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PubMed1999

Kinetic and structural characteristics of the inhibition of enoyl (acyl carrier protein) reductase by triclosan.

Triclosan is used widely as an antibacterial agent in dermatological products, mouthwashes, and toothpastes. Recent studies imply that antibacterial activity results from binding to enoyl (acyl carrier protein) reductase (EACPR, EC 1.3.1.9). We first recognized the ability of triclosan to inhibit EACPR from Escherichia coli in a high throughput screen where the enzyme and test compound were preincubated with NAD(+), which is a product of the reaction. The concentration of triclosan required for 50% inhibition approximates to 50% of the enzyme concentration, indicating that the free compound is depleted by binding to EACPR. With no preincubation or added NAD(+), the degree of inhibition by 150 nM triclosan increases gradually over several minutes. The onset of inhibition is more rapid when NAD(+) is added. Gel filtration and mass spectrometry show that inhibition by triclosan is reversible. Steady-state assays were designed to avoid depletion of free inhibitor and changes in the degree of inhibition. The results suggest that triclosan binds to E-NAD(+) complex, with a dissociation constant around 20-40 pM. Triclosan follows competitive kinetics with respect to NADH, giving an inhibition constant of 38 pM at zero NADH and saturating NAD(+). Uncompetitive kinetics are observed when NAD(+) is varied, giving an inhibition constant of 22 pM at saturating NAD(+). By following regain of catalytic activity after dilution of EACPR that had been preincubated with triclosan and NAD(+), the rate constant for dissociation of the inhibitor (k(off)) is measured as 1.9 x 10(-4) s(-1). The association rate constant (k(on)) is estimated as 2.6 x 10(7) s(-1) M(-1) by monitoring the onset of inhibition during assays started by addition of EACPR. As expected, the ratio k(off)/k(on) = 7.1 pM is similar to the inhibition constants from the steady-state studies. The crystal structure of E. coli EACPR in a complex with coenzyme and triclosan has been determined at 1.9 A resolution, showing that this compound binds in a similar site to the diazaborine inhibitors. The high affinity of triclosan appears to be due to structural similarity to a tightly bound intermediate in catalysis.

Anti-Infective Agents, Local↗

PubMed2003

Inhibition of human liver microsomal (S)-nicotine oxidation by (-)-menthol and analogues.

(-)-Menthol is a widely used flavoring ingredient present in mouthwash, foods, toothpaste, and cigarettes; yet, the pharmacological effects of menthol have not been widely studied. Mentholated cigarette smoking may increase the risk for lung cancer. Many African American smokers smoke mentholated cigarettes, and African Americans have a significantly higher incidence of lung cancer as compared with whites. There may be a relationship between the incidence of lung cancer and the type of cigarette smoked because the use of mentholated cigarettes by white smokers is significantly less and the incidence of lung cancer is less. The mechanism whereby (-)-menthol could increase the health risk of smoking is not known. The results of our in vitro studies herein show that (-)-menthol and synthetic congeners inhibit the microsomal oxidation of nicotine to cotinine and the P450 2A6-mediated 7-hydroxylation of coumarin. Replacement of the alcohol oxygen atom of menthol with other heteroatoms increased the potency of P450 2A6 inhibition. Thus, the K(i) value of (-)-menthol for inhibition of microsomal nicotine oxidation was 69.7 micro M but neomenthyl thiol possesses a K(i) value of 13.8 micro M. Menthylamine inhibited nicotine oxidation with a K(i) value of 49.8 micro M, but its hydroxylamine derivative gave an IC(50) value of 2.2 micro M. A series of 16 menthol derivatives and putative metabolites were procured or chemically synthesized and tested as inhibitors of P450 2A6. While highly potent inhibition of P450 2A6 was not observed for the menthol analogues examined, it is nevertheless possible that smoking mentholated cigarettes leads to inhibition of nicotine metabolism and allows the smoker to achieve a certain elevated dose of nicotine each day. This may be another example of self-medication to obtain the desired effect of nicotine.

