Is the Oral Cavity of Intensive Care Unit Pediatric Patients More Susceptible to Methicillin-Resistant Staphylococcus aureus Infection?

Objective: The aim of this study was to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of pediatric patients hospitalized at an intensive care unit (ICU). Methodology: Thirty ICU patients (group 1) and 30 healthy patients (group 2), between 1 and 12 years of age, matched by sex and age, were selected from a public hospital in Brazil. After oral examinations, biological specimens (nostril swab, oral mucosa, and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred after growth in Tryptic Soy Broth with 7.5% of NaCl for 48 hours, growth in Mannitol Salt Agar, gram staining, catalase, and coagulase tests. S. aureus isolates were submitted to antibiotic sensitivity test. Results: Only 36.7% of patients in the ICU perform oral hygiene during the hospitalization period and 41.7% presented high level of dental biofilm accumulation. The presence of S. aureus was similar in patients from group 1 (43.3%, 13) and group 2 (50.0%, 15) (p = 0.60). Both groups presented 18 samples each that tested positive for S. aureus. However, when considering patients infected by MRSA, the prevalence was higher in group 1 (eight; 26.7%) than in group 2 (five; 16.7%) but no statistical difference was observed (p = 0.53). In group 1, nine MRSA samples were resistant to erythromycin and seven to clindamycin. In group 2, two MRSA samples were resistant to erythromycin and two to clindamycin. Conclusions: Although ICU children did not show a significant higher carriage of MRSA when compared with the healthy group in the population studied, the number of highly resistant strains in the oral cavity isolated from ICU patients adds an important risk factor to be considered by the medical team as possible source of systemic infections, extended hospital stay, and poor outcomes.

Staphylococcus aureus Interferes with Streptococci Spatial Distribution and with Protein Expression of Species within a Polymicrobial Oral Biofilm.

We asked whether transient Staphylococcus aureus in the oral environment synergistically interacts with orally associated bacterial species such as Actinomyces oris, Candida albicans, Fusobacterium nucleatum, Streptococcus oralis, Streptococcus mutans, and Veillonella dispar (six-species control biofilm 6S). For this purpose, four modified biofilms with seven species that contain either the wild type strain of the S. aureus genotype (USA300-MRSA WT), its isogenic mutant with MSCRAMM deficiency (USA300-MRSA ΔMSCRAMM), a methicillin-sensitive S. aureus (ST72-MSSA-) or a methicillin-resistant S. aureus (USA800-MRSA) grown on hydroxyapatite disks were examined. Culture analyses, confocal-laser-scanning microscopy and proteome analyses were performed. S. aureus strains affected the amount of supragingival biofilm-associated species differently. The deletion of MSCRAMM genes disrupted the growth of S. aureus and the distribution of S. mutans and S. oralis within the biofilms. In addition, S. aureus caused shifts in the number of detectable proteins of other species in the 6S biofilm. S. aureus (USA300-MRSA WT), aggregated together with early colonizers such as Actinomyces and streptococci, influenced the number of secondary colonizers such as Fusobacterium nucleatum and was involved in structuring the biofilm architecture that triggered the change from a homeostatic biofilm to a dysbiotic biofilm to the development of oral diseases.

Cohort Profile: ZOE 2.0-A Community-Based Genetic Epidemiologic Study of Early Childhood Oral Health.

Early childhood caries (ECC) is an aggressive form of dental caries occurring in the first five years of life. Despite its prevalence and consequences, little progress has been made in its prevention and even less is known about individuals' susceptibility or genomic risk factors. The genome-wide association study (GWAS) of ECC ("ZOE 2.0") is a community-based, multi-ethnic, cross-sectional, genetic epidemiologic study seeking to address this knowledge gap. This paper describes the study's design, the cohort's demographic profile, data domains, and key oral health outcomes. Between 2016 and 2019, the study enrolled 8059 3-5-year-old children attending public preschools in North Carolina, United States. Participants resided in 86 of the state's 100 counties and racial/ethnic minorities predominated-for example, 48% (n = 3872) were African American, 22% white, and 20% (n = 1611) were Hispanic/Latino. Seventy-nine percent (n = 6404) of participants underwent clinical dental examinations yielding ECC outcome measures-ECC (defined at the established caries lesion threshold) prevalence was 54% and the mean number of decayed, missing, filled surfaces due to caries was eight. Nearly all (98%) examined children provided sufficient DNA from saliva for genotyping. The cohort's community-based nature and rich data offer excellent opportunities for addressing important clinical, epidemiologic, and biological questions in early childhood.

