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PubMed1992

Oral anticoagulant therapy in patients undergoing dental surgery.

The literature on dental surgery in patients receiving oral anticoagulants is reviewed, and methods of managing anticoagulant therapy to minimize the risk of complications are discussed. Although blood loss during and after oral surgery in patients receiving oral anticoagulant drugs can be substantial, research indicates that most bleeding incidents are not serious and can be controlled by local measures. Studies of 241 anticoagulant-treated patients undergoing more than 500 dental extractions during the 1950s and 1960s showed that only 9 had postoperative bleeding. More recent studies indicate that continued anticoagulation can increase the frequency of prolonged bleeding and delay wound healing. An antifibrinolytic mouthwash containing tranexamic acid can effectively suppress postoperative bleeding. Gelatin sponges, oxidized cellulose, and microcrystalline collagen are other useful hemostatic agents. A reduction in the intensity of anticoagulation therapy has been recommended; the prothrombin time should be measured shortly before the procedure in such patients. In many patients the duration of subtherapeutic anticoagulation must be minimized to reduce the possibility of thromboembolism. An option for high-risk patients is to switch them to heparin. Each patient must be evaluated individually, and the level of risk of the dental procedure and the risk of thromboembolism should be taken into account. In patients taking oral anticoagulants who must undergo dental surgery, careful control of the intensity of anticoagulation and improved methods of local hemostasis can minimize the risk of hemorrhagic complications and thromboembolism.

Administration, Oral↗

PubMedDate not supplied

Analysis of postoperative symptoms following surgical endodontic treatment.

OBJECTIVE: The purpose of this prospective study was to analyze postoperative pain and swelling of patients undergoing surgical endodontic treatment using a strict protocol incorporating measures to control postoperative symptoms. METHOD AND MATERIALS: The study consisted of 82 patients referred for surgical endodontic treatment. All surgical procedures were performed using a microsurgical technique employing strict protocol. All patients were premedicated with a single dose of oral dexamethasone (8 mg) preoperatively and two single doses (4 mg) 1 and 2 days postoperatively. Antibiotics were prescribed selectively only when severe symptoms were present due to infection. Patients were administered chlorhexidine mouthwash twice daily starting 3 days before the operation and an additional 7 days postoperatively starting the day after surgery. Cold compresses were applied on the skin at the site of surgery intermittently every 15 minutes during the operative day. Pain and swelling were recorded pre- and postoperatively, and the influence of different variables on postoperative sequelae were analyzed. RESULTS: One day postoperatively, 76.4% of the patients were completely pain free, less than 4% had moderate pain, and 64.7% did not report any swelling. The preoperative symptoms significantly influenced the pain experience post-surgery. CONCLUSION: There was a low incidence of postoperative pain and swelling following endodontic surgical treatment according to protocol with measures to control postoperative signs and symptoms. Patients with preoperative pain were more likely to have postoperative pain.

Administration, Oral↗

PubMed2003

[The relationship between Helicobacter pylori in oral cavity and the Hp infection in stomach].

OBJECTIVE: To analyze the relationship between Helicobacter pylori (Hp) in oral cavity and the Hp infection in stomach. METHODS: 102 patients with gastric Hp infection and periodontitis were enrolled in this study. DNA was extracted from subgingival plaques, mouthwashes and stomach mucosa samples by using the glass-milk (SiO2) purification method. To identify the presence of Hp in these samples, PCR (polymerase chain reaction) was carried out, and two pairs of oligonucleotide primer were used to amplify a portion of gene urease C and gene cag A of Hp. RESULTS: The rate of Hp detected in oral cavity was significantly higher in patients with positive Hp in stomach (43.1%, n=58) than in those with negative Hp in stomach (22.7%, n=44, P<0.05). After the treatment for gastric Hp infection for 4 weeks, the eradication rate of Hp in stomach was lower, but only slightly in patients with positive oral Hp (16/25, 64%) than in those with negative oral Hp (24/33, 72.7%). However, this difference became apparent (36.0% vs 63.6%, P<0.05) after one year of the treatment. CONCLUSIONS: The effectiveness of the eradication therapy for gastric Hp infection is affected by the presence of Hp in oral cavity. Oral colonization of Hp may imply that there is a risk of the relapses of gastric and duodenal Hp infection and ulcer after the antibiotics treatment for the eradication of Hp.

Adult↗

PubMedDate not supplied

Dental implications of mood disorders.

