Methamphetamine abuse and dentistry.

Methamphetamine is a highly addictive powerful stimulant that increases wakefulness and physical activity and produces other effects including cardiac dysrhythmias, hypertension, hallucinations, and violent behavior. The prevalence of methamphetamine use is estimated at 35 million people worldwide and 10.4 million people in the United States. In the United States, the prevalence of methamphetamine use is beginning to decline but methamphetamine trafficking and use are still significant problems. Dental patients who abuse methamphetamine can present with poor oral hygiene, xerostomia, rampant caries ('Meth mouth'), and excessive tooth wear. Dental management of methamphetamine users requires obtaining a thorough medical history and performing a careful oral examination. The most important factor in treating the oral effects of methamphetamine is for the patient to stop using the drug. Continued abuse will make it difficult to increase salivary flow and hinder the patient's ability to improve nutrition and oral hygiene. Local anesthetics with vasoconstrictors should be used with care in patients taking methamphetamine because they may result in cardiac dysrhythmias, myocardial infarction, and cerebrovascular accidents. Thus, dental management of patients who use methamphetamine can be challenging. Dentists need to be aware of the clinical presentation and medical risks presented by these patients.

The association of xerostomia and inadequate intake in older adults.

Recent studies indicate that nearly one in five older adults has xerostomia (dry mouth). Salivary gland dysfunction and/or inadequate saliva increases the difficulty of these older adults in obtaining proper nutrition. Problems in lubricating, masticating, tolerating, tasting, and swallowing food contribute notably to the complex physiological and psychological manifestations of aging. To our knowledge, the literature has not demonstrated an association between xerostomia and malnutrition in the elderly. We randomly selected 67 older adults from institutionalized and free-living geriatric populations. Nutritional intake analysis was performed on both groups of study subjects, who were found to have xerostomia by use of sialometry, and on control subjects matched for age, sex, and physical status. Intake of total energy, protein, dietary fiber, total fat, saturated fat, cholesterol, sodium, potassium, vitamin A, vitamin C, thiamin, riboflavin, vitamin B-6, calcium, iron, and zinc was compared with the 1989 Recommended Dietary Allowances. Subjects' intakes were also compared with that of a control group. Medical systemic information and number and types of medications were compared among the groups. Statistical analysis of the data indicated significant (p less than .001) inadequacies in the nutritional intake patterns of institutionalized and free-living older adults with xerostomia. Subjects with xerostomia (more than 75% of the free-living and institutionalized seniors) had significant deficiencies of fiber, potassium, vitamin B-6, iron, calcium, and zinc. Taste and food perception were significantly reduced in the elders with xerostomia. Our study indicates the potential contribution of xerostomia to the high prevalence of geriatric malnutrition in the United States.

Periodontal status of individuals in early stages of human immunodeficiency virus infection.

The purpose of this study was to evaluate the association of periodontal health and human immunodeficiency virus infection among individuals in the early stages of disease who were participating in randomized placebo-controlled clinical trials of zidovudine. Previous reports have described a rapidly progressive periodontitis and atypical gigivitis associated with late stages of infection by the human immunodeficiency virus. A health history was completed by each subject. Baseline oral examinations were completed on 97 asymptomatic patients and nine with AIDS-related complex (ARC) during their regular clinic visit. Follow-up examinations were conducted at 3-month intervals throughout the 48 weeks of the oral study. Evaluations of plaque, calculus, gingival abnormalities, caries, and periodontal disease were conducted. Periodontal measurements included plaque index (PI), gingival index (GI), bleeding index (BI), probing depth (PD), and observation for cratering, necrosis, and tooth mobility on six teeth in each patient. More than half of the subjects had visited their dentist during the previous year and had had an oral prophylaxis; less than 25% of them had had either restorative work or extractions. The mean scores for periodontal indices averaged over the course of the study in asymptomatic and ARC respectively were: PI: 0.9 (SE 0.04) and 0.9 (SE 0.08), 0.818; GI: 1.0 (SE 0.04) and 0.9 (SE 0.07), P = 0.412; BI: 0.6 (SE 0.04) and 0.4 (SE 0.07), P = 0.278; PD: 2.9 (SE 0.05) and 2.6 (SE 0.10), P = 0.140. There was no evidence of cratering, necrosis, or tooth mobility in either group. Few had calculus or dental caries. There were no clinically significant differences detected between ARC versus asymptomatic patients. Dental histories and oral examinations showed that two groups of patients in early stages of HIV-disease were in good periodontal health.

