Oral health and functional outcomes following mechanical thrombectomy for ischemic stroke

BACKGROUND

An association between poor dentition and the risk of ischemic stroke has previously been reported in the literature. In this study we assessed oral hygiene (OH), including tooth loss and the presence of dental disease, to determine if an association exists with functional outcomes following mechanical thrombectomy (MT) for large-vessel ischemic stroke.

METHODS

A retrospective review was conducted of consecutive adult patients at a single comprehensive stroke center who underwent MT from 2012 to 2018. Inclusion criteria included availability of CT imaging to radiographically assess OH. A multivariate analysis was performed, with the primary outcome being 90-day post-thrombectomy modified Rankin Scale (mRS) score >2.

RESULTS

A total of 276 patients met the inclusion criteria. The average number of missing teeth was significantly higher in patients with a poor functional outcome (mean (SD) 10 (11) vs 4 (6), p<0.001). The presence of dental disease was associated with poor functional outcome, including cavities (21 (27%) vs 13 (8%), p<0.001), periapical infection (18 (23%) vs 11 (6.7%), p<0.001), and bone loss (27 (35%) vs 11 (6.7%), p<0.001). Unadjusted, missing teeth was a univariate predictor of poor outcome (OR 1.09 (95% CI 1.06 to 1.13), p<0.001). After adjustment for recanalization scores and use of tissue plasminogen activator (tPA), missing teeth remained a predictor of poor outcome (OR 1.07 (95% CI 1.03 to 1.11), p<0.001).

CONCLUSION

Missing teeth and the presence of dental disease are inversely correlated with functional independence following MT, independent of thrombectomy success or tPA status.

Intraoral management of odontogenic infection associated with severe trismus under local anesthesia

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

A case report of generalized tetanus in a 42-year-old man with dental infection

Background In the post-vaccination era, as it is today, generalized tetanus is a rare diagnosis, although mortality and morbidity continue to increase significantly throughout the world. Infection occurs when the Clostridium tetani spores are introduced into wounds, skin lesions and infections. The symptoms often begin with stiffness or spasms in the jaw muscles; they are called trismus or "lockjaw" and/or then spread to the neck and abdominal muscles. Case presentation This is a report of a 42-year-old man who was referred to the hospital with dysphagia, rigidity and trismus. He was diagnosed with generalized tetanus with a Philips score of 15. The patient was admitted to the isolation unit, received treatment that included procaine penicillin, metronidazole, diazepam, human tetanus immunoglobulin (TIG) and anti-tetanus serum (ATS). Treatment was considered according to the guidelines of the World Health Organization, and also, the drug dose has no adverse event reaction during the treatment. Conclusion The therapeutic response is related to the identification and appropriate treatment, especially in hospitalized patients with inadequate immunization so that patients recover soon.

Hepatic abscess due to Dialister pneumosintes - A case report

Dialister pneumosintes is an obligate anaerobic Gram-negative rod associated with infections of the oral cavity. We report on a previously healthy, 51-year-old woman who presented with a liver abscess caused by Dialister pneumosintes as a complication of a dental abscess. The microorganism was identified by using a broad-range bacterial 16S rRNA gene PCR in the liver exudate. The patient was cured after abscess drainage and 4-week antibiotic treatment. Our case highlights the importance of a good history and physical examination when taking care of patients admitted for pyogenic liver abscess.

A retrospective analysis of the prevalence of dental diseases in patients with digestive system cancers

The relationship between dental diseases and the prevalence of digestive system cancers remains unclear. The aim of the present study was to examine the prevalence of dental diseases in patients treated for digestive system cancers.The medical and dental records of patients treated for digestive system cancers were retrospectively reviewed, and the results obtained (decayed/filled/missing teeth [DMFT] indices and community periodontal index [CPI] codes) were compared with data from the national survey of dental diseases in order to investigate the relationship between oral health and digestive system cancers.DMFT, D, and F indices were significantly lower, while the M index was slightly higher in digestive system cancer patients than in the national survey. The proportions of individuals with more than 20 residual teeth and denture wearers were significantly lower in cancer patients than in the national survey. The prevalence of periodontitis (CPI codes 3 and 4) and severe periodontitis (CPI code 4) were significantly higher in cancer patients than in the national survey.The present results showed that digestive system cancers were closely associated with multi-tooth loss and/or a low denture-wearing rate. The prevalence of severe periodontitis was also found to be higher in cancer patients. These results suggest that periodontitis and associated multi-tooth loss play a potential role in digestive system cancers.

Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations

RATIONALE AND OBJECTIVES

Routine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease.

MATERIALS AND METHODS

Head CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each other's findings.

RESULTS

One hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%-41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371).

CONCLUSIONS

Incidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.

Evaluation of the diagnostic yield of dental radiography and cone-beam computed tomography for the identification of dental disorders in small to medium-sized brachycephalic dogs

OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and cone-beam CT (CBCT) methods for the identification of 31 predefined dental disorders in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 31 predefined dental disorders were evaluated separately and scored by use of dental radiography and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A qualitative scoring system was used. Dental disorders were grouped into 10 categories for statistical analysis. Point of reference for presence or absence of a dental disorder was determined as the method that could be used to clearly identify the disorder as being present. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated with the McNemar χ² test of marginal homogeneity of paired data. RESULTS When all 3 CBCT methods were used in combination, the diagnostic yield of CBCT was significantly higher than that of dental radiography for 4 of 10 categories (abnormal eruption, abnormally shaped roots, periodontitis, and tooth resorption) and higher, although not significantly so, for all categories, except for 1 (loss of tooth integrity). CONCLUSIONS AND CLINICAL RELEVANCE CBCT provided more detailed information than did dental radiography. Therefore, CBCT would be better suited for use in diagnosing dental disorders in brachycephalic dogs.

Common dental diseases in children and malocclusion

Malocclusion is a worldwide dental problem that influences the affected individuals to varying degrees. Many factors contribute to the anomaly in dentition, including hereditary and environmental aspects. Dental caries, pulpal and periapical lesions, dental trauma, abnormality of development, and oral habits are most common dental diseases in children that strongly relate to malocclusion. Management of oral health in the early childhood stage is carried out in clinic work of pediatric dentistry to minimize the unwanted effect of these diseases on dentition. This article highlights these diseases and their impacts on malocclusion in sequence. Prevention, treatment, and management of these conditions are also illustrated in order to achieve successful oral health for children and adolescents, even for their adult stage.

The effects of oral health on systemic health

The oral cavity is the intersection of medicine and dentistry and the window into the general health of a patient. Hundreds of diseases and medications impact the oral cavity, and pathologic conditions in the mouth have a greater systemic impact than many providers appreciate. It is unclear whether there is true causality or just an association between periodontal disease and certain other systemic conditions, including atherosclerotic vascular disease, pulmonary disease, diabetes, pregnancy-related complications, osteoporosis, and kidney disease. Diabetes has a true bidirectional relationship with periodontal disease, and there is strong evidence that treating one condition positively impacts the other. A shared trait of periodontal disease and these medical conditions is that they are chronic conditions that take a long time to develop and become clinically significant. Primary prevention-treating the patient prior to the onset of symptoms, myocardial infarction, stroke, diabetic complications, or significant periodontal disease-is the challenge. Complications associated with these conditions cause significant morbidity and mortality and are incredibly costly to the healthcare system. Unfortunately, a lack of access to primary medical or dental care prevents some patients from engaging the system until a negative event has occurred. Despite the absence of clear evidence of causality and the direct impact of treatments, the consequences of these chronic conditions for the population are well understood. Dentists, family physicians, and all primary care providers must increase their collaboration and communication to maximize the benefit to patients.

Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature

BACKGROUND

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin.

METHODS

In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need.

CONCLUSIONS

Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

[Is there interference between the manducatory apparatus and the postural system?]

Posturology is a specific area of theoretical and clinical physiology applicable in numerous fields of medicine and related disciplines and aims at studying the standing position and related dysfunctions. This functional medical approach offers a range of powerful multiprofessional diagnostic and therapeutic tools based on position-related neurophysiology and human movement in the management of a large number of pathologies. As posturologists, we frequently encounter disorders of the standing position due to one or several manducatory dysfunctions. However, conversely, it is also essential to be aware of why and how a postural syndrome can give rise to therapeutic failure in dentofacial orthopaedics. Drawing on the current state of knowledge, we intend to propose a protocol for diagnostic and therapeutic management making it possible to avoid Orthodontic and Dento-Facial-Orthopedic Failures defined as the "non-achievement of the expected results".

Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study

This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3-4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.

[Local anesthesia selection algorithm in patients with concomitant somatic diseases]

The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

FREQUENCY OF HEPATITIS B AND C IN PATIENTS SEEKING TREATMENT AT THE DENTAL SECTION OF A TERTIARY CARE HOSPITAL

BACKGROUND

Hepatitis B and C are serious health problems and a major cause of liver disease worldwide. Like medical patients, dental patients are at increased risk of getting hepatitis B and C viral infection during various procedures. Keeping in view the rising incidence of hepatitis B and C in Pakistan, it was considered important to know about the frequency and distribution of HBV and HCV in patients undergoing various procedures during treatment in dentistry section.

METHODS

This study was based on the review of the records of the patients visiting the dental section of Ayub Teaching Hospital Abbottabad between April to December 2014. The,Secondary data of 3549 patients who visited the dental section for treatment during this period was used for this study.

RESULTS

Male patients constituted 53.9% (1914) and female patients were 46.1% (1635) of total screened patients. Total infection with hepatitis B and C were found in 4.1% (147) of the screened patients. Out of these infections, hepatitis C was found in 66% (97) patients and hepatitis B in 32.7% (48), whereas 1.3% (2) of the patients had both the infections. Infection with hepatitis B and C viruses was detected in 39.5% (58) male patients and 60.5% (89) female patients. Alarmingly. high proportions of new 75.5% (111) cases of both the infections were detected during the nine month period.

CONCLUSION

Due to high prevalence of HBV and HCV among patients coming for dental treatment, it is recommended that regular screening for HBV and HCV be performed on every patient before carrying out any procedure upon.

Two Cases of Liver Abscesses Derived from Dental Disease in Patients with Alcoholic Chronic Pancreatitis

Among the etiologies of pyogenic liver abscess (PLA), bacterial spread from the biliary tract or portal flow is the major cause, while the onset of PLA due to arterial bacterial transmission is rare. We herein report two cases of PLA thought to be caused by arterial transmission from dental disease. In both cases, there was benign biliary stricture as a result of alcoholic chronic pancreatitis, although normal oral flora was detected as the causative bacteria and oral hygiene was poor in both patients. We presumed that the origin of PLA was dental disease and successfully treated the patients with percutaneous drainage, antibiotics and dental procedures.

Early dental treatments for patients with cleidocranial dysplasia

OBJECTIVE

To explore the early dental interventional strategies for adolescent patients and a child patient with cleidocranial dysplasia (CCD).

METHODS

Surgical exposure using the apically repositioned flap technique combined with orthodontic traction was used in the adolescent patients whose ideal treatment time for initiating treatment was missed. For the child patient whose ideal treatment time for initiating treatment was not missed, the simple surgical exposure method was carried out in order to promote the eruption of the impacted incisors.

RESULTS

All the impacted maxillary incisors of the three CCD patients were successfully positioned into a proper alignment either through the two stages of crown exposure and the elastic traction or simple surgical exposure.

CONCLUSION

Crown exposure surgery combined with light force orthodontic traction provides an effective approach to treat the typical dental abnormalities of adolescent CCD patients. Simple surgical exposure was also an effective way for a child CCD patient for whom the most ideal time for initiation of treatment was not missed.

U.S. emergency department admissions for nontraumatic dental conditions for individuals with intellectual and developmental disabilities

The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR]  =  1.06; 95% confidence interval [CI]  =  0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR  =  0.49; 95% CI  =  0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.

Extracranial head and neck infections

This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.

Evaluation of student perception of the lecture "oral functional medical rehabilitation: balneophysiotherapy"

Th aim of the study was to assess this course as perceived by the 6th year dentistry students.

MATERIAL AND METHODS

Applying and validating the "Dundee Ready Education Environment Measure (DREEM)" for the first time in Romania.

