Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial

CONTEXT

It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates.

OBJECTIVE

We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery.

DESIGN, SETTING AND PARTICIPANTS

Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53).

INTERVENTION

a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning.

PRIMARY OUTCOME

the presence of infection.

RESULTS

The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days.

CONCLUSION

The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events.

CLINICAL TRIAL REGISTRATION

Site Ensaclinicos.gov.br number U1111-1214-2862.

DESCRIPTORS

Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.

Effectiveness of a training program for the nursing staff on the oral health of institutionalised aged. Randomised trial

Background: it has been suggested that nursing-staff’ should be educated in maintaining the oral health (OH) of institutionalised elder people. Objective: this work aimed for measuring the effectiveness of a 3-hour oral health training-programme (OHTP) provided to nursing-staff by assessing the residents’ OH gains. Materials and methods: this was a one-year longitudinal-controlled-interventional study evaluated via a nursing-staff’ questionnaire and residents’ oral examinations. Managers of 30 nursing homes in Granada, Spain, were contacted and offered three oral examinations for their residents and an OHTP for the nursing-staff; nine of them consequently agreed to participate for all consenting people. 269 residents were examined at baseline and 12 months. After the baseline examination, the nursing homes were randomised into an intervention or control group; the OHTP was then carried out on the intervention group. Results: the residents’ denture hygiene (p=0.03) and wearing of dentures at night (p=0.003) improved significantly in the intervention group; caries prevalence increased in both groups. Conclusions: the OHTP was effective for improving caregivers’ knowledge and OH care routines, but the improvements were not enough to improve residents’ overall OH.

Implications of Differential Expression of β-Catenin in Oral Carcinoma

BACKGROUND

Alterations of β-catenin can promote cancer progression, but there has been little analysis of this protein in oral squamous cell carcinoma (OSCC). The objective of this study was to investigate the role of β-catenin in OSCC development.

MATERIALS AND METHODS

Expression of β-catenin and Ki-67 from 92 OSCC was immunohistochemically studied in tissues close to the tumor invasion point and, in 37 cases, in tissues distant from the invasion point.

RESULTS

Loss of membranous β-catenin expression was observed in 77.2% of "close" samples and 94.4% of "distant" samples. Nuclear β-catenin expression was detected in 35.9% of adjacent samples and 44.4% of "distant" samples. Nuclear β-catenin expression in ≥10% of cells was observed in 6.6% of "close" samples and 25% of "distant" samples. No relationship was found between β-catenin expression and cell proliferation.

CONCLUSION

β-Catenin plays a major oncogenic role in OSCC, principally through increase in invasiveness due to loss of its membranous expression.

Assistência à saúde bucal em residências geriátricas de Granada, Espanha e Santa Catarina, Brasil*

Resumo Objetivo: Descrever a assistência à saúde bucal nas residências geriátricas da Província de Granada, Espanha, e Estado de Santa Catarina, Brasil, e comparar os dados obtidos. Metodologia: Trata-se de estudo exploratório, transversal. Os dados foram coletados por meio de questionário fechado, enviado pelo correio, para todas as residências geriátricas cadastradas em Granada (99) e Santa Catarina (78), em 2005. Resultados: O perfil das residências (29 em SC e 30 em Granada) foi semelhante, com predominância de instituições privadas. Não houve diferenças estatísticas significativas quanto aos residentes, exceto quanto ao número de instituições acima da mediana combinada para quantidade de mulheres e idosos totalmente dependentes, superiores em Granada. Embora as residências granadinas apresentassem maior número de profissionais da saúde, não houve diferenças quanto à insuficiente assistência à saúde bucal aos idosos, considerados: registro das condições de saúde bucal, circunstâncias em que essas condições são (re)avaliadas e realização sistemática de higiene bucal. Em face de um problema de saúde bucal apresentado pelo idoso, a família é comunicada, com maior frequência, nas residências granadinas. Conclusões: A assistência à saúde bucal não é prática sistemática nas instituições investigadas, em ambas as regiões, que transferem à família ou aos serviços locais de saúde o encaminhamento quando surgem problemas. Os procedimentos de higiene mais apontados foram escovação de dentes e próteses, porém práticas ineficazes são citadas. Foi frequente a alegação de falta de cooperação dos idosos para justificar a ausência de uma higiene bucal sistemática, revelando transferência de responsabilidades das instituições e cuidadores para o idoso.

Alopecia areata of dental origin

The association of alopecia areata and infectious foci of dental origin is relatively common, and may be explained by the autoimmune nature of the disorder. We describe a case of alopecia areata with no apparent cause and that was effectively resolved by eliminating a focalized dental infection via endodontic treatment. The presence of common immune mediators in the pathogenesis of both alopecia areata and dental infection could account for the dental origin of the hair loss. In this sense, patients with localized alopecia should be subjected to careful exploration of the oral cavity in search of possible dental infections.

Thalassemias and their dental implications

Thalassemias constitute a form of anemia that pose clear problems in relation to dental treatment. Dental professionals must be aware of the treatment adaptations required in patients with severe forms of beta-thalassemia. Until medical research is able to afford a definitive solution to these diseases (thereby greatly simplifying the dental management of such patients), effort will continue to center on the improvement of available therapeutic modalities, with the aim of obtaining effective and inexpensive oral chelators and drugs that either individually or in combination allow increases in fetal hemoglobin levels. Undoubtedly, the use of such measures together with serial blood transfusions has made it possible for an ever increasing number of patients with beta-thalassemia to reach adult age, where the provision of integral rather than merely palliative dental treatment must be seriously considered. At present, the clinical orofacial manifestations caused by the erythroid mass expanding the facial bones - resulting in dental malocclusions and protrusions tend to be less intense as a result of early medical treatment. In the future, gene therapy may be expected to allow a normal facial appearance thanks to complete healing of the patient.