Factors associated with prolonged hospitalizations from odontogenic infections in children.

OBJECTIVE: Oro-facial infections are common pathologies comprising a substantial health concern in the pediatric population. Incorrect or late treatment may lead to serious and possibly life-threatening complications. The aim of this study is to analyze variables associated with prolonged length of hospital stays (LOS) due to odontogenic infections in children. STUDY DESIGN: Data was collected from the records of patients (age <15 years) hospitalized due to odontogenic infections at Poriya Medical Center during the period of 1/2010-12/2015. Patients with oro-facial infections originating from other organs were excluded from the study as well as children with underlying systemic medical conditions that may affect recovery. RESULTS: A total of 411 patients (mean age 6.5 ± 2 years) were included in this study, with 58.4% being male. There were significantly higher (p < 0.05) values of white blood cell (WBC) counts in patients with >3 days LOS. Patients with >3 days LOS were also significantly older (8.4 vs. 6.3 years). There were no significant differences in sex distribution or other clinical or laboratory parameters between the groups. CONCLUSION: Older child age and higher WBC counts on admission are indicators for prolonged LOS.

Effect of azithromycin on a red complex polymicrobial biofilm.

Azithromycin has recently gained popularity for the treatment of periodontal disease, despite sparse literature supporting efficiency in treating periodontal bacterial biofilms. The aim of this study was to evaluate the effect of azithromycin on biofilms comprised of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in comparison to an amoxicillin and metronidazole combination. P. gingivalis W50, T. denticola ATCC35405, and T. forsythia ATCC43037 grown under anaerobic conditions at 37°C were aliquoted into 96-well flat-bottom plates in different combinations with addition of azithromycin or amoxicillin + metronidazole at various concentrations. For the biofilm assay, the plates were incubated at 37°C anaerobically for 48 h, after which the biofilms were stained with crystal violet and measured for absorbance at AU620. In this model, polymicrobial biofilms of P. gingivalis + T. denticola, P. gingivalis + T. forsythia, and T. denticola + T. forsythia were cultured. Combination of all three bacteria enhanced biofilm biomass. Azithromycin demonstrated a minimal biofilm inhibitory concentration (MBIC) of 10.6 mg/L, while the amoxicillin + metronidazole combination was more effective in inhibiting biofilm formation with a MBIC of 1.63 mg/L. Polymicrobial biofilm formation was demonstrated by combination of all three red complex bacteria. Azithromycin was ineffective in preventing biofilm formation within a clinically achievable concentration, whereas the combination of amoxicillin and metronidazole was more effective for this purpose.

Axial relationship between dental implants and teeth/implants: a radiographic study.

The relationship of dental implants with neighboring teeth will affect both occlusal relationship and distribution of forces; thus, the purpose of this study was to examine implants' axial relationship with adjacent and opposing teeth/implants. Data of dental implants patients was retrieved. Panoramic X rays were digitized. Computer-based software was used to measure the angular relationship between the implants and adjacent/opposing teeth and implants. Data was further sorted by the mode of placement and implants position. 50 patients (219 implants) were included. Mean angle to adjacent tooth/implant was 178.71° ± 9.18° (range 129.7°-206°). Implants were more parallel to adjacent teeth (180.99° ± 1.06°) than to adjacent implants (176.32° ± 0.54°; P = .0001). Mean angular relationship to opposite tooth was 167.88° ± 8.92° (range 137.7°-179.8°). Implants that were placed freehand or with positional guide had similar intra-arch relationship (178.22° and 178.81°, respectively) and similar inter-arch angulations (164.46° and 167.74°). Molars had greater deviation of the angular relationship (175.54°) compared to premolars (181.62°) and incisors (180.55°, P = .0001). Implants placed in the maxilla had smaller axial deviation compared to implants in the mandible (180.41° ± 0.64 vs 177.14° ± 1.02; P = .0081). Good axial relationship may be obtained in most implants placed by an experienced clinician, even when placed freehand. The mandibular posterior region is more prone to axial deviation and as such requires special attention.

Antibiotic susceptibility of Aggregatibacter actinomycetemcomitans JP2 in a biofilm.

