The impact of timing and modalities of dental prophylaxis on the risk of 5-fluorouracil-related oral mucositis in patients with head and neck cancer: a nationwide population-based cohort study

PURPOSE

This study investigated the impact of dental prophylaxis on 5-fluorouracil (5-FU)-related oral mucositis (OM) according to the head and neck cancer (HNC) locations and treatment times.

METHODS

A total of 13,969 HNC participants, including 482 5-FU-related OM subjects and 13,487 comparisons were enrolled from the Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan between 2000 and 2008. All subjects were stratified into subgroups based on the times to perform chlorhexidine use, scaling, and fluoride application before 5-FU administration. The dental prophylaxis related to 5-FU-related OM was estimated by multiple logistic regression and represented with odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Fluoride gel application and scaling significantly impacted on OM development (p < 0.001), and the joint effect of fluoride gel and scaling induced 5-FU-related OM (OR = 3.46, 95% CI = 2.39-5.01). The risk of OM was raised 2.25-fold as scaling within 3 weeks before 5-FU-related chemotherapy (95% CI = 1.81-2.81), and a 3.22-fold increased risk of OM while fluoride gel was applied during 5-FU-related treatment (95% CI = 1.46-7.13).

CONCLUSION

Dental prophylaxis significantly affected 5-FU-related OM in the HNC population. A short interval between dental scaling or fluoride application and 5-FU administration may be associated with higher prevalence of OM. Scaling simultaneously combined with chlorohexidine promoted 5-FU-related OM in specific HNC patients excluding the oral cancer and nasopharyngeal cancer population. Proper timing of the prophylactic dental treatments prior to 5-FU therapy could reduce the risk to develop 5-FU-related OM.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013.

OBJECTIVES

1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I² = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence).

AUTHORS' CONCLUSIONS

For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.

Transient bacteremia induced by dental cleaning is not associated with infection of central venous catheters in patients with cancer

OBJECTIVE

The aim of this study was to determine the incidence of bacteremia resulting from dental cleaning and of subsequent established bloodstream infection (BSI) caused by oral microorganisms in patients with cancer with central venous catheters (CVCs).

STUDY DESIGN

Twenty-six patients with cancer with CVCs and absolute neutrophil count over 1000 cells/µL received dental cleaning without antibiotic prophylaxis. Periodontal status was assessed at baseline by using the Periodontal Screening and Recording (PSR) score. Blood cultures were drawn via the CVCs at baseline, 20 minutes into cleaning, and 30 minutes and 24 hours after cleaning. Medical records were monitored for 6 months.

RESULTS

Baseline blood culture results were negative in 25 patients. Nine of 25 patients (36%) had positive blood culture 20 minutes into cleaning, all associated with at least 1 microorganism typically found in the mouth. These 9 patients had significantly higher mean PSR score (3.22) compared with the other 16 (2.56; P = .035). These expected bacteremias did not persist, with blood culture results (0/25) at 30 minutes and 24 hours after cleaning showing no positivity (P = .001). There were no cases of CVC-related infection or BSI attributable to dental cleaning.

CONCLUSIONS

Bacteremia resulting from dental cleaning is transient and unlikely to cause CVC-related infection or BSI in patients with absolute neutrophil count greater than 1000 cells/µL.

Insufficient evidence to determine the effects of routine scale and polish treatments

DATA SOURCES

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register.

STUDY SELECTION

Randomised controlled trials (excluding split mouth) of routine scale and polish treatments with and without OHI in healthy dentate adults without severe periodontitis.

DATA EXTRACTION AND SYNTHESIS

Study assessment, data extraction and risk of bias assessment were carried out independently by two reviewers. Mean and standardised mean differences were calculated when different scales were reported. Fixed effects models were used as there were only a small number of studies.

RESULTS

Three studies involving a total of 837 patients, and all considered to be at unclear risk of bias were included. No studies reported any adverse effects. Only one trial (conducted in general practice) provided data comparing scale and polish versus no scale and polish. It found no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months. There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.One study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.

CONCLUSIONS

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

Dissemination of periodontal pathogens in the bloodstream after periodontal procedures: a systematic review

BACKGROUND

To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude, duration, prevalence and nature of bacteremia caused by periodontal procedures.

STUDY DESIGN

Systematic Review.