Mood disorders refers to a heterogenous group of mental conditions characterized by extreme exaggeration and disturbance of mood and affect. This article examines major depression and bipolar disorders and how these disorders can affect a patient's dental care. The drugs used to treat these conditions have significant side effects that dentists should be aware of. In addition, important drug interactions can occur as a result of agents used by the dentist. The dentist should refer patients found with signs and symptoms of mood disorders for medical evaluation and treatment. Depressed patients often have poor oral hygiene due to a lack of interest in self-care. Xerostomia occurs due to depression and the drugs used to treat it. The dentist needs to provide an aggressive preventive dental education program for these patients, including the use of artificial salivary products, mouthwashes, and topical fluoride applications, in addition to the treatment of candidiasis when present.

Antidepressive Agents↗

PubMed2004

The aetiology and treatment of oral halitosis: an update.

Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.

Bacteroidaceae Infections↗

PubMed2004

New laboratory methods to study tooth surface coverage and interproximal plaque control by dentifrice products.

OBJECTIVE: To develop and test an in vitro tooth model for use in conjunction with laboratory methods to study interproximal effects and efficacy of dentifrices. The application of the model should offer visual evaluation of dentifrice coverage of the tooth surface, and measure dental plaque control at posterior interdental spaces with a dentifrice. METHODOLOGY: The dentifrice products tested with the model were: Colgate Total 2 in 1 Toothpaste and Mouthwash (CTTM), Colgate Total dentifrice (CTD), and Colgate Regular dentifrice (CRD). Extracted human posterior teeth were disinfected, cleaned, aligned, and mounted in denture acrylic. In the area coverage method, tooth surface coverage and penetration of two different forms of dentifrice products (CTTM and CRD) were compared using digital photography. In the interproximal plaque control method, the teeth were coated with human saliva and incubated anaerobically with a mixture of representative oral bacteria for six hours at 37 degrees C. In vitro dental plaque was assessed after brushing the facial surface with one of the three dentifrice products using a clinical plaque scoring index. RESULTS: The area coverage method demonstrated that both dentifrice products tested covered approximately 70% of the facial tooth surface; the CTTM dentifrice coverage on the lingual tooth surface was significantly higher than the coverage for the CRD dentifrice. With the interproximal plaque control method, in the presence of an active ingredient, the CTTM dentifrice had equivalent efficacy to the CTD dentifrice. Both CTTM and CTD were significantly superior to the CRD for interproximal dental plaque control. CONCLUSION: Using the developed tooth model, two assessment methods have been shown to have the potential to demonstrate tooth surface coverage, and to assess the potential efficacy of a dentifrice for the control of interproximal dental plaque. This process can indicate potential clinical evaluation of an oral care product, and support clinical findings with controlled evidence.

Bacteria↗

PubMed2005

Halitosis: a review.

Halitosis, or bad breath, is caused by mainly volatile sulfur compounds (VSC) as a result of bacterial breakdown of protein and can be quantitatively and qualitatively measured in the expired oral breath. In eight to ninety percent of cases, halitosis originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth on the posterior third of the dorsal surface of the tongue. In the remaining ten to twenty percent of cases, bad breath is caused by systemic disorders such as hepatic, pancreatic and nephritic insufficiencies, trimethylaminuria, upper and lower respiratory tract infection, medication and cases where gastric content may generate oral malodour. The methods of detecting or diagnosing halitosis are organoleptic or human sense of smell, sulfide monitoring and gas chromatography. All of these methods have limitations and disadvantages. A more accurate, analytical system which will be able to precisely detect the volatile compounds in the expired air and correlate the results to a specific cause is not yet available. Dental professionals require a good knowledge on the subject of bad breath in order to feel secure about counseling and managing patients suffering from this condition. The management of halitosis involves maintenance of plaque control, elimination of active periodontal disease and cleaning the tongue on a routine basis. Oral rinsing with a mouthwash could be indicated in some instances, as a temporary measure.

Bacteria, Anaerobic↗

PubMed2005

Management of xerostomia related to radiotherapy for head and neck cancer.