Animals↗

PubMed1998

Halitosis and Helicobacter pylori: a possible relationship.

With the aim of investigating a possible relationship between "objective" halitosis (established by sulfide levels in the breath) and Helicobacter pylori, we performed a study in 58 dyspeptic patients reported to suffer from "bad breath." Furthermore, we evaluated the effects on halitosis of eradication therapy (only for H. pylori-positive patients) and chlorhexidine antiseptic mouth rinses (in all patients). Sulfide compound assay indicated objective halitosis in 52/58 patients, 30 of whom were positive and 22 negative for H. pylori. In 19/30 eradication by double therapy provoked a decrease to below the cutoff value of sulfide levels in 15. In the other 11 of the 30 subjects, in whom H. pylori positivity persisted, halitosis parameters did not change. Chlorexidine reduced sulfides to below the cutoff value in 16/22 H. pylori-negative patients, but did not provoke any change in the 11 unsuccessfully treated H. pylori-positive subjects. In these, objective halitosis disappeared only after a successful eradication by triple therapy (9/11). Our results show a possible association between halitosis and H. pylori since bacterial eradication may resolve the symptom. Antiseptic mouthwashes may be effective only in absence of H. pylori, when halitosis may be due to oral putrefactive microbial activity. In a small number of subjects the cause and treatment of halitosis need to be clarified.

Adolescent↗

PubMed2004

Association between dependent smoking and a polymorphism in the tyrosine hydroxylase gene in a prospective population-based study of adolescent health.

This study reports pilot data on an association between tobacco dependence and a five-allele tetranucleotide repeat polymorphism in the first intron of the tyrosine hydroxylase (TH) gene. One hundred and twenty-six Australian adolescents who had participated in the Health in Transition Study (1993-1997), and who showed patterns of either dependent or nondependent smoking across four waves of data collection, consented to participation in the pilot study. The smoking status of those recruited was confirmed using a telephone-administered drug use questionnaire during 2000. Tobacco dependence was defined as smoking more than 6 days per week and more than 10 cigarettes per day during wave 5 (year 2000) and at least one prior wave ( n = 58). A second, more stringent phenotype included smoking within an hour of waking ( n = 37). The control group comprised adolescents who had used tobacco but had remained low-level social smokers across each wave of data ( n = 56). DNA was collected using a mouthwash procedure. Using the more strictly defined tobacco dependence phenotype, and after adjusting for sex, a significant protective association was found between the K4 allele and tobacco dependence (OR 0.27, 95% confidence interval [CI] 0.09, 0.82). No association was found using the liberal criteria of tobacco dependence (OR 0.51, 95% confidence interval [CI] 0.23, 1.2). These preliminary results replicate a previous association between tobacco use and the K4 allele of the TH gene (Lerman et al., 1997). The potential significance of including time to first cigarette in definitions of tobacco dependence and the possible role that these TH variants might play in tobacco dependence are discussed.

Adolescent↗

PubMed2003

Utility of [13C] urea breath test for Helicobacter pylori detection in partial gastrectomy patients.

Many reports on the diagnostic efficacy of the [13C] urea breath test ([13C] UBT) for the detection of Helicobacter pylori in the residual stomach have shown negative results. We previously reported on the utility of [13C] UBT and conducted an evaluation to establish a standardized protocol with a shorter sampling time for [13C] UBT in partial gastrectomy patients. Sixty-two patients who had undergone partial gastrectomy were included. The [13C] UBT protocol included ingestion of 100 mg [13C] urea, use of mouthwash, and the body in a horizontal position on the left side. The sensitivity of [13C] UBT was 95.7%. Thirty minutes and a cutoff of 2.0 per thousand were found to be optimal for the test, with the body position horizontal on the left side. In the present protocol [13C] UBT appears to be a reliable and convenient tool with the same accuracy rate as other routine tests in patients with a remnant stomach.

