Impact of salivary hypofunction on incidence of orofungal infections with use of topical steroids for management of oral lichen planus and xerostomia.

OBJECTIVES: The aim of this study was to determine if salivary hypofunction increases the incidence of oral fungal infections (OFIs) after topical steroid use for the management of oral lichen planus (OLP). STUDY DESIGN: Patients with a diagnosis of OLP, treated for at least 2 weeks with topical steroids, had baseline salivary flow evaluations completed, and had a follow-up visit within 5 weeks of steroids being prescribed were assessed. Patients were evaluated for clinical signs of fungal infection at follow-up visits. RESULTS: Forty-Seven patients (91% female) met the inclusion criteria, with 21.3% developing an OFI after topical steroid use. Demographic characteristics, type of OLP, steroid used, and antifungal used did not impact the development of an OFI. The mean stimulated salivary flow was significantly lower in the group that developed an OFI compared with the group that did not develop an OFI (8.31 mL/15 min vs 15.4 mL/15 min, respectively; P = 0.0006). A higher incidence of OFIs occurred in the low stimulated flow group versus the normal flow group (39% vs 4%, respectively). Most patients in the OFI group received a preventative antifungal (90%). CONCLUSIONS: OFIs increased after steroid treatment in patients with OLP who had low stimulated salivary flows. Antifungals (90%) were not effective in preventing OFIs in patients with OLP who had salivary hypofunction and were treated with topical steroids.

Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon.

Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population.

The MiiA motif is a common marker present in polytopic surface proteins of oral and urinary tract invasive bacteria.

Many surface virulence factors of bacterial pathogens show mosaicism and confounding phylogenetic origin. The Streptococcus gordonii platelet-binding GspB protein, the Streptococcus sanguinis SrpA adhesin and the Streptococcus pneumoniae DiiA protein, share an imperfect 27-residue motif. Given the disparate domain architectures of these proteins and its association to invasive disease, this motif was named MiiA from Multiarchitecture invasion-involved motif A. MiiA is predicted to adopt a beta-sheet folding, probably related to the Ig-like fold, with a symmetrical positioning of two conserved aspartic residues. A specific hidden Markov model profiling MiiA was built, which specifically detected the motif in proteins from 58 species, mainly in cell-wall proteins from Gram-positive bacteria. These proteins contained one to ten MiiA motifs, which were embedded within larger repeat units of 70-82 residues. MiiA motifs combined to other domains and elements such as coiled-coils and low-complexity regions. The species carrying MiiA-proteins included commensals from the urogenital tract and the oral cavity, which can cause opportunistic endocarditis and sepsis. Intra-protein MiiA repeats showed a complex mixture of orthologal, paralogal and inter-species relationships, suggestive of a multistep origin. Presence of these repeats in proteins involved in oligosaccharide recognition and lifestyle of species suggest a putative function for MiiA repeats in sugars binding, probably those present in receptors of epithelial and blood cells. MiiA modules appear to have been transferred horizontally between species co-habiting in the same niche to create their own MiiA-containing determinants. The present work provides a global study and a catalog of potential MiiA virulence factors that should be analyzed experimentally.

In vitro Evaluation of Copaifera oblongifolia Oleoresin Against Bacteria Causing Oral Infections and Assessment of Its Cytotoxic Potential.

The oral cavity, which harbors more than 750 bacterial species, is one of the most diverse sites of the human body. Some of these bacteria have been associated with oral diseases, such as dental caries and endodontic infections. We report on the antimicrobial and cytotoxic activities of Copaifera oblongifolia oleoresin against bacteria that cause caries and endodontic infections. The aim of this study is to determine the minimum (MIC) and the bactericidal (MBC) inhibitory concentrations as well as the biofilm inhibition ability (through determination of MBIC50) of the C. oblongifolia oleoresin. This study also investigated the bactericidal kinetics (time-kill curves) and the synergistic effect of the C. oblongifolia oleoresin. Additionally, this study evaluated the cytotoxic activity of the oleoresin toward V79 cells by means of the colony-forming assay. The C. oblongifolia oleoresin gave promising MIC and MBC values, which ranged from 25 to 200 µg/mL. Analysis of the MBIC50values of the oleoresin revealed it displayed biofilm inhibitory activity against all the assayed bacteria. Analysis of the bactericidal kinetics showed different behaviors of the oleoresin against the tested bacteria at the different time intervals and concentrations assayed in this study. An additive effect of the oleoresin with chlorhexidine dihydrochloride occurred only for S. mitis and A. actinomycetemcomitans. The C. oblongifolia oleoresin showed cytotoxic activity at concentrations ≥ 625 µg/mL.