RESULTS AND DISCUSSION

The reliability of the test according to Cronbach alpha method, which measures the internal consistency of a test, was 0.87 (Cronbach alpha coefficient should be above 0.70). As to the reliability coefficients (internal consistency) for each test subscale and for the entire test, DREEM proved a very good overall reliability, with alpha = 0.89. The reliability of each DREEM subscale was also analyzed. The DREEM test results, with a global score of 149, indicate a "more positive than negative" perception (score between 101 and 150).

CONCLUSIONS

The DREEM test showed that the assessment and treatment of pain in dental-maxillary pathology and TMJ dysfunctions through medical rehabilitation by means of balneophysiotherapy is of interest to final year dental medicine students. As a student-teacher partnership, modern education cannot ignore the practical needs of students and should add to their theoretical training with courses and practical training programs necessary in their future profession.

[Odontogenic pain syndrome: integrated approach in analgesia]

The article deals with the study of 96 patients (69 women and 27 men) with odontogenic facial pain syndrome. All patients received complex neurodentist examination with radiological assessment of maxillofacial area and additional functional methods. Patients were divided into two groups, 48 patients in each group. All patients received usual therapy; mouth cavity sanitation, selective grinding of teeth, drug therapy (anticonvulsants, B vitamins) and physiotherapy. Patients in group 2 received corporeal acupuncture. Efficacy of the therapy was assessed by changes of basic subjective and objective significatives on 10th, 30th and 60th day of treatment. Reflective anaesthesia techniques using allowed to stop the pain faster and decreased the dosage of drugs in patients of group 2.

Management of dental-oral procedures in patients with hereditary angioedema due to C1 inhibitor deficiency

BACKGROUND

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) has considerable implications for dental health care providers, since dental procedures may trigger severe and even life-threatening episodes. The aim of the present study was to analyze the efficacy and safety of premedication with attenuated androgens (AAs), plasma-derived human C1 esterase inhibitor concentrate (pdhC1INH), or both to prevent the development of upper airway angioedema after dental-oral procedures in patients with HAE-C1-INH.

MATERIAL AND METHODS

All dental-oral procedures performed on patients with HAE-C1-INH who were followed up at La Paz University Hospital, Madrid, Spain were reviewed. Demographic data, maintenance treatment, preprocedure prophylaxis, disease severity, and occurrence of upper airway angioedema were recorded.

RESULTS

Twenty-four patients (14 male/10 female; mean age, 42.6 years) underwent 66 procedures. Most procedures were performed on patients with severe HAE-C1-INH (20 procedures) or moderate HAE-C1-INH (26 procedures). Only 9 procedures were performed without short-term prophylaxis. Mild upper airway angioedema developed after 3 procedures performed without short-term prophylaxis in patients with minimal or asymptomatic HAE-C1-INH. A statistically significant association was found between development of mild postprocedure upper airway angioedema and lack of maintenance treatment with AA, lack of increased dose of preprocedure AA, and failure to administer preprocedure pdhC1INH (P = .002, Fisher exact test).

CONCLUSIONS

Increased doses of prophylactic AA, administration of pdhC1INH, or both were good options for ambulatory management of dental-oral procedures in patients with HAE-C1-INH. Prophylaxis with pdC1INH or increased doses of AA is advisable before dental-oral procedures, even in patients with low disease severity.

[Odontogenic maxillary sinusitis in elderly and old age]

On the basis of a detailed analysis of the clinical picture of odontogenic maxillary sinusitis the peculiarities of its flow in elderly and senile patients are demonstrated. The causes of odontogenic inflammation of the maxillary sinuses, the clinical features of inflammation of the maxillary sinus in older age groups, including those with oroantral communication are shown.

[Congenital insensitivity to pain: difficulty of management]

INTRODUCTION

Congenital insensitivity to pain with anhidrosis (CIPA) is a very rare disorder, most often of genetic origin.

CASE REPORT

The authors present the case of two siblings, 10 and 13 years old, both followed-up since the age of 2 for CIPA diagnosed after discovering insensitivity to pain during iterative falls, burns, and of severe oro-digital self-mutilating behavior. Sural nerve biopsy and an electromyogram confirmed the diagnosis.

