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PubMed1982

Nosocomial Pseudomonas cepacia infection associated with chlorhexidine contamination.

During the period of January to July 1980, a marked increase in the number of Pseudomonas cepacia isolates was observed in a microbiologic surveillance program. Although P. cepacia was isolated from wound specimens and vaginal cultures, the majority of isolates were of urinary origin from catheterized patients. Retrospective chart analysis of the patients failed to verify a causal pathogenic role for P. cepacia. However, fulminant sepsis subsequently developed in two hospitalized immunocompromised patients, with both blood and urine cultures positive for P. cepacia. Investigation revealed the presence of this organism in chlorhexidine (0.2 percent) mouthwash as well as other chlorhexidine antiseptic solutions used for routine urologic and obstetric procedures. The source of the P. cepacia was identified as the rubber tubing in the pharmacy through which deionized water passed during the dilution of concentrated (5 percent) chlorhexidine gluconate. In vitro tests demonstrated that P. cepacia was resistant to 0.2 percent chlorhexidine.

Aged↗

PubMed1990

Prevention of colonization of Streptococcus mutans by topical application of monoclonal antibodies in human subjects.

Topical application of Streptococcus mutans-specific MAbs was examined as a means of preventing colonization in the mouth. The MAbs recognize the cell surface antigen (SA I/II) of Strep. mutans and also bind to the intact bacterial cell. In experiments with implantation of an exogenous Strep. mutans strain, specific MAb significantly reduced the levels of implantation when compared with that in controls given a non-specific MAb. In a second investigation, the effect of MAb on recolonization by indigenous Strep. mutans was studied in subjects after treatment with a topical antibacterial mouthwash (chlorhexidine), which had decreased Strep. mutans to undetectable levels. In control subjects, the indigenous Strep. mutans started to recolonize within days, but those receiving MAb remained free of Strep. mutans for up to 2 yr. By using different Strep. mutans-specific MAbs, it was found that the serotype and epitope specificities of the IgG MAb were essential, but that the IgG sub-class may not be important. No clinical side-effects were detected in any of the subjects receiving MAb and there was no evidence of serum, salivary or gingival fluid antibody responses against the antibody. Local passive immunization with MAbs is a safe method for preventing colonization of Strep. mutans in the mouth.

Administration, Topical↗

PubMed1976

Congenital neutropenia. Report of a case and a biorationale for dental management.

Congenital neutropenia is characterized by a marked decrease in or lack of circulating PMN's in children with no prior history of drug intake. The neutropenia is persistent and the clinical course is one of early onset of severe, recurrent, and eventually fatal infections. Bone marrow studies show a maturation arrest of neutrophilic precursors. Because of their greatly increased susceptibility to infection, patients with congenital neutropenia present a difficult dental management problem. A case of congenital neutropenia has been presented, as well as a biorationale for dental treatment. On the basis of reports in the literature, the following recommendations for the management of patients with congenital neutropenia are made: 1. The prevention and control of infection and the interception of dental disease before surgical intervention becomes necessary should be the overriding considerations in the management of patients with congenital neutropenia. 2. The carious breakdown of teeth should be prevented by the daily application of a 0.4 per cent stannous fluoride gel in addition to oral hygiene and limitation of sucrose intake. 3. Periodontal therapy should be palliative only, since alveolar bone loss is progressive despite frequent oral hygiene instruction and prophylaxis. The goal of periodontal therapy for patients with congenital neutropenia should therefore be a decrease in gingival inflammation to make the patient's mouth more comfortable and to slow down alveolar bone loss. Periodontal surgery is contraindicated. 4. Bacteremia and subsequent septicemia should be prevented since a minor infection can become life threatening in patients with congenital neutropenia. The patient should rinse for 30 seconds and the gingival sulci should be irrigated with a phenolated antiseptic mouthwash prior to all dental manipulations of the soft tissue. This will significantly reduce the incidence of bacteremia. 5. Surgery should be avoided if at all possible because of the high risk of post-operative infection. All surgery sholld be performed in the hospital, and the patient should be given antibiotics as determined by his physician. Primary closure should be done with fine polyglycolic acid sutures to reduce the chance of infection. If postoperative infection can be prevented, wound healing will progress normally despite the complete absence of PMN's.

