Frank's Sign and Cardiovascular Risk: An Observational Descriptive Study.

PURPOSE: This study was undertaken to analyze the relationship between the diagonal earlobe crease and the main indices of cardiovascular risk, considering the crease's anatomical variations. METHODS: The study group consisted of 1050 adults residing in Spain. Participants underwent the following determinations: age, sex, body mass index, smoking habit, blood pressure, glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and cardiovascular events. Cardiovascular risk was calculated applying the Framingham-Anderson equation, the Systematic Coronary Risk Evaluation equation, and the Atherosclerotic Cardiovascular Disease Risk Score calculator. Both earlobes were examined, recording diagonal earlobe crease presence, length and depth, and presence of accessory creases. Results were analyzed by using chi-square test, Student's t test, analysis of variance, and Mann-Whitney or Kruskal-Wallis tests. To extract the functions of cardiovascular risk, a script in R was created (https://cran.r-project.org/). RESULTS: The estimated cardiovascular mortality risk was significantly higher in individuals who presented diagonal earlobe crease (P < .001). The number of individuals with moderate, high, or very high cardiovascular risk increased significantly as the presence of the crease increased (23.8% had no crease, 35.6% had unilateral creases, and 58% had bilateral creases; P < .001). The mean cardiovascular risk estimated was significantly higher for individuals with longest and deepest diagonal earlobe crease (P < .001 and P < .001, respectively), and with accessory creases (P < .001). CONCLUSIONS: The diagonal earlobe crease is independently associated with higher cardiovascular risk scores, especially when the crease is complete, bilateral, deep, and has accessory creases.

Oral amoxicillin/clavulanate for the prevention of bacteremia following dental extractions.

This study aimed to evaluate the effectiveness of oral amoxicillin/clavulanate (AMX-CL) for the prevention of bacteremia following dental extractions. The study group (AMX-CLG) comprised 40 adults requiring dental extractions under general anesthesia who were administered a prophylactic regimen of 1875/125 mg of AMX-CL orally 1-2 h prior to the surgery. Venous blood samples were collected from each patient at baseline and at 30 s and 15 min after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The results for the AMX-CLG were compared with those of a control group (CG; no prophylaxis) and an amoxicillin group (AMXG; 2 g of amoxicillin orally), consisting of randomly selected patients from among those participating in two clinical trials that we have previously published. The prevalence of bacteremia in the CG, AMXG, and AMX-CLG was 97%, 50%, and 15%, respectively, at 30 s after completing the extractions, and 67%, 10%, and 4% at 15 min, respectively, after the last extraction. The prevalence of bacteremia in the AMXG and the AMX-CLG at 30 s and at 15 min after completing the extractions was significantly lower than that in the CG (p < 0.001 and p < 0.001, respectively; Fisher's exact test). The prevalence of bacteremia in the AMX-CLG at 30 s after completing the extractions was significantly lower than that in the AMXG (p < 0.001; Fisher's exact test). Based in the results of this preliminary study, oral AMX-CL could be an excellent option for preventing bacteremia secondary to dental procedures in patients at risk.

Bibliometric Analysis of Medication-Related Osteonecrosis of the Jaw: High Citation Rates but Low Evidence.

