Implant decontamination with 2% chlorhexidine during surgical peri-implantitis treatment: a randomized, double-blind, controlled trial.

OBJECTIVE: The objective of this randomized, double-blind, controlled trial was to evaluate the clinical, radiographic, and microbiological effects of implant surface decontamination with a 2% chlorhexidine (CHX) solution in comparison with a 0.12% chlorhexidine + 0.05% cetylpyridinium chloride (CPC) solution during resective surgical peri-implantitis treatment. MATERIAL AND METHODS: Forty-four patients (108 implants) with peri-implantitis were treated with resective surgical treatment consisting of bone re-contouring, surface debridement and chemical decontamination, and apically repositioned flap. Patients were randomly allocated to decontamination with a 2% CHX solution (test group) or 0.12% CHX + 0.05% CPC (control group). Clinical and radiographic parameters were recorded before treatment (baseline), and at 3, 6, and 12 months after treatment. Microbiological parameters were recorded during surgery. RESULTS: Multilevel analysis showed no significant differences in bleeding, suppuration, probing pocket depth, and radiographic bone loss between control and test group over three follow-up measurements (3, 6, and 12 months) from baseline. Both decontamination procedures resulted in significant reductions in anaerobic bacterial counts on the implant surface, but no significant difference was noted between control and test group (mean log 3.37 ± 2.34 vs. 3.65 ± 2.87, P = 0.99). CONCLUSIONS: The use of a 2% CHX solution for implant surface decontamination during resective peri-implantitis therapy does not lead to improved clinical, radiographic, or microbiological results compared with a 0.12% CHX + 0.05% CPC solution. Overall, the additional use of CHX reduces anaerobic bacterial load on the implant surface better than mechanical debridement alone, but does not seem to enhance clinical treatment outcomes (ClinicalTrials.gov number NCT01852253).

In vitro antimicrobial effects of two antihalitosis mouth rinses on oral pathogens and human tongue microbiota.

OBJECTIVES: The aim of the study was to compare the antimicrobial activity of a mouth rinse containing chlorhexidine and cetylpyridinium chloride (MR1) with a stannous fluoride-based mouth rinse (MR2) in vitro. MATERIALS AND METHODS: Samples of the tongues from 10 subjects with and 10 subjects without halitosis were inoculated on blood agar plates. The agar was perforated, and the cylindrical holes were filled either with mouth rinse MR1 or with mouth rinse MR2. After incubation, inhibition zones of the whole tongue microbiota and Fusobacterium nucleatum were measured. In addition, MR1 and MR2 were applied in a short interval killing test (SIKT) on four oral pathogens Porphyromonas gingivalis, Prevotella intermedia, F. nucleatum and Aggregatibacter actinomycetemcomitans. Total viable cell counts were made after two minutes of incubation with increasing concentrations of MR1 and MR2. RESULTS: MR1 showed a significantly higher in vitro antimicrobial activity against the whole tongue microbiota and F. nucleatum than MR2 in both groups of subjects. In the SIK test, MR1 showed a significantly greater killing capacity than MR2. The results show that a mouth rinse with low concentrations of chlorhexidine and 0.05% cetylpyridinium chloride appears to be more effective in inhibiting growth of the human tongue microbiota in vitro than a fluoride/stannous fluoride-containing mouth rinse. CONCLUSION: This in vitro observation supports the use of chlorhexidine and cetylpyridinium chloride in the treatment of oral halitosis.

Borderline tumour arising in a transposed ovary in utero: a rare complication of the Estes operation.

Ovarian transposition into the uterine cavity to restore fertility, the so-called Estes operation, has rarely been performed worldwide. Malignant degeneration of such transposed ovaries has never been reported in the literature. We present a case of a borderline tumour arising in a transposed ovary after an Estes operation.

Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review.