Agranulocytosis↗

PubMed1979

A review of chemotherapeutic plaque control.

Of the plaque-control agents studied, it would appear that chlorhexidine is the most suitable agent to prevent plaque accumulation and the development of gingivitis. It also is attractive to speculate on the possibilities of a commercially available mouthwash. A trio of antibiotics--kanamycin, spiramycin, and vancomycin--may prove of value in the treatment of severe gingival and periodontal disease. The ultimate role of xylitol has yet to be determined. Regardless of the agent selected, access to the gingival sulcus region seems critical.

Anti-Bacterial Agents↗

PubMed1992

Prenatal screening for cystic fibrosis.

Screening for carriers of CF (cystic fibrosis) is now possible but the best way of delivering such a service is unknown. In one model 4348 women attending antenatal clinics in an Edinburgh maternity hospital were invited to participate in a trial of prenatal screening. Mouthwash samples were tested for six CF alleles (85% of mutant genes) and when a woman was found to be a CF carrier her partner was also tested. Heterozygous couples were offered prenatal diagnosis. 609 (14%) women declined to enter the trial and another 574 (13%) were not screened, usually because of late booking. Among the remaining 3165 women there were 111 carriers of a CF gene (1 in 29). 4 of these 111 had carrier partners and these couples opted for prenatal diagnosis, the 1 pregnancy with an affected fetus being terminated. The psychological impact of screening was assessed by the general health questionnaire. There was a significant increase in stress at the time of the test result among women identified as carriers. However, this disappeared when their male partners tested normal and did not reappear later in the pregnancy. By providing time for couples to discuss the possibility of screening and by offering the test at a point (the antenatal booking clinic) at which most pregnant women are seen, this approach has advantages, provided that counselling is readily available.

Alleles↗

PubMed1996

The use of organic compounds of phosphorus in clinical dentistry.

Organic compounds of phosphorus have been developed for a range of applications in clinical dentistry. These include dentine bonding agents, restorative materials and therapeutic agents, such as active ingredients in anticaries mouthwashes. A characteristic feature of all of these applications is the good bonding of the phosphorus compound to the tooth. This review highlights the progress that has been made to date in preparing functional and durable organophosphorus bonding agents and cements, and includes coverage of recent synthetic work aimed at preparing improved organophosphorus molecules for this application. The review concludes that this remains a promising field of chemistry to explore in the search for improved, clinically useful dental materials.

Dental Bonding↗

PubMed1992

Improved pain management with daily nursing intervention during radiation therapy for head and neck carcinoma.

This study evaluated the response to a defined mouth care and analgesic treatment protocol for oropharyngeal mucositis in patients undergoing radiation therapy for head and neck carcinoma. Nineteen patients completed a 15 question pain survey before each radiation treatment. Patients were given instructions on the use of mouthwashes and a three-step analgesic protocol: acetaminophen, acetaminophen with codeine suspension, and oral morphine (20 mg/mL) for mild, moderate, and severe pain, respectively. Patients were seen daily by a radiation therapy nurse who reviewed the survey and prompt changes in the prescribed analgesic regimen were then made by a physician. Marked differences in control of pain related to radiation mucositis were observed when compared to patients from our prior study who used the same daily survey but had only sporadic nursing intervention and no analgesic protocol. Patients having daily nursing intervention reported fewer days of moderate/severe pain, had less pain throughout the day, and noted less disturbance in sleep, eating, and energy level. Weight loss of greater than 5 kg was noted in only three patients. Analgesics were used on 77% of treatment days and relieved all or most of the pain in 94% of these days. Daily review of a symptom survey by a radiation therapy nurse, combined with a well-defined strategy for mouth care, and analgesics results in improved pain management of radiation induced oropharyngeal mucositis because of prompt attention to patient needs. Future trials should incorporate defined strategies for oral care and analgesic use to control for possible bias in assessing efficacy.

