders. Dentists need to be alert to the possibility of primary ENT disorders in patients who present with TMD symptoms, as should ENT physicians be familiar with the clinical presentation of TMD, especially in those patients who present with ENT symptoms but no sign of ENT disease.

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 1. The differential diagnosis of tooth sinus pain--the dentist's view

The close relationship of the teeth and the maxillary sinus requires both communication and cooperation between the dentist and the ENT specialist to ensure the best outcome for the patient.

The differential diagnosis of sensitive teeth

A major presenting complaint in dental practice is of sensitive teeth. In order to manage the problem well, a correct diagnosis is essential. Whilst it is true that 'common things occur commonly', one should consider all possible causes of pain in taking a history and examining the patient. This paper summarizes how to identify the potential causes of such a complaint.

Cutaneous sinus tracts of dental origin: clinical review of 37 cases

Cutaneous sinus tracts in the face and neck region are often dental in origin. The purpose of this study was to characterize the clinical features and treatment of 37 consecutive cases of odontogenic cutaneous sinus tracts, collected and reviewed in a 15-year period. More than half of the patients (21 cases, 57%) were referred from medical doctors, particularly plastic surgeons and dermatologists. The sinus tracts were associated with caries (26 cases), incomplete endodontic treatment (7), crown fracture (2), vertical root fracture (1) and impacted mandibular third molar (1). They occurred most often in adolescents and adults (30 cases, 81%). The most common causative teeth were mandibular teeth (34 teeth, 85%). The chin, submental, and cheek areas were the most common sites of sinus tracts (30 cases, 81%). The majority of causative teeth (32 teeth, 80%) were treated endodontically. All fistulas healed uneventfully after proper dental treatment, without cosmetic surgery. In 63% (20 cases) of the recorded cases, complete resolution occurred within 8 weeks. Half of the patients had had fistulas for more than 6 months before receiving dental treatment, demonstrating that delays in proper diagnosis and treatment were common. As most patients suffered from unnecessary medication or surgery due to the delay of dental treatment, early dental consultation and treatment is important. Conventional endodontic treatment should be the treatment of choice if the tooth is salvageable. The increasing incidence of incomplete endodontic treatment in association with the occurrence of sinus tracts indicates that standardized endodontic therapy should be emphasized for prevention.

Pretherapy dental decisions in patients with head and neck cancer. A proposed model for dental decision support

OBJECTIVE

The proposed model was designed to function as a tool for the development and testing of evidence-based clinical guidelines for the pretherapy oral screening and dental management of patients with head and neck cancer.

STUDY DESIGN

Methods of clinical decision analysis were used to analyze the decision dilemma and construct a decision algorithm and decision tree. The robustness of the model was tested by means of a probabilistic sensitivity analysis with second-order Monte Carlo simulations (n = 10.000).

RESULTS

Clinical criteria for evaluating dental pathologic conditions and malignancy- and patient-related conditions were transformed in probability estimates. The tradeoffs between the benefits and drawbacks of the dental intervention were integrated into the model to identify the optimal option for dental intervention. The calculation process of "folding back and averaging out" the decision tree enabled the identification of the optimal options for dental intervention in four different pretherapy risk conditions.

CONCLUSIONS

A priori testing of the proposed model with 95% confidence intervals suggests that it has a great potential for solving clinical dilemmas associated with pretherapy dental decision-making. In addition, it seems a useful tool for the development of evidence-based clinical guidelines. A posteriori clinical testing should further validate the model before its assimilation into clinical practice takes place.

A survey of oral health in a population of adults with developmental disabilities: comparison with a national oral health survey of the general population

During 1991, an oral health assessment of 101 adults with developmental disabilities aged from 21 to 53 years was undertaken as part of a broader health survey which also included medical, psychological and nutritional assessments. The study group consisted of a random sample of adults chosen from the developmentally disabled population known to be living in the lower North Shore area of Sydney. This paper describes the results of the oral health assessment and compares them with an oral health survey of the Australian population done in 1987/88. Forty-six per cent of the study group were males (mean age 33.5 years) and 54 per cent were females (mean age 33.0 years). Compared with similar age subgroups in the Australian population, the following factors were more frequently reported in the developmentally disabled group: a dental visit in the last 12 months (65 per cent vs 50 per cent; Odds Ratio (OR) 1.9:95 per cent Confidence Interval (CI): 1.3-2.8); use of public rather than private dental services (42 per cent vs 6 per cent; OR 11.3:95% CI 7.5-16.9); oral mucosal pathology requiring treatment (15 per cent vs 2 per cent; OR 8.5:95% CI 5.2-13.8); severe periodontal disease (16 per cent vs 3 per cent; OR 6.9:95% CI 4.2-11.4); and moderate to severe malocclusion (26 per cent vs 11 per cent; OR 2.1:95% CI 1.3-3.5). Fifty-eight per cent of subjects felt they needed no dental treatment but on examination of the oral mucosa, periodontal tissues and teeth, over 90 per cent were found to require some sort of dental treatment.