DISCUSSION

CIPA with anhidrosis is a very rare disease. It is characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and sometimes mental retardation. Complications of this insensitivity (non-treated fractures, burns, and oro-digital mutilation) may be lethal. Treatment remains preventive. The patient must observe a very strict hygiene. Prevention for maxillofacial involvement consists in breaking the cycle of oral self-mutilation.

[Guidelines for dental care in hemophilia patients]

Dentist usually lacking knowledge about congenital blood-clotting disorders. That leads to unreasonable limitations in use of modern dental care techniques. The following study result obtained in specialized center for blood-clotting disorders treatment should serve as guidelines for dental care in hemophilia patients.

[An update on focal infection of oral origin]

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

Dentists' knowledge about anaphylaxis caused by local anaesthetics

BACKGROUND

IgE-mediated systemic reactions to local anaesthetics may be seen--although rarely--by dentists. However, it is not known whether dentists are familiar with symptoms, signs and management of anaphylaxis.

METHODS

In this study we aimed to evaluate knowledge of dentists of the symptoms and signs and current treatment of anaphylaxis. For this, some dentists working in their private offices in Istanbul were asked to complete an anonymous questionnaire with 15 questions related to anaphylaxis.

RESULTS

A total of 86 dentists agreed to participate in the study. None of the attendants were completely aware of the symptoms and signs of anaphylaxis. About half of the attendants (48.8%) knew epinephrine as the first drug in the treatment of anaphylaxis and keep it in their offices (55.6%), but only one third of the dentists (31.5%) preferred intramuscular route as the most effective route for epinephrine injection.

CONCLUSION

Our data show that the level of dentists' knowledge of local anaesthetics allergy and anaphylaxis is inadequate. This may endanger patients' lives. An educational programme that may improve general dentists' knowledge about local anaesthetics allergy and anaphylaxis is urgently necessary.

The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach

Although all dentists are taught about the importance of oral health to general health and that systemic disease can manifest in the oral cavity, the 4-year dental school curriculum does not allow time to gain competency in these relationships. Nevertheless, all dentists must have skills in taking a medical history and an appreciation of oral findings that might have a systemic origin. This article focuses on the identification of abnormal signs and symptoms in the oral cavity and the determination of those that have a systemic origin. It is imperative that clinicians are mindful of the possible oral-systemic associations, because these could potentially have a huge impact on patient care.

[Morphofunctional changes of maxillary sinus mucosa in odontogenic fungal sinusitis]

Complex morphological research of maxillary sinus mucosa in odontogenic fungal sinusitis has revealed signs of granulomatous inflammation. In epithelium occurred metaplasia of simple cubic or columnar layer. Epithelium fiber-synthetic and plastic functions showed significant down-regulation.

Most pregnant women in California do not receive dental care: findings from a population-based study

OBJECTIVES

We examined the prevalence of dental care during pregnancy and reasons for lack of care.

METHODS

Using a population-based survey of 21,732 postpartum women in California during 2002-2007, we calculated prevalence of dental problems, receipt of care, and reasons for non-receipt of care. We used logistic regression to estimate odds of non-receipt of care by maternal characteristics.

RESULTS

Overall, 65% of women had no dental visit during pregnancy; 52% reported a dental problem prenatally, with 62% of those women not receiving care. After adjustment, factors associated with non-receipt of care included non-European American race/ethnicity, lack of a college degree, lack of private prenatal insurance, no first-trimester prenatal insurance coverage, lower income, language other than English spoken at home, and no usual source of pre-pregnancy medical care. The primary reason stated for non-receipt of dental care was lack of perceived need, followed by financial barriers.

CONCLUSIONS

Most pregnant women in this study received insufficient dental care. Odds were elevated not only among the poorest, least educated mothers, but also among those with moderate incomes or some college education. The need for dental care during pregnancy must be promoted widely among both the public and providers, and financial barriers to dental care should be addressed.

Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems

OBJECTIVES

To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self-management behaviors.

DESIGN

Cross-sectional.

SETTING

Rural North Carolina.

PARTICIPANTS

Six hundred thirty-five community-dwelling adults aged 60 and older.

MEASUREMENTS

Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1-2 foods, 3-14 foods) and modification (0-3 foods, 4-5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index-2005 (HEI-2005) scores. Linear regression models tested the significance of associations between HEI-2005 measures and food avoidance and modification.