BACKGROUND: Localized aggressive periodontitis (LAgP) is an inflammatory disease associated with specific bacteria, particularly Aggregatibacter actinomycetemcomitans, which can result in early tooth loss. The bacteria grow as a biofilm known as subgingival plaque. Treatment includes mechanical debridement of the biofilm, often associated with empirical antibiotic treatment. OBJECTIVE: The aims of this study were to test in vitro the sensitivity of A. actinomycetemcomitans JP2 during planktonic and biofilm growth to doxycycline and to the combination of metronidazole and amoxicillin, which are two antibiotic protocols commonly used in clinical practice. DESIGN: Two in vitro biofilm models were used to test the effects of the antibiotics: a static 96-well plate assay was used to investigate the effect of these antibiotics on biofilm formation whilst a flow chamber model was used to examine the effect on established biofilms. RESULTS: Of the antibiotics tested in this model system, doxycycline was most efficacious with a minimal inhibitory concentration (MIC) against planktonic cells of 0.21 mg/L and minimal biofilm inhibitory concentration (MBIC) of 2.10 mg/L. The most commonly prescribed antibiotic regimen, amoxicillin + metronidazole, was much less effective against both planktonic and biofilm cells with an MIC and MBIC of 12.0 mg/L and 20.2 mg/L, respectively. A single treatment of the clinically achievable concentration of 10 mg/L doxycycline to sparse A. actinomycetemcomitans biofilms in the flow chamber model resulted in significant decreases in biofilm thickness, biovolume, and cell viability. Dense A. actinomycetemcomitans biofilms were significantly more resistant to doxycycline treatment. Low concentrations of antibiotics enhanced biofilm formation. CONCLUSION: A. actinomycetemcomitans JP2 homotypic biofilms were more susceptible in vitro to doxycycline than amoxicillin + metronidazole.

Periodontal status in post-liver transplantation patients: 10 years of follow-up.

OBJECTIVE: To compare the current (t1) periodontal status of post-liver transplantation patients to their status 10 years earlier (t0). METHOD AND MATERIALS: Seventeen patients 45 to 71 years of age who were evaluated approximately 10 years previously were enrolled in the study. All subjects had undergone a liver transplantation 1 to 10 years prior to the initial examination (t0). Clinical and radiographic parameters were recorded for the Ramfjord Index teeth and compared between t0 and t1, including Plaque Index (PI), Gingival Index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO). Bone loss was measured on digitized images of panoramic radiographs. RESULTS: Mean PI, GI, CAL, and GO were slightly lower at t1 than at t0; however, these differences were not statistically significant (P > .05, Student t test for paired observations). The mean PD was reduced at t1 (2.43 ± 0.18 mm) compared with t0 (3.35 ± 0.22 mm), which was statistically significant (P = .001, Student t test for paired observations). To the contrary, the mean radiographic bone loss at t1 was higher than at t0 (5.61 vs 4.48 mm, respectively), which was also statistically significant (P = .017). Tooth loss was observed in some of these patients, ranging from 0 to 4 during the 10 years of follow-up, which amounted to an annual rate of 0.24 teeth per patient. CONCLUSION: Post-liver transplantation patients maintained stable clinical periodontal parameters during a 10-year period; however, some radiographic bone loss occurred during this time.

Intraoperative bleeding during open flap debridement and regenerative periodontal surgery.

BACKGROUND: The objective of this study was to measure the intraoperative bleeding during periodontal flap surgery. METHODS: Patients scheduled for periodontal surgery were recruited for this study. Data regarding smoking habits, general health, and medications were collected. The amount of the local anesthetic that was injected was then recorded, as well as the number of teeth in the operative field and the duration of the procedure. During surgery, the liquids from the oral cavity were suctioned and collected into a sterile empty vial. To calculate the net amount of blood volume in the liquids, colorimetric assay using capillary blood fructosamine as a reference molecule was used. RESULTS: Twenty-six patients were included in this study. The amount of blood lost during the procedure ranged from 6.0 to 145.1 mL, with an overall mean of 59.47 ± 38.2 mL. Patients taking aspirin (acetylsalicylic acid) showed mean blood loss of 43.26 ± 31.5 mL, whereas the mean blood loss among patients that did not use this medication was higher (65.4 ± 39.4 mL) but not statistically significant. Local anesthetic amount, surgical field size, and the operation duration did not relate to blood-loss volume. The mean blood loss among current smokers was significantly higher (96.47 ± 44.2 mL) compared to former (12 ± 8.4 mL) or never (54.74 ± 30.5 mL, P = 0.011) smokers. CONCLUSION: The results of the current study support previous papers and confirm that blood loss during periodontal surgery is minimal.

