Antibiotic resistance.
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Anti-Bacterial Agents↗
Biomedical subjects
J Bagg
Publications and source records attributed to J Bagg.
Predominance of HCV type 2a in saliva from intravenous drug users.
Paired serum and saliva samples were collected simultaneously from 50 intravenous drug users with serologically proven hepatitis C virus infection. The oral health of the volunteers was also assessed. Hepatitis C virus RNA was detected by nested PCR, employing primers from the 5' noncoding region. Positive PCR products were sequenced using the Sequenase PCR Product Sequencing Kit (Amersham Life Sciences). HCV RNA was detected in 33 (66%) of the 50 serum samples. HCV RNA was detected in 19 (57.6%) of the corresponding 33 saliva samples. There was no correlation between oral health status or HIV seropositivity and the detection of HCV in saliva. However, subjects with HCV in their saliva were significantly more likely to complain of xerostomia (P < 0.05). Isolate genotypes were identified in paired serum and saliva of 15 intravenous drug users. HCV genotypes 1, 2, 3 and 6 were detected in both specimens. In seven cases, a differing HCV genotype was found in serum compared to the paired saliva specimen. The distributions of genotypes in serum and saliva were very different, with genotype 2a more common in saliva than serum (P < 0.005). These data suggest that in some cases the source of salivary HCV may not be serum transudation along the periodontal membrane or across damaged mucosa, and that an alternative local source, possibly the salivary glands themselves, should be considered.
Adult↗
Fluconazole-resistant Candida species in the oral flora of fluconazole-exposed HIV-positive patients.
The purpose of this study was to examine the effect of preceding fluconazole treatment on the oral mycologic flora and on the sensitivity of oral Candida albicans isolates to fluconazole. Saline oral rinses were collected from 89 HIV-positive patients, of whom 48 had been exposed to fluconazole and 41 were fluconazole-naive. The rinses were cultured on Sabouraud's and Pagano Levin agars, and yeasts were identified by standard methods. Fluconazole sensitivity of C. albicans isolates was measured by disk diffusion assay. C. albicans was isolated from 69% of patients who had received fluconazole and from 93% of the patients who were fluconazole-naive (p < 0.05). Nine other species of yeasts were also isolated, most commonly C. glabrata. Five patients previously exposed to fluconazole harbored fluconazole-resistant C. albicans, whereas no resistance was detected among the patients who were fluconazole-naive (p < 0.01). Sixteen of the patients who were fluconazole-exposed carried yeasts other than C. albicans, compared with only five patients in the fluconazole-naive group (p < 0.01). All of the fluconazole-resistant strains were isolated from patients with low CD4 counts (less than 100 cells/ml) and after lengthy fluconazole exposures. Nevertheless, patients in Charlotte, N.C., who had a greater mean fluconazole exposure time (10.25 +/- 1.41 months) than patients in Glasgow, UK, (0.65 +/- 0.18 months; p < 0.005), did not develop significantly more in vitro resistance or species diversity. This study indicates that long-term fluconazole treatment can have significant effects on the yeast flora of the mouth, particularly in a patient with a CD4 count of less than 100 cells/ml.
Adult↗
Oral disease in terminally ill cancer patients with xerostomia.
Xerostomia is common among patients with advanced cancer and is likely to contribute to oral disease. This study determined the prevalence of oral signs and symptoms among a group of 70 terminally ill cancer patients [25 male, 45 female; age range 42-88 (mean 66) years] complaining of oral dryness, and examined the associated oral microflora. Imprint cultures for yeasts, coliforms and staphylococci were collected from the tongue and, in denture wearers, from the plate and denture fitting surface. A swab was collected for culture of herpes simplex virus. 68 patients (97%) complained of oral dryness during the day and 59 patients (84%) complained of oral dryness at night. Oral soreness was reported by 22 patients (31%). 46 patients (66%) had difficulty talking and 36 (51%) reported difficulty eating. Of the 56 denture wearers, 40% complained of denture problems. On examination, 63 (90%) of the patients had clinically dry mouths. Oral mucosal abnormalities were detected in 45 patients (65%), most commonly erythema (20%), coated tongue (20%), atrophic glossitis (17%), angular cheilitis (11%) and pseudomembraneous candidosis (9%). 47 (67%) of the patients carried yeasts, 18 (26%) were carriers of Staphylococcus aureus and 13 (19%) carried coliforms. Herpes simplex virus was isolated from 5 patients, of whom 2 had herpetic stomatitis. Oral complications and abnormalities of the oral microflora can be detected among significant numbers of terminally ill cancer patients with xerostomia.