BACKGROUND: The objective of this review was to summarize the available evidence regarding the effects of mechanical tongue cleaning compared with no mechanical tongue cleaning on breath odour and tongue coating (TC). METHODS: PubMed-MEDLINE, EMBASE and Cochrane-CENTRAL were searched to identify potentially relevant studies. The inclusion criteria included the following: randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs) conducted in humans in good general health (no systemic disorders) and a patient age of ≥17 years. For the intervention, we considered tongue cleaning [the use of a tongue scraper (TS) or tongue brush (TB)] and for the control, brushing only (B) groups. Clinical parameters such as volatile sulphur compound concentration, organoleptic scores and TC were the outcome variables of interest. Study selection, quality assessment and data extraction were carried out by two independent reviewers. RESULTS: After screening of the titles and abstracts and subsequent full text reading of the potential papers, we identified five publications that met the eligibility criteria and provided seven experiments. The five studies consisted of three RCTs and two CCTs. All experiments show a positive effect of mechanical tongue cleaning in addition to toothbrushing on various parameters of oral malodour. CONCLUSIONS: This review demonstrated that mechanical approaches, such as tongue brushing or tongue scraping to clean the dorsum of the tongue, have the potential to successfully reduce breath odour and TC. However, data concerning the effect of mechanical tongue cleaning on chronic oral malodour (halitosis) are insufficient.

Tongue Cleaning Increases the Perceived Intensity of Salty Taste.

OBJECTIVE: Tongue coating, which refers to a greyish white deposit on the tongue surface, often covers the taste papillae on the dorsal tongue surface, decreasing taste sensitivity. This study investigated whether mechanical removal of the tongue coating affected the intensity of salt taste perception. PARTICIPANTS: This cross-sectional single blind study included 90 subjects (29 males, 61 females) with a mean age of 45 years (range 25-70 years). INTERVENTION: The presence and the amount of coating on the six sextants of the tongue were scored using the Winkel Tongue Coating Index (WTCI); the 90 included subjects had total WTCI scores ≥ 3. The intensity of the salt taste was tested using a drop of prepared tomato soup applied to the middle of the dorsal surface of the tongue before and then after tongue cleaning. MEASUREMENT: The salt taste intensity was measured using a general Labeled Magnitude Scale (gLMS). RESULTS: The mean salt taste intensity was significantly different (p value = 0.0002) after the intervention versus before it, with the taste intensity increasing after tongue cleaning. CONCLUSIONS: The results indicated that the salt taste intensity increased after removal of the tongue coating. This study indicates that tongue cleaning, a simple technique used for oral hygiene, may be an effective way to reduce excess salt intake. Tongue cleaning could help individuals adhere to the WHO recommendations on dietary salt intake.

Microbial Characteristics of Peri-Implantitis: A Case-Control Study.

BACKGROUND: The aim of this case-control study is to compare oral microbiologic characteristics of patients with healthy peri-implant conditions and patients with peri-implantitis and to explore the influence of various patient- and implant-related factors on microbiologic characteristics. METHODS: Peri-implant submucosal microbial samples were collected from 85 patients with peri-implantitis (cases) and from 69 patients with only implants with healthy peri-implant conditions (controls). Samples were analyzed using culturing techniques. Multivariable logistic regression was used to explore the association of disease status and various patient- and implant-related factors (sex, patient age, smoking, number of remaining teeth, percentage of teeth with bone loss, implant function time, implant surface, and presence of plaque) with microbiologic characteristics. RESULTS: Peri-implant disease status was significantly associated with the submucosal presence of Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf), and Fusobacterium nucleatum (Fn). The association with disease status was most obvious for Pi (odds ratio [OR]: 15.1; 95% confidence interval [CI]: 5.1 to 45.3) and Tf (OR: 13.3; 95% CI: 5.4 to 32.5). The prevalence of Aggregatibacter actinomycetemcomitans and Staphylococcus species was very low. CONCLUSIONS: The periodontal pathogens Pg, Pi, Tf, and Fn are associated with peri-implantitis. A. actinomycetemcomitans and Staphylococcus species do not seem to play an important role in peri-implantitis.

Role of maximal oxygen consumption in establishment of heart transplant candidacy for heart failure patients with intermediate exercise tolerance.

Maximal exercise oxygen consumption (VO2max) was measured in patients with chronic congestive heart failure undergoing evaluation for heart transplantation. Although VO2max correlated with survival for the group as a whole, it did not demonstrate survival discrimination for patients in the intermediate range (VO2max = 12 to 17 ml/kg/min) and should therefore not be used as a benchmark test for determination of appropriateness for cardiac transplantation in this group of patients.