Dental implants placed in previously failed sites: survival rate and factors affecting the outcome.

OBJECTIVES: The purpose of the present study was to evaluate the survival rate of dental implants in previously failed implant sites. In addition, factors that might affect the outcome of these redo procedures were also explored. MATERIAL AND METHODS: Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Data on the failed implants were collected. The same parameters, along with the interval between retrieval and re-implantation, were collected for the second set of implants. Descriptive statistics were used to describe the patients and implants. Life table analysis of these implants was tabulated for both implant sets. The effect of systemic, environmental and local factors on the survival of the redo dental implants was evaluated. RESULTS: Fifty-six patients with a total of 79 redo implants were included in this study. Implants were followed for 7-78 months (mean 29.9+/-2). Thirteen implants failed that resulted in an overall survival rate of 83.5%. Successful implants had greater diameter (4.05+/-0.52 mm) than failed implants (3.72+/-0.56 mm); however, these differences were only marginal (P=0.06). Conversely, smoking habits, implants length and location, mode of placement and spontaneous exposure did not have a significant effect on the outcome of this procedure. CONCLUSION: Redo of dental implants has a lesser survival rate compared with previous reports for implants in pristine sites. These results were not associated with most implant- and/or patient-related factors. Thus, a possible negative effect that is associated with the specific implant's site might account for this phenomenon.

Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels.

AIM: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees. PATIENTS AND METHODS: Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined. RESULTS: Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33+/-2.32 mm (range 0.67-9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2+/-26.4). The mean 25(OH)D(3) was 11.68+/-4.7, range 3.5-21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D(3) levels > or =30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r =-0.474, p=0.03). A positive correlation was found between ABL, PTH (r =0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r =0.810, p=0.004). CONCLUSIONS: The majority of liver transplant patients had insufficient 25(OH)D(3) serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.

Evidence of periopathogenic microorganisms in placentas of women with preeclampsia.

BACKGROUND: Periodontal disease is a chronic inflammatory infectious disease that may act as a focus of infection. Preeclampsia is a pregnancy-specific hypertensive disorder that often leads to maternal morbidity and mortality. Acute atherosis, the placental lesion of preeclampsia, shares many histopathological features with atherosclerosis. Recently, chronic infection was linked to the initiation of atherosclerosis. Oral pathogens have been detected in atherosclerotic plaques, where they may play a role in the development and progression of atherosclerosis. The purpose of the present study was to explore the possibility that periopathogenic bacteria may translocate into the placental tissues of women with preeclampsia. METHODS: Samples were taken from 16 placentas obtained from cesarean sections of women with preeclampsia and from 14 age-matched healthy pregnant women. Polymerase chain reaction was used to detect Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ssp., Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola. RESULTS: Eight of the 16 (50%) placenta specimens were positive for one or more periopathogenic bacteria in the preeclampsia group, compared to only two of the 14 samples (14.3%) from controls. Bacterial counts were statistically significantly higher in the preeclampsia group for all of the periopathogenic bacteria examined (P

Pregnancy tumor occurring twice in the same individual: report of a case and hormone receptors study.

A case of 2 pregnancy tumors in the same individual and at the same site within 2 years, during 2 consecutive pregnancies, despite complete eradication of the first lesion, is described. A 27-year-old woman at 32 weeks gestation was referred for gingival swelling. Gingival enlargement was pronounced on her maxillary right side, and a hemangioma was present on the lip adjacent to this mass. Despite preventive periodontal treatment the lesion continued to grow, interfering with speech and mastication, and became painful; it was therefore removed surgically. Sixteen months later, during a subsequent pregnancy, the woman returned at 20 weeks gestation for treatment of a recurrent lesion at the same site, and the lesion was excised. The roles of female sex hormones, multiplicity of vascularity, and local irritants in the development of pregnancy tumors are examined.

Severe pregnancy complication (preeclampsia) is associated with greater periodontal destruction.

