The financial burden of acute odontogenic infections: the South Australian experience.

BACKGROUND: Acute odontogenic infections are a common surgical emergency managed by public hospitals in Australia which cause considerable patient morbidity and occasionally, mortality. Despite posing a significant public health burden, Australian data evaluating the cost of the management of these patients are lacking. This study assessed the patient and treatment variables associated with inpatient management of deep odontogenic infections, and their respective financial impact, at a statewide Oral & Maxillofacial service. METHODS: A retrospective audit was carried out of patients with deep odontogenic infections at our institution, over a 7-year period. The primary outcome was the total cost of admission. Secondary outcomes included treatment received, operating room time, return-to-theatre, length of admission (LOS), and intensive care unit (ICU) use. Cost variables were assessed against the total LOS and ICU use to determine clinical predictors affecting outcome. RESULTS: Four hundred and sixty two patients met the inclusion criteria. The average cost per patient was $12 228 Australian Dollars. After multivariate analysis, variables most significantly associated with increased cost of care and LOS were high-risk infections with airway compromise, high admission white cell count and age. CONCLUSION: Hospital-based management of deep-space odontogenic infections engender significant costs compared to early primary care intervention such as a dental extraction ($181/extraction).

In-vivo evaluation of a reinforced ovine biologic: a comparative study to available hernia mesh repair materials.

PURPOSE: Two innovative reinforced biologic materials were studied in a non-human primate hernia repair model. The test articles, which combine layers of ovine decellularized extracellular matrix with minimal amounts of synthetic polymer, were evaluated for their biologic performance as measured by inflammatory response, healing kinetics, integration, and remodeling into functional host tissue. For comparison, seven clinically used biologic and synthetic meshes were also studied. METHODS: Animals were implanted with test articles in surgically created full-thickness midline abdominal wall defects, and evaluated macroscopically and histologically at 4, 12, and 24 weeks. RESULTS: Macroscopically, biologics resorbed and remodeled into naturally appearing tissue; the reinforced biologics appeared similar, but remodeled earlier and were less prone to stretch. Synthetics developed a layer of reactive tissue above and separate from the contracted mesh structure. At early time points, the collagen networks of biologics and reinforced biologics were infiltrated by host cells primarily as a peripheral layer on the biologics. As early as 12 weeks, the collagen networks associated with the reinforced biologics remodeled into organized host collagen. By 24 weeks, both reinforced biologics and biologics had low levels of inflammation. In contrast, a foreign body response persisted at 24 weeks with the synthetics, which had developed less organized collagen, separate in space from the actual mesh. CONCLUSIONS: The current study shows a favorable response to reinforced biologics, which were associated with an initial inflammatory response, resolving by later time points, followed by active remodeling, and the formation of new morphologically functional collagen.

Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9-year retrospective audit.

BACKGROUND: The aims of this study were to evaluate the microbiological trends in severe odontogenic infections requiring hospital admission in the South Australian Oral and Maxillofacial Surgery Unit. Rates of antibiotic resistance to empirical antibiotic regimens were determined to quantify the clinical implications of antibiotic-resistant odontogenic infections. METHODS: A retrospective case audit was performed on all odontogenic infections admitted to the Royal Adelaide Hospital over a 9-year period. Data was collected regarding demographics, microbiological culture and sensitivity results, and clinical outcome variables. RESULTS: Of a total of 672 patients, microbiology data was available for 447 cases. Penicillin-resistant organisms were identified in 10.8% of patients, who required a significantly longer length of hospital admission (mean, 9.93 days) and higher rates of non-response to initial surgical therapy (40%). CONCLUSIONS: There were moderate rates of antibiotic-resistant odontogenic infections within the South Australian population. Patients within this subgroup demonstrate markedly poorer clinical outcomes. Effective treatment of odontogenic infections involves early operative intervention, with adjunctive use of appropriate antibiotic therapy that involves close monitoring of response to removal of the cause and use of first-line antibiotic agents. Cases that fail to respond require urgent specialist review in order to reduce morbidity and mortality outcomes.