PURPOSE: Citation analysis is one of the most commonly used bibliometric tools for measuring the academic importance of a report in a specific area of knowledge. The objective of the present study was to identify the 100 most cited reports on medication-related osteonecrosis of the jaw (MRONJ), determine their main bibliometric characteristics, and identify the bibliometric variables that affected the citation rates. MATERIALS AND METHODS: We performed a data search in the Scopus database to determine the number of MRONJ article citations up to September 30, 2018. We next selected the 100 most referenced studies and recorded the following information: ranking according to the number of citations; citation density; number and names of authors; language and year of publication; country and institution of origin; financial support; journal name, impact factor, category, and quartile; type of research; evidence level; and area of study. RESULTS: The 100 most cited reports had a mean citation density of 21.7 ± 20.7 (range, 6.2 to 99.4) and an h-index of 96. The 100 most cited reports on MRONJ had been published in 42 scientific journals, classified into 10 separate categories of the Journal Citation Reports; 56% of the articles were in the first quartile of their category. Most of the studies had been classified with a level of evidence of 4 (n = 45) or 5 (n = 29). In the bivariate analyses, only the conflict of interest (P = .002) was associated with citation density. After adjusting for numerous variables, conflict of interest (r = 0.27; P = .020) and country of the first author (r = 0.23; P = .043) were significantly associated with citation density. CONCLUSIONS: The 100 most cited studies of MRONJ had a large number of citations and had been reported in journals with a high impact factor; however, the studies had a generally low evidence level and randomized clinical trials were lacking.

Survival of dental implants in patients with Down syndrome: A case series.

STATEMENT OF PROBLEM: The need for tooth replacement in individuals with Down syndrome (DS) is explained by the high prevalence of dental agenesis and by the premature loss of teeth through severe periodontal disease. Dental implants may be the dental procedure of choice in some of these patients. PURPOSE: The purpose of this clinical study was to analyze dental implant survival in a series of patients with DS. MATERIAL AND METHODS: This was a multicenter, retrospective, observational study. Information on patients was gathered using a standardized questionnaire designed specifically for this study, including personal details, oral health status, information on the surgical and prosthetic phases, and follow-up visits. The questionnaire was sent to centers registered with the research network of the Spanish Society of Special Needs Dentistry (SEOENE). Patients with DS aged 18 years or older were included in the study if they had at least 1 dental implant and the corresponding prosthesis and had been followed up for at least a year. RESULTS: The study population was formed of 25 adult patients (13 men and 12 women) aged between 19 and 60 years. The interventions were performed by 5 different dental surgeons, usually under general anesthesia or deep sedation (n=17 patients). A total of 73 implants were inserted, 30 in the maxilla and 43 in the mandible, most commonly in the anterior region (n=51). The mean time to loading the implants was 4.1 ±1.3 months after surgery (range, 1 to 7 months). All patients completed prosthetic rehabilitation; the most frequent design used was the single fixed prosthesis (n=13 patients). A total of 17 (23.2%) implants failed in 8 (32%) patients; the majority (n=14 implants) failed in the postsurgical period before implant loading. The distribution by patients was 1 implant failure in 6 patients, 3 failures in 1 patient, and 8 failures in 1 patient. CONCLUSIONS: Dental implant survival is lower in individuals with DS than in the general population. The reasons for early implant failure in these patients have still not been clearly identified.

Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems.

OBJECTIVES: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. STUDY DESIGN: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). RESULTS: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). CONCLUSIONS: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications.

Oral health status of patients with a mild decrease in glomerular filtration rate.

OBJECTIVE: The aim of this study was to evaluate the oral health status of patients with mildly decreased glomerular filtration rate (GFR). STUDY DESIGN: The study group comprised 80 adults with GFR 60-89 mL/min. A group of 80 age- and gender-matched control subjects with GFR > or =90 mL/min were selected. Medical history, clinical examination, and biochemistry blood tests were performed in patients and control subjects. Renal function was estimated using the Modification of Diet in Renal Disease formula. A single dentist performed an intraoral examination of each patient and control subject. RESULTS: No significant differences were detected between patients and controls in the number of decayed, missing, or filled teeth, supragingival plaque accumulation, calculus deposits, gingival inflammation, depth of periodontal pockets, clinical attachment loss, or dental mobility. CONCLUSION: To our knowledge, this is the first study on dental health in the early stages of chronic renal failure. The results suggest that in patients with mildly decreased GFR, there are no alterations of the oral health status.

Chemoprophylaxis of bacterial endocarditis recommended by general dental practitioners in Spain.

The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an "at risk" patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for "at risk" patients before dental procedures among Spanish GDPs.