Implications of the changing medical profile of a dental school patient population.

Representative adult patient populations seeking treatment at a dental school in 1976 and 1986 were analyzed for the prevalence and the characteristics of medical conditions. Patients' records (N = 3,000) were randomly selected from the examination clinics and reviewed for the presence and types of compromising medical conditions. The results indicated a significant increase in the percentage of dental patients who had medical conditions in 1986 as compared with 1976 (P less than .001), as well as significant changes in the types of medical conditions present. These data indicate an increase in the number of patients with medical problems in the general dental school patient population.

Sjögren's syndrome.

Sjögren's syndrome (SS) is a progressive autoimmune rheumatic disorder. Its precise etiology is unknown, although several contributing factors have been identified. One theory is that the condition results from complications related to infection with the Epstein-Barr virus. Primary exposure to or reactivation of Epstein-Barr virus elicits expression of the human leukocyte antigen complex. This is recognized by T lymphocytes (CD 4+) resulting in the release of cytokines (tumor necrosis factor, interleukin-2, interferon-gamma, and others). A genetic marker specific for Sjögren's syndrome, HLA-DR4, has been identified. According to the World Health Organization, the prevalence of Sjögren's syndrome is unknown. A recent epidemiologic study in Sweden estimated the prevalence in the adult population to be 2.7%. In the United States, 10 years ago, the number of patients with Sjögren's syndrome was thought to be fewer than 100,000. This number today is estimated to be more than 1 million. Sjögren's syndrome has been reported in nearly every major country of the world, and the geographic distribution of cases appears to be relatively uniform. Sjögren's syndrome typically affects women (90%) during the fourth or fifth decade of life. Isolated cases of Sjögren's syndrome in children have been reported.

Candida albicans levels in patients with Sjögren's syndrome before and after long-term use of pilocarpine hydrochloride: a pilot study.

OBJECTIVE: The purpose of this study was to compare the quantities of oral Candida albicans in patients with primary and secondary Sjögren's syndrome before and after the use of orally administered pilocarpine hydrochloride for 1 year. METHOD AND MATERIALS: Twelve female subjects with primary (n = 4) and secondary (n = 8) Sjögren's syndrome (mean age +/- SEM = 56.7 +/- 5.7 years) were enrolled in the study, after meeting rigid enrollment criteria. Oropharyngeal collection of samples and culturing was performed on each subject. Cultures specific for Candida albicans were plated into a culture media tube using the Oricult kit and also by serial dilutions and plating by a streptomycin-vancomycin technique. Cultures were incubated for 48 hours at 37 degrees C. The subjects used 5 mg of pilocarpine hydrochloride, administered orally three times daily, for 1 year, after which both of the Candida cultures were repeated. None of the subjects used antifungal medications, none smoked, and all were dentate. RESULTS: There was a significant difference in the prevalence of Candida after the use of pilocarpine hydrochloride for both groups. At the start of the study, 75% of all subjects were positive for Candida. Following the use of pilocarpine, 25% had positive cultures. There was also a decrease in the prevalence of clinical manifestations of infection from 75% of subjects to 25%. There was a significant decrease in the numbers of Candida cultured following the use of pilocarpine. CONCLUSION: Long-term administration of pilocarpine hydrochloride resulted in a significant reduction in Candida albicans colonization in patients with primary or secondary Sjögren's syndrome.

The prevalence and clinical significance of maxillary sinus mucous retention cysts in a general clinic population.