Global oral inequalities in HIV infection.

Analysis of the prevalence and incidence of HIV infection globally reveal striking variances with regard to continent, country, region and gender. Of the global total of 33 million people infected with HIV, approximately 65% are in sub-Saharan African countries and 15% in South and South-East Asia with the remaining 20% spread over the rest of the world. As a percentage of the population, the Caribbean at 1.1% is second only to sub-Saharan Africa (5.5%). The majority of the world's HIV is in women. Deaths from HIV are twenty-fold greater in Africa than in Europe or the USA. Individual countries in sub-Saharan Africa show huge variances in the HIV+ prevalence with most West African countries having a rate of less than 2% whilst southern African countries including Swaziland and Botswana have rates of around 25%. Environment, education and social habits all contribute to the HIV infection rates. Similar variations between countries are seen in SE Asia with Cambodia and Papua New Guinea having rates three times greater than Pakistan. One of the most striking examples of inequality is in life years added to HIV populations as a result of antiretroviral therapy. UN AIDS figures over 1996-2008 suggest an average of 2.88 added years in the USA and Europe, but only 0.1 in sub-Saharan Africa, a thirty-fold difference largely due to accessibility to ART. ART leads to a reduction in oral lesions but it is estimated that some 10 million HIV+ subjects do not have access to oral care. Thus, inequalities exist both for HIV infection and for the associated oral lesions, mainly related to ART access. HIV infection and oral mucosal lesions both appear to be related to general social determinants of health. Oral HCW must be part of mainstream healthcare teams to address these inequalities.

Knowledge and reported practice of antibiotic prescription by dentists for common oral problems.

OBJECTIVE: To assess the knowledge and reported practice in relation to antibiotic prescribing regarding common oral problems by dentists in Karachi, Pakistan. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Three Dental Colleges of Karachi, from July to December 2010. METHODOLOGY: The cross-sectional study was conducted in Karachi, Pakistan in the Outpatient Departments (OPD) of three dental colleges. Inclusion criteria were full time employed dentists working in their respective OPDs (n = 100). The dentists were asked to fill a questionnaire. The questionnaire included (i) general information, (ii) perception and knowledge of antibiotic resistance, (iii) reported management of oral problems, (iv) perceptions about oral infections and (v) perceptions of how people perceive oral problems. To assess dentists´ ability to relate knowledge to practice regarding the management of the most common oral problems, written simulated case scenarios with related questions were also included. Scores were given for each correct answer. RESULTS: The response rate was 85%. Of the total respondents, 65 (76%) were under the age of 30 years, 53 (62%) were males and 32 (38%) females. Out of 85 respondents 53% (n = 45) reported prescribing of antibiotics 4-5 times a week, 87% (n = 74) prescribe antibiotics based upon symptoms and 64% (n = 54) prescribed antibiotics in abscess condition. The total score for all four scenarios showed that nearly two thirds (61%) of all respondents scored sub-optimally. CONCLUSION: A substantial number of dentists had suboptimal knowledge regarding antibiotic use. This might lead to the provision of suboptimal care of patients with dental infections. Therefore, continuing education, training and supervision are recommended to improve the quality of dental management.

Oral infections: impact on human health, well-being, and health-care costs.

Both caries and periodontal disease, as well as many diseases of the mucous membranes, tongue, and salivary glands, are infectious. If left untreated or inadequately treated, they have profound systemic, as well as local, effects. Maintenance of oral health goes beyond the physiological needs of proper nutritional intake and protection of the oral tissues. It also includes protection against oral sources of systemic infection and encompasses a range of social and psychological attributes. The rising expectations of patients in the pursuit of comfort and esthetics has provided evidence of the oral contribution to quality of life. Oral infections and their sequela account for the major portion of annual dental expenditures.

In vitro assessment of the antimicrobial activity of a local sustained release device containing amine fluoride for the treatment of oral infectious diseases.