Aspergillus in endodontic infection near the maxillary sinus / Aspergillus em infecções endodônticas próximas ao seio maxilar

ABSTRACT INTRODUCTION: Diseases of the maxillary sinus have been associated with dental roots near the maxillary sinus that have undergone endodontic treatment. OBJECTIVE: To investigate the presence of filamentous fungi in patients with dental roots near the maxillary sinus who had apical periodontitis treated endodontically, and to alert practitioners that this could be a possible avenue of contamination of the sinus in patients who develop maxillary sinus infection. METHODS: Cross-sectional study in 60 palatal roots of the first maxillary molars near the maxillary sinus, that underwent endodontic treatment for apical periodontitis. After removal of the filling material, dentin shavings were collected and placed in test tubes containing Sabouraud dextrose agar and chloramphenicol. The phenotype was determined by macroscopic and microscopic examination of the colonies. For polymerase chain reaction, the primers ITS-5 and ITS-4 were used. The sequences obtained were compared with those deposited at GenBank using the Basic Local Alignment Search Tool program. RESULTS: Filamentous fungi were isolated from 6 of 60 canals (10%):Aspergillus niger (6.7%), Aspergillus versicolor (1.6%), and Aspergillus fumigatus(1.6%). CONCLUSION: Root canals near the maxillary sinus with endodontic treatment and apical periodontitis may exhibit positive cultures for filamentous fungi. Interested professionals should be alert, because these microorganisms have pathogenic characteristics that can cause disease of odontogenic origin in the maxillary sinus.

RESUMO Introdução: Doenças do seio maxilar têm sido associadas à raízes com tratamento endodôntico próximas ao seio maxilar. Objetivo: Investigar a presença de fungos filamentosos em raízes com tratamento endodôntico e lesão periapical, próximas ao seio maxilar, alertando para uma possível contaminação do seio maxilar por via odontogênica. Método: Estudo transversal em sessenta raízes palatinas de primeiros molares superiores próximas ao seio maxilar, com tratamento endodôntico e lesão periapical. Após remoção do material obturador, raspas de dentina foram coletadas e inseridas em tubos de ensaio contendo Agar Sabouraud Dextrose e Clorafenicol. O fenótipo foi determinado pela análise macroscópica e microscópica das colônias. Para o PCR utilizou-se iniciadores ITS-5 e ITS-4. As sequencias obtidas foram comparadas as disponíveis no GenBank utilizando Basic Local Alignment Search Tool. Resultados: Fungos filamentosos foram isolados de 6 dos 60 canais (10%):Aspergillus niger (6,7%), Aspergillus versicolor (1,6%) e Aspergillus fumigatus(1,6%). Conclusão: Raízes próximas ao seio maxilar com tratamento endodôntico e lesão periapical, podem apresentar cultura positiva para fungos filamentosos. Profissionais afins devem estar alerta, pois este micro-organismo possuem características de patogenicidade podendo causar doenças no seio maxilar de origem odontogênica.

Aspergillus in endodontic infection near the maxillary sinus.

INTRODUCTION: Diseases of the maxillary sinus have been associated with dental roots near the maxillary sinus that have undergone endodontic treatment. OBJECTIVE: To investigate the presence of filamentous fungi in patients with dental roots near the maxillary sinus who had apical periodontitis treated endodontically, and to alert practitioners that this could be a possible avenue of contamination of the sinus in patients who develop maxillary sinus infection. METHODS: Cross-sectional study in 60 palatal roots of the first maxillary molars near the maxillary sinus, that underwent endodontic treatment for apical periodontitis. After removal of the filling material, dentin shavings were collected and placed in test tubes containing Sabouraud dextrose agar and chloramphenicol. The phenotype was determined by macroscopic and microscopic examination of the colonies. For polymerase chain reaction, the primers ITS-5 and ITS-4 were used. The sequences obtained were compared with those deposited at GenBank using the Basic Local Alignment Search Tool program. RESULTS: Filamentous fungi were isolated from 6 of 60 canals (10%): Aspergillus niger (6.7%), Aspergillus versicolor (1.6%), and Aspergillus fumigatus (1.6%). CONCLUSION: Root canals near the maxillary sinus with endodontic treatment and apical periodontitis may exhibit positive cultures for filamentous fungi. Interested professionals should be alert, because these microorganisms have pathogenic characteristics that can cause disease of odontogenic origin in the maxillary sinus.