Xerostomia is a permanent and devastating sequela of head and neck irradiation, and its consequences are numerous. Pharmaceutical therapy attempts to preserve or salvage salivary gland function through systemic administration of various protective compounds, most commonly amifostine (Ethyol) or pilocarpine. When these agents are ineffective or the side effects too bothersome, patients often resort to palliative care, for example, with tap water, saline, bicarbonate solutions, mouthwashes, or saliva substitutes. A promising surgical option is the Seikaly-Jha procedure, a method of preserving a single submandibular gland by surgically transferring it to the submental space before radiotherapy. Improved radiation techniques, including intensity-modulated radiotherapy and tomotherapy, allow more selective delivery of radiation to defined targets in the head and neck, preserving normal tissue and the salivary glands. Acupuncture may be another option for patients with xerostomia. All of these therapies need to be further studied to establish the most effective protocol to present to patients before radiotherapy has begun.

Acupuncture Therapy↗

PubMed1991

Apolipoprotein E genotyping using the polymerase chain reaction and allele-specific oligonucleotide primers.

A method for apolipoprotein (apo) E genotyping was developed using the polymerase chain reaction (PCR) with allele-specific oligonucleotide primers (ASP). Synthetic oligonucleotides with base-pair mismatches at the 3' terminus were used as primers to amplify the apoE gene in subjects previously phenotyped using isoelectric focusing (IEF). Complementary primer-allele combinations were specifically amplified by PCR, together with a control pair of primers specific to the human prothrombin gene. Identification of genotype by PCR using ASP was consistent with the phenotypes that were determined by IEF for 14 healthy normolipidemic subjects. These results were achieved using DNA isolated from buccal epithelial cells obtained from a mouthwash or DNA extracted from leukocytes. Genotype identification required analysis of the PCR products on an ethidium-stained agarose gel, yielding results 3 h after DNA extraction. In comparison with other current methods, PCR using ASP is suggested as a rapid and simple noninvasive technique for determining population apoE allelic distribution.

Alleles↗

PubMedDate not supplied

[Antimicrobial approaches to periodontal therapy].

The relationship between the periodontal microbiota and the threshold for periodontal disease is dependent on the specific bacterial composition of the plaque and the resistance of the host. Supragingival plaque is the cause of gingivitis and plays a primary role in the initiation of periodontitis. The 0.2% chlorhexidine mouthwash (twice a day) is safe and most effective antiplaque and anti-gingivitis agent. The use of adjunctive tetracycline for 2 week periods (1 gm daily) with root debridement is highly effective against Actinobacillus actinomycetemcomitans and many of suspected virulence microorganisms, the major etiological agents of juvenile periodontitis. For rapidly progressive periodontitis and refractory adult periodontitis, metronidazole for 1-2 week periods (600 mg.daily) has excellent activity against strictly anaerobic bacteria such as Bacteroides gingivalis, Spirochetes and others. Clinical use of antimicrobial agent in adjuvant with scaling, root planing, and personal oral hygiene instruction cause a significant improvement of the periodontium.

Actinobacillus↗

PubMed1990

Effect of two oral care protocols on the incidence of stomatitis in hematology patients.

Research-based oral care protocols for the control and treatment of stomatitis secondary to cytotoxic therapy are scarce in the nursing literature. The purpose of this pilot study was to determine the efficacy of two different oral care protocols in decreasing the incidence of stomatitis in patients with hematologic malignancies receiving chemotherapy and radiation therapy. It was hypothesized that patients with hematologic malignancies using oral care protocol A would have a lower incidence of treatment-induced stomatitis than patients using oral care protocol B. Eighteen subjects with hematologic malignancies treated with high doses of chemotherapy alone or in combination with radiation therapy were randomly assigned to one of two specific oral care protocols. Protocols differed in the type of lip lubricant, toothette, and mouthwash used. The Oral Assessment Guide (21) was used to assess oral status five times a week for the duration of each subject's hospitalization. A t test for independent samples was used to determine if the difference in the condition of the oral cavity was related to the different oral care treatments. A statistically significant difference was not found between the mean oral assessment scores of the two groups. A trend emerged, however, of a lower incidence of stomatitis in the subjects using the experimental oral care protocol. A serendipitous finding was that reinforcement of oral care instructions and nursing assessments of the oral cavity seemed to promote patient compliance with the oral care regime. A supplementary analysis revealed a statistically significant (r = -0.7177) negative correlation between the degree of stomatitis and the peripheral white blood cell count.

Adult↗

PubMed1990

[The role of topical fluorides in the prevention of dental caries].

Employment of fluorides means the employment of methods and processes which aim at increasing the fluoride concentration of the tooth surface. Methods requiring cooperation of experts (dentist, mouth hygienist) mean application of fluoride compounds of higher concentration at given periods (3 to 6 months). Methods not requiring professional cooperation prefer frequent (daily) employment of products of low concentration (toothpastes, mouthwashes etc.). In countries where such fluoride containing oral hygiene products are used extensively and systematically, frequency of caries significantly decreases. By topically employed fluorides the beneficial effect of the systemic fluoride use, (drinking water, salt, tablets) is increased.