Previous studies have documented the occurrence and potential clinical significance of MSMR cysts. Studies also have alluded to a relationship between the MSMR cyst and certain signs or symptoms of disease. We determined the prevalence of MSMR cysts in a general clinic population and identified some important correlations with clinical signs and symptoms.

Electrocardiographic examination of dental patients with systemic lupus erythematosus.

Cardiac complications and abnormalities associated with systemic lupus erythematosus (SLE) have been well described. The most well-recognized cardiac myopathies in SLE are pericarditis and valvular problems such as verrucous endocarditis. Electrocardiogram (EKG) abnormalities and arrhythmias have also occurred and such individuals may have persistent tachycardia. To determine the prevalence of dental patients with SLE who have these EKG changes, a pilot study was designed in which a group of 13 subjects with SLE underwent EKG monitoring in the clinic. Most of these were patients referred to the oral medicine clinic. A randomly selected group of age-gender matched controls were monitored in an identical manner. All subjects first completed a cardiac screening questionnaire, were comfortably seated, and then monitored. The results indicated that the overall prevalence of EKG abnormalities among the subjects with SLE was 61.5% (n = 8). The most common arrhythmia was supraventricular extrasystoles. These were compared with a control group with a prevalence of 23% (n = 3). Of the 76.9% of the subjects with SLE who reported a positive history of cardiac abnormalities, 80% demonstrated EKG abnormalities as compared with 50% of the control group. Of the subjects with SLE who did not report a previous history, none demonstrated EKG abnormalities as was the same for the control group. These results indicate a high prevalence of EKG abnormalities in dental patients with SLE, especially those with a positive cardiac history.

An update on the management for the dental patient with Sjögren's syndrome and xerostomia.

Sjögren's syndrome is a chronic and uncomfortable inflammatory condition for the individuals who suffer from it. There are many and varied systemic and oral complications associated with Sjögren's syndrome. It is also a complex and challenging condition for the dentist to diagnose and manage. The key concepts are early recognition and intervention to prevent the secondary complications from hyposalivation. To the degree possible, salivary flow should be restored by either artificial salivas or stimulated by secretogogues or both, which is usually the case. Atrophy and secondary infections of the oral mucosa should be properly identified, effectively treated, and frequently monitored. Pilocarpine HCl (Salagen) has been shown to be effective in increasing salivary flow in patients with SS. Preventive and supportive therapy including supplemental fluorides, dietary assessment, and frequent professional recalls are imperative to maintaining the oral health of the patient with SS.

A metaproteomic analysis of the human salivary microbiota by three-dimensional peptide fractionation and tandem mass spectrometry.

Metagenomics uses gene expression patterns to understand the taxonomy and metabolic activities of microbial communities. Metaproteomics applies the same approach to community proteomes. Previously, we used a novel three-dimensional peptide separation method to identify over 2000 salivary proteins. This study used those data to carry out the first metaproteomic analysis of the human salivary microbiota. The metagenomic software MEGAN generated a phylogenetic tree, which was checked against the Human Oral Microbiome Database (HOMD). Pathway analyses were performed with the Clusters of Orthologous Groups and MetaCyc databases. Thirty-seven per cent of the peptides were identifiable only at the level of cellular organisms or bacteria. The rest were distributed among five bacterial phyla (61%), archea (0.5%), and viruses (0.8%); 29% were assignable at the genus level, and most belonged to Streptococcus (17%). Eleven per cent of all peptides could be assigned to species. Most taxa were represented in HOMD and they included well-known species such as periodontal pathogens. However, there also were 'exotic' species including aphid endosymbionts; plant, water, and soil bacteria; extremophiles; and archea. The pathway analysis indicated that peptides were linked to translation (37%), followed by glycolysis (19%), amino acid metabolism (8%), and energy production (8%). The taxonomic structure of the salivary metaproteome is very diverse but is dominated by streptococci. 'Exotic' species may actually represent close relatives that have not yet been sequenced. Salivary microbes appear to be actively engaged in protein synthesis, and the pathway analysis is consistent with the metabolism of salivary glycoproteins.