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van Noort HHJ, Harderwijk A, Everaars B, Akkermans R, van der Putten GJ, Waal GHD. The Dutch version of the Oral Health Assessment Tool: Translation and inter-rater reliability among community nurses. Int J Dent Hyg 2024; 22:140-147. [PMID: 37093920 DOI: 10.1111/idh.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 02/02/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Translating the Oral Health Assessment Tool (OHAT) into Dutch and assessing the inter-rater reliability among community nurses. METHODS The original version of the OHAT was translated following the five stages of the 'Guidelines for the Process of Cross-Cultural Adaptation'. After a forward and backward translation, consensus on the pre-final version was obtained in an expert panel discussion. This version was pre-tested on its comprehensibility among 31 nurses and hereafter finalized. Then, inter-rater reliability of the OHAT-NL was determined by two trained nurses during oral assessments of 37 care-dependent community-dwelling older people. Intraclass correlation coefficient (ICC) and the Cohen's kappa statistic for individual items were estimated. RESULTS Feedback from nurses in the pre-test did lead to minor changes of the OHAT-NL. Inter-rater reliability was good (ICC 0.79; 95% CI 0.63-0.89) on the total score. Agreement on item level ranged from fair to very good, the kappa ranged from 0.36-0.89. CONCLUSIONS OHAT is now available in Dutch having good inter-rater reliability among trained community nurses. Future research can further validate the OHAT-NL and develop intervention according to total OHAT-NL scores.
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Affiliation(s)
- Harm H J van Noort
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Nutrition, Physical Activity and Sports, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Anne Harderwijk
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
- Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Babette Everaars
- Research Group Innovations in Preventive Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Reinier Akkermans
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gert-Jan van der Putten
- Medical Department, Orpea Dagelijks Leven, Apeldoorn, The Netherlands
- Department of Oral Function and Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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BaHammam F, Durham J, Abdulmohsen B, Wassall R, McCracken GI. Oral health decline in patients after stroke: a qualitative study. Br Dent J 2023; 235:881-885. [PMID: 38066151 DOI: 10.1038/s41415-023-6558-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 12/18/2023]
Abstract
Introduction To develop and implement effective oral care interventions for patients after stroke, there is a need to understand the causes behind the decline in their oral health. This qualitative study was, therefore, undertaken to explore experiences and views of health service providers about the causes of oral health decline in this group of patients.Methods A purposively selected sample of healthcare service providers who work in two NHS Trusts in the North of England were interviewed utilising a semi-structured interview technique. Interviews were conducted with the assistance of a topic guide and continued until data saturation (n = 30) was reached. The constant comparative approach was used to analyse the data.Results Two major factors, perceived by the participants, were thought to cause oral health decline in patients after stroke. Post-stroke neurological deficits resulting in oral-related functional disturbances was the first. The second was the barriers leading to difficulties in performing or receiving daily oral care. These barriers were related to the patients, their service providers, or the environment in which care is being delivered.Conclusions This study described the major factors affecting the oral health of patients after stroke, which can offer a starting point for developing effective oral care interventions for them.