Adolescent↗

PubMed1989

New method for quantitating yeasts in clinical specimens.

Existing methods for quantitating yeasts in clinical specimens usually rely on plate counts of sediments. A new method has been developed which uses filtration to concentrate a sample and fluorescence microscopy to facilitate counting. This method is fast and easy to perform and can be used for a wide variety of specimens including urine, mouthwash water, and vaginal fluid.

Colony Count, Microbial↗

PubMed1989

Molecular analysis of aldolase B genes in the diagnosis of hereditary fructose intolerance in the United Kingdom.

To investigate the molecular basis of hereditary fructose intolerance, we have studied 12 British patients, all of whom were found to carry a single mutation in the gene coding for aldolase B. We have estimated the frequency of this lesion, termed A149P, amongst affected individuals in the population and predict that a diagnosis may be made non-invasively in more than 83 per cent of cases by demonstrating the presence of this allele. Genetic diagnosis and detection of asymptomatic carriers of the disease may be achieved by the specific amplification of DNA derived from mouthwash samples followed by hybridization to allele-specific oligonucleotides.

Adolescent↗

PubMed1979

[Acute necrotizing-ulcerative gingivitis in young men].

Acute necrotizing ulcerative gingivitis is a disease in which the bacilli of the flora normally found in the buccal cavity (fusiform bacilli and spirochetae) play a role. This type of gingivitis occurs relatively frequently in young men. The frequency of the disease tends to peak in the winter. We examined 72 young men between the ages of eighteen and twenty-one with acute necrotizing ulcerative gingivitis, fever and swelling of the regional lymph nodes for possible noxas. All of the individuals were smokers: approximately 3/4s of the group smoked more than 60 cigarettes per day. Roughly half of the individuals examined showed extremely poor oral hygiene or underlying psychological or physical stress at the onset of the disease. Dentitio difficilis and alcohol abuse however appeared to be less important factors. Symptomatic measures, such as mouthwash and oral hygiene, proved to be effective therapy. Diseases and disorders of internal structures of the body could not be diagnosed in any of these individuals.

Adolescent↗

PubMedDate not supplied

[Use of chlorhexidine in the therapy of some stomatological diseases].

A mouthwash or toothpaste containing chlorhexidine gluconate was used to treat spontaneous or provoked bacterial plaque, primary or postoperative secondary gingivitis, and aphthae in 74 male and female subjects (mean age: 37 yr). As observed by other authors the antiseptic was very effective in the prevention of plaque, the healing or primary gingivitis, and the cicatrisation of surgical wounds. It also accelerated the regression of recurrent aphthae.

Adolescent↗

PubMed1978

[Gingival bleeding test with a new tonometer and testing of a chlorhexidine containing dentifrice].

A novel gingival tonometer is introduced with which definable pressures from 8.2-196.7 p/mm2 on the gum can be exerted. Bleeding from the gum can be produced by definable pressure, relating the inflammatory condition to the pressure insult and so achieving objective measurements. In 53 cases of periodontitis marginalis the results of treatment with a mouthwash containing chlorhexidine was tested. The gingivitis was so far improved by one week's treatment with the rinsing combination that in 1287 periodontitis cases the pressure had to be doubled before bleeding was produced.

Biguanides↗

PubMedDate not supplied

[Dentinal hypersensitivity in periodontal disease. Aetiology Aetiology--management].

The exposure of dentine has a multifactoral aetiology and pain may frequently be elicited by a number of stimuli. Management of dentinal hypersensitivity tends to be empirical because of the lack of knowledge concerning the mechanism of pain transmission through dentine. Nevertheless, whichever theory proves to be correct, occlusion of dentinal tubules would appear an essential prerequisite for an effective desensitising agent. A large number of compounds as well as iontophoresis have been employed in the management of dentinal hypersensitivity. These desensitising agents are: sodium, fluoride, stannous fluoride, sodium monofluorophosphate, strontium chloride, calcium hydroxide, potassium nitrate, silver nitrate, formalin, corticosteroids, resins, varnishes and glass ionomers. The most effective of the compounds mentioned above, are fluorides used as gels, varnishes, mouthwashes or toothpastes, strontium chloride and potassium nitrate.

Dentin Sensitivity↗