RESULTS

Thirty-five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI-2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods.

CONCLUSION

Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed.

[Peculiarities of face regional hemodynamics in treatment of acute purulent jaw odontogenic periostitis]

53 patients were under observation with acute purulent jaw odontogenic periostitis. In 27 out of them after operation as drainage material strips of napkin were used, containing as the active components metronidazol, dimexide and sodium alginate. Curative process efficacy evaluation was done according to the data of hemodynamic study (determination of the artery's diameter, maximal systolic speed and index of circulatory resistance) of the magistral face arteries. It was established that in the group of patients with rational treatment blood circulation in face arterial vessels was restored most actively than in the control group with the use of traditional treatment scheme.

Growing burden of noncommunicable diseases: the contributory role of oral diseases, Eastern Mediterranean Region perspective

Associations of oral diseases with noncommunicable diseases such as diabetes, cardiovascular diseases, chronic respiratory diseases, osteoporosis and chronic renal failure are widely reported in the literature from developed countries. Commonality of risk factors, changes in systemic inflammatory mediators and body metabolism play a role in this association. This paper reviews current knowledge on the burden and association of oral and systemic diseases, and highlights the paucity of information and research from the Eastern Mediterranean Region and other developing countries. A call is made for further research to understand the status and significance of oral-systemic disease associations and develop guidelines for their control in this Region.

Dental management in renal failure: patients on dialysis

Chronic renal failure is an important health care problem throughout the world, with an incidence of 337, 90, 107 and 95 new cases per million inhabitants/year in the United States, Australia, New Zealand and the United Kingdom, respectively. These figures moreover invariably tend to increase. During the progression of renal damage, clinical manifestations are noted in practically all body organs and systems, and 90% of all affected patients experience oral symptoms. The existing management options range from simple measures based on changes in diet and life style, to different forms of dialysis (hemodialysis and peritoneal dialysis), and also kidney transplantation. Given the multiple oral manifestations of chronic renal failure, and the different repercussions of its treatment upon the oral cavity, these patients require special considerations and precautions in the face of dental treatment. Consultation with the nephrologist is essential before any dental treatment is carried out, in order to determine the condition of the patient, define the best moment for dental treatment, introduce the necessary pharmacological adjustments, or to establish other important aspects for preventing complications in the dental clinic. The present study reviews the characteristics of the disease, the existing therapeutic options, and the considerations of relevance for the dental professional.

Epidemiological investigation in outpatients with symptomatic gastroesophageal reflux from the Department of Medicine in Zhejiang Province, east China

BACKGROUND AND AIM

To elucidate the epidemiology of gastroesophageal reflux disease (GERD) symptoms in outpatients from the Department of Medicine in 10 hospitals in Zhejiang Province, east China.

METHODS

A cross-sectional survey in the cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version of the reflux disease questionnaire and other items recording the demographic characteristics for GERD symptoms. The statistical analysis was performed with SPSS 13.0 programs.

RESULTS

A total of 15,283 outpatients from the Department of Medicine were investigated. The prevalence of GERD symptoms was 7.28% (95% confidence interval [CI], 6.87%, and 7.69%) with the prevalence rate increasing with age (P < 0.001), which was higher in men (7.79%, 95% CI: 7.20%, 8.38%) than in women (6.73%, 95% CI: 6.18%, 7.28%; chi2 = 5.81, P < 0.05). The prevalence rate of the gastrointestinal symptoms in GERD symptoms, including epigastric discomfort, nausea, retrosternal pain, belching, globus sensation, loss of appetite, excessive salivation, vomiting, wheezing cough, weight loss, and dysphagia were all higher than the non-GERD patients (P < 0.0001). In the GERD patients, the prevalence of diseases, such as pharyngolaryngitis, snoring, bronchitis, liver disease, and gallbladder disease were all higher than the non-GERD patients (P < 0.01). The multiple logistic regression analysis showed that old age, night-shift work, heavy work burdens, single or divorced people, increase intake of greasy or sweet foods, excessive eating, and constipation were independent risk factors associated with GERD symptoms.

CONCLUSION

GERD has a high prevalence in China and its main associated factors include respiratory, laryngopharyngeal and dental disorders, sex, anthropometrical variables, and social-psychological characteristics.

