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Allergic urticaria and angioedema caused by a hemostatic sponge of bovine fibrin used in tooth extraction.

We report the case of a 54-year-old woman with no history of atopic diseases or drug allergies who developed a generalized anaphylactic reaction with urticaria and angioedema a few hours after tooth extraction. The skin scratch and RAST tests demonstrated IgE-mediated hypersensitivity to the product Hémofibrine, a hemostatic sponge made of bovine fibrin. Of all RAST controls, only one serum with known positivity to bovine serum albumin (BSA) showed a low degree of positivity to Hémofibrine. Bovine fibrin should be added to the list of medical products that can elicit allergic reactions following dental treatment.

Anaphylaxis

Brain stem degeneration patterns following tooth extractions: visualization of dental and periodontal afferents.

The terminal central nervous system distribution of those primary afferent neurons from the teeth and periodontium in cats was studied by degeneration methods. Lesions were created by combinations of tooth extractions and the brain stem was examined at 14, 30 and 60 days survival for degeneration patterns, with 30 days being the optimal survival time. Degenerating axons and terminals are seen bilaterally, but somewhat less on the side contralateral to the lesions and are concentrated in the ventral half of pars interpolaris and pars caudalis near obex. The results are discussed with regard to the current controversies concerning the primary central termination of these trigeminal neurons.

Afferent Pathways

Effects of various antiseptics on bacteremia following tooth extraction.

The effect of local irrigation of the gingival sulcus, which is considered an important source of bacteremia following dental procedures, with three different antiseptic solutions including hydrogen peroxide, chlorhexidine and povidone iodine, on the frequency of bacteremia after tooth extraction was determined, and the efficacies of the three antiseptics were compared. Although all the antiseptic solutions reduced the frequency of bacteremia to various degrees, povidone iodine was the most effective, and seemed to be the best choice since the decrease was statistically significant. Local administration of antiseptic solutions is therefore recommended as an adjuvant to systemic antibiotic prophylaxis.

Adult

[The comparison of blood levels between peripheral vein and tooth extraction wound after the oral administration of antibiotics (author's transl)].

The oral administration of 300 mg of clindamycin was undertaken on 23 patients, of 500 mg of cefadroxil on 11 patients and of 250 mg of talampicillin on 12 patients, and then tooth extraction was performed under local anesthesia. Blood samples were taken from the extraction wound and the peripheral vein at the same time and assayed by the bioassay method. The blood levels of clindamycin and cefadroxil indicated a similar pattern between the extraction wound and the peripheral vein, but the blood level of talampicillin reached peek level rapider than clindamycin and cefadroxil. The blood levels of the extraction wound were 60 - 80% as compared with the venous blood levels with each antimicrobial agent.

Administration, Oral

Changes in collagen types during the healing of rabbit tooth extraction wounds.

Three alpha chains of type V collagen--alpha 1 (V), alpha 2 (V), and alpha 3 (V)--were initially demonstrated together with the expected collagen types I and III in the pepsin-soluble fraction of both normal mandibular bone and tooth extraction wound tissues of rabbits, as analyzed by sodium dodecyl sulfate-gel electrophoresis. The total collagen content of each extraction wound, as determined by the hydroxyproline assay, was observed to increase continuously from day 5 through day 17 and then leveled off or decreased. The ratio of type V to type I collagen was significantly higher in the initial stage of wound healing and decreased sharply down to the level of mandibular bone by day 5. The ratio of type III to type I collagen in the pepsin-soluble fraction increased and reached a maximum on day 5, whereas it was maximal on day 7 in the cyanogen bromide-soluble fraction, and thereafter decreased gradually in both fractions. The ratio for the pepsin-soluble fraction was, however, significantly higher than that for the cyanogen bromide-soluble fraction in the early stage of wound healing.

Alveolar Process

[Animal experiment studies on the effect of unilateral tooth extraction on the growth of the skull and masticatory muscles. III. The masticatory muscles].

All continuous teeth were unilaterally extracted on the right side of the upper and lower jaws of 57 male and female Vietnamese belly pig. The animals were slaughtered 6, 7, 8, 9, 10, 11 and 12 after the extraction. Our investigations into quantitative changes in the masticatory musculature after unilateral extraction showed the dry weight of the musculature on the extraction side was reduced. This reduction was greatest in the case of the M. temporalis. The findings relating to the muscles are consistent with the results of the skull evaluations reported in the first 2 publications, with indicated that tooth extraction leads to only local changes in the jaw during postnatal development. The findings published in the 3 publications of this series relating to the bones and muscles are discussed.

Animals

Tooth extraction.

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Tooth Extraction

Bacteremia after tooth extractions studied with the aid of prereduced anaerobically sterilized culture media.

Both prereduced molten agar and broth and aerobic molten agar and broth were inoculated with blood samples collected from patients with periodontitis, but in otherwise good health, both before and after extraction of two or more teeth. Postoperative blood samples from 23 of 25 patients sampled yielded anaerobic and facultative species. Colony counts from nine samples yielded from less than 1 to over 100 colonies per ml of blood. Organisms detected were species belonging to the genera Bacteroides, Fusobacterium, Peptostreptococcus, Leptotrichia, Propionibacterium, Peptococcus, Veillonella, plus Streptococcus mitis, S. salivarius, vibrio forms, and strains resembling S. mutans. The data indicate that prereduced anaerobically sterilized culture medium with polyanethol sulfonate is effective for detecting anaerobic species in bacteremia and that anaerobic species can be prevalent in bacteremias immediately after tooth extraction in patients with periodontitis.

Aerobiosis

Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (2nd report)--schedule of administration and clinical effects in low back pain and tooth extraction.

D-phenylalanine (DPA) is known to block the activity of carboxypeptidase, an enzyme which degrades enkephalins, endogenous morphine-like substances. Therefore, it is considered that DPA administered as an inhibiting drug of this degrading enzyme might prolong analgesia induced by acupuncture. 1) Thirty patients suffering from chronic low back pain were treated with acupuncture 30 minutes after the oral administration of 4.0 grams of DPA. The results were: excellent in 7 cases, good in 11, fair in 6 and poor in 6. Cases graded excellent and good were then compared with a placebo group. The effect was increased 26% in the DPA-acupuncture group, which shows no statistically significant difference (P less than 0.1). 2) In 56 patients, tooth extraction was performed under acupuncture anesthesia: 18 had received 4.0 gram of DPA (P.O.) 30 minutes earlier. The results were excellent in 8, good in 6, fair in 3, and poor in 1. The excellent and good cases were compared with 38 placebo group cases. The effect in the DPA-acupuncture anesthesia group was significantly increased by 35% (P less than 0.01). 3) In order to determine the optimum time for the administration of DPA, two schedules of administration were compared. [1] DPA was given on the previous day in three 0.5 gram doses (26 cases). [2] A single 4 gram dose was administered 30 minutes before treatment (30 cases). The results from the "excellent", "good" and "fair" cases showed a 16% increase in effectiveness when DPA was administered the day before, not a statistically significant difference (P less than 0.1), but a clear tendency to increase was observed. The above findings show that DPA has an enhancing effect on acupuncture analgesia and anesthesia in clinical practice.

Acupuncture Analgesia