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Affiliation(s)
- Fahad BaHammam
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Justin Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bana Abdulmohsen
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca Wassall
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Giles I McCracken
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Antibiotic prophylaxis of infective endocarditis in oral and maxillofacial surgery: incomplete implementation of guidelines in everyday clinical practice. Int J Oral Maxillofac Surg 2020; 49:522-528. [DOI: 10.1016/j.ijom.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/12/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
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4
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Lund Håheim L, Schwarze PE, Thelle DS, Nafstad P, Rønningen KS, Olsen I. Low levels of antibodies for the oral bacterium Tannerella forsythia predict cardiovascular disease mortality in men with myocardial infarction: A prospective cohort study. Med Hypotheses 2020; 138:109575. [PMID: 32088522 DOI: 10.1016/j.mehy.2020.109575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/01/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
Antibody levels to periodontal pathogens in prediction of cardiovascular disease (CVD) mortality were explored using data from a health survey in Oslo in 2000 (Oslo II-study) with 12 1/2 years follow-up. IgG antibodies to four common periodontal pathogens; Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD) all termed collectively the "red complex", and Aggregatibacter actinomycetemcomitans(AA) were analysed. The study sample consisted of 1172 men drawn from a cohort of 6,530 men who participated in the Oslo II-study, where they provided information on medical and dental history. Of the study sample, 548 men had reported prior myocardial infarction (MI) at baseline whereas the remaining 624 men were randomly drawn from the ostensibly healthy participants for comparative analyses. Dental anamnestic information included tooth extractions and oral infections. An inverse relation was found for trend by the quartile risk level of TF predicting CVD mortality, p-value for trend = 0.017. Comparison of the first to fourth quartile of TF antibodies resulted in hazard ratio (HR) = 1.82, 95% confidence interval 1.12-2.94, p = 0.015, adjusted for age, education, diabetes, daily smoking, and systolic blood pressure. Specificity comparing decile 1 to deciles 2-10 of TF predicting mortality was 92.3%. We found an increased HR by low levels of antibodies to the bacterium T. forsythia predicting CVD mortality in a 12 ½ years follow-up in persons who had experienced an MI but not among non-MI men. This novel finding constitutes a plausible causal link between oral infections and CVD mortality.
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Affiliation(s)
- Lise Lund Håheim
- Department of Oral Biology, Dental Faculty, University of Oslo, Norway.
| | - P E Schwarze
- Norwegian Institute for Public Health, Oslo, Norway
| | - D S Thelle
- Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Norway; Department of Community Medicine and Public Health, University of Gothenburg, Sweden
| | - P Nafstad
- Norwegian Institute for Public Health, Oslo, Norway; Institute of Health and Society, Medical Faculty, University of Oslo, Norway
| | - K S Rønningen
- Department of Paediatric Research, Division for Women and Children, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - I Olsen
- Department of Oral Biology, Dental Faculty, University of Oslo, Norway
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Carmona IT, Diz Dios P, Scully C. Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin. J Dent Res 2016; 86:1142-59. [DOI: 10.1177/154405910708601203] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.
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Affiliation(s)
- I. Tomás Carmona
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
| | - P. Diz Dios
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
| | - C. Scully
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
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Abstract
Extraordinary technological advances have greatly accelerated our ability to identify bacteria, at the species level, present in clinical samples taken from the human mouth. In addition, technologies are evolving such that the oral samples can be analyzed for their protein and metabolic products. As a result, pictures are the advent of personalized dental medicine is becoming closer to reality.
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7
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Rogers GB. The human microbiome: opportunities and challenges for clinical care. Intern Med J 2015; 45:889-98. [DOI: 10.1111/imj.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/19/2014] [Indexed: 12/11/2022]
Affiliation(s)
- G. B. Rogers
- Microbiome Research; South Australian Health and Medical Research Institute Infection and Immunity Theme; School of Medicine; Flinders University; Adelaide South Australia Australia
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8
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Okui A, Soga Y, Kokeguchi S, Nose M, Yamanaka R, Kusano N, Morita M. Detection of Identical Isolates of Enterococcus faecalis from the Blood and Oral Mucosa in a Patient with Infective Endocarditis. Intern Med 2015; 54:1809-14. [PMID: 26179542 DOI: 10.2169/internalmedicine.54.3223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The detection of infective endocarditis (IE) of oral origin has been previously discussed. However, there are few reports confirming this infection using molecular biological techniques. We herein describe the case of a 67-year-old man who developed IE. Blood culture samples and strains obtained from the gingival and buccal mucosa showed 100% identity to Enterococcus faecalis JCM 5803 on sequencing of 16S rRNA gene fragments. A random amplification of polymorphic DNA (RAPD) analysis showed the same pattern for these samples, thus confirming the identity of E. faecalis isolates in the blood and oral mucosa. Our observations provide novel information regarding the level of identity between IE pathogens and oral bacteria.
