C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections.

Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe. The relations between degree of severity and CRP concentration on admission (<100mg/L compared with 100+), age (years), sex, and duration of hospital stay (days) were examined using Poisson regression (because the distribution of characteristics, and particularly the duration of stay, were skewed). The overall model was significant (p=0.003). Pearson and deviance chi square tests did not indicate overdispersion (p=0.97 in both cases), which suggested that the assumptions about the Poisson distribution were valid. Log-rank chi square tests indicated that only severity had a significant effect (p=0.0001), and C-reactive protein concentration was not significantly associated with group on admission, age, or sex. The moderately and very severe groups had longer median (range) durations of stay than the less severe group (5 (2-8) compared with 3 (1-8) days, respectively). CRP concentration was not a prognostic factor for the extent of odontogenic infections or presumed duration of stay, but severity scoring was a significant factor in the prediction of duration of stay in hospital.

[The mouth of patients with acromegaly]. / La bouche de l'acromégale.

Orofacial changes are frequent in acromegaly. Their evolution is slowly progressive. The lips (everted and thickened), the mandibular morphology (prognathism), the tongue (macroglossia), the soft palate and the uvula (increased and thickened), the parodontis (gingival hyperplasia, paradontitis), the teeth (increased interdental spaces, hypercementosis, increased dental mobility, multiple tooth loss) are concerned. Functional consequences are significant (obstructive sleep apnea syndrome, malocclusion, pain of the oral maxillofacial area, decrease of the quality of life). They are rarely noticed as the first symptoms of the disease and rarely responsible for the diagnosis of acromegaly because of a progressive development over a long period of time, and because of the low prevalence of the disease which can be unknown by dentists and dental surgeons. When patients are cured or well-controlled, abnormalities of soft tissues improve but are not always completely reversible and bone enlargement remain unchanged. If any corrective surgical procedures are to be performed, this should be carried out only after normalization of GH and IGF I levels.

Increased oral inflammation, leukocytes, and leptin, and lower adiponectin in overweight or obesity.

OBJECTIVES: The association between body mass index (BMI) and oral diseases was investigated, and levels of obesity-related inflammatory mediators were evaluated. SUBJECTS AND METHODS: Participants (n = 160) were clinically and radiographically examined for oral diseases. Blood profiles were recorded. Levels of adiponectin, leptin, and C-reactive protein (CRP) were measured. RESULTS: One hundred and thirteen (70.6%) participants had overweight or obese status (BMI ≥ 23.0 kg/m2 ). Sum of dental diseases and severe periodontitis were higher in overweight or obese individuals than in normal-weight participants (p = .037 and p = .002, respectively). A significant difference in oral mucosal disorders between normal weight and overweight or obesity was not found. Plasma leukocyte counts, liver enzymes, leptin, and CRP levels were increased while adiponectin levels were decreased in individuals with BMI≥23.0 kg/m2 compared with normal-weight participants. After adjusting for age, sex, fasting plasma glucose level, smoking, and exercise, obesity was associated with sum of dental diseases (ß = 0.239, p = .013), severe periodontitis (OR=4.52; 95% CI 1.37, 14.95, p = .013), adiponectin (ß = -0.359, p < .001), leptin (ß = 0.630, p < .001), and CRP levels (OR=12.66; 95% CI 3.07, 52.21, p < .001). CONCLUSION: Overweight or obese Thai people were related to an increase in inflammatory dental and periodontal diseases with an altered health profile and plasma inflammatory mediators.

[The oral cavity: A mirror of diabetes]. / La bouche : un miroir du diabète.

Diabetes and the oral cavity are closely associated as diabetes physiopathology affects the mouth and the oral manifestations are numerous and varied. These need to be searched systematically at every clinical examination as they are not only comorbidity factors but also have a two-way relationship with diabetes control. Periodontal diseases are the most frequent pathologies and the relationship with glycemic control has clearly been established: their frequency increases in case of uncontrolled glycemia, which makes them a good marker of glycated hemoglobin. Thorough oral health follow-up of diabetic patients that is coordinated by its various actors from the beginning of the treatment is thus of great interest. Most of the care given to diabetic patients can easily be performed at the dental clinic, provided adequate precautions are taken and improvement of the oral cavity is beneficial to glycemic control as well as to the patients' quality of life. When implemented by trained oral health professionals in dental clinics, therapeutic education proves highly efficient.

Plasma concentration of calcium, magnesium and phosphorus in chinchilla with and without tooth overgrowth.

The aim of the study was to identify the causes underlying overgrowth of incisors in chinchillas through an analysis of selected plasma electrolyte concentrations, with particular consideration of minerals involved in the formation of osseous tissue, i.e., Ca, Mg, and P. The analysis involved 40 female standard chinchillas managed in a commercial farm system, aged 2 to 4 years, divided into two groups of 20 individuals each: D--chinchillas with incisor overgrowth and C--controls with normal dentition. Concentrations of Ca, Mg, and P were measured in blood plasma. The analysis was carried out using ICP OES (inductively coupled plasma optical emission spectrometry) by means of the Optima 2000 DV instrument (Perkin Elmer). The resulting data were analysed statistically using one-way ANOVA with Duncan's range test. The results show that abnormal metabolism of dental tissue minerals, especially Ca and P, cannot be excluded as the cause of tooth overgrowth in chinchilla.

Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors.

OBJECTIVES: To assess the relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors in an Italian population. MATERIAL AND METHODS: The study population consisted of 63 males aged 40-65 years with proven CHD and 50 controls matched for age, geographic area, and socioeconomic status. A detailed description of their oral status was given using four different dental indices (total dental index (TDI), panoramic tomography score, clinical periodontal sum score (CPSS), and clinical and radiographic sum score (CRSS)). Blood samples were taken for measurement of the following CHD risk factors: serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and glucose; a series of systemic markers of inflammation (C-reactive protein, leucocytes, fibrinogen, homocysteine) and a series of haemostatic factors (von Willebrand factor, fibrin D-dimer, prothrombinic fragment F1.2, plasminogen activator inhibitor type I (PAI-1), and serum antibodies) against oxidized LDL (anti-Ox-LDL). RESULTS: Multiple logistic regression adjusted for all risk factors for CHD showed statistically significant relationships (p<0.01) between all dental indices and CHD. Significant relationships (p always <0.01) were found between CPSS and CRSS and leucocyte count. Significant relationships (p always <0.05) were also found between TDI and the von Willebrand factor, and between CPSS and the von Willebrand factor, anti-Ox-LDL, and PAI-1. CONCLUSIONS: The present study suggests an association between poor oral status and CHD, and provides evidence that inflammatory and haemostatic factors could play an important role in this association.

Dental infections and serum inflammatory markers in patients with and without severe heart disease.

OBJECTIVE: The objective of this study was to investigate if patients with severe heart disease (CHD patients) present more signs of dental infections than patients without heart disease (non-CHD patients), if serum inflammatory markers differ between the groups, and if there is a link between these and the oral health parameters. METHODS: We performed clinical and radiologic dental examinations and collected serum samples of 256 patients with New York Heart Association class II-IV heart disease (CHD patients) and 250 non-CHD controls. Serum samples were analysed using pertinent methods in the clinical laboratory of the hospital, and the differences in serum biomarkers between CHD patients and non-CHD patients were examined using various statistical methods. A modified dental index (MDI) was constructed and used in the analyses. RESULTS: CHD patients were significantly more likely to be edentulous (34.8% vs. 14.8%) and retain less natural teeth than non-CHD patients (8.6 vs. 17) (P <.001). In CHD patients the remaining teeth and supporting tissues were more often diseased. High MDI scores were significantly associated with CHD status (OR 1.31, CI 1.16-1.48), as was gingivitis (OR 3.37, CI 1.66-6.86), while the presence of deep periodontal pockets was not. Serum C-reactive protein and fibrinogen concentrations and blood erythrocyte sedimentation rates were higher in the CHD group. Also, H. pylori and Chlamydia antibodies were significantly higher in the CHD group. CONCLUSION: CHD patients presented with poorer oral health status than non-CHD patients. Serum inflammatory markers were significantly higher in the CHD patients compared to the non-CHD group. High MDI scores linked with risk of CHD.

Diseases and outcomes in rabbits with high BUN levels.

One hundred and ninety cases of rabbits, seen at animal hospitals in Saitama and Tokyo, Japan from 1998 to 2001, with BUN values greater than 27 mg/dl were analyzed regarding their underlying and/or complicating diseases and outcomes. Gastrointestinal disorder (54 cases) was the most common disease, followed by overgrowth of molar teeth and then liver disturbance. The total mortality was 48.9% within three months, and cases showing complications such as liver disturbance or bacterial infection showed highest mortality. Cases with higher BUN values showed even higher mortality, although mortality varied depending on the complications. Therefore, the prognosis of rabbit cases with high BUN values should be evaluated based on findings from blood chemistry, together with the seriousness of the underlying and/or complicating disease.

HCV-RNA occurrence in saliva of odontoiatric HCV seropositive patients.

BACKGROUND: HCV-RNA occurrence in saliva of patients suffering from C hepatitis induced to consider saliva as a possible diffusion mean of this disease. METHODS: Saliva and blood samples from 32 C hepatitis seropositive patients, followed for odontostomatologic problems in Odontoiatric Clinic of Brescia University were obtained. In every blood and saliva sample HCV-RNA concentration was evaluated following HCV-RNA 2.0 Assay (bDNA) Quantiplex test (Chiron), in Microbiology Institute of Brescia University. RESULTS: All patients showing HCV-RNA in serum presented virus in saliva also; two patients with negative HCV-RNA serum presented virus in saliva. In latter cases, we supposed that viral concentration in serum was under sensibility threshold of employed method. CONCLUSIONS: Saliva appears an easily and not invasively obtainable medium for epidemiological studies on HCV diffusion in humans. Its role in C hepatitis transmission, on the contrary, has not been cleared till now.