TYPES OF STUDIES REVIEWED

MEDLINE, EMBASE and LILACS databases were searched in duplicate through August, 2013 without language restriction. Observational studies were included if blood samples were collected before, during or after periodontal procedures of patients with periodontitis. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS).

RESULTS

Search strategy identified 509 potentially eligible articles and nine were included. Only four studies demonstrated high methodological quality, whereas five were of medium or low methodological quality. The study characteristics were considered too heterogeneous to conduct a meta-analysis. Among 219 analyzed patients, 106 (49.4%) had positive bacteremia. More frequent bacteria were S. viridans, A. actinomycetemcomitans P. gingivalis, M. micros and species Streptococcus and Actinomyces, although identification methods of microbiologic assays were different among studies.

CLINICAL IMPLICATIONS

Although half of the patients presented positive bacteremia after periodontal procedures, accurate results regarding the magnitude, duration and nature of bacteremia could not be confidentially assessed.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.

OBJECTIVES

The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information.

MAIN RESULTS

Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

The impact of Prasugrel, a new anti-platelet agent, on dental care of patients

With increasing usage of Prasugrel (Effient), a new and highly efficient antiplatelet agent, in the management of cardiovascular events, the potential for bleeding complications has also increased. This is further compounded by the lack of a reversal agent, therefore poses a problem for clinicians engaged in oral invasive procedures. A case in which a patient taking daily Prasugrel suffered significantly prolonged bleeding following dental cleaning is reported. Local measures were used to achieve hemostasis. It is prudent to consult the prescribing physician about the risk of Prasugrel-induced bleeding, the potential for recurrence of cardiovascular events with disruption of medication, and the appropriate management strategy in advance of planned oral invasive procedures. Local measures are the first line of approach for management of hemostatic complications associated with Prasugrel, and patients should be referred to specialized centers if local approach fails. As more data become available, further evidence-based guidelines can be established.

Inflammatory response to dental polishing and prophylaxis materials in rats

OBJECTIVE

To describe the tissue response to implanted polishing and prophylaxis materials using a rat model system.

MATERIAL AND METHODS

Two polishing pastes (diamond polishing paste and aluminum polishing paste), two prophylaxis materials (prophylaxis paste with fluoride and air polishing prophylaxis powder) and negative and positive controls were subcutaneously implanted in rats. Tissue specimens obtained after 2 days, 1, 4, 6 and 8 weeks after implantation were processed for routine hematoxylin and eosin staining and polarized light evaluation.

RESULTS

Air polishing prophylaxis powder produced a mild inflammatory response. A more intense inflammation was elicited by diamond polishing paste, and the prophylaxis paste with fluoride elicited an even greater response. The aluminum polishing paste produced the most severe and persistent tissue response, which was of the granulomatous type.

CONCLUSIONS

This finding suggests that foreign body reaction should be considered in a gingivitis that does not respond to plaque control or does not represent a mucocutaneous lesion.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided.

OBJECTIVES

The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 5th March 2007.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals; outcomes - tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and mean differences were calculated as appropriate using random-effects models.

MAIN RESULTS

Nine studies were included in this review. All studies were assessed as having a high risk of bias.Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry.

AUTHORS' CONCLUSIONS

The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

The prophylactic extraction of third molars: a public health hazard

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of "standard discomfort or disability"--pain, swelling, bruising, and malaise--result postoperatively, and more than 11000 people suffer permanent paresthesia--numbness of the lip, tongue, and cheek--as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard.

Effect of rinsing with povidone?iodine on bacteraemia due to scaling: a randomized-controlled trial

AIM

To investigate rinsing with povidone-iodine on bacteraemia caused by ultrasonic scaling.

MATERIAL AND METHODS

Sixty patients with gingivitis undertook a randomized, placebo-controlled trial in which 30 rinsed with 0.9% saline and 30 with 7.5% povidone-iodine for 2 min. before ultrasonic scaling of FDI teeth 31-35. Blood samples before and after 30 s and 2 min. of scaling were cultured by lysocentrifugation.