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Affiliation(s)
- Akemi Okui
- Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital, Japan
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Abstract
Background. The pathophysiology of cardiovascular disease (CVD) includes inflammation in the development of atherosclerosis and thrombosis. Increasing evidence supports oral infections, and in particular the common periodontal disease, to be associated with CVD development. Periodontal infection is present in populations worldwide and in the moderate to mild form in about 35% of populations according to the World Health Organization. Objective. This review of the literature aims to present cross evidence from medical research disciplines that explore how oral infections can contribute to increase the risk for CVDs and how treatment of oral infections can reduce the risk for CVDs. Design. Review article. Results. Long-term exposure to active nontreated infections of the oral cavity presents an opportunity for bacteria, bacterial products, and viruses to enter the circulation. Toxic bacterial products enter the circulation, affecting atherosclerosis, causing platelet adhesiveness that results in clot formation, and establishing cardiac vegetation. Pathological observations have identified oral bacteria in heart valves, aortic aneurysms, and arterial walls. Clinical intervention studies on periodontal disease reduce the risk level of serological predictors for CVDs. Conclusions. This paper presents evidence across medical research disciplines for oral infections to be considered as one of the risk factors for CVDs.
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10
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Diz Dios P. Infective endocarditis prophylaxis. Oral Dis 2014; 20:325-8. [PMID: 24373017 DOI: 10.1111/odi.12221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
Antibiotic prophylaxis for infective endocarditis continues to be administered empirically, although its indications are ever more restrictive. Some expert committees have even suggested that antibiotic prophylaxis is unnecessary, rekindling the controversy between those who defend the scientific evidence and those working in clinical practice; in any case, this proposal will facilitate the undertaking of prospective placebo-controlled trials, so necessary to resolve this issue. In the meantime, the most prudent approach is to adopt the recommendations proposed by the expert committees in each country.
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Affiliation(s)
- P Diz Dios
- OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
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11
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Naveen Kumar V, van der Linden M, Menon T, Nitsche-Schmitz DP. Viridans and bovis group streptococci that cause infective endocarditis in two regions with contrasting epidemiology. Int J Med Microbiol 2013; 304:262-8. [PMID: 24220665 DOI: 10.1016/j.ijmm.2013.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/19/2013] [Accepted: 10/13/2013] [Indexed: 11/28/2022] Open
Abstract
Viridans group (VGS) or bovis group streptococci (BGS) are the major causes for streptococcal infective endocarditis (IE). However, the causative isolates are not sufficiently characterized. Using multilocus sequence analysis we have examined VGS and BGS (VGS/BGS) isolates that caused IE in southern India and Germany, two distant geographic regions with a contrasting IE epidemiology. Other than in Germany, the majority of patients (68%) in Chennai, southern India had an underlying rheumatic heart disease (RHD). In accord with the high prevalence of RHD in the younger population and with the expansive age structure of India, the median age (24 years) of the VGS/BGS endocarditis patients was lower than in Germany (63 years), where RHD is rare and the age structure is contractive. Both in Germany and in southern India, the majority of cases were caused by mitis group streptococci, however, with considerable differences in the spectra of causative (sub)species. BGS endocarditis was more frequent in Germany. The spectrum of VGS/BGS that cause IE differs considerably between distant geographic regions in which different predisposing conditions prevail. Therefore, improved microbiological diagnosis in IE may facilitate determination of the optimal therapy.
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Affiliation(s)
- Venkatesan Naveen Kumar
- Department of Microbiology, PG Institute of Basic Medical Sciences, University of Madras, Chennai 600113, Tamil Nadu, India
| | - Mark van der Linden
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, D-52074 Aachen, Germany
| | - Thangam Menon
- Department of Microbiology, PG Institute of Basic Medical Sciences, University of Madras, Chennai 600113, Tamil Nadu, India
| | - D Patric Nitsche-Schmitz
- Department of Medical Microbiology, Helmholtz Centre for Infection Research, D-38124 Braunschweig, Germany.