Adult↗

PubMed2001

Anaphylactic reactions in anaesthetised patients - four cases of chlorhexidine allergy.

Chlorhexidine is widely used all over the world in many different preparations. In Denmark chlorhexidine is the standard skin disinfectant used before surgery or invasive procedures and it is widely used in the general population in mouthwash or for disinfection of minor scratches etc. The potential for developing allergy to chlorhexidine is thus great, especially in surgical patients. We have identified four patients with serious allergic reactions in connection with surgery and general anaesthesia, who on subsequent skin testing tested positive for chlorhexidine. Symptoms appeared 20-40 min into the operation and all four patients required treatment with adrenaline. All four patients had a history of minor symptoms like rashes or faints in connection with previous surgery/invasive procedures. Allergy to chlorhexidine may be more prevalent in surgical patients and cases may have been overlooked due to the nature of reactions and lack of suspicion towards this substance.

Aged↗

PubMed2002

Clinical, genetic and microbiological findings in a Brazilian family with aggressive periodontitis.

BACKGROUND/AIM: Aggressive periodontitis comprises a group of rapidly progressive forms of periodontitis. Besides bacteria, a high level of subject susceptibility must be involved in the expression of disease. In the present study, we report the clinical, microbiological and genetic profile of a 14-individual family with aggressive periodontitis. METHOD: PCR was utilized to detect pathogenic bacteria of affected sites. DNA was obtained from epithelial cells through a mouthwash with 3% glucose and scrapping of the oral mucosa. RFLP-PCR was used to analyze cytokine genetic polymorphisms. RESULTS: Localized aggressive periodontitis was diagnosed for an 18-year-old systemically healthy non-smoking proband, with siblings displaying aggressive periodontitis. Bacteroides forsythus and Treponema denticola were the most frequent pathogens. The proband presented Actinobacillus actinomycetemcomitans and detectable levels of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola. Allele 2 of IL-1alpha (-889) polymorphism was found in all individuals as well as allele 1 of the IL-1beta (+3953) gene. Alleles 1 and 2 (50 % each) of IL-1beta (-511), allele 1 of TNF-alpha (-308) and allele 2 (in homo or heterozygosity) of IL-RN (intron 2) gene were present. CONCLUSION: The results show that the present microbiological and genetic parameters were not relevant for the prediction of periodontitis susceptibility in this family.

Adolescent↗

PubMed2002

A clinical comparison of three powered toothbrushes.

AIM: The purpose of the present study was to compare the ability of the Braun Oral-B 3D Excel power toothbrush (BPT), the Sonicare power toothbrush (SPT) and the Philips Sensiflex 2000 (HX 2550) power toothbrush (PPT) to control plaque and reduce experimentally induced gingivitis. MATERIALS AND METHODS: Two experiments were carried out in two different groups of subjects using a split-mouth design whereby the two halves of the mandible which had been allowed to develop gingivitis were brushed over a 4-week period with the test toothbrushes. Experiment 1 compared the BPT with the SPT (n = 35) and experiment 2 compared the BPT with the PPT (n = 32). The study used a run-in period of 2 weeks, which, together with the 3-week experimental gingivitis phase, represented the pretrial phase of the experiment. The purpose of this phase was two-fold: first, to enable the subjects to become acquainted with the two power brushes and for them to receive proper oral hygiene instruction, and, second, to develop a reasonable level of gingivitis on the mandible. Those subjects with at least 40% of sites exhibiting bleeding in each quadrant in the mandible at day 21 of the experimental gingivitis phase were allowed to continue with the trial. During the next 4 weeks (treatment phase) of each experiment, subjects were told to brush according to a split-mouth design, the right and left sides of the mouth being randomly allocated to a toothbrush. During this period, no rinsing with an antiseptic mouthwash or flossing was allowed and a standard toothpaste (Zendium(R)) was used. After 1, 2 and 4 weeks, the plaque index (Quigley & Hein) and the bleeding tendency on marginal probing were assessed in the mandible. RESULTS: Experiment 1 showed that the bleeding score was reduced from 1.63 to 1.12 at 4 weeks by the BPT and from 1.65 to 1.26 by the SPT. This reduction was more rapid and greater with the BPT (P < 0.05). The plaque index was reduced from 2.19 at day 21-1.03 at 4 weeks by the BPT, and from 2.18 to 1.20 by the SPT. The difference between the two toothbrushes was not significant. Experiment 2 showed that the bleeding score was reduced from 1.77 at day 21 to 1.07 at 4 weeks by the BPT and from 1.75 to 1.24 by the PPT. This reduction was more rapid and greater with the BPT (P < 0.05). There was no significant difference in plaque index at 4 weeks (BPT, 1.09; PPT, 0.95). Data from the questionnaire at the end of the study revealed that, in both experiments, most subjects preferred the BPT. CONCLUSIONS: The data from this study show that the design and action of the Braun Oral-B 3D Excel power toothbrush are more effective in resolving gingivitis than the Sonicare & the Philips Sensiflex 2000 power toothbrushes.