Radiofrequency catheter ablation of atrial flutter after orthotopic heart transplantation: insights into the redefined critical isthmus.

We report a case of successful radiofrequency catheter ablation of recurrent atrial flutter in a heart transplant recipient and discuss technical aspects of the procedure. A counterclockwise flutter circuit was defined during endocardial mapping of the donor atrium. Termination of atrial flutter was achieved by creating lines of radiofrequency lesions from the tricuspid ring to the suture line between donor and recipient atria. Creation of bidirectional conduction block in the tricuspid ring-suture line isthmus resulted in abolition of atrial flutter.

Outpatient inotropic therapy in heart transplant candidates: should its use influence waiting list priority status?

BACKGROUND: The use of outpatient intravenous inotropic therapy in heart transplant candidates is contentious. In addition to concerns about morbidity and mortality rates, the current United Network for Organ Sharing (UNOS) heart allocation system presently grants no waiting list priority status benefit to candidates who receive intravenous inotropic therapy in the outpatient setting (UNOS status 2), whereas identical therapy given in an intensive care unit setting does increase priority status (UNOS status 1). The goal of this study was to determine whether an increase in UNOS waiting list priority status is justified in heart transplant candidates receiving outpatient intravenous inotropic therapy by comparing the waiting list mortality of UNOS status 2 candidates on such therapy with that of UNOS status 2 candidates maintained on oral heart failure agents alone. METHODS: This is a retrospective analysis of the pretransplantation outcomes of heart transplant candidates initially listed as UNOS status 2, comparing 29 candidates receiving intravenous outpatient inotropic therapy (group 1) to 109 candidates maintained on oral heart failure agents alone (group 2). RESULTS: The waiting list mortality was not significantly different between the two groups (group 1=7% vs group 2=20%, p=.18); however, group 1 patients had greater morbidity rates while awaiting transplantation than group 2 patients. A greater percentage of group 1 than group 2 patients clinically deteriorated to UNOS status 1 while awaiting transplantation (45% vs 11%), resulting in more group 1 patients undergoing transplantation overall, (59% vs 33%, p=.01) and more group 1 than group 2 patients undergoing transplantation at a higher priority status, UNOS status 1 (76% vs 33%, p=.003). Group 1 patients had more pretransplantation heart failure admissions (1.2 vs 0.6 admissions/total waiting period, p=.02) and longer hospital stays (26+/-39 vs 8.8+/-16 days, p=.03), spent a greater percentage of their total waiting time hospitalized (7% vs 2%, p=.003), and were more likely than group 2 patients to receive intravenous inotropic therapy during hospitalization (70% vs 25%, p=.001). CONCLUSION: This study suggests that heart transplant candidates who require maintenance outpatient intravenous inotropic therapy represent a subgroup of UNOS status 2 candidates with greater waiting list morbidity, but no greater waiting list mortality than candidates who can be maintained on oral heart failure agents alone. However, the current UNOS heart allocation system provides for this increased illness acuity by assigning a higher priority status when necessary. A larger, prospective study is necessary to determine whether a true difference in waiting list mortality rates exists and if an increase in priority status is justified for UNOS status 2 candidates requiring maintenance inotropic therapy.

Hypotension, acidosis, and vasodilatation syndrome post-heart transplant: prognostic variables and outcomes.