BACKGROUND: Preeclampsia is a pregnancy-specific disease which is one of the leading causes of maternal and fetal morbidity and mortality. The etiology of preeclampsia remains elusive. The underlying pathology may be related to a generalized intravascular hyperinflammatory state. Since the placental histopathologic lesions of acute atherosis, seen in preeclampsia, bear resemblance to those seen in atherosclerosis, and recent evidence links atherosclerosis with chronic infection, we decided to investigate a possible link between preeclampsia and chronic periodontal infection. METHODS: Thirty primigravidas, 15 suffering from preeclampsia, had full mouth periodontal examinations. Gingival crevicular fluid samples were taken for laboratory immunological assessment. Similar examination and sampling were performed in 15 age- and maternal status-matched controls. RESULTS: Significantly higher periodontal probing depth and clinical attachment level scores were found in the preeclamptic group compared with controls (2.98 versus 2.11 and 3.33 versus 2.30, respectively). Plaque index, gingival index, and mean gingival overgrowth scores were very similar in both groups. Furthermore, prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, and interleukin (IL)-1beta levels were all significantly higher in the preeclamptic group (247.4 ngr/sample versus 89.1 ngr/sample, 8.03 pgr/sample versus 4.03 pgr/sample, and 175.7 pgr/sample versus 62.2 pgr/sample, respectively). CONCLUSION: The above results suggest a possible association between periodontal inflammation and preeclampsia.

Subcutaneous implantation of pure crystalline estradiol pellets for conception control.

OBJECTIVES: Assessment of the contraceptive effectiveness of pure estradiol pellets implanted annually under the skin, thus avoiding the 'first passage phenomenon' through the liver, using a modification of Emperaire and Greenblatt's method. STUDY DESIGN: 228 women wishing birth control for 1 year or more were included. 5 pellets of estradiol (25 mg each) were implanted initially. At each subsequent annual treatment, 4 pellets were implanted. Withdrawal bleeding was induced monthly with oral norethindrone acetate 5 mg taken for 7 days. Our experience encompassed 8,136 cycles, or 678 women years. The study obtained approval of the local Ethical Committee. RESULTS: Annual continuation rates were 51 per 100 women in the second year, 65 in the third, 72 in the fourth and 84 +/- 10.1 annually over the next 6 years. Through 12 years of our study, 2 accidental pregnancies occurred. The annual net cumulative pregnancy rates were 0.44 and 0.48 per 100 women at 1 and 2 years, and reduced to 0.29 at the end of 10 years. Return of fecundity after discontinuing treatment was 53% after 12 months, 81% after 24 months and 89% after 36 months. The mean estradiol levels were 1,413 +/- 161 pmol/l one week following the pellet installation. The mean serum estradiol level of the 43 women who were assayed arbitrarily or a year following last insertion was 1,207 pmol/l (range 462-2,904 pmol/l); 22% had serum estradiol levels <1,000 pmol/l and 6.3% (3 women) had levels >1,750 pmol/l. A total of 28 endometrial biopsies were obtained -19 were proliferative, 6 showed slight simple hyperplasia, and three, benign cystic glandular hyperplasia. CONCLUSION: Subcutaneous implantation of pure estradiol pellets offers excellent birth control, has minimal untoward effects, is simple to insert and can serve as a possible alternative for conception control. It could be considered for 3 indications: for women who have completed family planning; for women in older age group (above 35 years) who are approaching the climacteric; and for women at any age, who need prolonged periods of contraception.

Common oral manifestations during pregnancy: a review.

UNLABELLED: Pregnancy has far-reaching systemic effects extending beyond the reproductive system. Oral and masticatory changes during pregnancy have been documented for many years; however, their magnitude and frequency have not been stressed. This review highlights the major oral complications during pregnancy. Pregnancy gingivitis and pregnancy tumor are described and presented, and possible preventive strategies are suggested. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to summarize the major oral complications during pregnancy, to outline the etiologic factors associated with each of these conditions, and to explain the role of dental treatment during pregnancy.

Guided tissue regeneration in smokers: effect of aggressive anti-infective therapy in Class II furcation defects.