Attitude to Health↗

PubMed2003

Polymorphism at position -174 of IL-6 gene is associated with susceptibility to chronic periodontitis in a Caucasian Brazilian population.

BACKGROUND: Interleukin-6 (IL-6) is a multifunctional cytokine that mediates inflammatory tissue destruction. A G to C substitution at position -174 in the promoter of IL-6 gene reduces in vitro transcription of IL-6. This polymorphism has been associated with inflammatory diseases like chronic arthritis. OBJECTIVE: The aim of this study was to investigate the association between the IL-6-174 polymorphism and susceptibility to chronic periodontitis in Brazilians. MATERIAL AND METHODS: Eighty-four nonsmoking subjects over 25 years (mean age 42.4) were divided according to the severity level of periodontal disease: 36 healthy individuals (control group), 24 subjects with moderate and 24 with severe periodontitis. Genomic DNA was obtained from epithelial cells through a mouthwash with 3% glucose and scraping of oral mucosa. The samples were analyzed for IL-6-174 polymorphism using PCR-RFLP. The significance of the differences in the frequencies of the polymorphism in the control and groups with periodontitis was assessed by chi2 test (p<0.05). RESULTS: Differences were found between control and groups with periodontitis in the genotype (p=0.0036, OR=3.0) and in the allele (p=0.0838, OR=1.9) frequencies. CONCLUSION: We concluded that the IL-6-174 polymorphism is associated with susceptibility to chronic periodontitis in the population studied.

Adult↗

PubMed1996

Nicotinamide pharmacokinetics in humans: effect of gastric acid inhibition, comparison of rectal vs oral administration and the use of saliva for drug monitoring.

The effect of inhibiting gastric acid secretion on nicotinamide pharmacokinetics was studied in five volunteers with the intent of reducing the large variations observed previously in the time to and magnitude of peak plasma concentrations. Plasma levels were determined using a standard high-performance liquid chromatography (HPLC) method after an oral dose of 3 g of nicotinamide either alone or preceded by pretreatment with omeprazole. Suppression of gastric acid production had no significant effect on the rate of uptake or on the peak levels achieved. To bypass gastric acidity, the rectal route was also assessed using a suppository in four volunteers and one patient undergoing radiotherapy. Absorption was slow and variable and much lower plasma levels were observed than after oral dosing. Thus, no improvement in the pharmacokinetics of nicotinamide was observed using either of these two approaches. Parallel estimations were made using a novel and non-invasive method for monitoring nicotinamide pharmacokinetics in saliva. A large and variable fraction of the total amount of nicotinamide-related material in saliva was found to be nicotinic acid, a metabolite not normally found in human plasma. This conversion was inhibited by the use of a chlorhexidine mouthwash, indicating that the oral flora was responsible for its production. The time to peak levels of nicotinamide or of nicotinamide plus nicotinic acid in saliva correlated well with that in plasma. However, peak concentrations for nicotinamide alone were significantly lower than in plasma, and very variable, whereas for nicotinamide plus nicotinic acid saliva levels were 20-30% higher, but more consistent. Although there are some practical difficulties in quantitatively handling saliva, the method is very useful for monitoring nicotinamide pharmacokinetics and for assessment of compliance with nicotinamide treatment.