BACKGROUND: In recent years a syndrome characterized by hypotension, acidosis, and vasodilatation, which we have designated HAV syndrome, has been reported to occur more frequently after heart transplantation (HT), but its pathogenesis is unknown. METHODS: We analyzed consecutive patients undergoing HT between January 1994 and June 1998 (aged 50 +/- 8 years; 87% male; 40% African American; ischemia time, 190 +/- 20 minutes; given triple immunosuppression without anti-lymphocyte antibodies) in 2 groups: 38 (54%) who developed HAV (systemic vascular resistance < or = 800 dines x sec x cm(-5) and serum bicarbonate < or = 20 mEq/liter) and 32 (46%) who did not. To identify causes of HAV, we compared 113 pre-HT donor and recipient variables, 28 peri-HT variables, and 46 post-HT variables between groups. We used Mann-Whitney, Fisher exact, and chi-squared tests to compare variables and to determine significance. RESULTS: Univariate analysis showed that HAV patients had significantly greater recipient and donor weight (p = 0.000007 and 0.0017, respectively), longer ischemia times (p = 0.0052), pre-HT use of beta-blockers (p = 0.009), and longer waiting times for HT (p = 0.018). African-American patients had less HAV than Caucasians (p = 0.047). Patients with pre-HT mechanical circulatory assistance had less HAV than pharmacologically treated patients (p = 0.014). Multivariate analysis showed that recipient (p = 0.0004) and donor weight (p = 0.0394) and ischemia time (p = 0.0015) independently predicted HAV and correlated with HAV severity. Deaths at < or =30 days of HT occurred more in patients with (33%) than in those without (15%) HAV. CONCLUSIONS: (1) Hypotension, acidosis, and vasodilatation after HT are associated with high mortality. (2) Recipient and donor weights and ischemia time are independent risk factors for HAV. (3) Pre-HT mechanical circulatory assistance and African-American race confer protection against HAV. (4) Because HAV risk factors can be altered, prevention may be possible. Further study is needed to identify the cellular and humoral mediators of HAV.

Translocation (7;7)(p13;q21) in a Wilms' tumor.

Reports of single chromosome aberrations in Wilms' tumors are rare, with most tumors being characterized by multiple complex karyotype aberrations. An 11-month-old female patient with Wilms' tumor and a derivative chromosome 7 resulting from t(7;7)(p13;q21) as the sole cytogenetic aberration is described.

Polymorphisms of the interleukin-1 gene family, oral microbial pathogens, and smoking in adult periodontitis.

Interleukin (IL)-1alpha, IL-1beta, and IL-1ra contribute to regulation of the inflammatory response in periodontal tissues. We aimed to investigate the distribution of polymorphisms in the IL-1 gene family among periodontitis patients and controls, taking into account smoking and microbiology as additional variables. Fifty-three non-smoking and 52 smoking patients with severe adult periodontitis and 53 controls were genotyped for bi-allelic IL-1A(-889), IL-1B(-3954), and a penta-allelic 86-bp VNTR IL-1RN gene polymorphisms. The presence of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was established by culture techniques. We found a higher frequency of allele 2 carriage in IL-1A, IL-1B, and IL-1RN in periodontitis patients who were non-smokers and in whom P. gingivalis and A. actinomycetemcomitans could not be detected (42.1% vs. 11.3% in controls; P = 0.0068; OR 5.7, 95% CI: 1.6-19.8). Our results provide evidence that polymorphisms in genes of the IL-1 family are associated with severe adult periodontitis in the absence of other risk factors tested in this patient population.

The chromosome-breaking activity of the restriction endonuclease Alu I in CHO cells is independent of the S-phase of the cell cycle.

The restriction endonuclease Alu I induces chromosomal aberrations in living Chinese hamster ovary (CHO) cells. Multiple fixation times reveal that the chromosome-breaking activity of Alu I is similar to that of ionizing radiation in that it is independent of the S-phase of the cell cycle. These results indicate that DNA double-strand breaks are the ultimate lesions for the production of chromosomal aberrations in all stages of the cell cycle.

Smoking affects the subgingival microflora in periodontitis.