RESULTS

Oral bacteraemia occurred in 33.3% of the saline group and 10% of the povidone-iodine group. Regression analysis showed that rinsing with povidone-iodine was approximately 80% more effective than rinsing with saline in reducing the occurrence of bacteraemia, with a statistically significant odds ratio (OR) of 0.189 (95% confidence intervals, OR=0.043-0.827). There were 24 oral bacterial isolates in the saline group and 3 in the povidone-iodine group. Viridans streptococci comprised 11 of the isolates in the saline group and none in the povidone-iodine group. Bacteraemia magnitude was 0.1 colony-forming units/ml in the povidone-iodine subjects and 0.1-0.7 CFU/ml in the saline group.

CONCLUSIONS

Rinsing with 7.5% povidone-iodine reduced the incidence and magnitude of bacteraemia and eliminated viridans streptococci from such bacteraemia. Povidone-iodine rinsing may be helpful for ultrasonic scaling of gingivitis patients at risk of infective endocarditis.

Evaluation of dentin abrasion during professional tooth cleaning in an in vitro model

OBJECTIVES

Professional tooth cleaning (PTC) may lead to loss of exposed dentin. The aim of the present study was to determine the absolute loss of dentin during PTC using various product combinations with an in vitro model.

MATERIAL AND METHODS

Dentin specimens (72) were randomly assigned to nine groups. In four groups each, prophy brushes and prophy cups were used in combination with four different abrasives (calcium pyrophosphate, pumice, Hawe cleanic, Nupro coarse). In the ninth group, a rubber cup with embedded fluoride and abrasives was used (pasteless prophy cup). The treatment time was 37 s. Surface loss was determined by profilometry.

RESULTS

The surface loss in the nine groups was as following: (1) brush/calcium pyrophosphate: 6.18 microm (a); (2) brush/pumice: 5.51 microm; (3) brush/Nupro coarse: 10.10 microm (b); (4) brush/Hawe cleanic: 1.88 (a, b); (5) prophy cup/calcium pyrophosphate 2.07 (c); (6) prophy cup/pumice: 6.07 microm; (7) prophy cup/Nupro coarse: 5.93 microm (c); (8) prophy cup/Hawe cleanic: 4.93 microm (c); (9) pasteless prophy cup: 11.86 microm (c). Groups with the same letter in parentheses are statistically significant different at p<0.05. In a pooled analysis, no statistically significant difference between brushes and prophy cups was found.

CONCLUSION

In the present study, the surface loss of about eight PTC procedures was simulated. Hence, the dentin loss ranged between 0.24 and 1.48 microm per PTC. Therefore, PTC does not seem to be a main factor in dentin loss.

Angio-oedema in Dentistry: Management of Two Cases using CI Esterase Inhibitor

Angio-oedema is a rare condition; it may be a hereditary or acquired form. It results from biochemical defects which cause excessive activation of the complement cascade and result in deep swellings in the skin and alimentary tract, called angio-oedema. These swellings are painful rather than itchy and not associated with urticaria, which helps to differentiate angio-oedema from allergic reactions. Even mild trauma can give rise to swelling, which may be life-threatening in the oral region. Management of two cases, one hereditary and the other acquired angio-oedema, are reported to demonstrate the use of C1 esterase inhibitor prophylaxis.

CLINICAL RELEVANCE

It is important that patients giving a history of angio-oedema are thoroughly investigated and, in discussion with the patient's medical team, appropriate prophylactic measures are taken to prevent swelling.

Clinical course and complications of infective endocarditis in patients growing up with congenital heart disease

BACKGROUND

Although a high number of patients with congenital heart disease (CHD) undergo surgical palliation or definite correction up to adolescence, adult congenital heart disease (ACHD) may remain a potential lifelong risk factor for infective endocarditis (IE) in patients growing up with congenital heart disease (GUCH).

METHODS

In a retrospective case study of a tertiary care center long-term clinical course and complications of patients with IE and GUCH were analysed.

RESULTS

Data of 52 patients with CHD, who fulfilled the Saiman criteria for infective endocarditis and were treated between April 1986 and March 2001, were identified: Risk factors for infective endocarditis were previous cardiovascular operation (51.9%), use of foreign material (38.5%), dental or other surgical procedures without recommended antibiotic prophylaxis (25.0%), or cardiac catheterization (5.8%). Staphylococcal (38.9%) or streptococcal species (35.2%) were cultivated in most cases as causative microorganisms. Complications were: recurrence of IE (7.7%), septic embolisms (30.8%) leading to central nervous complications (7.7%), embolism of pulmonary arteries (7.7%), renal arteries (1.9%), arteries of the extremities (9.6%), or infarction of spleen (1.9%). Other cardiac (23.1%) or extracardiac (13.5%) complications were frequent. The need of re-operations during or after IE was high (67.3%). The hospital mortality was 1.9%, late mortality was 7.7%.