Reducing condylar compression in clenching patients.

The two major muscle groups used during clenching activity are the masseter and temporalis muscles. EMG readings of the masseter and temporalis muscles rise significantly during times of macro-clenching. Clenching occurs when the masseter and temporalis muscles contract, pulling the mandible superiorly. The continued contraction of the masseter and temporalis muscles results in compression forces on the teeth and temporomandibular joints. Theoretical joint loading models are utilized to demonstrate the load on the TMJ due to forces generated by the masseter and temporalis muscles. This study measures the EMG readings during bilateral macro-contraction of the masseter and anterior temporalis muscles. An appliance is fabricated to disengage the posterior teeth and a second series of EMG readings are taken to record lowered EMG readings. The vector forces of the reduced EMG's recordings demonstrate reduced condylar compression during macro-clenching.

Patients' perception of dentists' positive and negative attributes.

Earlier studies have shown that dental patients concern themselves with the personality characteristics of their dentists as well as with their professional competence. The present study is part of a wider survey which compared the characteristics of regular and irregular or non-attenders for dental check-ups. In this article patients' characteristics such as sex, age, level of dental anxiety and certain previous dental experiences were related to their perceptions of dentists' positive and negative attributes. The results confirmed previous findings that dentists were seen generally by their patients in a favourable light. Respondents who admitted to higher levels of dental anxiety were more likely to choose more negative attributes and less positive ones than respondents who admitted to lower levels; women, younger subjects and the dentally anxious consistently chose unsympathetic and indifferent as the two top negative characteristics of their dentists.

Some characteristics of regular and irregular attenders for dental check-ups.

Previous surveys of dental care have shown that a substantial proportion of people do not attend dentists regularly. Reasons given for such non-attendance included fear as well as other negative attitudes. Recent studies have attributed fear of dentistry to painful traumatic experiences. The purpose of this study was to compare regular and irregular or non-attenders for dental check-ups on a number of variables, including sex and age, self and family dental anxiety, and previous dental experience. A sample of 531 subjects of both sexes and ranging in age from 16 to 78 years was made available by two large organizations in London and surveyed during office hours. Dental anxiety appeared as a significant factor in non-attendance but there was little support for a simple conditioning hypothesis to explain dental anxiety. Attenders and non-attenders differed markedly in their perception of dentists but there was no difference between the groups as to sex and age.

Effect of growth temperature on membrane fatty acid composition and susceptibility to cold shock of Bacillus amyloliquefaciens.

We investigated the fatty acid composition of the membrane of Bacillus amyloliquefaciens grown at different temperatures. A decrease in growth temperature was accompanied by an increase in the ratio of branched- to straight-chain fatty acids and a marked increase in the level of unsaturation of branched-chain fatty acids. When cells of this organism grown at 30 degrees C were cold shocked, viability and ability to secrete extracellular protease were lost. Growth of this organism at lower temperatures or addition of Tween 80 to cells caused the critical temperature zone for cold shocking to be lowered significantly. These results suggest a direct correlation between membrane fluidity and the susceptibility to cold shock.

Isolation and characterization of genomic clones for two chicken phenobarbital-inducible cytochrome P-450 genes.

A cDNA clone specific for a chicken phenobarbital-inducible cytochrome P-450 was used to screen a chicken genomic library. Twenty-nine clones were isolated, restriction mapped, and divided into two non-overlapping groups. The cDNA clone hybridized to 12 kilobases of DNA from both groups. Both groups contained restriction fragments which hybridized to both 5' and 3' fragments of the cDNA clone, and it was concluded that the two groups were derived from two separate genes. Southern transfer analysis of individual chicken DNAs and quantitative hybridization analysis indicated that these two genes are independent and are present as single copies/haploid genome. Comparison of restriction digests of the cloned DNAs and total genomic DNA discounted the possibility that other closely related P-450 genes are present in the chicken genome.