Adult↗
Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients.
Thirty-five hospice patients complaining of dry mouth entered a double-blind, single-phase placebo-controlled trial of a mucin-containing oral spray (Saliva Orthana) for the relief of xerostomia. The sprays were administered ad libitum for two weeks by the patients themselves, with nursing help as necessary. A detailed history and examination were undertaken, together with collection of microbiological specimens, at entry and after seven and 14 days of spray usage, respectively. Thirty-one patients were available for follow-up at seven days and 26 patients after 14 days. Relief of oral dryness during the day was reported by 9/15 patients on Saliva Orthana and 10/16 patients on placebo by day 7, with a similar degree of improvement maintained to day 14. The corresponding figures by day 7 for relief of dryness at night were 8/15 for Saliva Orthana and 8/16 for placebo. There were no statistically significant differences between those on active and those on placebo spray for any of the oral symptoms recorded. Neither spray had any major impact on the oral microflora. However, the majority of patients in both treatment groups wished to continue using a mouth spray at the end of their involvement in the trial. Whilst the data from this study provide no evidence for increased benefit of a mucin-containing spray over a mucin-free placebo among xerostomic hospice patients, it is clear that both sprays provided worthwhile symptomatic relief of oral dryness for many of the participants.
Aerosols↗
Tuberculosis: a re-emerging problem for health care workers.
The current upward trend in the incidence of tuberculosis, particularly in the USA, and the problems of treating multiply drug resistant strains of Mycobacterium tuberculosis have caused a resurgence of interest in this infection. This review describes the microbiology, routes of transmission and epidemiology of Mycobacterium tuberculosis infections. The emergence and problems of treating multiply drug resistant strains are outlined. The significant potential for occupationally acquired infection among health care workers is discussed, together with a summary of the available infection control measures currently being examined. The true level of occupational risk to dental personnel remains uncertain.
Dental Offices↗
Hepatitis C virus in saliva of haemophiliac patients attending an oral surgery unit.
This study determined the frequency with which hepatitis C virus (HCV) could be detected in the saliva of 21 HCV-seropositive haemophiliac patients attending an Oral Surgery Unit. All sera were positive for HCV RNA by the polymerase chain reaction (PCR). Six of the patients were also HIV antibody positive. Saliva was collected both by spitting into a Universal container (whole saliva), and by means of Salivettes. Following RNA extraction from saliva specimens and synthesis of cDNA, nested PCR was performed. Amplified DNA was detected by agarose gel electrophoresis and ethidium bromide staining. Overall, HCV was detected in saliva from 10 of the subjects (8 HIV seronegative and 2 HIV seropositive) but there was not complete concordance between the Salivette specimens and normal whole saliva. Analysis of pellet and supernate fractions from whole saliva produced similar discrepancies. Repeat runs of PCR for HCV following freezing and thawing of the initially positive saliva specimens were unsuccessful. It was concluded that HCV is present in the saliva of some haemophiliac patients. However, careful optimisation of sample handling and storage methods and of PCR technique are required before the true prevalence of HCV shedding in saliva can be determined.
Adult↗
A clinical and laboratory evaluation of three types of operating gloves for use in orthodontic practice.
This prospective study examined the durability and user acceptability of three types of operating glove for use in orthodontic practice. The glove types studied were a lightweight examination glove (Microtouch, Johnson and Johnson), a dedicated dental procedure glove (Biogel D, Regent Hospital Products) and a non-latex, nitrile glove (N-Dex, Best Manufacturing Europe N.V.). A water-leak test was used to examine 50 pairs of unused gloves of each type for manufacturing defects. Subsequently, six operators of varying experience were asked to use 20 pairs of each type of glove for fixed appliance treatment sessions and record their suitability for different clinical procedures. The used gloves were collected and tested in the laboratory for punctures. At the end of the study the six operators completed a detailed questionnaire recording their preferences for each glove type.