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12
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Fine DH, Furgang D, McKiernan M, Tereski-Bischio D, Ricci-Nittel D, Zhang P, Araujo MWB. An investigation of the effect of an essential oil mouthrinse on induced bacteraemia: a pilot study. J Clin Periodontol 2010; 37:840-7. [DOI: 10.1111/j.1600-051x.2010.01599.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Eskandari A, Abolfazli N, Lafzi A. Endocarditis Prophylaxis in Cardiac Patients: Knowledge among General Dental Practitioners in Tabriz. J Dent Res Dent Clin Dent Prospects 2008; 2:15-9. [PMID: 23285324 PMCID: PMC3533632 DOI: 10.5681/joddd.2008.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 02/13/2008] [Indexed: 12/04/2022] Open
Abstract
Background and aims
Dental procedures injuring oral tissues may induce bacterial release to blood stream that can cause infective endocarditis in susceptible patients. The aim of this study was to determine the level of knowledge of general dental practitioners (GDPs) in Tabriz, Northwest of Iran, regarding endocarditis prophylaxis in cardiac pa-tients receiving dental treatments.
Materials and methods
This was a cross-sectional, descriptive, analytical study that included 150 GDPs. All practitioners were given a self-administered questionnaire which consisted of three parts assessing their knowledge of cardiac diseases requiring prophylaxis, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis. Statistical analysis of data was carried out using independent t-test, one-way ANOVA and chi-square test.
Results
The level of knowledge among GDPs in three areas of cardiac diseases requiring prophylax-is, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis were 63.7%, 66.8% and 47.7%, respectively. Their overall level of knowledge regarding endocarditis prophylaxis was 59%. Association of the level of knowledge with age and practice period was statis-tically significant (P < 0.05). However, the level of knowledge was not significantly associated with gender or university of graduation in either of three areas evaluated (P > 0.05).
Conclusion According to our results, the knowledge of endocarditis prophylaxis among GDPs in Tabriz was in a moderate level. Regarding the importance of endocarditis prophylaxis in sus-ceptible patients, it should be more emphasized in the curriculum of dental schools and continuing dental education programs.
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Affiliation(s)
- Amir Eskandari
- Assistant Professor, Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Iran
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15
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Nagata E, Okayama H, Ito HO, Semba I, Inoue M, Oho T. Experimental infective endocarditis induced by human supragingival dental plaque in rats. Eur J Oral Sci 2007; 113:499-504. [PMID: 16324140 DOI: 10.1111/j.1600-0722.2005.00258.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human dental plaque is thought to contribute to disease, not only in the oral cavity but also at other body sites. To investigate the pathogenicity of dental plaque in tissues remote from the mouth, we examined the ability of human supragingival dental plaque to induce infective endocarditis (IE) in rats. In total, 15 out of 27 catheterized rats survived after intravenous injections with human supragingival dental plaque suspensions containing 3 x 10(6) colony-forming units (CFU) of bacterial cells. In surviving rats, infected vegetations were formed in all except one rat. The microbial composition of the infected vegetations was different from that of the respective dental plaque inocula, with Streptococcus oralis comprising the majority of the isolates. In rats affected with endocarditis, the aortic sinus was filled with fibrinous vegetation containing bacteria. Inflammatory cells infiltrated the aortic valve, the aorta adjacent to the valve, and the cardiac muscles. The inoculation of catheterized rats with a cell suspension of S. oralis isolate (5 x 10(6) CFU) was not lethal but capable of inducing endocarditis in all animals. The results suggest that if dental plaque were introduced into the bloodstream, it could serve as a potent source of bacteria causing IE in humans.
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Affiliation(s)
- Emi Nagata
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan.