CONCLUSIONS

Patients with IE and CHD show a broad clinical spectrum of cardiac and extracardiac complications. They may lead to a complicative short- and long-term course with the potential risk of death and a high number of re-operation. Efforts have to be made to improve long-term outcome of patients with ACHD by an interdisciplinary cooperation.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided.

OBJECTIVES

The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapist or dental hygienist) on periodontal health.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 9th April 2003.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals ; outcomes- tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and weighted mean differences were calculated as appropriate using random-effects models.

MAIN RESULTS

Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or Professionals Complementary to Dentistry.

AUTHORS' CONCLUSIONS

The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

Surface wear on cervical restorations and adjacent enamel and root cementum caused by simulated long-term maintenance therapy

BACKGROUND

In an in vitro study, the surface wear on cervical restorations and adjacent enamel and root cementum caused by different tooth-cleaning methods in simulated long-term therapy was investigated.

METHODS

Cervical restorations of amalgam (Oralloy), modified composite resin (Dyract), glass-ionomer cement (ChemFill Superior), and composite (Tetric) were instrumented by POL (polishing), CUR+POL (curette and polishing), US+POL (ultrasonic device with polishing) and the polishing agents Cleanic and Proxyt in a computer-controlled test bench. Treatment time corresponding to a real-time period of 5 or 10 years. Substance loss from instrumented surfaces was measured with a digital gauge. A three-way anova was used in the statistical evaluation.

RESULTS

The results showed that POL led to slight substance loss, which was greater using Cleanic (27 microm) than Proxyt (5 microm). CUR+POL produced a significantly greater substance loss than did US+POL, with 186 microm versus 35 microm on glass-ionomer cement, respectively, and 123 microm versus 18 microm, respectively, on root cementum, followed by composite (111 microm versus 27 microm, respectively), polyacid modified composite resin/compomer (89 microm versus 36 microm), amalgam (75 microm versus 19 microm), and enamel (32 microm versus 23 microm).

CONCLUSIONS

As opposed to the use of US+POL or POL, substance loss on cervical restorations and especially root cementum must be expected to result from tooth-cleaning during long-term maintenance treatment using CUR+POL.

In vitro study of heat production during power reduction of equine mandibular teeth

OBJECTIVE

To measure the amount of heat generated during 3 methods of equine dental reduction with power instruments.

DESIGN

In vitro study.

SAMPLE POPULATION

30 premolar and molar teeth removed from mandibles of 8 equine heads collected at an abbatoir.

PROCEDURE

38-gauge copper-constantan thermocouples were inserted into the lingual side of each tooth 15 mm (proximal) and 25 mm (distal) from the occlusal surface, at a depth of 5 mm, which placed the tip close to the pulp chamber. Group-NC1 (n = 10) teeth were ground for 1 minute without coolant, group-NC2 (10) teeth were ground for 2 minutes without coolant, and group-C2 (10) teeth were ground for 2 minutes with water for coolant.

RESULTS

Mean temperature increase was 1.2 degrees C at the distal thermocouple and 6.6 degrees C at the proximal thermocouple for group-NC1 teeth, 4.1 degrees C at the distal thermocouple and 24.3 degrees C at the proximal thermocouple for group-NC2 teeth, and 0.8 degrees C at the distal thermocouple and -0.1 degrees C at the proximal thermocouple for group-C2 teeth.

CONCLUSIONS AND CLINICAL RELEVANCE

In general, an increase of 5 degrees C in human teeth is considered the maximum increase before there is permanent damage to tooth pulp. In group-NC2 teeth, temperature increased above this limit by several degrees, whereas in group-C2 teeth, there was little or no temperature increase. Our results suggest that major reduction of equine teeth by use of power instruments causes thermal changes that may cause irreversible pulp damage unless water cooling is used.