Adult↗

PubMed1996

The dental problems of patients with head and neck cancer treated with CHART.

Between 1985 and 1990, 99 head and neck cancer patients were treated at Mount Vernon Centre for Cancer Treatment in a CHART pilot study. The aims of this retrospective review were to obtain baseline data for this population on their pretreatment dental status and to determine the extent to which our conservative policy of teeth preservation is being realised. This is of particular interest because of the believed sparing of late normal tissue effects by CHART compared with conventional fractionation. Prior to treatment, 40% of patients were edentulous, and prophylactic dental clearance was avoided in 59% of the remaining (dentate) patients. Following radiotherapy, only 21% of dentate patients subsequently lost all their remaining teeth. The proportion of patients with full or partial upper dentures increased from 61% pretreatment to 76% post-treatment; the corresponding increase in lower dentures was 46% to 66%. However, actual usage of dentures decreased somewhat. There was only one documented case of (minor) osteo-radionecrosis of the mandible which resolved with conservative care. The greater use in our patients of prophylactic measures, in particular, chlorhexidine and fluoride mouthwashes seemed indicated.

Adult↗

PubMed2004

Survey of oral care practices in US intensive care units.

BACKGROUND: Research has shown that oral care involving toothbrushes and topical antimicrobials improves the oral health of medically compromised patients and may reduce the incidence of nosocomial infections including pneumonia. This survey research was undertaken to determine the type and frequency of oral care in intensive care units (ICUs) in the United States and the attitudes, beliefs, and knowledge of health care workers. METHODS: A randomly selected survey of 102 ICUs within the continental United States participated with 556 respondents; 97% of respondents were registered nurses. MEASUREMENTS: Frequency and type of oral care provided, attitudes and beliefs, and knowledge and training in oral care were measured. RESULTS: Ninety-two percent of respondents perceived oral care to be a high priority. The primary methods of oral care involved the use of foam swabs, moisturizers, and mouthwash. Toothbrushes and toothpaste were used infrequently by almost 80% of respondents. The majority of nurses indicated a need for research-proven oral care standards and desired to learn more. CONCLUSIONS: In this random sample of ICUs, oral care methods were not consistent with current research and oral care protocols. The translation of oral care research into practice in the ICU may improve the quality of care and decrease the incidence of ventilator-associated pneumonia.

Critical Care↗

PubMed2004

Fluoridated elastomers: effect on the microbiology of plaque.

The objective of this study was to investigate the effect of fluoridated elastomeric ligatures on the microbiology of local dental plaque in vivo. This randomized, prospective, longitudinal, clinical trial had a split-mouth crossover design. The subjects were 30 patients at the beginning of their treatment with fixed orthodontic appliances in the orthodontic departments of the Liverpool and the Sheffield dental hospitals in the United Kingdom. The study consisted of 2 experimental periods of 6 weeks with a washout period between. Fluoridated elastomers were randomly allocated at the first visit to be placed around brackets on tooth numbers 12, 11, 33 or 22, 21, 43. Nonfluoridated elastomers were placed on the contralateral teeth. Standard nonantibacterial fluoridated toothpaste and mouthwash were supplied. After 6 weeks (visit 2), the elastomers were removed, placed in transport media, and plated on agar within 2 hours. Nonfluoridated elastomers were placed on all brackets for 1 visit to allow for a washout period. At visit 3, fluoridated elastomers were placed on the teeth contralateral to those that received them at visit 1. At visit 4, the procedures at visit 2 were repeated. Samples were collected on visits 2 and 4. A logistic regression was performed, with the presence or absence of streptococcal or anaerobic growth as the dependent variable. A mixed-effects analysis of variance was carried out with the percentage of streptococcal or anaerobic bacterial count as the dependent variable. The only significant independent variables were the subject variable (P =<.001) for the percentage of streptococcal and anaerobic bacterial count and the visit variable for the percentage of streptococcal count (P =<.001). The use of fluoridated or nonfluoridated elastomers was not significant for percentage of either streptococcal (P =.288) or anaerobic count (P =.230). Fluoridated elastomers are not effective at reducing local streptococcal or anaerobic bacterial growth after a clinically relevant time in the mouth.