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16
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Modic changes, possible causes and relation to low back pain. Med Hypotheses 2007; 70:361-8. [PMID: 17624684 DOI: 10.1016/j.mehy.2007.05.014] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 05/04/2007] [Indexed: 12/20/2022]
Abstract
UNLABELLED In patients with low back pain (LBP) it is only possible to diagnose a small proportion, (approximately 20%), on a patho-anatomical basis. Therefore, the identification of relevant LBP subgroups, preferably on a patho-anatomical basis, is strongly needed. Signal changes on MRI in the vertebral body marrow adjacent to the end plates also known as Modic changes (MC) are common in patients with LBP (18-58%) and is strongly associated with LBP. In asymptomatic persons the prevalence is 12-13%. MC are divided into three different types. Type 1 consists of fibro vascular tissue, type 2 is yellow fat, and type 3 is sclerotic bone. The temporal evolution of MC is uncertain, but the time span is years. Subchondral bone marrow signal changes associated with pain can be observed in different specific infectious, degenerative and immunological diseases such as osseous infections, osteoarthritis, ankylosing spondylitis and spondylarthritis. In the vertebrae, MC is seen in relation to vertebral fractures, spondylodiscitis, disc herniation, severe disc degeneration, injections with chymopapain, and acute Schmorl's impressions. The aim of this paper is to propose two possible pathogenetic mechanisms causing Modic changes. These are: A mechanical cause: Degeneration of the disc causes loss of soft nuclear material, reduced disc height and hydrostatic pressure, which increases the shear forces on the endplates and micro fractures may occur. The observed MC could represent oedema secondary to the fracture and subsequent inflammation, or a result of an inflammatory process from a toxic stimulus from the nucleus pulposus that seeps through the fractures. A bacterial cause: Following a tear in the outer fibres of the annulus e.g. disc herniation, new capilarisation and inflammation develop around the extruded nuclear material. Through this tissue it is possible for anaerobic bacteria to enter the anaerobic disc and in this environment cause a slowly developing low virulent infection. The MC could be the visible signs of the inflammation and oedema surrounding this infection, because the anaerobic bacteria cannot thrive in the highly aerobic environment of the MC type 1. PERSPECTIVES One or both of the described mechanisms can - if proven - be of significant importance for this specific subgroup of patients with LBP. Hence, it would be possible to give a more precise and relevant diagnosis to 20-50% of patients with LBP and enable in the development of efficient treatments which might be antibiotics, special rehabilitation programmes, rest, stabilizing exercise, or surgical fixation, depending on the underlying cause for the MC.
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Sakamoto H, Karakida K, Otsuru M, Aoki T, Hata Y, Aki A. Antibiotic prevention of infective endocarditis due to oral procedures: myth, magic, or science? J Infect Chemother 2007; 13:189-95. [PMID: 17721679 DOI: 10.1007/s10156-007-0537-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Indexed: 11/30/2022]
Abstract
Infective endocarditis (IE) can be induced by bacteremia attributable to dental procedures. To prevent this disease, prophylactic administration of antimicrobials prior to dental procedures has been recommended in several countries. However, no prospective study has proved its efficacy in a clinical setting. Recent recommendations from the American Heart Association (AHA) strongly suggested that dental work is not an important cause of IE; therefore, prophylactic use of antibiotics is of no use in most cases. Prevention of IE may be essential but its pathology and epidemiology remain unclear in various aspects. This article reviews the theoretical background of IE prophylaxis, and discusses how we should proceed when patients with a known cardiac disorder visit the dental clinic. The discussion includes antibiotics usage, daily maintenance procedures, and a possible new strategy with the use of antibacterial substances.
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Affiliation(s)
- Haruo Sakamoto
- Department of Oral Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan.
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Murdoch FE, Sammons RL, Chapple ILC. Isolation and characterization of subgingival staphylococci from periodontitis patients and controls. Oral Dis 2004; 10:155-62. [PMID: 15089925 DOI: 10.1046/j.1601-0825.2003.01000.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To isolate and characterize subgingival staphylococci from patients with periodontal disease and from periodontally healthy controls, to evaluate the periodontal environment as a potential source for systemic staphylococcal infections. METHODS Periopaper strips were used to isolate subgingival staphylococci from 28 patients with chronic periodontitis and 28 periodontally healthy age and sex-matched controls. Staphylococci were identified by microbiological methods and antibiotic resistance profiles determined. RESULTS Staphylococci were isolated from 54% diseased subgingival and 43% healthy subgingival sites in over 50% periodontitis patients and from 29% healthy subgingival sites in 54% controls. No significant differences in the frequency of isolation or numbers of staphylococci isolated from diseased and healthy sites were noted. Staphylococcus epidermidis was the predominant oral species. Seventy per cent (115 of 165) of all isolates were penicillin-resistant. CONCLUSIONS Subgingival staphylococci are present in both periodontitis patients and controls. In periodontitis there is an increased risk of bacteraemia because of the increased dentogingival surface area. The dental and periodontal health of patients at risk from haematogenous infections should therefore be maintained at a high level. Antibiotic resistance profiles of the oral staphylococcal isolates suggest that amoxicillin may no longer be a suitable antibiotic for prophylaxis against systemic infections such as prosthetic valve endocarditis.
