Treatment with infliximab: Implications in oral surgery? A case report.

Infliximab is a tumour necrosis factor-alpha (TNF-alpha) inhibitor (neutralising antibody), which is increasingly being used as an immunosuppressant to manage inflammatory conditions including rheumatoid arthritis, ankylosing spondylitis and Crohn's disease. Its side effects include diabetes mellitus, an increased incidence of lymphoma and greater susceptibility to infections such as pulmonary tuberculosis. In patients on infliximab, the oral cavity may act as a bacterial reservoir leading to unwanted local or systemic complications. To date no report describes the potential implication/s of infliximab in patients having oral surgery. This case report may be the first in the English language to report the development of mandibular osteomyelitis after surgical extraction in a patient on infliximab.

Capnocytophaga spp. in periodontitis patients manifesting diabetes mellitus.

BACKGROUND: The subgingival microflora in patients presenting concurrently with periodontitis and diabetes mellitus (DM) are poorly understood. While traditional putative periodontal pathogens are implicated, research involving other oral organisms; e.g., Capnocytophaga spp., is lacking. These organisms produce a range of bacterial enzymes relevant to periodontal breakdown. It is inferred that periodontal bacteria acquire systemic access through the ulcerated periodontal pocket surface; conclusive evidence supporting this notion is limited. The aims of this investigation were to: 1) quantify and identify Capnocytophaga spp. present in healthy and diseased sites in periodontitis patients with and without DM, and 2) isolate periodontal pathogens from these patients' blood. METHODS: Twenty-one DM-periodontitis and 25 periodontitis patients were recruited. Subgingival plaque was collected from three healthy and three diseased sites per subject. Capnocytophaga spp. and total (facultative and obligate) anaerobic counts from each site were estimated. Capnocytophaga spp. were identified using 16S rRNA polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). Statistical analyses were performed using multilevel modeling. Blood samples were subjected to HbA(1c) estimation and bacterial culture. RESULTS: A total of 848 Capnocytophaga spp. were isolated and identified. Significantly higher numbers of Capnocytophaga spp. (P <0.001) and anaerobes (P <0.001) were present in diseased sites in DM-periodontitis subjects compared to healthy sites in non-DM-periodontitis and DM-periodontitis subjects. C. ochracea (and variant) and C. granulosa were the most prevalent species. Blood samples were negative for Capnocytophaga spp. CONCLUSIONS: Total mean counts for Capnocytophaga spp. were significantly higher in DM-periodontitis subjects versus non-DM-periodontitis (P = 0.025) and at diseased sites versus healthy sites (P <0.001). Analysis of individual species revealed that the outcome varied with site status and DM status.

Time to shift: from scaling and root planing to root surface debridement.

Non-surgical periodontal treatment has traditionally been based on the notion that bacterial plaque (dental biofilm) penetrates and infects dental cementum. Removal of this infected cementum via scaling and root planing (SRP) was considered essential for re-establishing periodontal health. In the 1980s the concept of SRP was questioned because several in vitro studies showed that the biofilm was superficially located on the root surface and its disruption and removal could be relatively easily achieved by ultrasonic instrumentation of the root surface (known as root surface debridement (RSD). Subsequent in vivo studies corroborated the in vitro findings. There is now sufficient clinical evidence to substantiate the concept that the deliberate removal of cementum by SRP is no longer warranted or justified, and that the more gentle and conservative approach of RSD should be implemented in daily periodontal practice.

Glossodynia and necrosis of the tongue caused by giant cell arteritis.

Spontaneous, endogenous pain in the tongue (glossodynia) is rare, particularly when this progresses to ulceration and necrosis of the tongue. We report the case of a 74-year-old woman who presented with glossodynia that eventually resulted in necrosis of the tongue. The diminished blood supply was the result of histologically confirmed giant cell arteritis.

Molecular identification of Capnocytophaga spp. via 16S rRNA PCR-restriction fragment length polymorphism analysis.

Capnocytophaga spp. have been implicated as putative periodontal pathogens associated with various periodontal diseases. Although the genus is known to contain five human oral isolates, accurate identification to species level of these organisms recovered from subgingival plaque has been hampered by the lack of a reliable method. Hence, most studies to date have reported these isolates as Capnocytophaga spp. Previous attempts at identification were based on biochemical tests; however, the results were inconclusive. Considering the differing virulence features of the respective isolates, it is crucial to identify these isolates to species level. The universal and conservative nature of the 16S rRNA gene has provided an accurate method for bacterial identification. The aim of this study was to identify Capnocytophaga spp. via restriction enzyme analysis of this gene (16S rRNA PCR-restriction fragment length polymorphism). The results (backed up by 16S rRNA gene sequencing) showed that this method reliably identifies all named Capnocytophaga spp. to species level.