Biomedical subjects
Publications and source records attributed to M T Jaspers.
Two cases of oral caliber-persistent artery are reported. Both cases were different from the five previously reported oral examples of this unusual entity. One case is the first reported instance of a caliber-persistent artery not associated with spontaneous hemorrhage, inflammation, or ulceration. The clinical importance of this entity to the patient and the treating practitioner is stressed.
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Two models concerning morphometric traits occurring frequently in aneuploidy states posit, respectively, 1) that they reflect the expression of specific major oligogenes for that trait on the chromosome involved or 2) that they result from a generalized disruption of developmental homeostasis. In contrast to previous studies that have investigated variations in morphometric traits in a single aneuploidy state, this study investigates a single morphometric trait, taurodontism, as it occurs in otherwise normal individuals, in nonchromosomal syndromes, and in aneuploidy syndromes to determine whether the trait best fits the oligogene or the disrupted developmental homeostasis model. Taurodontism is diagnosed from dental radiographs. It is an extreme variation in tooth form seen in multirooted teeth in which the bifurcation or trifurcation of the roots is displaced toward the apex of the root, resulting in increased size of the pulp chamber. The point of furcation, and consequently the size of the pulp chamber, is a quasicontinuously distributed trait. The results indicate that taurodontism most likely is the result of disrupted developmental homeostasis.
The purpose of the investigation was to determine the extent to which the 1984 American Heart Association prophylaxis guidelines were adopted in a sample of dental school patients and to determine whether implementation strategies resulted in change in the management of patients at risk for infective endocarditis (IE). Dental records of 330 patients requiring medical consultation on the basis of a heart problem identified in the medical history questionnaire were reviewed. One hundred fifty-four patients required IE prophylaxis according to their physicians. Only 11 percent of IE-susceptible patient charts showed documentation of correct prophylaxis for every appointment at which a bacteremia was possible. Only 35 percent of patients receiving prophylaxis after December 1984 were covered according to the new American Heart Association guidelines.
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The need for prophylactic antibiotic coverage before dental treatment to prevent late prosthetic joint infection has not been established. Most orthopedic surgeons who responded to the survey thought that no relationship existed between dentally induced transient bacteremias and prosthetic joint infections, but a majority of these respondents recommended antibiotic prophylaxis anyway. The current literature discloses few late prosthetic joint infections that can be attributed to the transient bacteremia expected to occur after dental treatment. Most of the respondents who recommended prophylactic antibiotics, preferred a cephalosporin. The use of this antibiotic may not be indicated because transient bacteremias that occur after dental treatment primarily are streptococcal and are of oral origin. The preferred drug for the control of oral organisms remains penicillin. Penicillin also remains the antibiotic recommended by the American Heart Association as the preferred prophylaxis against infective endocarditis secondary to dental treatment. Before any definitive statement concerning the prevention of prosthetic joint infections occurring after dentally induced transient bacteremias can be made, additional research needs to be conducted to determine the extent of the relationship and to determine the antibiotic most effective in controlling the specific bacteria involved. Currently, we recommend that dental practitioners who provide treatment to patients with arthroplasty consult with and follow the recommendations of the patient's orthopedic surgeon regarding antibiotic prophylaxis. However, we believe that the orthopedic and dental professions need to form a joint committee to examine and evaluate the current data. After this evaluation, a joint statement that concerns the relationship of and recommendations for the prevention of dentally induced bacteremias and joint infections should be issued.
Infective (bacterial) endocarditis has presented a "changing face" over the previous years but remains a disease with potentially serious complications. Surveys have indicated that up to 92% of cases of infective endocarditis could be attributed to a dental origin; yet most susceptible persons do not understand their condition or the precautions necessary prior to dental treatment. Up to 80% of infective endocarditis patients received no protection prior to dental or genitourinary manipulation. Dental practitioners, therefore, play an important role in the prevention of this disease and must be familiar with recent developments on the subject. This article provides an in-depth review of the disease and outlines and stresses the dental practitioner's responsibility in its prevention.
Dental records of 99 patients for whom a medical consultation was required to establish or eliminate the need for infective endocarditis prophylaxis were examined. The purpose of the review was to determine if the consultative process was effective and if patients requiring antibiotic prophylaxis were managed according to the current American Heart Association guidelines. The record review indicated that the consultative process is effective in determining need but that there are deficiencies in management documentation. An analysis of the consultation replies revealed that dental staff members must be thoroughly familiar with the current American Heart Association recommendations for the prevention of infective endocarditis.
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A review of the literature on teeth with enlarged pulp chambers and apical displacement of the bifurcation or trifurcation of roots (taurodontism) and investigation of the association of this trait with X-chromosomal aneuploidy shows that: (1) Taurodontism is not a rare trait in modern man, as indicated by the majority of recent reports, but occurs in approximately 2.5% of adult Caucasians. (2) Taurodontism occurs in syndromes, particularly in those having an ectodermal defect. (3) Among 12 patients showing taurodontic teeth radiographically, all had normal karyotypes. (4) Among 12 patients showing various combinations of X-chromosomal aneuploidy, 11 had taurodontic molars. (5) Patients with a female habitus and X-chromosomal aneuploidy as well as patients with a male habitus and X-chromosomal states have taurodontic teeth. (6) There is no simple association of the degree of taurodontism and the number of X chromosomes, but, in general, patients with the more severe forms of the trait--meso- or hypertaurodontism--are more likely to have X-chromosomal aneuploidy. While taurodontism may be viewed as an extension of a continuous trait of pulp chamber size, the extreme shape may arise when conditions disturbing the epithelial-derived root sheath produce a generalized amplified instability of development, as has been suggested from tissue culture studies of X-chromosomal aneuploid cells.
A brief review of the literature concerning fibrous dysplasia and fibro-osseous lesions of the jaws is presented. Five cases of fibrous dysplasia are described. The manner of presentation, diagnosis, histologic appearance, and treatment of this disease entity are discussed in light of previously published data. Histologically, two cases showed the "classic" features of woven bone in the fibrous stroma. The remaining three cases showed variable amounts of lamellar bone. The presence of lamellar bone is not considered incompatible with a diagnosis of fibrous dysplasia of the jaw, especially in older patients and in those in whom the lesion is of longer duration.
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Uremia is defined as the accumulation of nitrogenous waste products in the blood. Uremia may be caused by either acute or chronic renal failure. Uremic stomatitis represents a relatively uncommon intraoral complication of uremia. Uremic stomatitis has classically been divided into ulcerative and nonulcerative types. Reported here is a patient with chronic renal failure exhibiting intraoral lesions that persisted despite local treatment but rapidly cleared following renal dialysis. This case represents the first published report of the microscopic appearance of the nonulcerative type and presents unusual tissue changes heretofore unreported.