Adolescent↗

PubMed2006

Characterizing variation in sex steroid hormone pathway genes in women of 4 races/ethnicities: the Study of Women's Health Across the Nation (SWAN).

This report characterizes genotypes and haplotypes in 6 genes (27 single nucleotide polymorphisms [SNPs]) from the Sex Steroid Hormone Genetics Protocol developed though the DNA Repository of the Study of Women's Health Across the Nation (SWAN) Genetics Study. The SWAN Genetics Study is a component of a longitudinal study describing health-related attributes of the menopausal transition in African American, Caucasian, Chinese, Hispanic, and Japanese women. At baseline, SWAN recruited menstruating women, aged 42 to 52 years, who were not using exogenous hormones. During the sixth and seventh years of the study, buccal cells in a mouthwash slurry and whole blood were collected for a DNA repository. Immortalized cell lines were created and genotyped in 1,538 specimens from 1,757 women who participated in the SWAN Genetics Study. DNA from those cells was genotyped for genes in the sex steroid hormone pathway. SNPs were evaluated for genotype and allele frequencies (and differences) according to race/ethnicity and haplotyped in anticipation of studying their associations with health-related measures. We demonstrated that allele frequencies differed significantly by race/ethnicity. There was substantial linkage disequilibrium among many of the SNPs and only a few SNPs showed significant Hardy-Weinberg disequilibrium within race/ethnicity. Finally, there are a number of haplotype patterns that vary according to race/ethnicity, including a "yin-yang" pattern for 17HSD among Caucasian, Chinese, and Japanese women, but not among African American women. Repository specimens developed in anticipation of genomic or metabolomics studies can extend the contribution of the parent study by developing hybrid strategies that support both SNP association studies as well as coarse and fine mapping to evaluate possible genomic locations of causal variants.

Adult↗

PubMed2005

Apo e4 allele is associated with endothelium-dependent arterial dilation in women with type 2 diabetes.

OBJECTIVE: Previous studies have suggested that the e4 allele of apolipoprotein E (apo E) relates to the endothelium-dependent arterial dilation in men with type 2 diabetes. This study attempted to assess whether apo e4 allele is associated with endothelial dysfunction in women with type 2 diabetes. RESEARCH DESIGN AND METHODS: We selected 144 Chinese Han female type 2 diabetic patients without clinically detectable angiopathy. Polymerase chain reaction/ASO probes were used to determine their mouthwash DNA apo E genotypes, and high-resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (with increased flow causing endothelium-dependent dilation) and after sublingual glyceryltrinitrate (GTN, an endothelium-independent dilator). RESULTS: The flow-mediated arterial dilation among the subjects with e4/3 or e4/4 was 3.56+/-0.23%, which was significantly lower than that in subjects with e2/2 or e3/2 (3.97+/-0.36%) (p=0.000). The baseline vessel size, GTN-induced dilation and baseline blood flows were not significantly different among different apo E genotypes. On univariate analysis, reduced flow-mediated arterial dilation was significantly related to total cholesterol, LDL, Lp(a), high blood pressure, older age, family history of premature vascular disease, larger vessel size, duration of diabetes and e4 allele (p<0.05). By multiple stepwise regression analysis, reduced flow-mediated arterial dilation was associated with older age, large vessel size, duration of diabetes, positive family history, LDL, Lp(a) and e4 allele (p<0.01). CONCLUSION: The apo e4 allele is associated with impairment of endothelium-dependent arterial dilation in the relatively early stage of female type 2 diabetes.

Adult↗

PubMed2004

Evaluation of the association of demographics and beverage consumption with dental caries.

