Efficacy of antibiotic prophylactic regimens for the prevention of bacterial endocarditis of oral origin.

Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.

"Scheduling delay" in oral cancer diagnosis: a new protagonist.

Diagnostic delays in oral cancer have been classified as "patient delay" and "delay by the clinicians". However, the influence of the accessibility (scheduling delay) to the health care system in oral cancer diagnosis has not been studied before. To assess scheduling delay, a descriptive, cross-sectional study was designed. This study was based upon role-play telephone conversations with two standardised patients (lingual ulceration-SP1 and patient seeking fixed prosthodontics-SP2). that followed a structured script. The variables considered in the study were days to go until the arranged appointment, professional degree of the contacted person and referral to other provider of care. The scheduling delay for SP1 reached a median value of 1 day, and for SP2 was 6 days. When the professional degree (receptionist vs GDP) of the person arranging the appointment for the patient with lingual ulceration was considered, the scheduling delay was significantly shorter when the appointment was fixed by the GDP (X approximately i-X approximately j=4.5; 95%CI=-7.48,-1.51). GDPs gave priority to the patients with lingual ulcerations over those demanding fixed bridgework (X approximately i-X approximately j=6.48; 95%CI=-9.46,-3.50). The GDPs showed a high level of awareness of the oral cancer, however, educational interventions seem to be necessary for dental surgery receptionists.

Intra-alveolar granulocytic sarcoma developing after tooth extraction.

Granulocytic sarcoma (GS) is a malignant tumour composed of poorly differentiated myeloid cells forming in an extramedullary site. It is generally associated with acute leukaemia, particularly the myelocytic type. Its appearance in patients with chronic myeloid leukaemia is exceptional. GS can appear in multiple locations with the oral cavity being rarely involved. A mandibular GS detected in a patient with chronic myeloid leukaemia 10 days after a tooth extraction is reported. The pathogenesis (by metastatic cells or migration through the Haversian canals) of the tumour is discussed.

An update on infective endocarditis of dental origin.

OBJECTIVES: The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). METHODS: A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. RESULTS: According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. CONCLUSIONS: These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

Bacterial endocarditis of oral etiology in an elderly population.

The aim of this study was to analyze the prevalence and characteristics of bacterial endocarditis (BE) of oral origin in a group of elderly people. A retrospective study of 115 BE clinical records was performed, focusing on the demographic and predisposing features, as well as on the analytical and clinical variables. Twenty-two of the 115 cases were excluded as they were detected in intravenous drug users. Of the remaining 93 cases, 54.8% were diagnosed in patients older than 60 years of age (group A) and 45.2% in patients younger than 60 years (group B). There were 16 cases (17.2%) of oral origin; 4 BE cases mainly associated with tooth extractions were found in group A and 12 BE (most of them related with odontogenic abscesses) in group B. Within group A, 1 patient (25%) had not an underlying cardiac condition versus 5 cases (41.6%) in group B. Even though the prevalence of BE of oral origin in patients older than 60 is low, the high frequency of cardiopathies, poor oral health and high number of dental procedures shown by the old population makes them a risk group for BE of oral origin.

[Cerebral abscesses of oral origin]. / Abscesos cerebrales de origen oral.

INTRODUCTION: It has been suggested that between 3% and 13% of the cerebral abscesses (CA) are presumably associated to oral infections or dental procedures. AIM: Determine the prevalence of CA of oral origin, discussing their clinical and microbiological characteristics. PATIENTS AND METHODS: Retrospectively, 54 cases of CA diagnosed in 3 hospitals of Galicia between 2001 and 2002 were reviewed. RESULTS: A presumed oral portal of entry was recorded in 6 patients (11.1%); 4 cases were associated to oral infections and the remaining 2 had received dental treatment in the months prior to the onset of symptoms. Half of the patients showed irrelevant medical record, 2 had had previous extracranial abscesses and 1 presented a type A immunoglobulin deficiency. In 4 cases, the microbiological analysis was positive and typical oral bacteria (Streptococcus viridans and Peptostreptococcus spp.) were identified. CONCLUSIONS: The results of this study suggest that a significant number of CA are probably of oral origin. In consequence, to maintain a good oral health status is important and specific prophylactic measures before any dental procedure should be applied, especially in patients with risk recognized factors.

Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions.

We evaluated the efficacies of oral prophylactic treatment with amoxicillin (AMX), clindamycin (CLI), and moxifloxacin (MXF) in the prevention of bacteremia following dental extractions (BDE). Two hundred twenty-one adults who required dental extractions under general anesthesia were randomly assigned to a control group, an AMX group, a CLI group, and an MXF group (the individuals in the drug treatment groups received 2 g, 600 mg, and 400 mg, respectively, 1 to 2 h before anesthesia induction). Venous blood samples were collected from each patient at the baseline and 30 s, 15 min, and 1 h after the dental extractions. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were processed in a BACTEC 9240 instrument. Subculture and the further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalences of BDE in the control group, AMX group, CLI group, and MXF group were 96, 46, 85, and 57%, respectively, at 30 s; 64, 11, 70, and 24%, respectively, at 15 min; and 20, 4, 22, and 7%, respectively, at 1 h. Streptococcus spp. were the most frequently identified bacteria in all groups (44 to 68%), with the lowest percentage being detected in the AMX group (44%). AMX and MXF prophylaxis showed high efficacies in reducing the prevalence and duration of BDE, but CLI prophylaxis was noneffective. As a consequence, MXF prophylaxis is a promising antibiotic alternative for the prevention of BDE when beta-lactams are not indicated.