[Diagnostic image (155). A man with facial emphysema. Subcutaneous facial emphysema due to dental cleaning]

A 47-year-old man developed subcutaneous emphysema of the right side of his face during a dental cleaning procedure by the dentist.

Root defects following air polishing

AIM

Air-polishing devices (APDs) are highly effective in removing plaque and extrinsic staining. Their application on root surfaces, however, may result in clinically relevant substance removal, limiting the use in patients with periodontitis, where denuded root surfaces are frequently found. Therefore, the purpose of the study was to assess the influence of different working parameters on root damage and to identify those minimizing root damage.

MATERIAL AND METHODS

Defect depth and defect volume after instrumentation of roots with an APD (Dentsply Prophy-Jet) using conventional NaHCO3 powder at instrumentation times of 5, 10 and 20 s, combinations of low, medium and high powder and water settings, distances of 2, 4 and 6 mm, and angulations of 45 degrees and 90 degrees were quantified laseroptically. A total of 297 roots were instrumented and parameter combinations were performed in triplicate. The influence of each working parameter on substance loss was determined by multiple regression analysis.

RESULTS

Time had the greatest influence on defect volume and depth (beta-weights 0.6 and 0.57, respectively), when compared with powder setting (beta-weights 0.49 and 0.3) and water setting (beta-weights 0.28 and 0.3). Variations in distance affected defect depth (beta-weight 0.44), but not volume (beta-weight 0.04). No major differences were found at 45 degrees and 90 degrees. Various parameter combinations led to maximal defect depths of 473.5 +/- 26.2 micro m within 20 s.

CONCLUSION

Root damage varies among combinations of working parameters. Using the APD with the assessed NaHCO3 powder, all parameter combinations led to substantial root damage. Thus, APDs using NaHCO3 may not be safely utilized on exposed root surfaces.

Effect of prophylactic treatments on the superficial roughness of dental tissues and of two esthetic restorative materials

Dental prophylaxis is a common way to remove dental plaque and stain, both undesirable factors in most dentistry procedures. However, besides cleaning the tooth surface, prophylactic techniques may increase the surface roughness of restorations and dental tissues, which, in turn, may result in plaque accumulation, superficial staining and superficial degradation. This study evaluated the effect of three prophylactic techniques--sodium bicarbonate jet, pumice paste and whiting paste--on the superficial roughness of two restorative materials--a composite resin and a compomer--and on the superficial roughness of two dental surfaces--enamel and cementum/dentin--through rugosimetric and scanning electron microscopy (SEM) analysis. Statistical analysis of the rugosimetric data showed that the use of pumice paste on enamel produced a significantly smoother surface than the natural surface. However, comparing the effect of the three techniques, prophylaxis with the pumice paste produced a rougher surface than did the other techniques as regards enamel and cementum/dentin probably due to its abrasiveness. On composite resin, the pumice paste only produced a rougher surface than did the whiting paste. On compomer, all of the applied treatments produced similar results. Based on rugosimetric and SEM analysis, we could conclude that the prophylactic treatments employed did not improve roughness of the studied surfaces. As to the effects of the techniques, they were different depending on the surfaces on which the prophylactic treatments were applied.

A clinical study of patients with hypersensitive teeth

Hypersensitive teeth have been a nemesis to patients in every dental practice. This clinical study was done to find a causal relationship of hypersensitive teeth and other organs of special senses, namely, sight, hearing, taste, smell, and touch. The analysis of the findings offers a basis for conclusion that dentition hypersensitivity and hypersensitivity of the special senses have a causal relationship. The dental clinician can provide the patient with an understanding and explanation of the cause(s) of hypersensitivity that will assist in a cooperative analysis of the symptoms and aid in the treatment to alleviate the pain.

Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review

There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice.

An update on the controversies in bacterial endocarditis of oral origin

OBJECTIVES

The aim of this review was to evaluate the evidence implicating dental procedures in bacterial endocarditis (BE) development and the basis for antimicrobial prophylaxis (AP).

STUDY DESIGN

In this article, the literature is reviewed and meaningful findings about epidemiology, pathogenesis, and AP guidelines for BE of oral origin are highlighted. Available results are used to formulate clinical recommendations for the dental practitioner.

RESULTS

The nature of dental procedures that cause bacteremia, patients at risk for BE, and the effectiveness of AP guidelines, continue to be points of controversy. There appears to be further evidence to support the important role of oral health status in the prevention of BE of dental origin.