Dental caries and periodontal diseases are chronic infectious diseases caused by oral bacteria. Local sustained release delivery systems extend the time in which the drug is present in the oral cavity, thus enhancing its therapeutic potential while reducing its side effects. Amine-fluorides (AmF) are known anticaries agents and have recently been found to have an antibacterial effect against periodontal pathogens and caries-associated bacteria. The purpose of this in vitro study was to assess the antimicrobial activity of a local sustained release device (LSRD) containing AmF on Streptococcus sobrinus 6715. LSRD was prepared from an ethylcellulose matrix containing AmF. Release kinetics of AmF from the LSRD was measured simultaneously with its antimicrobial activity. The organic amine and the fluoride were released in different kinetics profiles: The fluoride was released faster than the organic amine. The antimicrobial activity of AmF was measured on planktonic bacteria in solution and on bacteria as part of experimental dental plaque. During a 10-day period, the concentration of the released AmF was above its MIC and no bacterial growth was observed. Bacterial counts in the dental plaque were reduced by 1 to 2 log units. Hence, the LSRD containing AmF has the potential to serve as a medicament in prevention and treatment of dental caries and periodontal diseases.

Oral infections in the immunocompromised host.

The prevalence of infections in the immunocompromised host is increasing. The oral cavity is a primary or sole site in many cases. It is important for the practicing clinician to recognize the more common infections in this growing patient population. Oral examinations are an essential component of all physical examinations, especially when immunosuppression is known or suspected. We recommend that all patients starting immunosuppressive therapy receive a comprehensive oral examination before the institution of such therapy to eliminate potential sources of oral and odontogenic infections. The examination should include full mouth dental radiographs and a complete soft-tissue examination. Timely, accurate diagnoses may have important implications with regard to management, prognosis, cost, morbidity, and mortality.

Use of a clinical assessment tool for orally intubated patients.

BACKGROUND: Although oral hygiene is difficult to perform in orally intubated, critically ill patients, oropharyngeal status may be related to acquisition of nosocomial organisms and should therefore be addressed. OBJECTIVE: To develop a clinical tool for assessment of the mouth in orally intubated patients. METHODS: Sixteen orally intubated patients from one surgical and one medical intensive care unit were subjects. Demographic, clinical, and baseline oropharyngeal assessment data, including sputum and mouth cultures, were obtained on patient admission to the study and every other day. RESULTS: Oropharyngeal cultures of four subjects grew nosocomial bacterial organisms and of two subjects, fungal species. These same organisms were cultured from sputum specimens. Seven patients displayed severe xerostomia; 10 lip lesions were identified in nine subjects, 8 tongue lesions in nine subjects, and 8 mucosal lesions in nine subjects. CONCLUSION: Systemic oropharyngeal assessment in critically ill orally intubated patients may prevent more serious oropharyngeal infections.

A review of oral fungal infections and appropriate therapy.

Dental health care providers must recognize oral fungal pathogens that often are markers for early signs of immune deterioration. After accurate identification, appropriate therapy can be initiated. Predisposing factors for development of oral fungal infections, identification of oral fungal infections, treatment options and their relative costs are reviewed.

Epidemiology of dental emergency visits to an urban children's hospital.

All 1482 emergency room dental visits to Seattle's Children's Hospital and Medical Center from 1982 to 1991 were studied to evaluate trends in patients seeking care: 60% of visits were for trauma, the remainder for infection or other reasons. The number of visits was 2.1 times greater in 1991 than in 1982. Comparing the periods of 1982-1987 and 1988-1991, there was an increase in the proportion of infection-related visits from 30.5 to 43.5% of all visits. Spring/summer and weekends had the highest volume. More males (61.2%) than females received care. The largest number of visits (47.9%) occurred between 6:00 PM and midnight. Nearly two-thirds (62%) of children did not have a usual source of medical care; 30.2% of children had no medical insurance, and 21.5% received Medicaid benefits. Medicaid patients were twice as likely to be seen for infection as for trauma. Among the uninsured, there was no difference in the rates of trauma or infection. Non-Caucasian patients were twice as likely to be seen for infection as Caucasians. Infection visits were for pulpitis (32.1%), and periapical and gingival abscess (53.5%). Trauma patients were younger (66 months) than infection patients (89 months). Trauma was primarily to the maxillary anterior teeth (70.1%) and upper lip and gingiva (12.1%). Common agents for trauma were furniture, bicycles, and sports.

Distribution of mutans streptococci among Nigerian school children.

A group of 504 Nigerian school children with an average age of 13 years were included in this study. The children attended 4 schools in the Jos area, Plateau State, and Toro Local Government area of Bauchi State. Salivary levels of mutans streptococci in these children were estimated with the "Strip mutans" test. Mutans streptococci were found in 73% of the urban children and 65% of the rural ones. Compared to most known populations, the prevalence of mutans streptococci was relatively low (69%). On the other hand 45% of the children had high salivary levels of mutans streptococci (score 3, approximately > 10(6) per ml saliva).