BACKGROUND: Tobacco smoking has been identified as one major risk factor for destructive periodontal disease. Scaling and root planing have been shown to be less effective in smokers with periodontitis. The aim of the present study was to compare the subgingival microbial flora of treated and untreated smokers and non-smokers. METHODS: Four independent adult patient groups with periodontitis were included in this investigation: 88 untreated smokers (U-S); 90 untreated non-smokers (U-NS); 119 treated non-smokers (T-NS); and 171 treated smokers (T-S). Clinical variables included cumulative plaque index (CPI), probing depth (PD), clinical attachment level (CAL), cumulative bleeding index (CBI), and cumulative suppuration index (CSI). Paper point samples from the deepest bleeding pocket in each quadrant of the dentition were analyzed for the presence and levels of 6 periodontal bacterial pathogens using anaerobic culture techniques. RESULTS: U-S showed a higher mean cumulative plaque index than U-NS (3.5 versus 2.7). Mean PD and mean CAL were higher in the T-S in comparison to the T-NS group (7.0 versus 6.6 mm and 5.6 versus 4.7 mm, respectively). Microbiological characteristics of U-S were a higher prevalence of Prevotella intermedia/nigrescens and higher mean levels of Peptostreptococcus micros (Pm) and Fusobacterium nucleatum (Fn). T-S patients were characterized by higher prevalence of Bacteroides forsythus (Bf), Pm, and Campylobacter rectus (Cr) and higher mean levels of Pm and Fn. The mean percentage of B. forsythus tended to be higher in the T-S group than in the T-NS group (6.9% versus 5.6%). The relative risk to be infected with Bf, Pm, and Cr was statistically higher in smokers (odds ratios: 1.9, 1.9, and 1.6, respectively). The chance to find > or =10% of Bf, Pm, and/or Fn was 3.3 higher in smokers when A. actinomycetemcomitans and P gingivalis were absent. Detection of > or =20% Pm/Fn in treated patients was strongly associated with smoking (odds ratio 13.8, P= 0.002). CONCLUSIONS: Smoking is a determining factor for the composition of the subgingival microflora in adult patients with periodontitis and may select for a specific cluster of periodontal pathogens, notably Bf, Pm, Fn, and Cr. On the basis of these observations, smoking, among other criteria, may be one parameter to use in deciding to treat refractory periodontitis in smokers with a systemic antibiotic therapy directed against smoking-associated periodontal bacteria.

Microbiology in diagnosis and treatment of severe periodontitis. A report of four cases.

The purpose of this report is to illustrate the use of microbiology in the diagnosis and treatment in four cases of severe adult periodontitis. All four patients were subgingivally infected with Actinobacillus actinomycetemcomitans which was the basis for an adjunct minocycline therapy. Scaling and root planing plus minocycline were not able to establish a clinically stable periodontal condition. A. actinomycetemcomitans was not eliminated from the pockets in any of the patients. Good clinical and microbiological results were obtained after continuous conventional treatment with an adjunct therapy of metronidazole plus amoxycillin. With a 7 day course of this antibiotic therapy, the pockets of all four patients became free of A. actinomycetemcomitans and were still negative on repeated sampling on recall visits. Microbiological monitoring of severe periodontitis in adults seems to be a valuable adjunct to clinical examination. Furthermore, effective antibiotic therapy in A. actinomycetemcomitans-associated periodontitis appears of paramount importance in obtaining a stable periodontal situation.

[Periodontitis: a hidden chronic infection]. / Parodontitis: een verborgen chronische infectie.

Periodontitis is a chronic inflammatory disease of the tooth supporting tissues which has a prevalence of 35% in the adult population. Risk factors are dental plaque, calculus, smoking, diabetes mellitus, stress and genetic traits. In parallel with chronic intestinal inflammatory diseases and stomach cancer, gene polymorphisms in the interleukin-I gene family are associated with severity of periodontitis. Periodontitis is usually painless. Symptoms of the disease are bleeding, redness and swelling of the gums, suppuration and migration of teeth. Halitosis may be present. Treatment of periodontitis involves supra- and subgingival mechanical debridement, oral hygiene instruction and surgical elimination of residual deepened and bleeding pockets on indication. Microbiological testing can be used to select patients who may benefit from additional systemic antimicrobial therapy. Periodontal lesions may act as a portal of entry for dissemination of periodontal bacteria into the blood stream, which may result in extraoral infections. For this reason it is recommended to include diagnosis of periodontitis in focal examination. Associations have been documented between periodontitis and cardiovascular diseases, arthritis and premature low birth weight infants.

[Treatment planning for patients with periodontal disease]. / Behandelingsplanning bij patienten met parodontale aandoeningen.

The planning and execution of dental treatment in patients suffering from (severe) periodontal disease has to be carried out thoroughly and systematically. Based on a proper diagnosis and prognosis (problem analysis), a temporary treatment plan (problem solution) will be formulated. The initial (periodontal) treatment is concluded with a reevaluation. After this new diagnosis, and if necessary adjustment of the original goal of the treatment plan, a definite treatment plan can be effected. Also in this plan, the therapy must be carried out in separate phases with evaluations in between. Primarily, the periodontal therapy must be finalized, after which the definite restorative-prosthetic treatment can be carried out. A good cooperation between the dentist, dental hygienist and patient is of prime importance to achieve a permanent result. The principles of periodontal treatment planning are discussed in this contribution.