CONCLUSIONS

One objective of the dental practitioner in caring for patients at risk for BE should be to promote oral health care. There are no hard data on which to scientifically base the need for AP in patients at risk for BE. However, it would appear prudent, at least from the medicolegal perspective, to provide AP, at least to persons with previous BE or prosthetic heart valves and to those undergoing oral surgery, periodontal treatment, or implant placement.

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures

BACKGROUND

This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV.

TYPES OF STUDIES REVIEWED

MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing.

RESULTS

The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions.

CLINICAL IMPLICATIONS

Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.

Comparison of dentine hypersensitivity in selected occidental and oriental populations

Epidemiological data on dentine hypersensitivity (DH) prevalence are limited. Few studies have compared prevalence between populations. The aim of this investigation, therefore, was to compare the perception and prevalence of DH in two distinct non-periodontal practice populations, one U.K. and one Korean. Completed questionnaires from 557 patients (230 males and 327 females, comprising 115 males and 162 females, mean age 41.7 years (s.d.=14.36), U.K. and 115 males and 165 females, mean age 29.7 years (s.d.=11.86), Korean) were collected. Analysis was by frequency distribution and cross-tabulation (Statistical Package for the Social Sciences (SPSS)). DH prevalence was similar and at levels comparable with those reported previously. Prevalence was higher in the third and fourth decades in both populations. Although there were no differences between U.K. or Korean males and U.K. or Korean females, there was a significant difference between gender reporting of DH, with more females complaining of DH than males (standard normal deviation (SND)=4.3, 95% confidence interval (CI)=0.1134-0.2736). DH appeared to be regarded by patients as not severe in most cases, so treatment was not generally sought. Of those who claimed to have sought treatment, a significant number had received restorative treatment. Of those patients, only 23.3% of U.K. and <or=2% of Korean patients claimed to have used a desensitizing dentifrice. Pain from DH was reported as low grade (slight, occasional) occurring over 5 years in both populations. Cold appeared to be the most reported stimulus in the two populations. Less periodontal surgery had been undertaken in these two populations (12.6% U.K. and 7.1% Korean) compared with those referred to a teaching hospital periodontal department (34.5%). This compared favourably with previous findings in the general dental population (15.5%). Discomfort following hygiene therapy did not appear to last >or=7 days in either population. The results indicated that there were no significant differences between U.K.- and Korean-based populations in their perception of DH, with the exception that more females complained of sensitivity than males in both groups. Overall, DH was not considered a major dental problem by most patients in either of the populations.

Acute metastatic infection of a revision total hip arthroplasty with oral bacteria after noninvasive dental treatment

The risk of hematogenous bacterial infection of a total joint prosthesis is currently considered to be greatest in the 2 years after arthroplasty or when the patient is chronically ill or immunocompromised, for dental treatments that are considered invasive, with a higher incidence of bacteremia. We report the case of a healthy man who had undergone revision hip arthroplasty 11 months previously and who developed acute signs of infection of the hip prosthesis with an oral organism 30 hours after supragingival dental cleaning, performed with the specific intention to be noninvasive, without antibiotic prophylaxis.

Odontogenic bacteremia following tooth cleaning procedures in children

PURPOSE

This study was designed to investigate the prevalence and intensity of odontogenic bacteremia from tooth cleaning procedures in children and adolescents.

METHODS

One hundred and fifty five children receiving dental treatment under general anesthesia at The Great Ormond Street Hospital for Children and Guy's Hospital were recruited. Each child was randomly allocated to one of three tooth cleaning groups. These were (1) toothbrushing, (2) professional cleaning with a rubber cup and (3) scaling.

RESULTS

There was no significant difference in the prevalence of positive blood cultures or intensity of bacteremia between the three groups. The bacterial species isolated were similar to those reported by other workers. These were S. mitis, S. sanguis and Coagulase--negative staphylococci, all of which are implicated in the pathogenesis of Bacterial Endocarditis.

CONCLUSIONS

Patients at risk are as likely to develop odontogenic bacteremia from toothbrushing at home as from professional scaling and polishing of the teeth at dental surgery.