Absorption↗

PubMed1998

Treatment-induced mucositis: an old problem with new remedies.

Mucositis may be a painful, debilitating, dose-limiting side-effect of both chemotherapy and radiotherapy for which there is no widely accepted prophylaxis or effective treatment. The basis of management is pain relief, prevention of dehydration and adequate nutrition. When tested vigorously, most antiseptic mouthwashes and anti-ulcer agents are ineffective. Simple mechanical cleansing by saline is the most effective traditional measure. A variety of new agents are effective. Granulocyte macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) act outwith the haemopoeitic system and can reduce mucositis, but the best schedule, dosage and method of administration is not known or which is the best growth factor to prevent this side-effect. A placebo-controlled randomized trial of antibiotic pastilles has shown a significant reduction in mucositis and weight loss during radiotherapy for head and neck cancer. Another method to reduce radiation effects in normal tissue is to stimulate cells to divide before radiotherapy by silver nitrate or interleukin 1. These methods may be particularly effective when given along with hyperfractionated radiation treatment such as CHART.

Anti-Bacterial Agents↗

PubMed1995

Management of the orthodontic patient 'at risk' from infective endocarditis.

There are no clear guidelines for the application of current antibiotic prophylactic regimes to orthodontic patients at risk from infective endocarditis. In order to ascertain current practice, a survey on various aspects of the management of orthodontic patients at risk from infective endocarditis was undertaken. Questionnaires were sent to all 1038 members of the British Society for the Study of Orthodontics and the British Association of Orthodontists. A total of 518 replies were received, 480 (46%) of which were completed in full and analysed. Eight cases of infective endocarditis associated with orthodontic treatment over a 44-year period were reported. The majority of respondents underestimated the number of at risk patients likely to be encountered over a 5-year period. Most orthodontists routinely contact the medical practitioner (62%) or hospital consultant (65%) for advice on the prescription of prophylactic antibiotics. Only 58 (12%) claimed to have refused orthodontic treatment for at risk patients. The majority of respondents advise the use of antibiotic prophylaxis for band placement and removal and manipulation of an unerupted tooth. A high standard of oral hygiene must be established prior to orthodontic treatment for at risk patients. Antibiotic prophylaxis in orthodontics should be used for procedures which cause gingival trauma eg band placement and removal. The daily use of a chlorhexidine mouthwash during treatment and prior to appliance adjustment is recommended.

Adolescent↗

PubMed1997

Use of proprietary agents to relieve recurrent aphthous stomatitis.

AIM: To examine the subjective efficacy of proprietary agents for aphthous stomatitis. DESIGN: A simple open study. SETTING: Hospital out-patients in the UK in 1993. SUBJECTS: 50 consecutive patients with aphthae. OUTCOME: Patients assessed agent efficacy as very effective, possibly effective or not effective at relieving symptoms. RESULTS: 38 of 54 available agents were used. Difflam Oral Rinse (benzydamine hydrochloride) appeared to give most control of pain. Overall, Corsodyl mouthwash (chlorhexidine gluconate) gave most beneficial effect. CONCLUSIONS: Difflam and Corsodyl appear to give some symptomatic relief to aphthous victims.

Administration, Topical↗

PubMed2005

Gelatinous drop-like corneal dystrophy in a child with developmental delay: clinicopathological features and exclusion of the M1S1 gene.