Extraoral etiology of halitosis.

Halitosis is a frequent complaint which is estimated to be found in around 50 to 60% of the general population and that carries serious personal and social repercussions. Although the majority of cases are due to oral problems, it is considered that 10-13% of halitosis cases are of extraoral etiology. In these cases the responsibility of the general dental practitioner, who is frequently the first person to examine and treat these patients, is to refer the patient for evaluation to an otorhinolaryngologist in order to rule out the presence of chronic tonsillitis or chronic sinusitis. If the otorhinolaryngologist does not detect alterations concerning his specialty, the digestive system should be explored in order to detect gastric pathology, obstructions or inflammatory gastrointestinal processes, the liver to rule out hepatic insufficiency or cirrhosis, the endocrine system to exclude diagnoses of diabetes or trimethylaminuria, the airways to rule out bronchiectasis or pulmonary abscesses, and the kidney to eliminate possible renal insufficiency. Finally, in the absence of any systemic organic pathology, the possibility of halitosis of psychiatric etiology, which requires the patient's psychological profile to be checked by the corresponding specialist, should be considered.

Eficacia clínica del moxifloxacino en el tratamiento de abscesos odontogénicos submucosos / Clinical efficacy of moxifloxacin in the treatment of submucosal odontogenic abscesses

INTRODUCCIÓN. En la terapéutica de los abscesos odontogénicos a menudo es necesario prescribir un tratamiento antibiótico. El objetivo del presente estudio es analizar la eficacia clínica del moxifloxacino en el tratamiento farmacológico de abscesos odontogénicos. MÉTODOS. Se realizó un ensayo clínico comparando la eficacia de moxifloxacino y amoxicilina-ácido clavulánico, administrados por vía oral, en el tratamiento de abscesos odontogénicos en dos Unidades de Salud Bucodental de la red de Atención Primaria del Servicio Gallego de Salud. El grupo de estudio lo compusieron 80 pacientes que presentaban abscesos odontogénicos submucosos. Tras una exploración inicial, los pacientes se distribuyeron aleatoriamente en dos grupos: A (recibieron moxifloxacino 400 mg/24 h/5 días) y B (recibieron amoxicilina-ácido clavulánico 500/125 mg/8 h/7 días). A todos los pacientes se les prescribió dexibuprofeno (400 mg/8 h/3 días). La valoración de las características clínicas de los abscesos se efectuó aplicando una versión modificada de los "Criterios de evaluación de eficacia para antibióticos" de la Sociedad Japonesa de Cirugía Oral. RESULTADOS. Tras completar el tratamiento farmacológico los pacientes fueron reevaluados. Ambos grupos evolucionaron positivamente sin que se obtuviesen diferencias estadísticamente significativas en ninguna de las variables analizadas. El grado de adherencia al tratamiento fue mejor entre los pacientes tratados con moxifloxacino. CONCLUSIONES. Consideramos que en determinadas situaciones como alergias a antibióticos beta-lactámicos o resistencias a macrólidos, el moxifloxacino podría constituir una alternativa en el tratamiento farmacológico de los abscesos odontogénicos submucosos

INTRODUCTION. In the treatment of odontogenic abscesses, it is often necessary to prescribe antibiotic treatment. This study aims to analyze the clinical efficacy of moxifloxacin in drug treatment of odontogenic abscesses. METHODS. A clinical trial was conducted. It compared the efficacy of orally administered moxifloxacin and amoxicillin-clavulanic acid in the treatment of odontogenic abscesses in two buccodental Health Care Units of the Primary Health Care network of the Galician Health Care Service. The study group was made up of 80 patients who had submucosa odontogenic abscesses. After an initial examination, the patients were distributed randomly into two groups: A (they received moxifloxacin 400 mg/24 h/5 days) and B (they received amoxicillin-clavulanic acid 500/125 mg/8 h/7 days). Dexibuprofen (400 mg/8 h/3 days) was prescribed to all the patients. Assessment of the clinical characteristics of the abscesses was done by applying a modified version of the "Assessment criteria of efficacy for antibiotics" of the Japanese Society of Oral Surgery. RESULTS. After completing the drug treatment, the patients were reevaluated. Both groups evolved positively, no statistically significant differences being obtained in any of the variables analyzed. Treatment compliance grade was greater among the patients treated with moxifloxacin. CONCLUSIONS. We consider that moxifloxacin could be an alternative in drug treatment of submucosa odontogenic abscesses in certain situations, such as allergies to beta-lactamic antibiotics or resistances to macrolides