Attitude of Health Personnel↗
Common infectious diseases.
Many of the common infectious diseases of humans are highly transmissible, and there is ample opportunity within the dental office for spread of these infections between patients and staff. Adherence to universal infection control procedures, however, introduced to deal with the threat posed by unknown carriers of bloodborne viruses, also greatly limits spread of the more common infectious agents described in this article.
Adult↗
Serological and salivary markers compared with biochemical markers for monitoring interferon treatment for hepatitis C virus infection.
Paired serum and saliva specimens were collected on a regular basis from 18 asymptomatic blood donors participating in a controlled clinical trial of interferon alpha 2a (IFN) treatment of chronic hepatitis C virus (HCV) infection. Nine patients were randomised to receive interferon and nine to observation only. Serum and salivary HCV RNA was detected by a "nested" polymerase chain reaction (PCR) assay. Complete follow-up data were available for 14 patients (7 treated and 7 untreated). Serum ALT levels declined to normal in five of the seven IFN-treated patients by the twelfth week. Of these five, loss of hepatitis C viraemia was observed in three. Of the seven treated patients, the three responders had a lower viraemia level than the partial or nonresponders. Both nonresponders had infection with type 1 HCV, but the complete and partial responders were infected with types 2 or 3. HCV RNA was detected in the saliva of all seven observation patients during the follow-up period. HCV was also detected in the saliva of the two patients who did not respond to IFN treatment. No correlation was shown between the level of HCV RNA in serum and the presence of HCV RNA in saliva. A role for noninvasive salivary investigations in monitoring treatment is possible, but further refinement of the methodology is required.
Adult↗
Seroepidemiology of herpes virus infections among dental personnel.
OBJECTIVES: To examine the possible occupational hazard of infection with human herpes viruses among dental personnel. METHODS: Sera from 81 preclinical dental students, 53 clinical dental students and 103 qualified dental surgeons were tested for antibodies to herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and human herpes virus type 6 (HHV-6). The same number of control subjects, matched individually for age (+/- 1 year), sex and social class, was also examined. Antibodies were detected by ELISA for HSV-1, latex agglutination for CMV, indirect immunofluorescence with P3HR1 cells for EBV and indirect immunofluorescence with infected JJhan cells for HHV-6. Each participant also completed a questionnaire to permit correlation of demographic data and risk factors with serological results. RESULTS: No significant difference in seroprevalence was detected between any of the dental groups and their respective controls. There was a significantly higher prevalence of antibodies to EBV among clinical students (P = 0.02) and qualified dentists (P = 0.0003) than among preclinical students. These significant increases were not mirrored in the three corresponding control groups. CONCLUSION: The results suggest a possible occupational risk of infection with EBV in dentists. There was no evidence for a significant risk of occupational infection with HSV-1, CMV or HHV-6.
Adolescent↗
Microbiological assessment of denture hygiene among patients in longstay and daycare community places.
A simple, inexpensive microbiological assay for objective measurement of denture hygiene has been devised. Small individual filter paper discs were applied to the fitting surface of dentures for 20 seconds, eluted in phosphate buffered saline and bacterial counts on blood agar plates performed on the eluate. There was a strong positive correlation between denture cleanliness (graded on a scale of 0 to 4) and both total anaerobic count (r = 0.829; P < 0.001) and total aerobic count (r = 0.786; P < 0.001) following logarithmic transformation. Yeasts in the eluted disc specimens could be used as an aid to diagnose oral candidiasis. The method provided an objective measure of denture hygiene among elderly patients in longstay hospitals and daycare community places. It may be applicable to audit studies following implementation of new oral health care policies.
Adult↗
Experience with a novel selective medium for isolation of Actinomyces spp. from medical and dental specimens.
A selective medium containing mupirocin and metronidazole was evaluated for the isolation of Actinomyces spp. from clinical material. The study was a one-year prospective comparison of the method with existing methods, which use nonselective media, at a general hospital and a dental hospital. Significantly more Actinomyces spp. were isolated on the selective medium than on nonselective media from both dental specimens and intrauterine contraceptive devices. However, differentiating between Actinomyces spp. and related nonsporulating gram-positive rods remains a slow and sometimes uncertain process which can introduce lengthy delays in reporting.