There is much speculation about the role of carbonated soft drinks in the development of dental caries. We examine the relationships between certain demographic variables, beverage consumption, and professional dental care and their contribution to the number of decayed, missing, and filled surfaces (DMFS). The National Health and Nutrition Examination Survey III (NHANES III) conducted by the National Center for Health Statistics was used to examine DMFS among four age groups: 17-24 yr, 25-40 yr, 41-60 yr, and over 60 yr. Age has a strong, positive relationship with DMFS. About 15% of young adults aged 17-24 yr have no DMFS, and the average DMFS is only 10.4 in this age group. Less than 1% of adults over age 40 have a DMFS score of 0, and nearly one in five has the maximum of 128 DMFS. Controlling for other factors, whites have more DMFS than do blacks and Hispanics. Beverages have a weak, but statistically significant, relationship with DMFS among the older age groups only. Regular professional dental care was associated with lower DMFS among the older age groups. Age and ethnicity are the strongest predictors of DMFS. Young adults have fewer DMFS regardless of dietary factors. This study suggests that carbonated soft drinks are not associated with poor dental health. Useful strategies to reduce dental caries involve good personal dental hygiene, regular use of fluoridated toothpastes and mouthwashes, and regular care by dental professionals.

Adolescent↗

PubMed2005

Randomized, double-blind study on effectiveness of intra-alveolar chlorhexidine gel in reducing the incidence of alveolar osteitis in mandibular third molar surgery.

Chlorhexidine (CHX) mouthwash is a good prophylactic agent for postextraction alveolar osteitis (AO), a very common complication. Recently, a bio-adhesive gel to deliver the active substance, CHX, has been introduced. The intra-alveolar positioning of the bio-adhesive gel allows more direct and prolonged action of CHX, which could be useful in the prevention of AO following extraction of impacted third molars. Presented here is a double-blind, randomised and parallel-group study evaluating the efficacy of the bio-adhesive 0.2% CHX gel (n=53) applied once within the alveolus during third molar surgery, compared to placebo gel only (n=50), in reducing the incidence of impacted third-molar postextraction AO. A 63.33% reduction in the occurrence of AO (P=0.019) was observed in the experimental group. In the control group, the occurrence of AO was 30% compared to 11% in the experimental group. Bio-adhesive 0.2% CHX gel, applied only once within the alveolus site at the time of surgery, may reduce the incidence of AO following removal of impacted third molars.

Adolescent↗

PubMed2004

Evaluation of antiplaque activity of Azadirachta indica leaf extract gel--a 6-week clinical study.

Various chemical agents have been evaluated over the years with respect to their antimicrobial effects in the oral cavity; however, all are associated with side effects that prohibit regular long-term use. Therefore, the effectiveness of neem (Azadirachta indica A. Juss) leaf extract against plaque formation was assessed in males between the age group of 20-30 years over a period of 6 weeks. Present study includes formulation of mucoadhesive dental gel containing Azadirachta indica leaf extract (25 mg/g). A 6-week clinical study was conducted to evaluate the efficacy of neem extract dental gel with commercially available chlorhexidine gluconate (0.2% w/v) mouthwash as positive control. Microbial evaluation of Streptococcus mutans and Lactobacilli species was carried out to determine the total decrease in the salivary bacterial count over a period of treatment using a semi-quantitative four quadrant streaking method. The results of the study suggested that the dental gel containing neem extract has significantly (P<0.05) reduced the plaque index and bacterial count than that of the control group.

Adult↗

PubMed2004

Determination of cationic surfactants as the preservatives in an oral solution and a cosmetic product by capillary electrophoresis.

In this study, a capillary electrophoresis method was developed for the determination of cationic surfactants, benzethonium and cetylpyridinium ions, which are commonly used as preservatives in various pharmaceutical and cosmetic products. Determination was performed in a fused-silica capillary using a mixed 75 mmol/L phosphoric acid and 50% acetonitrile electrolyte at pH 2.5. Analysis of benzethonium and cetylpyridinium ions was achieved in around 5 min. Repeatability in migration times (R.S.D.%) for benzethonium and cetylpyridinium ions were 0.3. The calibration curves were linear from 0.0125 to 0.400 mmol/L for benzethonium ions and from 0.025 to 0.400 mmol/L for cetylpyridinium ions. The minimum detection limits (signal-to-noise ratio=3) are 1.47 and 4.30 microg/mL for benzethonium and cetylpyridinium ions, respectively. The method was applied to the analysis of benzethonium ion in a cosmetic product and cetylpyridinium ion in a mouthwash.