[Metronidazole in the treatment of refractory periodontitis]. / Metronidazol bij de behandeling van refractaire parodontitis.

In this article the clinical and microbiological effects of systemic metronidazole in the treatment of refractory periodontitis in adult patients is discussed. For this study, 27 adult patients with detectable Bacteroides forsythus and culture negative for Actinobacillus actinomycetemcomitans were selected. After renewed supra- and subgingival debridement, patients were treated with systemic metronidazole (500 mg TID) for 7 days. Mean probing pocket depth, probing attachment level and bleeding index significantly improved after metronidazole therapy. Patients that became culture negative for B. forsythus showed a significant better therapy response in comparison to subjects that had detectable B. forsythus post-therapy. The maximum clinical response was observed in patients that became negative for B. forsythus, Porphyromonas gingivalis and Prevotella intermedia after renewed debridement and metronidazole therapy. It is concluded that systemic metronidazole therapy can be effective in refractory adult periodontitis. Microbiological analyses of the subgingival microflora in these patients can assist in selecting patients that may benefit from systemic metronidazole therapy.

[Antibiotic resistance in the subgingival microflora in patients with adult periodontitis. A comparative survey between Spain and the Netherlands]. / Antibioticumresistentie in de subgingivale microflora in patiënten met adulte parodontitis. Een vergelijkend onderzoek tussen Spanje en Nederland.

The widespread use of antibiotics for treatment of bacterial infections has lead to the emergence of resistant human pathogens. Great differences have been documented between European countries in the use of systemic antibiotics. In parallel, significant differences in levels of resistant pathogens have been documented. In order to investigate whether differences in antibiotic use influence the level of antimicrobial resistance of the subgingival microflora, microorganisms from the subgingival plaque of untreated patients with adult periodontitis in The Netherlands (n = 30) and Spain (n = 31) were compared. Blood agar plates containing breakpoint concentrations of penicillin, amoxicillin, amoxicillin and clavulanate, metronidazole, erythromycin, azithromycin, clindamycin and tetracycline were used to determine the proportion of bacteria from the subgingival plaque that was resistant to these antibiotics. In the Spanish patients, statistically significant higher mean levels of resistance were found for penicillin, amoxicillin, metronidazole, clindamycin and tetracycline. The mean number of different bacterial species growing on the selective plates was higher in the Spanish patients, as was the percentage of resistant strains of most periodontal pathogens. A striking difference was observed in the frequency of occurrence of tetracycline-resistant periodontal pathogens. In Spain, 5 patients had > 3 tetracycline resistant periodontal pathogens, whereas this was not observed in any of the Dutch patients. It is concluded that the widespread use of antibiotics in Spain is reflected in the level of resistance of the subgingival microflora of adult patients with periodontitis.

[Risk factors in adult periodontitis: polymorphism in the interleukin-1 gene family]. / Risicofactoren voor adulte parodontitis: polymorfismen in de interleukine-1 genfamilie.

Interleukin (IL)-1 alpha, IL-1 beta and IL-1 receptor antagonist (ra) play a major role in regulation of the inflammatory response in periodontal tissues. The aim of this study was to investigate the distribution of genetic variation in the IL-1 gene family among periodontitis patients and controls, taking into account smoking and microbiology as additional variables. There were 53 non-smoking and 52 smoking patients with severe adult periodontitis and 53 periodontal healthy controls genotyped for genetic variation in the IL-1 gene family. The presence of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans was established by culture techniques. A higher frequency of genotype+ (IL-1A*2 + IL-1B*2 + IL-1RN*2) was found in non-smoking periodontitis patients in whom P. gingivalis and A. actinomycetemcomitans could not be detected (42.1% vs. 11.3% in controls; p = 0.0068; or 5.7, 95% ci: 1.6-19.8). This data provide evidence that polymorphisms in genes of the IL-1 family are associated with severe adult periodontitis and may be a risk factor for severe periodontitis.