Assessing the relationship between dental disease and coronary heart disease in elderly U.S. veterans

Several recent studies have shown a link between dental disease and coronary heart disease. The authors studied 320 U.S. veterans in a convenience sample to assess the relationship between oral health and systemic diseases among older people. They present cross-sectional data confirming that a statistically significant association exists between a diagnosis of coronary heart disease and certain oral health parameters, such as the number of missing teeth, plaque benzoyl-DL-arginine-naphthylamide test scores, salivary levels of Streptococcus sanguis and complaints of xerostomia. The oral parameters in these subjects were independent of and more strongly associated with coronary heart disease than were recognized risk factors, such as serum cholesterol levels, body mass index, diabetes and smoking status. However, because of the convenience sample studied, these findings cannot be generalized to other populations.

[Odontogenic (concomitant) etiology of headache]

A systematic follow-up showed that out of 785 headache patients 1/4 had odontogenic pathogenic factors with possible connections to the headache syndrome and were indicated to be operated. 158 could be systematically examined and (surprisingly enough) improvement of headache syndromes ranking at 2/3 was about equally frequent within the group of those who had undergone dental operation and those that had not wanted to do so. In sub-groups different responses to operation were observed: cephalaea (permanent headache), better than migraine (attack figured headache); etiology of wisdom-tooth better than other tooth-pathology; upper jaw better than lower jaw. Our results once more underlined the multifactorial etiology of headache, that is opposed to a monocausal oriented headache diagnosis (as the IHS-nomenclature tries to impose). Still it has considered to be relevant that a good diagnostic examination in the field of tooth-, jaw- and mouth medicine should be conducted in every headache patient, even in "typical" migraine patients. When indicated, operations should be done; however the patient properly informed that improvement is not obligatory. Same time all the other possible etiologies for headaches shall be regarded and if positive treated.

Dental erosion associated with soft-drink consumption in young Saudi men

This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) of young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar 'cuppings', DMFT and DMFS, visible plaque index, and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks. Other statistically significant associated factors, although of less predictive strength, were type of cleaning aid and gingival bleeding index. In subgroup comparisons, dental problems (primarily pain), number of buccal cervical defects, and number of missing teeth were significantly greater in the high- than in the low-erosion subgroup.

Oral health and history of respiratory tract infection in frail institutionalised elders

OBJECTIVES

The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects.

SETTING AND SUBJECTS

302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist.

OUTCOME MEASURES

The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders.

RESULTS

One third (33%) of the subjects had experienced at least one episode of RTI, and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P = 0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1-3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5-6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated.

CONCLUSIONS

The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.

[Psychiatric and psychologic aspects of stomatologic diseases, or stomatologic aspects of psychiatric diseases. Review of the literature]

Dental symptoms, oral medicine and psychiatric and psychologic problems have strict relationships in several domains. Behavior and behavioural problems (deficient oral hygiene, lack of regular dental control, dependence of nicotine or alcohol, etc.) as well as certain psychiatric diseases influence the patients' dental state to a great extent. There are further problems determined by the different types of anxiety, fear and bad previous experiences which have an impact on people's attitudes towards dental treatment and the development of hygienic habits. Dentists' psychologic and psychiatric knowledge can have a considerable contribution to the reduction of the patients' anxiety, furthermore to an appropriate treatment, by the recognition of the underlying psychiatric disease.

Oral disease burden in patients undergoing prosthetic heart valve implantation

BACKGROUND

Valvular heart disease predisposing to endocarditis and requiring prosthetic valve implantation is common among the elderly. Spontaneous bacteremias associated with acute or chronic oral/odontogenic infections may represent a far greater cumulative risk for the development of endocarditis than do occasional health care procedures administered in a professional setting.

METHODS

To determine the oral disease burden in patients undergoing mechanical or bioprosthetic heart valve implantation, we performed a comprehensive clinical and radiographic regional examination on 156 consecutive patients, with emphasis on identifying acute and chronic oral/odontogenic infections and conditions.

RESULTS

The mean number of remaining teeth in the cohort was 19.32; of these, 1.07 were carious, involving a mean number of 2.51 tooth surfaces. In addition, 15.38% of the patients had evidence of acute or chronic periapical abscesses, and 43.6% of the patients had moderate to advanced periodontitis.

CONCLUSIONS

In view of the substantial morbidity and mortality associated with prosthetic valve endocarditis and based upon the high incidence of dental disease identified in patients undergoing valvular operations, routine preoperative dental assessment should be deemed a "medical necessity" by third-party payors. Appropriate therapeutic intervention should be initiated whenever possible before valve implantation.