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Affiliation(s)
- F E Murdoch
- The School of Dentistry, The University of Birmingham, St Chad's Queensway, Birmingham, UK
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Holmstrup P, Poulsen AH, Andersen L, Skuldbøl T, Fiehn NE. Oral infections and systemic diseases. Dent Clin North Am 2003; 47:575-98. [PMID: 12848466 DOI: 10.1016/s0011-8532(03)00023-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An association between periodontal infection and CVD has been revealed in some epidemiologic studies, whereas other studies were unable to demonstrate such an association. A link between the two diseases may be explained by shared established or nonestablished risk factors. Future studies with extended control of confounding factors and intervention studies may add to the understanding of a possible relationship between the diseases. In some cases, IE is caused by dental plaque bacteria. Several studies are suggestive of oral bacteria causing respiratory infection. The pathogenesis and course of a number of other diseases including DM and rheumatoid arthritis have been associated wish periodontitis, but more research is necessary to elucidate possible pathogenic interactions.
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Affiliation(s)
- Palle Holmstrup
- Department of Periodontology, School of Dentistry, University of Copenhagen, 20 Nørre Allé DK-2200, Copenhagen, Denmark.
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Coleman P. Improving oral health care for the frail elderly: a review of widespread problems and best practices. Geriatr Nurs 2002; 23:189-99. [PMID: 12183742 DOI: 10.1067/mgn.2002.126964] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral health is an important component of overall health, well-being, and quality of life for institutionalized elders. Despite reports by nurses of the importance of oral hygiene, empirical evidence shows that daily oral care interventions have not been effective in safeguarding the oral and general health of this vulnerable population. Effective practice must involve not only recognizing its importance but also ensuring that daily oral hygiene receives the same priority as other care practices.
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Affiliation(s)
- Patricia Coleman
- Syracuse University School of Nursing and the Center for Clinical Research on Aging, University of Rochester School of Nursing, in Rochester, N.Y., USA
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Abstract
The culture of viable microorganisms from the blood or from cardiac tissue is currently the most important test for diagnosis of IE. This is followed by phenotypic identification methods used for taxonomic positioning of isolates. However, in those cases where the invading microorganism is difficult or impossible to culture (including instances of prior antimicrobial treatment), molecular methods provide the best means for detection. Molecular identification methods, either nucleic acid target or signal amplification alone or in combination with sequence analysis can offer a more specific and in some cases a more rapid alternative to the phenotypic methods. We propose revised Duke criteria of IE, including positive identification of an organism by molecular biology methods.
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Affiliation(s)
- Annette Moter
- Charité – Universitätsmedizin Berlin, Institut für Mikrobiologie und Hygiene, Dorotheenstr. 96, 10117 Berlin, Germany
| | - Michele Musci
- Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dinah Schmiedel
- Charité – Universitätsmedizin Berlin, Institut für Mikrobiologie und Hygiene, Dorotheenstr. 96, 10117 Berlin, Germany
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Kowolik MJ, Dowsett SA, Rodriguez J, De La Rosa RM, Eckert GJ. Systemic neutrophil response resulting from dental plaque accumulation. J Periodontol 2001; 72:146-51. [PMID: 11288786 DOI: 10.1902/jop.2001.72.2.146] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is considerable current interest in putative relationships between oral and systemic diseases. Since the host response to oral bacteria may be the critical link in this association, our hypothesis was that dental plaque accumulation in healthy subjects would elicit a systemic inflammatory response. METHODS Twenty-three healthy subjects, aged 18 to 25, participated in a 4-phase study. An initial hygiene phase was followed by a 21-day experimental phase (the so-called experimental gingivitis model) in which subjects refrained from all oral hygiene practices, thus permitting the accumulation of bacterial plaque. At days 0, 7, and 21 total and differential peripheral white blood cell (wbc) counts, together with full mouth plaque and gingivitis scores, were recorded. Following a 28-day recovery phase, in which normal oral hygiene practices were resumed, subjects entered the final 21-day control phase which mirrored the experimental phase but with subjects maintaining normal oral hygiene practices. RESULTS The experimental model performed as anticipated with a correlation between plaque and gingivitis scores of 0.95, also reflecting subject compliance. Total wbc and neutrophil counts increased during the experimental phase. Furthermore, comparison of neutrophil counts between the experimental and control phases demonstrated a significantly higher cell count for the experimental phase on both days 7 and 21 (P= 0.0301 and 0.009, respectively). For total wbc, this was significant on day 21 (P= 0.0262). CONCLUSION The results of this study support the hypothesis that the accumulation of dental plaque can result in a measurable systemic inflammatory response, providing further in vivo data to support a mechanistic relationship between oral and systemic pathology.
