Halitosis: knowing when 'bad breath' signals systemic disease.

Halitosis in older adults is a common condition that may have oral or nonoral sources, result from a number of different etiologies, and have more than just social consequences. In some cases, bad breath may reflect serious local or systemic conditions, including gingivitis, periodontal disease, diabetic acidosis, hepatic failure, or respiratory infection. Your role as the primary care physician is first to determine whether the odor has an oral or nonoral cause. Odors can be distinct in their quality and thus can help make this determination. Management of nonoral sources requires treatment of the underlying cause, whereas suspected oral sources require referral for a dental evaluation.

Management of traumatic oral-facial injury in the hemophiliac patient with inhibitor: case report.

This report describes identification of Factor VIII inhibitor in a patient who then received immune tolerance therapy. The precipitating event was a traumatic orofacial injury that was nonresponsive to traditional factor-replacement therapies. An inhibitor complicates medical and dental management of the hemophiliac patient because it counteracts usual techniques of hemorrhage control using coagulation agents derived from Factor VIII (Monoclate--Armour, Blue Bell, PA). Successful identification and management of the inhibitor patient require communication and consultation between the physician and dentist, up-to-date knowledge regarding the hemophiliac patient's bleeding and infusion history and aggressive application of local adjunctive hemostatic therapies.

Management of orofacial manifestations of Parkinson's disease with splint therapy: a case report.

Patients with Parkinson's Disease display a number of orofacial manifestations. These manifestations are secondary to motor and sensory deficits, resulting in bradykinesia, muscle rigidity and tremor, and difficulties with speech, swallowing, proprioception, tactile sensitivity, and hard- and soft-tissue trauma. This case describes the use of a bruxism splint which benefited a PD patient by diminishing the occurrence of orofacial pain secondary to muscle tremor and rigidity while reducing the cumulative damage to the oral structures common with the disease. The impact of therapy on sleep, speech, and swallowing difficulties is also discussed.

Congenital diaphragmatic hernia: implications for nitrous oxide use in dentistry.

The development of diaphragmatic hernias, their associated physical and diagnostic signs and symptoms, and the potential complications with nitrous oxide use are presented with a case report. Depending upon the location and extent of the diaphragmatic defect, portions of the stomach, omentum, liver and/or intestine can occupy a portion of the thoracic cavity. Nitrous oxide's solubility properties allow for rapid expansion of the herniated bowel, resulting in compression of the thoracic organs or strangulation of the herniated abdominal viscera. The presence of a diaphragmatic hernia may necessitate a change in sedation or anesthesia plans to eliminate the use of nitrous oxide during prolonged procedures.

Facial nerve paralysis related to HIV disease. Case report and dental considerations.

Neurologic manifestations of human immunodeficiency virus disease have been well documented and include peripheral neuropathy of the facial nerve. HIV-related peripheral facial nerve paralysis may be of predictive value in endemic populations, and it may be associated with acute HIV infection. It may herald the onset of seroconversion, and it is more common in the later stages of HIV disease. Treatment is palliative in nature and, although self-limiting, the condition may be of an extended duration and result in increased patient morbidity. The nutritional impact of HIV-related peripheral facial nerve paralysis on the patient and associated exacerbation of oral manifestations of HIV disease resulting from the presence of oral dryness are addressed. Early dental intervention is essential to reduce patient morbidity.

Management of aspiration and swallowing incidents: a review of the literature and report of case.

This article has reviewed aspiration and swallowing incidents in a dental environment with particular emphasis on the young child and the medically, physically and mentally handicapped patient. A thorough review of prevention, signs and symptoms, management and documentation of these incidents has been presented. This review was presented to reaffirm the potential of these incidents and strives to educate the practitioner who treats these special populations. The case report applies reported guidelines for noting signs and symptoms, management and documentation. This case report also affirms the need to check all dental instruments before their use, as a safeguard against possible failure. Current policy for infection control maintains strict guidelines for asepsis. With the increasing use of steam autoclaving and cleansing products, an increased rate of failure may be seen in some instruments. Manufacturers should be contacted for instrument care and sterilization recommendations, as well as projected longevity of the instrument, if their sterilization procedures are followed. The economic implications of replacing instruments because of the protocol for maintaining asepsis will undoubtedly contribute to the rising cost of care. Prevention has been the goal of dentistry for decades and dental emergencies are not excluded. Preparation for such incidents will prevent many incidents and allow for proper patient management should they occur.

Application of INSTAT hemostat in the control of gingival hemorrhage in the patient with thrombocytopenia. A case report.

Gingival bleeding in the patient with thrombocytopenia can be a difficult management problem. Primary therapy with platelet transfusions may not be sufficient to control the hemorrhage and adjunctive local therapy may be required. Currently, few local management techniques can effectively control this problem. INSTAT collagen absorbable hemostat can be used as a local adjunct with platelet transfusions and has certain application advantages over topical thrombin and microfibrillar collagen. Two successful techniques of INSTAT application to control gingival hemorrhage in a patient with severe thrombocytopenia in leukemic relapse are described.

Incidence of lingual nerve trauma and postinjection complications in conventional mandibular block anesthesia.

Trauma to the lingual nerve is potential risk factor for patients receiving mandibular block anesthesia. This paper describes the results of a patient survey of 9,587 conventional mandibular blocks received by 2,289 adults. The incidence of lingual nerve trauma and postinjection complications is reported along with an associated analysis of the duration of complications, procedures at the time of incident, the side of occurrence (right or left), and gender ratios. In addition, recommendations for patient evaluation, treatment, and follow-up care are discussed.

Stability of immunofluorescence reactions produced by polyclonal and monoclonal antibody conjugates for rabies virus.

We investigated two consumer complaints that described fading of immunofluorescence reactions associated with the use of a commercial antirabies, fluorescein-labeled, monoclonal antibody conjugate. We compared the performance of this product with that of two polyclonal antibody antirabies conjugates and observed significant diminution of fluorescence with the monoclonal antibody conjugate only. Furthermore, the fading occurred only on tissue impressions that had been mounted but not exposed to UV light excitation, thereby essentially eliminating the photobleaching associated with fluorescence microscopy as a causative factor. Our observations suggest that mounting medium pH and the holding temperature of stained slides may be critical factors in maintaining optimal immunofluorescence reactions with this monoclonal antibody conjugate. We discuss some probable mechanisms that could produce the type of fading observed and also suggest certain precautionary measures for use with this monoclonal antibody conjugate.

Reproducibility of serological titers.

Serologists are making increasing use of the term "reproducibility" when referring to the reliability or repeatability of serological tests. The practical use of the concept, however, has been limited by the absence of an appropriate numerical scale on which differing reproducibilities can be quantified and objectively compared. This limitation can be overcome by adopting the proposed quantitative measure of reproducibility. The recommended measure is a natural extension of the common practice of considering a serological test to be acceptably reporducible so long as replicate titers remain within a twofold range. The measure can be readily used in the field of serology, and examples are given of how this can be done.

Premarket evaluation of commercial toxoplasmosis indirect fluorescent-antibody reagents.

The quality of commercial toxoplasmosis indirect fluorescent-antibody reagents was evaluated over a 6-year period. Seven manufacturers voluntarily submitted their products for evaluation in the Center for Disease Control Premarket Evaluation Program. Each product was tested in accordance with the Center for Disease Control performance and labeling specifications and evaluation methods. Only 49% of all of the products tested met the Center for Disease Control requirements. Performance criteria are outlined, and suggestions are offered to assist laboratorians in obtaining toxoplasmosis indirect fluorescent-antibody reagents of high quality.