Oral microflora as a cause of endocarditis and other distant site infections

Bacteremia originating from the oral cavity is common, but the role of bacteremia in the genesis of infective endocarditis and other distant site infections is unclear. Only a small percentage of oral flora have been associated with distant site infection. Important issues remain unresolved concerning the identification of patients at risk, the relative risk from invasive dental procedures versus naturally occurring bacteremia, and the impact of prophylactic antibiotics on the incidence, nature, magnitude, and duration of bacteremia from the oral cavity. This article addresses the controversies in infection management in patients at risk for distant site infection.

Perceptions of dentine hypersensitivity in a general practice population

Recent studies have attempted to determine the prevalence of dentine hypersensitivity (DH) in both hospital and general practice. Results indicate that DH prevalence is higher in patients referred for specialist treatment than in general practice. The aim of this study was to determine perception and prevalence of DH in general practice. Completed questionnaires from 277 patients (115 males, 162 females, mean age 41.7 years [SD 14.36]) were collected. Self-reported DH prevalence (52%) was observed between the third and fourth decades, peaking in the third and in good agreement with that previously published (45.2%), and significantly more females complained of DH than males (SND=2.24, 95% CI 0.01734-0.2661). Cold was perceived as the most common cause of DH, in agreement with other studies. Only 12.6% of patients reported periodontal surgery compared to 15.5% previously. Of those who received hygiene therapy (67.9%) only 15.5% reported DH following treatment which mainly did not last >/=5 days. Most patients with DH did not perceive the condition as severe and did not seek treatment (75.1%). Only 23.3% used a desensitizing dentifrice. The results indicated that self-reporting of DH is lower than reported in a dental hospital population and was not perceived as a major dental problem by most patients in a general dental practice population.

What hurts during dental hygiene treatment

PURPOSE

The purpose of this study was to examine clients' pain reports for routine clinical procedures during dental hygiene treatment, and to examine the degree to which physical and psychological variables contribute to pain.

METHODS

A convenience sample consisting of 53 (18 male, 35 female) undergraduate students enrolled at Dalhousie University participated as dental hygiene clients. Before treatment, the demographics, dental anxiety, and pain catastrophizing of students were measured. During procedures, dental status was measured. Following procedures, the amount of pain associated with procedures was recorded. Data was analyzed using an SPSS/PC statistical package.

RESULTS

Most procedures were associated with little or no pain. However, probing and scaling were associated with greater pain. Furthermore, 25 percent of the sample reported their pain was > or = 7/10 on at least one dental hygiene procedure. Dental status measures and treatment difficulty did not correlate with pain. Individuals higher in dental anxiety and pain catastrophizing reported greater pain. Multiple regression showed that all predictor variables combined to account for approximately 1/3 of the variance in pain reports.

CONCLUSION

On average, clinical dental hygiene treatment is associated with low levels of pain, but approximately 25 percent of subjects experienced at least one of the seven procedures as being moderately to severely painful. Findings illustrate the need for effective pain management that may be physiologically or psychologically based. Interventions geared toward reducing anxiety and pain catastrophizing may be useful additions to the curriculum of dental hygiene programs.

Haemophilus aphrophilus osteomyelitis after dental prophylaxis. A case report

A 36-year-old patient who was otherwise healthy had acute osteomyelitis of the humeral shaft develop after routine prophylactic dental cleaning and ultrasonic scaling. Haemophilus aphrophilus grew on cultures of material obtained during biopsy of the humerus, and pathologic examination confirmed the diagnosis of acute osteomyelitis. Haemophilus aphrophilus, a fastidious gram negative bacillus, is part of the normal oral flora and is a rare pathogen. Osteomyelitis caused by Haemophilus aphrophilus has not been reported to occur after routine dental prophylaxis. The patient was treated successfully with surgical debridement and appropriate antibiotics.