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Affiliation(s)
- M J Kowolik
- Indiana University School of Dentistry, Indianapolis 46202, USA.
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Daly CG, Mitchell DH, Highfield JE, Grossberg DE, Stewart D. Bacteremia due to periodontal probing: a clinical and microbiological investigation. J Periodontol 2001; 72:210-4. [PMID: 11288795 DOI: 10.1902/jop.2001.72.2.210] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing. METHODS Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth. RESULTS Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth. CONCLUSIONS Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided.
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Affiliation(s)
- C G Daly
- Discipline of Periodontics, University of Sydney, Australia.
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Gendron R, Grenier D, Maheu-Robert L. The oral cavity as a reservoir of bacterial pathogens for focal infections. Microbes Infect 2000; 2:897-906. [PMID: 10962273 DOI: 10.1016/s1286-4579(00)00391-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dental procedures, but more importantly, oral infections and poor oral health can provoke the introduction of oral microorganisms into the bloodstream or the lymphatic system. The subsequent attachment and multiplication of these bacteria on tissues or organs can lead to focal oral infections. Pathogenic agents may also remain at their primary oral site but the toxins liberated can reach an organ or tissue via the bloodstream and cause metastatic injury. Finally, metastatic inflammation may result from an immunological injury caused by oral bacteria or their soluble products that enter the bloodstream and react with circulating specific antibodies to form macromolecular complexes.
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Affiliation(s)
- R Gendron
- Groupe de recherche en écologie buccale, Faculté de médecine dentaire, Université Laval, Cité universitaire,Québec, Canada
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Loesche WJ, Lopatin DE. Interactions between periodontal disease, medical diseases and immunity in the older individual. Periodontol 2000 1998; 16:80-105. [PMID: 10337306 DOI: 10.1111/j.1600-0757.1998.tb00117.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- W J Loesche
- Department of Biological and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, USA
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Igarashi T, Yamamoto A, Goto N. Direct detection of Streptococcus mutans in human dental plaque by polymerase chain reaction. ORAL MICROBIOLOGY AND IMMUNOLOGY 1996; 11:294-8. [PMID: 9028253 DOI: 10.1111/j.1399-302x.1996.tb00184.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Streptococcus mutans is an etiological agent in human dental caries. A method for the detection of S. mutans directly from human dental plaque by polymerase chain reaction has been developed. Oligonucleotide primers specific for a portion of the dextranase gene (dexA) of S. mutans Ingbritt (serotype c) were designed to amplify a 1272-bp DNA fragment by polymerase chain reaction. The present method specifically detected S. mutans (serotypes c, e and f), but none of the other mutans streptococci: S. cricetus (serotype a), S. rattus (serotype b), S. sobrinus (serotypes d and g), and S. downei (serotype h), other gram-positive bacteria (16 strains of 12 species of cocci and 18 strains of 12 species of bacilli) nor gram-negative bacteria (1 strain of 1 species of cocci and 20 strains of 18 species of bacilli). The method was capable of detecting 1 pg of the chromosomal DNA purified from S. mutans Ingbritt and as few as 12 colony-forming units of S. mutans cells. The S. mutans cells in human dental plaque were also directly detected. Seventy clinical isolates of S. mutans isolated from the dental plaque of 8 patients were all positive by the polymerase chain reaction. These results suggest that the dexA polymerase chain reaction is suitable for the specific detection and identification of S. mutans.
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Affiliation(s)
- T Igarashi
- Department of Oral Microbiology, Showa University School of Dentistry, Tokyo, Japan
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