Pyogenic liver abscess related to dental disease in an immunocompetent host

A 59-year-old man with poor oral hygiene presented to our hospital because of fever and chills. Abdominal ultrasonography and enhanced computed tomography (CT) revealed a liver abscess. The patient had no history of immunodeficiency and we confirmed the patient had no immunologic abnormalities. Blood culture revealed Fusobacterium nucleatum, a bacterium commonly found in the oral cavity. Even if a patient is immunocompetent, poor oral hygiene might be an independent risk factor for a pyogenic liver abscess. Professional mechanical tooth cleaning (PMTC) and appropriate self-care are recommended as a prophylaxis against not only dental, but also systemic diseases.

[Clinical substantiation of nootropic preparation use for premedication in outpatient stomatology]

The clinico-pharmacological description of nooclerin is given. The premedication effectiveness in patients with various individual typological features in out-patient stomatologic treatment was studied.

[The odontogenic maxillary sinusitis: 31 cases]

BACKGROUND

The odontogenic maxillary sinusitis is the consequence of the distribution of an inflammatory or infectious process of a tooth in sinuses mucous membranes.

AIM

The purpose of our work is to study epidemiological profile, clinical and radiological characteristics allowing the diagnosis of this pathology as well as the various therapeutic strategies adopted.

METHODS

We report a retrospective study of 31 observations of odontogenic maxillary sinusitis brought together in the service of ORL and of CMF of Rabta hospital over a period of 12 years.

RESULTS

In our series, the frequency of this pathology was considered at 42.5% among the group of all maxillary sinusitis brought together during the same period, the average age was of 38 years with a sex ratio of 1.04. The dental antecedents are obvious in 80% of cases, the iatrogenic was found in 64% of cases. Dental causes were dominated buy para-apical cysts (29%), and the movement of the dough canalaire (23%) especially in fongic forms of sinusitis.

[Possible causes of oro-facial pain]

Oral tissue damage and mucositis pain can be a significant problem for patients. The frequency and severity of these problems can vary significantly from patient to patient. Oral complications primarily are associated with discomfort and interference with oral function. Oral tissue damage and pain can result from a number of different processes. There are many types of pain and many locations to get pain. The body uses pain to tell the brain that something is wrong. Never ignore pain. Any type of pain symptom needs prompt professional medical advice for diagnosis of the underlying cause of the pain.

Connection between masticatory efficiency and pathomorphologic changes in gastric mucosa

OBJECTIVE

The purpose of this investigation was to establish a connection between masticatory deficiency and pathomorphologic alterations of gastric mucosa in patients with dyspepsia.

METHOD AND MATERIALS

In 40 dyspeptic, edentulous and partially dentate patients and in 40 dyspeptic control patients with good dental status, the Optosil masticatory function test was performed. Histopathologic changes of gastric mucosa and the severity of Helicobacter pylori infection were scored according to the updated Sydney Classification of Chronic Gastritis.

RESULTS

The comminution of Optosil particles after increasing the number of chewing strokes was significantly impaired in edentulous and partially dentate patients, indicating masticatory deficiency in this group. This masticatory deficiency group was subdivided into groups with a lower (subgroup 1) and higher (subgroup 2) degree of masticatory deficiency according to median X50 in the Optosil test. The endoscopic appearance of gastric mucosa in masticatory deficiency patients and in the control group suggested chronic gastritis. Higher inflammatory and infection scores were noted in subgroup 2 than in the control group and subgroup 1, especially in the antral part of the stomach. The differences between the antral part and the body of the stomach were significant only in subgroup 2.

CONCLUSIONS

Masticatory deficiency in patients with dyspepsia was connected with more severe chronic inflammatory changes and H. pylonri infection of gastric mucosa, especially in the antrum of the stomach. Higher values of inflammatory and infection scores in the subgroup with a higher degree of masticatory deficiency suggest its causal role in the promotion of gastritis and H. pylori infection.