Actinomyces↗
Helicobacter pylori infection in dentists--a case-control study.
To test the null hypothesis that frequent and multiple salivary exposure is not a risk factor for developing H. pylori infection, serum anti-H. pylori IgG from 179 dentists and dental students and 179 age-, sex- and socioeconomic-matched controls were assayed using an ELISA. Seroprevalence in dentists was 16% (11/70); clinical dental students 6% (3/47); and pre-clinical dental students 10% (6/62). There were no differences in H. pylori seropositivity between cases and controls. There was an increase in H. pylori seropositivity with age (chi (trend)2 9.04, p = 0.003). These data provide evidence that adults are not at high risk of developing H. pylori infection as a result of exposures to saliva from multiple sources.
Adolescent↗
Oral care for hospice patients with advanced cancer.
Mouth care forms an integral part of palliative care for hospice patients with advanced cancer. Oral disease is common in these patients and dental surgeons and their staff will be involved increasingly in the multidisciplinary care essential to effective palliative medicine. This article describes some of the more common problems the dental practitioner caring for these patients is likely to encounter and summarizes appropriate treatments, based on an approach that has been evolved in a Scottish hospice over the last 2 years.
Antineoplastic Agents↗
Seroepidemiological study of respiratory virus infections among dental surgeons.
Sera were collected from 50 practising dental surgeons and 50 control subjects matched for age (+/- 1 year) and sex. Each participant completed a questionnaire including personal details and, in the case of dentists, information relating to protective work-wear and other cross-infection control measures employed within the surgery. The sera were examined by complement fixation tests for antibodies to influenza A, influenza B, respiratory syncytial virus and adenovirus. The dental group had a significantly elevated prevalence of antibodies to influenza A (P = 0.01), influenza B (P < 0.001) and respiratory syncytial virus (P = 0.001) compared with the controls. More dentists than controls also carried antibodies to adenoviruses, although this difference did not attain statistical significance. Wearing of masks or eye protection did not markedly reduce infection with these viruses among the dentists. It is concluded that dentists are at occupational risk of infection with respiratory tract viruses, and that mask- or spectacle-wearing afford little protection.
Adenoviridae Infections↗
The detection of blood on dental surgery surfaces and equipment following dental hygiene treatment.
The Kastle-Meyer technique, a forensic test for blood, has been employed to assess the frequency and potential routes of contamination by blood between patients, staff and equipment during routine dental hygiene treatment. Fifty treatment sessions were studied and units were cleaned between patients according to the current hospital protocol. The surfaces most frequently contaminated after treatment were the 3-in-1 syringe buttons (40%), protective bibs (22%), tap handles (20%), light handles (18%) and operating cart handles (16%). Following cleaning of the units, the surfaces remaining contaminated were the 3-in-1 syringes (10%), tap handles (4%) and cart handles (2%). Modifications to the cross-infection control protocol have been made to eliminate these sources of contamination.
Blood↗
The relationship between micronutrient depletion and oral health in geriatrics.
Changes in the oral microbial flora, some of which are related to mucosal disease, have been detected in the elderly, but the causes are not fully understood. This study has examined the possible role of micronutrient depletions in the reduced colonisation resistance and oral infection exhibited by some elderly subjects. The oral health, oral microbiology and micronutrient status of 37 geriatric patients aged 65-91 years (mean 81 years) were examined. Ten of the patients had no oral mucosal disease. Mucosal pathology in the remainder included erythema (27%), denture stomatitis (24%), angular cheilitis (16%) and atrophic glossitis (41%). Those with mucosal pathology had significantly lower serum iron concentrations (P = 0.02). Serum or plasma concentrations of zinc, copper, selenium, C-reactive protein, transferrin, caeruloplasmin, albumin, vitamin A and vitamin E were not significantly different between those with oral disease and those with healthy mouths. Similarly, activity of the selenium-containing enzyme, red cell glutathione peroxidase, did not differ significantly between the two groups. In both groups, plasma selenium concentrations (82%), red cell glutathione peroxidase activity (47%), plasma zinc concentrations (58%) and albumin concentrations (44%) tended to be below the lower limit of the reference interval. The influence of subclinical infection on these values is discussed.
Aged↗