Antibiotic prophylaxis in dental patients with ventriculo-peritoneal shunts: a pilot study

Fourteen hydrocephalic children with ventriculo-peritoneal shunts received routine dental prophylaxis and topical fluoride application. No antibiotics were administered to these children for any reason during the three months before treatment or during the twelve months after treatment. None of these children presented with any signs of shunt infection during the twelve-month posttreatment period. In spite of the small sample size, this prospective pilot study suggests that patients with ventriculo-peritoneal shunts are not susceptible to shunt infection following a bacteremia induced by a dental prophylaxis and topical fluoride treatment. Dental prophylaxis without antibiotic coverage in patients with V-P shunts, therefore, does appear safe. We recommend that further study with a larger population, or a collaborative study by several medical centers, be performed to establish more conclusively that prophylactic antibiotics are not necessary for patients with ventriculo-peritoneal shunts who receive dental procedures. In addition, other investigations are needed to determine the risk of shunt infection with more invasive dental procedures, such as periodontal surgery or tooth extraction.

Antibiotic prophylaxis for orthopedic prostheses and GI procedures: report of a survey

OBJECTIVE

To determine the practice recommendations of Program Directors of infectious disease training programs with regard to infection prophylaxis for patients with prosthetic orthopedic devices who undergo gastrointestinal procedures.

METHODS

We surveyed Program Directors of infectious disease training programs to determine what they recommend when asked about antibiotic prophylaxis for patients with orthopedic prostheses who undergo gastrointestinal procedures.

RESULTS

More than 50% of the respondents agreed that prophylaxis is not indicated at any time for these procedures, although there was an almost even split when confronted with colonoscopy and polypectomy within 6 months of prosthesis insertion.

CONCLUSIONS

Most Program Directors agree with the recommendations of the American Society for Gastrointestinal Endoscopy and do not recommend prophylactic antibiotics for these patients. If antibiotics are chosen, they should be the same ones that are recommended for infectious endocarditis by The American Heart Association.

Salivary cortisol response to dental treatment of varying stress

The physiologic stress of various dental procedures (dental examination, dental prophylaxis, restoration, root canal therapy, and tooth extraction) was measured in 50 nonsmoking healthy men between the ages of 18 and 55 years (mean 34.6 years, range 21 to 53 years) with a salivary cortisol assay. Expectorated saliva was collected at four time points: 10 minutes before the start of the procedure, 15 minutes after the patient was seated, at the end of the procedure, and 1 hour after the completion of the procedure. Of the 196 samples included for analysis, mean cortisol values ranged from 0.1 to 3.8 micrograms/dl with a recovery of 100% +/- 8.4%. The mean cortisol value for the extraction group (1.09 +/- 0.42 microgram/dl) was significantly different (p < 0.05) from the mean values of the examination (0.46 +/- 0.10 microgram/dl), prophylaxis (0.64 +/- 0.64 microgram/dl), root canal (0.49 +/- 0.07 microgram/dl), and restorative (0.60 +/- 0.04 microgram/dl) groups as determined by the Duncan's multiple range test. Cortisol levels decreased from the initial reading to the end of the procedure by about 15% for patients undergoing an examination, root canal, and restorative procedure. Cortisol levels at the end of the procedure were elevated in the prophylaxis (55%) and extraction (148%) groups compared with the baseline cortisol recording. A minority of patients in the prophylaxis group had elevated cortisol levels throughout dental treatment, whereas cortisol levels were elevated during treatment in 80% of patients undergoing extraction. These data suggest that the adrenal stress response associated with tooth extraction(s) is greater than that associated with other routine dental procedures.

Anticoagulants

Treatment plans for patients taking anticoagulants can become complicated. Anticoagulants predispose a patient to bleeding problems. Many drugs used in dentistry cannot be taken concomitantly with these medications.

Possible side effects related to dental hygienists' treatment

The aim of the present investigation was to obtain information on the repertoire of patient-related remedies and materials used by dental hygienists and on the frequency and nature of side effects observed among their patients. Norwegian hygienists received a questionnaire on dental remedies and materials used, the number of patients seen, and side effects observed during the past year and earlier. Information from 169 hygienists provided a list of remedies comprising fluoride-containing varnishes, polishing remedies, pit and fissure sealants, oral disinfectants, fluoride gels and solutions, and plaque-disclosing solutions. In addition, some hygienists used temporary dental materials, polyalkeonate/composites, and local anesthetic spray or ointment. Fourteen brands of latex gloves were used. Possible side effects of general and local nature were observed by 37 dental hygienists. Reactions associated with the application of Duraphat in children (> 1:1640) and contact with latex gloves in adult patients (> 1:3300) were most important. The findings are discussed with specific emphasis on the content of colophony in the fluoride varnish.