Current status of conservative treatment of deep carious lesions.

Traditionally, deep carious lesions are treated by removal of all carious tissue, which may lead to pulp exposure. To minimize this risk, conservative carious tissue removal techniques have been proposed, including partial removal and stepwise excavation. However, there is no consensus in the literature about which is the better technique. Thus, the aim of this article is to describe and discuss the main techniques for carious tissue removal, according to scientific evidence. It was observed that both stepwise excavation and partial carious tissue removal presented lower pulp exposure rates and higher success rates. Clinical Relevance: Clinicians must be aware that conservative carious tissue removal techniques, such as stepwise excavation and partial carious tissue removal, present lower pulp exposure rates and higher success rates than traditional methods.

Seria a cárie dental uma doença transmissível? / Is dental caries a transmissible disease?

Este artigo tem por objetivo relatar o caso de uma criança com cárie de estabelecimento precoce, na qual foi identificada a influência de fatores biológicos e não-biológicos no estabelecimento deste quadro bucal. Dentre os fatores biológicos ressaltaram-se a colonização precoce, tendo a mãe como principal fonte de transmissão dos microrganismos, presença de biofilme espesso devido a escovação deficiente, entre outros. Quanto aos não-biológicos, foram verificados fatores culturais, comportamentais, socioeconômicos, psicológicos e direta interação entre a transmissibilidade de hábitos da mãe. Concomitantemente ao tratamento curativo, foram enfatizados os seguintes procedimentos preventivos: motivação à higiene dental, orientação de dieta, estímulo e valorização da saúde bucal, ressaltando a importância da transmissibilidade de hábitos familiares para o desenvolvimento da doença cárie

[Relation between biofilm, caries activity and gingivitis in HIV + children]. / Relação entre biofilme, atividade de cárie e gengivite em crianças HIV+

The utilization of medicines to treat HIV-infected children has been promoting a decrease in the prevalence of soft-tissue oral lesions, as years pass by. In contrast, it has been observed that the experience of caries and gingivitis is constant in this population, mostly because of the chronic influence of some factors involved in the HIV-infection process, such as the chronic utilization of sweetened liquid medicines and carbohydrate-enriched diet, as well as frequent episodes of hospitalization. So, the purpose of this study was to evaluate if the quality and quantity of biofilm are important factors in the activity of dental caries and gingivitis, also in this special group. After examination of the biofilm (biofilm index - Ribeiro23, 2000), the activity of caries and gingivitis was assessed in 56 children, aging from 0 to 14 years, who were patients with definitive diagnosis of HIV infection. It was observed that only 7 subjects (12.5%) did not present with clinically visible biofilm, and 33 (58.9%) presented with gingivitis, with the average of 4.44 bleeding sites. As to dental caries, 73.2% of the patients presented with active carious lesions. A strong correlation was verified between Biofilm Index, gingival status and active carious lesions (Spearman's correlation test, r s = +0.57 and r s = +0.49, respectively). It was concluded that, also in HIV-infected children, the quality and quantity of biofilm over the dental surfaces are important etiologic factors related to the activity of caries and gingivitis. Biofilm should, thus, be controlled in order to reestablish the oral health of HIV-infected children.

Relaçäo entre biofilme, atividade de cárie e gengivite em crianças HIV+ / Relation between biofilm, caries activity and gingivitis in HIV+ children

A utilizaçäo de terapia medicamentosa em crianças infectadas pelo HIV (HIV+) vem promovendo a diminuiçäo na prevalência de manifestaçöes bucais em tecidos moles ao longo dos anos. Entretanto, observa-se uma constância na experiência de cárie e gengivite desta populaçäo, sobretudo devido à influência crônica de alguns fatores envolvidos no processo da infecçäo pelo HIV, como uso prolongado de medicamentos líquidos açucarados, dieta rica em carboidratos e repetidos episódios de internaçäo. Assim, o objetivo do presente estudo foi avaliar se a qualidade e quantidade de biofilme representam um fator importante na atividade da doença cárie e gengivite neste grupo em especial. Após exame do biofilme (Índice de biofilme/ RIBEIRO23, 2000), da atividade de cárie e gengivite de 56 crian;as, de 0 a 14 anos, pacientes com diagnóstico definitivo de infecçäo pelo HIV, observou-se que somente 7 (12,5 por cento) näo apresentavam biofilme visível clinicamente e 33 (58,9 por cento) apresentavam gengivite, com, em média, 4,44 superfícies com sangramento. Quanto à doença cárie, 73,2 por cento das crianças apresentavam lesöes cariosas ativas. Verificou-se ainda a correlaçäo entre o Indice de biofilme, o estado gengival e a atividade das lesöes cariosas (Teste de correlaçäo de Spearman, rs +0,57 e rs +0,49, respectivamente). Conclui-se, que nas crianças HIV+ avaliadas, a qualidade e quantidade de biofilme sobre a superfície dental representam um importante fator na etiologia da atividade das doenças cárie e gengivite, podendo e devendo este ser trabalhado para que seja possível restabelecer a saúde bucal destas crianças