AIMS: Gelatinous drop-like corneal dystrophy (GDLD) is an early-onset, autosomal recessive condition characterised by amyloid deposits within the cornea. We report the histopathological and molecular genetic findings in a Caucasian child with GDLD who also exhibited global developmental delay. METHODS: Bilateral lamellar keratoplasty was carried out at age 6 and 7 years. Tissue was fixed for light and electron microscopy, including immunoelectronmicroscopy. The coding region of the M1S1 gene was screened for mutations in the affected proband and available relatives, using DNA extracted from mouthwashes. RESULTS: Nodular deposits, which were present subepithelially and in the central superficial stroma, stained typically for amyloid with PAS and Congo red. A nodular deposit of amyloid, together with large amounts of lactoferrin and sparse amounts of keratoepithelin (betaig-h3), was present in the central superficial stroma, causing destruction of Bowman's layer and elevation of the thinned, degenerate epithelium. Around the deposit zone, the stroma exhibited large numbers of thick filamentous proteoglycan deposits. While the affected child was homozygous for a novel A1133 C single-nucleotide polymorphism (SNP) that resulted in an aspartic acid to alanine substitution at position 173 of the M1S1 coding sequence, this polymorphism was also found at relatively high frequency in a sample of normal controls, enabling exclusion of the M1S1 gene as the disease locus. CONCLUSION: Increased epithelial permeability in GDLD may be explained in part by an altered membrane permeability of the superficial epithelial cells. An association with developmental delay has not been reported previously.

Amyloid↗

PubMed2004

Effectiveness of a hydrophilic primer when different antimicrobial agents are mixed.

The purpose of this study was to determine whether different types of antimicrobial agents with hydrophilic primer applied to etched enamel surfaces will affect the shear bond strength (SBS) and the bracket/adhesive failure modes of metallic orthodontic brackets. Eighty noncarious human premolars were divided into four groups of 20 each. A composite resin (Transbond XT) was used to bond stainless steel brackets. Teeth in the first group were used as a control and bonded with standard procedures. For the other three groups, mixtures containing a hydrophilic primer (Transbond MIP) and one of three anti-microbial agents were prepared (Cervitec: in 1:2 ratio; chlorhexidine mouthwash and EC40 varnish in 1:1 ratio). These mixtures were applied to the etched enamel surfaces and thoroughly light cured for 20 seconds, and the brackets were bonded and light cured for 40 seconds. The SBS values of these brackets (Mpa) were recorded using a universal testing machine. Adhesive Remnant Index scores were determined after failure of the brackets. Data were analyzed using analysis of variance (ANOVA), Tukey honestly significant difference, and chi-square tests. Results of ANOVA revealed statistically significant differences in bond strengths among the various groups tested (P < .05). The bond strength values in these four groups compared favorably with those from other studies and the minimal bond strength values that are clinically acceptable. However, results of this study demonstrated that groups 1 (control) and 2 (Cervitec varnish) had higher SBS values than the other applications. Application of different antimicrobial agents may result in differences in the site of failure.

Analysis of Variance↗

PubMed2003

Oral and intestinal mucositis - causes and possible treatments.