Parathyroid hormone, haematological and biochemical parameters in relation to dental disease and husbandry in rabbits.

During a two-year period between 1995 and 1997, over 80 blood samples were collected from pet rabbits in order to investigate an apparent osteodystrophy affecting the skulls of rabbits with acquired dental disease. A series of haematological and biochemical analyses relating to calcium metabolism were performed and samples were taken for parathyroid hormone (PTH) assay. The rabbits were categorised according to the condition of their teeth and the manner in which the pets were kept. PTH concentrations were higher and calcium concentrations lower in hutch-kept rabbits with advanced dental disease in comparison with those kept in free-range conditions. No dental problems were detected in the free-range rabbits on radiological or clinical examination. During the course of the study, differences in haematological pictures and albumin values emerged among rabbits kept under the different husbandry regimes. Complete blood counts from free-range rabbits were comparable with laboratory reference ranges, whereas there were significantly lower red cell and lymphocyte counts in rabbits exhibiting advanced dental disease. Serum albumin values were significantly higher in rabbits kept in free-range conditions than in those with advanced dental disease or those unaffected by dental disease but kept in hutches. Rabbits kept in hutches showed trends towards anaemia and lymphopenia. Results indicated that acquired dental disease of pet rabbits is related to husbandry and is associated with alterations in calcium metabolism.

Oral health and history of respiratory tract infection in frail institutionalised elders.

OBJECTIVES: The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. SETTING AND SUBJECTS: 302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. OUTCOME MEASURES: The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. RESULTS: One third (33%) of the subjects had experienced at least one episode of RTI, and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P = 0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1-3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5-6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. CONCLUSIONS: The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.

Bacterial isolates from plaque and from blood during and after routine dental procedures in dogs.

OBJECTIVE: This study evaluates the association between dental procedures and bacteremia in dogs, including a comparison of bacteria isolated from plaque and blood, severity of the bacteremia versus the severity of dental disease, and the longevity of bacteremia. STUDY DESIGN: Bacteria cultured from the blood over time were compared with those isolated from the plaque and crevicular fluid and in relation to severity of dental disease. ANIMALS OR SAMPLE POPULATION: Twenty adult greyhounds. METHODS: Blood samples were collected for culture before induction of general anesthesia, immediately after intubation, 20 minutes after initiation of the dental procedure, and at 10-minute intervals until 10 minutes after the dental procedure was completed. Samples of plaque were taken for microbiological culture. RESULTS: Sixty to ninety percent of the bacterial genera isolated from the plaque were present in the blood. Dogs classified according to severity of dental disease showed no difference in the total number of different species or number of different Gram-negative, Gram-positive, or anaerobic bacteria isolated from plaque or blood (P < .05). Bacteremia was present in all of the dogs studied, within 40 minutes from the initiation of the dental procedure, regardless of the severity of oral disease. CONCLUSIONS: Gram-negative, Gram-positive, and anaerobic bacteria are present in blood during dental procedures; the bacteremia can persist beyond the dental procedure, and is not associated with the severity of dental disease. CLINICAL RELEVANCE: The nature and extent of bacteremia occurring during routine dental procedures is important in understanding a potential risk to dogs.

Level of plasma proteins in patients with severe odontogenic infection and fever.

Twenty patients complaining of acute dental infection were admitted to the hospital. Clinical examination, peak of daily temperature for every patient were recorded. Electrophoretic studies of plasma proteins of all patients revealed slight increase of mean value of some plasma proteins (albumin, and gamma globulins) and more pronounced increase of mean values of alpha 1, and alpha 2 and beta globulins. The temperature and plasma proteins returned to normal levels after antibiotics therapy and dental treatment.

Distribution of alpha 2HS glycoprotein in pathological human dentins.

The concentration and distribution of alpha 2HS glycoprotein in teeth from patients with heritable dentin disorders were examined utilizing immunological techniques. ELISA for the quantitative determination showed lower concentrations of alpha 2HS glycoprotein in dentins of patients with heritable disorders than in the control; some cases contained very low and others intermediate concentrations. Immunohistochemical findings indicated that the concentration of this protein was correlated to the regularity of the dentinal tubules. This result suggests that alpha 2HS glycoprotein is incorporated into dentin in concomitance with the development of the dentinal tubule, especially with the deposition of peritubular dentin. Incorporation of this protein into dentin is thought to involve the function of odontoblasts.

Familial reinclusion of permanent molars.

Reinclusion of permanent molars was found in 55 individuals from 9 families. Inheritance is clearly autosomal dominant with complete penetrance. The provisional assignment of its gene locus to the same linkage group as the gene locus of blood group P (Bosker & Nijenhuis 1975) could not be confirmed.