Etiología extraoral de la halitosis / Extraoral etiology of halitosis

La halitosis constituye una "queja" bastante frecuente, cuya prevalencia se estima en torno al 50-60 por ciento de la población general, que conlleva importantes repercusiones a nivel personal y social. Aunque en la mayoría de los pacientes responde a causas órales, se considera que en el 10-13 por ciento de los casos la halitosis es de etiología extraoral.En estos casos, la responsabilidad del odontólogo, que es con frecuencia el primero en examinar y tratar a estos pacientes, es derivar al paciente para ser evaluado inicialmente por un otorrinolaringólogo, que descarte la presencia de tonsilitis crónica o sinusitis crónica. Si éste no detecta alteraciones concernientes a su especialidad, deben explorarse: el aparato digestivo, con el fin de detectar patología gástrica, obstrucciones o procesos inflamatorios gastrointestinales; el hígado, para excluir una insuficiencia o cirrosis hepática; el sistema endocrino, para descartar el diagnóstico de diabetes o trimetilaminuria; la vía aérea, para excluir bronquiectasias o abscesos pulmonares, y finalmente el riñón, para eliminar una posible insuficiencia renal. Por último, en ausencia de patología orgánica sistémica, se debe considerar la posibilidad de una halitosis de etiología psiquiátrica, que requerirá una evaluación del perfil psicológico del paciente por el especialista correspondiente (AU)

Pautas de profilaxis antibiótica de la endocarditis bacteriana en pacientes sometidos a tratamiento odontológico / Guidelines for antibiotic prophylaxis of bacterial endocarditis in patients undergoing dental therapy

El objetivo de este trabajo fue conocer las pautas de profilaxis antibiótica de la endocarditis bacteriana empleadas en diferentes centros sanitarios españoles. Para ello un odontólogo preguntó de forma oral en 50 Servicios de Cardiología y/o Medicina Interna distribuidos por toda la geografía española la profilaxis que debía administrar a un paciente portador de una prótesis valvular mitral antes de una exodoncia. Los resultados obtenidos demuestran que sólo 36 (72 por ciento) utilizaron las últimas pautas profilácticas recomendadas por la Asociación Americana de Cardiología o la Sociedad Británica de Quimioterapia Antimicrobiana. En pacientes alérgicos a la penicilina el antibiótico de elección fue la eritromicina (60 por ciento) seguida de la clindamicina (28 por ciento), aunque administradas en posologías muy diferentes (11 y 3 pautas, respectivamente). Sólo en el 44 por ciento de los centros encuestados las pautas aplicadas a pacientes alérgicos y no alérgicos correspondían al protocolo recomendado por el mismo grupo de estudio. La controversia generada en torno a las indicaciones profilácticas de la endocarditis bacteriana podría justificar en parte los resultados de este trabajo (AU)

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Abscesos cerebrales de origen oral / Cerebral abscesses of oral origin

Introducción. Se estima que entre el 3 y el 13 por ciento de los abscesos cerebrales (AC) pueden originarse como consecuencia de infecciones orales o manipulaciones odontológicas. Objetivo. Determinar la prevalencia de los AC de origen oral en nuestro entorno mediante el análisis de sus características clínicas y microbiológicas. Pacientes y métodos. Se estudiaron retrospectivamente las historias clínicas de 53 pacientes diagnosticados de AC en tres hospitales de Galicia en 2001 y 2002. Resultados. En seis casos (11,1 por ciento), los AC se consideraron de origen oral; cuatro se asociaron a la presencia de un proceso infeccioso, y los dos restantes a una manipulación odontológica que se realizó en los meses previos al inicio de los síntomas. En la mitad de los pacientes no existían antecedentes médicos de interés; dos tenían un historial previo de abscesos extracraneales y uno presentó un déficit de inmunoglobulina A. En cuatro casos, el estudio microbiológico del absceso fue positivo, y se identificaron bacterias típicas de la flora oral ( Streptococcus viridans y Peptostreptococcus spp.). Conclusiones. Los resultados del presente estudio demuestran que la prevalencia de los AC de origen oral es significativa; en consecuencia, es importante mantener un buen estado de salud oral y aplicar medidas de profilaxis específicas antes de cualquier manipulación odontológica, sobre todo en pacientes con factores de riesgo reconocidos (AU)

Introduction. It has been suggested that between 3% and 13% of the cerebral abscesses (CA) are presumably associated to oral infections or dental procedures. Aim. Determine the prevalence of CA of oral origin, discussing their clinical and microbiological characteristics. Patients and methods. Retrospectively, 54 cases of CA diagnosed in 3 hospitals of Galicia between 2001 and 2002 were reviewed. Results. A presumed oral portal of entry was recorded in 6 patients (11,1%); 4 cases were associated to oral infections and the remaining 2 had received dental treatment in the months prior to the onset of symptoms. Half of the patients showed unrelevant medical record, 2 had had previous extracraneal abscesses and 1 presented a type A immunoglobulin deficiency. In 4 cases, the microbiological analysis was positive and typical oral bacteria (Streptococcus viridans and Peptostreptococcus spp.) were identified. Conclusions. The results of this study suggest that a significant number of CA are probably of oral origin. In consequence, to maintain a good oral health status is important and specific prophylactic measures before any dental procedure should be applied, especially in patients with risk recognized factors (AU)