BACKGROUND: Guided tissue regeneration (GTR) using membrane barriers is still the reconstructive treatment of choice for a variety of periodontal defects. Smokers, however, present a reduced regenerative response to GTR. The purpose of the present study was to design and examine a new protocol with emphasis on anti-infective therapy for patients who are cigarette smokers and who require GTR procedures for the treatment of Class II furcation defects. METHODS: Chronic periodontitis patients who were smokers and who exhibited mandibular Class II furcations were initially pooled for further assessment. Patients were randomly assigned to either the experimental group (EG) or a control group (CG). Clinical measurements and indices were recorded at baseline and at 6, 9, and 12 months, and included: plaque assessment index; gingival assessment index; probing depth; and probing attachment level (vertical [PAL-V] and horizontal [PAL-H]) using a prefabricated acrylic stent as a reproducible reference point. All patients underwent hygienic phase periodontal therapy. Next, GTR was performed, and the furcation dimensions (height, width, and depth) were measured. A membrane was placed, and a 25% metronidazole gel was then applied over the outer surface of the membrane (EG only) and the flaps repositioned so that the membrane was completely submerged. Instructions included twice daily rinses with chlorhexidine gluconate 0.2% for 1 week (CG) or as long as the membrane was in place (EG), doxycycline 100 mg x 1/day for 1 week (CG) or 6 to 8 weeks (EG), and ibuprofen 3 x 400 mg/day for 7 days. Patients were initially seen for prophylaxis weekly (EG) or biweekly (CG). Metronidazole was applied to the free gingival margins and/or over the exposed membrane at every prophylactic visit (EG). Six to 8 weeks after surgery, the membrane was removed surgically, and the amount of new tissue growth (NTG) from the cemento-enamel junction (CEJ) to the most coronal extension of the new tissue was recorded. Following membrane retrieval, patients were seen for prophylaxis and oral hygiene reinforcement every month (EG) or quarterly (CG). At 12 months postoperatively, the area was surgically reentered and the surgical measurements repeated. RESULTS: Thirty-eight subjects, 21 females and 17 males, aged 35 to 61 were accepted in this study. Baseline clinical parameters were similar for both groups. One year postoperatively, there was no statistically significant difference in probing depth reduction or in horizontal PAL between EG and CG, but vertical PAL gain was significantly greater in EG. As for alveolar parameters 1 year postoperatively, the mid CEJ-crest distance and furcation width decreased in EG but increased in CG. A similar trend was observed for furcation height. Furcation depth reduction in both groups was similar. A comparison between new tissue growth at retrieval and eventual bone formation 1 year postoperatively demonstrated a smaller change in EG patients compared to CG patients, which was statistically significant for both the distal and the mid-tooth area, as well as for the tooth mean. CONCLUSIONS: While smoking prevented tissue maturation and mineralization, the anti-infective protocol enhanced these processes, resulting in a more favorable outcome. It is therefore suggested that when GTR is performed for Class II furcation defects in smokers, anti-infective therapy should be incorporated into the treatment protocol to enhance the regenerative outcome in these patients.

Periodontal changes in liver cirrhosis and post-transplantation patients. II: radiographic findings:.

BACKGROUND: Liver disease and transplantation affect bone turnover. The role of cylosporin A (CsA) in aggravating bone loss is controversial. The aim of the present study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy with either CsA or tacrolimus on alveolar bone height. METHODS: The experimental group consisted of 13 liver cirrhosis (LC) patients. A second experimental group included 24 post-liver transplantation patients (PT) receiving CsA or tacrolimus. Seventeen healthy subjects formed a control group. Panoramic x-rays were taken and digitized using a computer-based measurement software to assess alveolar bone height of all available teeth. RESULTS: Bone loss in the PT group (4.57+/-0.56 mm) was significantly higher than the control (C) (2.73+/-0.38 mm); however, it was significantly lower (P = 0.0005) than the LC (6.47+/-0.75 mm). Likewise, alveolar bone loss showed a trend for negative correlation (R = 0.404, P = 0.06) with the duration of immunosuppressive therapy post-liver transplantation. CONCLUSIONS: Liver cirrhosis patients demonstrated greater bone loss compared to healthy controls. Restoration of liver functions following transplantation seems to have the potential to reverse some of these radiographic changes. Further longitudinal studies will be necessary to substantiate these findings.