Administration, Oral↗

PubMed2006

s-Benzylthiuronium PVC matrix membrane sensor for potentiometric determination of cationic surfactants in some pharmaceutical formulation.

The construction and characteristic performance of s-benzylthiuronium (s-BT)-PVC membrane sensor responsive for cetylpyridinium chloride (CPC) are described. The sensor is based on the use of s-BT-tetraphenylborate (TPB) ion pair as electroactive material in PVC matrix in presence of dioctylphthalate as solvent mediator. The membrane sensor shows a fast, stable and near Nernstian response for CPC over the concentration range of 6 x 10(-6)-1 x 10(-3)M at 25 degrees C and pH range 6-12 with cationic slope of 57.0+/-0.4. The lower detection limit is 4 x 0(-6)M and the response time is 10-30 s. Selectivity coefficients for CPC relative to a number of different species were investigated, which there is negligible intereferences are caused by most of investigated cations, anions, and some organic compounds. The determination of 2.0-350.0 microg/ml of CPC in aqueous solutions shows an average recovery of 98.8%and a mean relative standard deviation of 1.87% at 64.0 microg/ml. The determination of CPC in mouthwash pharmaceutical solution gave results that compare favorably with those obtained by the British pharmacopoeia method. The s-benzylthiuronium electrode has been utilized as an end point indicator electrode for some precipitation titration reactions involving CPC as titrant.

Cetylpyridinium↗

PubMed2006

Potential of photodynamic therapy in treatment of fungal infections of the mouth. Design and characterisation of a mucoadhesive patch containing toluidine blue O.

Mucocutaneous oropharyngeal candidiasis is predominately caused by Candida albicans. The overall incidence of oral candidiasis in young adults has increased dramatically with the spread of HIV/AIDS. Conventional treatments have been shown to have a fungistatic rather than a fungicidal effect, resulting in an inadequate treatment outcome for patients. In addition, increasing resistance of C. albicans to antifungal agents has made effective treatment more difficult. Accordingly, interest has arisen in development of new prophylaxis/treatment regimens. One such alternative treatment is photodynamic antimicrobial chemotherapy (PACT), in which a combination of a photosensitising drug and visible light cause selective destruction of microbial cells. Due to the highly coloured nature of photosensitisers and the potential for staining of teeth, lips and buccal mucosa, administration of photosensitisers to humans as a liquid mouthwash is undesirable. Targeted delivery of the photosensitiser directly to the site of infection should be the aim. The current study, therefore, reports on a mucoadhesive patch containing toluidine blue O (TBO), as a potential delivery system for use in PACT of oropharyngeal candidiasis. Patches prepared from aqueous blends of poly(methyl vinyl ether/maleic anhydride) and tripropyleneglycol methyl ether possessed suitable properties for use as mucoadhesive drug delivery systems and were capable of resisting dissolution when immersed in artificial saliva. When releasing directly into an aqueous sink, patches containing 50 and 100mg TBO cm(-2) both generated receiver compartment concentrations exceeding the concentration (2.0-5.0 mg ml(-1)) required to produce high levels of kill (>90%) of both planktonic and biofilm-grown C. albicans upon illumination. However, the concentrations of TBO in the receiver compartments separated from patches by membranes intended to mimic biofilm structures were an order of magnitude below those inducing high levels of kill, even after 6h release. Therefore, short application times of TBO-containing mucoadhesive patches should allow treatment of recently-acquired oropharyngeal candidiasis, caused solely by planktonic cells. Longer patch application times may be required for persistent disease where biofilms are implicated.

Animals↗