Recuperaçäo da confiança do atleta com o uso de protetores bucais na prática de esporte: relato de caso / Athlete's confidence recuperation using mouth protectors in sports practice: case report

Com o aumento da prática de esportes entre crianças e adolescentes, a ocorrência de acidentes envolvendo injúrias aos tecidos bucais e peribucais vem se tornando cada vez mais comum. Assim os autores relatam um caso de trauma nos tecidos bucais, durante a prática de capoeira, sofrido por uma criança de 11 anos de idade, a qual, por apresentar-se insegura, foi encorajada a continuar praticando o esporte através do uso do protetor bucal. Os autores também descrevem a técnica de confecçäo dos protetores e enfatizam a necessidade de maior divulgaçäo para o uso destes na prática desportiva

Pânico na sala de espera / Panic in the waiting-room

O medo é um forte aliado na luta pela sobre vivência. Este sentimento funciona como um termômetro do perigo, colocando o indivíduo em alerta numa situação de risco. Porém, quando o medo se manifesta de forma intensa, persistente e irracional, pode dar lugar aos transtornos fóbicos-ansiosos, popularmente conhecidas como fobias. Estes distúrbios de ansiedade e angústia acometem 10 por cento da população. A fobia pode desencadear automaticamente uma série de manifestações no orgnismo

Síndrome de Parry-Romberg e suas implicações odontológicas: relato de caso / Parry-Romberg syndrome and its oral repercussion: case report

A síndrome de Parry-Romberg é uma doença rara, de causa desconhecida, caracterizada por uma atrofia unilateral progressiva da pele, do tecido subcutâneo, dos músculos e, por vezes, dos ossos da face. Os achados bucais não têm sido bem documentados, porém, nos casos mais avançados, têm sido descritas, entre outras características, a atrofia hemimandibular, hemimaxilar e hemilingual. O objetivo deste artigo é relatar o caso de uma criança, 8 anos de idade, com todas as características supracitadas associadas à epilepsia

Erupção retardada de dentes permanentes e retenção prolongada dos dentes decíduos: relato de caso / Delayed permanent tooth eruption and prolonged retention of deciduous tooth: case report

O presente estudo apresenta um caso de retenção prolongada de dentes decíduos e erupção retardada de dentes permanentes. Sugere-se que carências nutricionais sofridas pela paciente em tenra idade foram as principais responsáveis pela grande discrepância entre a idade dentária e a idade cronológica apresentada

Erupçäo ectópica irreversível do primeiro molar permanente: relato de caso / Irreversible ectopic eruption of the first permanent molar: case report

A erupçäo ectópica do primeiro molar permanente é um distúrbio local que pode levar a perda precoce de dentes decíduos, gerando problemas que podem ser evitados quando diagnosticada e tratada precocemente. Os autores relatam um caso de erupçäo ectópica irreversível do primeiro molar permanente, descrevem o tratamento realizado e discutem sobre as conseqüências do diagnóstico tardio nesses casos

A importância da atenção primária e do acompanhamento nos casos de intrusão traumática de dentes decíduos: relato de casos / The importance of primary attention and follow-up in cases of deciduous teeth traumatic intrusion: cases report

Este relato tem por objetivo descrever três casos de intrusão traumática de incisivos centrais decíduos ocorridos em crianças com idades compreendidas entre 1 ano e 7 meses e 2 anos e 7 meses de idade, bem como ressaltar a importância da anamnese e exames clínico e radiográfico cuidadosos, além de discutir as possíveis conseqüências e tratamentos para este tipo de traumatismo