Chemotherapy and radiotherapy, whilst highly effective in the treatment of neoplasia, can also cause damage to healthy tissue. In particular, the alimentary tract may be badly affected. Severe inflammation, lesioning and ulceration can occur. Patients may experience intense pain, nausea and gastro-enteritis. They are also highly susceptible to infection. The disorder (mucositis) is a dose-limiting toxicity of therapy and affects around 500 000 patients world-wide annually. Oral and intestinal mucositis is multi-factorial in nature. The disruption or loss of rapidly dividing epithelial progenitor cells is a trigger for the onset of the disorder. However, the actual dysfunction that manifests and its severity and duration are greatly influenced by changes in other cell populations, immune responses and the effects of oral/gut flora. This complexity has hampered the development of effective palliative or preventative measures. Recent studies have concentrated on the use of bioactive/growth factors, hormones or interleukins to modify epithelial metabolism and reduce the susceptibility of the tract to mucositis. Some of these treatments appear to have considerable potential and are at present under clinical evaluation. This overview deals with the cellular changes and host responses that may lead to the development of mucositis of the oral cavity and gastrointestinal tract, and the potential of existing and novel palliative measures to limit or prevent the disorder. Presently available treatments do not prevent mucositis, but can limit its severity if used in combination. Poor oral health and existing epithelial damage predispose patients to mucositis. The elimination of dental problems or the minimization of existing damage to the alimentary tract, prior to the commencement of therapy, lowers their susceptibility. Measures that reduce the flora of the tract, before therapy, can also be helpful. Increased production of free radicals and the induction of inflammation are early events in the onset of mucositis. Prophylactic administration of scavengers or anti-inflammatories can partially counteract or limit some of these therapy-mediated effects, as can the use of cryotherapy. The regular use of mouthwashes, mouth coatings, antibiotics and analgesics is essential, prior to and during loss and ablation of the epithelial layer. Granulocyte-macrophage colony-stimulating factor/granulocyte colony-stimulating factor or the use of laser light therapy may aid restitution and repair. Glutamine supplements may be beneficial in the repair/recovery phase.

Age Factors↗

PubMedDate not supplied

Factors influencing oral mucositis in patients receiving chemotherapy.

PURPOSE: Oral mucositis is a painful complication of chemotherapy and can greatly affect patients' morbidity and mortality. Findings from two previous studies suggested a decrease in the prevalence of chemotherapy-induced mucositis in patients with solid tumors. The purposes of this study were to follow a large cohort of outpatients to determine the prevalence of mucositis and to identify whether certain clinical factors were significant in the development of mucositis. DESCRIPTION OF STUDY: In this prospective study, a convenience sample of 199 outpatients was followed for three cycles or until mucositis developed. The clinical factors monitored included the following: pretreatment dental examination/repair; initial standard chemotherapy dosage; prophylactic use of colony-stimulating factors; and use of preventive mouthwashes or other prophylactic measures. RESULTS: Oral mucositis developed in 50 patients (25.1%). Prechemotherapy dental examination/repair and initial standard chemotherapy dosage were equivalent among both groups. Of the 48 patients in whom mucositis developed, 10 (20.8%) received prophylactic colony-stimulating factors. Of 134 patients in whom mucositis did not develop, 46 (34.3%) received prophylactic colony-stimulating factors. This difference was statistically nonsignificant. CLINICAL IMPLICATIONS: Differences in the clinical factors investigated could not explain the lower prevalence of oral mucositis among the current patient cohort. The reason for the diminishing prevalence of this side effect remains unclear, and additional parameters, particularly detailed oral hygiene practices, should be evaluated. In the meantime, oncology clinicians should consider the teaching of patients and urging them to use good oral hygiene practices as necessary and potentially preventive measures against chemotherapy-induced mucositis.

Ambulatory Care↗

PubMed2001

Patient compliance to instructions after oral surgical procedures.

The purpose of this study was to evaluate patient compliance to postoperative instructions from the oral surgeon. A total of 180 patients who underwent minor oral surgical procedures anonymously answered a questionnaire 1 week postsurgery. This questionnaire was used to evaluate how patients remembered the mode of transmission of instructions (written, verbal), their compliance to the postoperative instructions and to the antibiotic treatment and their comments. Of the patients, 40% did not remember receiving both written and verbal instructions, 36% remembered only the written instructions. Twelve percent did not comply with the postoperative instructions regarding mouthwashes and 67% did not comply with the antibiotic prescriptions; 43% took more antibiotics and 31% less, and 4% who did not receive an antibiotic prescription took them on their own initiative. The academic level of the patients did not influence patient compliance. Verbal and written recommendations worded simply with details are important for patient compliance and reduced postoperative stress and complaints. Better instructions on antibiotics use are necessary to ameliorate patient compliance to the antibiotic treatment.

Adolescent↗