Incontinentia pigmenti: clinical observation of 40 Korean cases

Incontinentia pigmenti (IP) is an uncommon genodermatosis that usually occurs in female infants. It is characterized by ectodermal, mesodermal, neurological, ocular, and dental manifestations. The aim of this study was to clarify clinical symptoms, accompanying diseases, and complications of IP. Forty cases of IP have been reviewed by their medical records, laboratory data, clinical photographs, and telephone survey. Male-to-female ratio was 1 to 19 and their onsets were mostly in utero. They were usually diagnosed during the neonatal period owing to their early expression of skin manifestation. Central nervous system anomalies were found in 46.7%. Ocular disorders and dental defects were detected in 66.7% and 72.7% respectively. The most commonly diagnosed anomalies were hypodontia, retinopathy, and seizure. For better understanding of IP, long term and close cooperation between dermatologists, pediatricians, neuroscientists, genetic counselors, and even dentists is crucial.

Immune status during odontogeneous abscesses and phlegmonas

Odontogeneous abscesses and phlegmonas are considered as one of the most urgent problems for stomatology. By its localization and complications the patients suffering from this pathology clearly show weakening of protective mechanisms of organism. By the use of modern methods of immunologic research we studied the nonspecific, cell, humoral and specific immune status. Study of immune status proved drastic decrease in nonspecific resistance indices, namely complete phagocytosis, total number of phagocytosis and phagocytosis index, as well as decreased alpha and beta interferon concentration. Cell immunity indices show decrease of number of T-effectors, T-helpers, T-lymphocytes and T-suppressors. Study of humoral immune status proved insignificant decrease of B-lymphocytes, Ig G, Ig M and Ig A. Serologic studies showed many-fold increase of concentration of anti-staphylococcus antibodies and presence of alpha -toxin (alpha -toxin must be absent in the norm). The results obtained by us refer to necessity of carrying out therapy with immune modulators alongside with the etiologic treatment of this pathology.

The association between the cervical spine, the stomatognathic system, and craniofacial pain: a critical review

AIMS

Craniofacial pain is a term that encompasses pain in the head, face, and related structures. Multiple etiologies and factors may be related to craniofacial pain; however, the association between the cervical spine and its related structures and craniofacial pain is still a topic of debate. The objective of this critical review was to present and analyze the evidence of the associations between the cervical spine, stomatognathic system, and craniofacial pain.

METHODS

A search of the databases Medline, PubMed, Embase, Web of Sciences, Cochrane Library, Cinahl, and HealthStar was conducted for all publications related to the topic in the English and Spanish languages. Relevant information was also derived from reference lists of the retrieved publications. The key words used in the search were cervical spine, cervical vertebrae, neck pain, neck injuries, neck muscles, craniofacial pain, orofacial pain, facial pain, temporomandibular joint pain, and temporomandibular joint disorders.

RESULTS

The search provided information referring to the biomechanical, anatomical, and pathological association between craniofacial pain, the stomatognathic system and the cervical spine.

CONCLUSION

The information provided by this review suggests an association between the cervical spine, stomatognathic system, and craniofacial pain, but most of this information is not conclusive and was derived from poor-quality studies (levels 3b, 4, and 5 based on Sackett's classification). Better designed studies are needed in order to clarify the real influence that the cervical spine has in relation to the stomatognathic system and craniofacial pain.

[Comparison of analgetic effect of magnetic and laser stimulation before oral surgery procedures]

Oral surgery procedures are often the cause of painful sensations because of their tissue invasiveness. To avoid these sensations a wide use of nonsteroid antiinflammatory drugs is usually accepted. Because of plenty side effects of these drugs alternative antipain agents are desired. The goal of this study was to assess antipain effect of laser stimulation and alternating magnetic field in oral surgery procedures. Pain sensations in patients during: local anesthetics application, surgical procedure and after it were assessed according to VAS scale. Level of stomatological fear was assessed with the use of Corah's scale. Achieved results were analyzed statistically. Conclusion of this analysis is that laser stimulation and alternating magnetic field applied directly before oral surgery procedure are effective antipain agents that decrease intra and postoperative sensations. It was observed that patients with high level of stomatological fear had more pain sensations but even in this group laser and magnetic stimulation significantly lowered these complaints.

Correlations between dentition anomalies and diseases of the of the postural and movement apparatus--a literature review

From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies. With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies. Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings. This literature review is aimed at providing an introduction to this still hotly debated issue.