The bacteremia of dental origin and its implications in the appearance of bacterial endocarditis

Numerous systemic diseases may affect the oral cavity and vice versa,in particular severe diseases that involve the heart valve. In these cases, additional measures or a modification to our dental treatment need to be taken. We are aware of various diseases that can cause the emergence of bacterial endocarditis (BE), such as; rheumatic fever, valve lesions due to intravenous drug use, Kawasaki disease and valve surgery, among others. Due to its severity when it is not taken into account in dental treatment, we intend to show the evolution of the antimicrobial prophylaxis towards this condition. Furthermore, we intend to publish the current guidelines of institutions and societies which increasingly encourage rational antimicrobial use. In addition, we intend to examine the evidence of the possible origins of this disease during dental treatment and at the same time describe the necessary considerations that need to be taken during dental treatment. Key words:Endocarditis, antibiotic profilaxis, dental treatment.     

Drug addiction and dental care.

Patients who are addicted to drugs, or are being treated for drug addiction, present a variety of management issues when they attend for dental care. A number of factors are related to the treatment planning and clinical management. Dentists should be aware of these factors in order to manage these patients sensitively and effectively. Important management issues include medical problems associated with drug abuse, dental problems and how drug abuse and its subsequent treatment affect the dentition, behavioural disorders, pain management, and control of cross-infection. People who have recovered from chemical dependency to opiates have special needs, especially in pain management. Establishing a good pre-treatment rapport with the patient will assist the dentist in reducing the need for postoperative analgesics, and will encourage this group of patients to return and obtain needed dental care. The more dental practitioners know about types and patterns of drug abuse and recovery programmes, the more safely this group of patients with special needs can be managed.     

Dental implications of mood disorders

Mood disorders refers to a heterogenous group of mental conditions characterized by extreme exaggeration and disturbance of mood and affect. This article examines major depression and bipolar disorders and how these disorders can affect a patient's dental care. The drugs used to treat these conditions have significant side effects that dentists should be aware of. In addition, important drug interactions can occur as a result of agents used by the dentist. The dentist should refer patients found with signs and symptoms of mood disorders for medical evaluation and treatment. Depressed patients often have poor oral hygiene due to a lack of interest in self-care. Xerostomia occurs due to depression and the drugs used to treat it. The dentist needs to provide an aggressive preventive dental education program for these patients, including the use of artificial salivary products, mouthwashes, and topical fluoride applications, in addition to the treatment of candidiasis when present.     

Rheumatoid arthritis: a review and suggested dental care considerations.

BACKGROUND: Rheumatoid arthritis, or RA, is a chronic multisystem disease of presumed autoimmune etiology. It is estimated that arthritis and other rheumatic conditions affect 42.7 million Americans. Medical complications due to RA and its treatment may affect the provision of oral health care. METHODS: The authors undertook an extensive review of the English literature relating to RA and dental care. They used primarily MEDLINE searches, which included such key words as "rheumatoid arthritis" and "dental care" and subsequent appropriate subheadings. While the MEDLINE search spanned the years from 1975 to the present, the most recent literature was prioritized. Appropriate medical and dental textbooks were also used. The authors extrapolated information from selected texts based on its relevance to dentistry, oral health and the role of the dental provider in the overall treatment of RA patients. RESULTS: The authors reviewed nearly 200 articles and seven textbooks. Their determination of the texts' relevance to oral health care was based on content, significance, quality, journal in which articles were published and year of publication. Major features of RA--including its diagnosis, pathophysiology, clinical features and medical treatment--were identified, as well as complications due to treatment modalities and various related oral manifestations and conditions. CONCLUSIONS: Medical complications due to RA and its treatment can affect oral health care. Oral health care providers need to recognize and identify modifications of dental care based on the medical status of patients with RA. Furthermore, oral health care providers play an important role in the overall care of these patients as it release to early recognition, as well as control of the disease. CLINICAL IMPLICATIONS: In most patients with RA, the condition will necessitate few or no changes in routine dental care. However, considerations include the patient's ability to maintain adequate oral hygiene, xerostomia and its related complications, the patient's susceptibility to infections, impaired hemostasis, and untoward drug actions and interactions. Patients with RA may require antibiotic prophylaxis owing to joint replacement and/or immune suppression, glucocorticosteroid replacement therapy and modifications in oral hygiene procedures. Intra- and extraoral conditions such as ulcerations, gingival overgrowth, disease-associated periodontitis and temporomandibular pathology also need to be recognized.     

Medical and psychosocial risk factors in the dental treatment of the elderly

There is evidence to show that a 'new' type of elderly consumer of dental services is evolving with characteristics and expectations different from those of the 'old' elderly that dentists have had experience in treating. In providing care for the 'new' elderly the dentist must consider the many modifying factors which influence the type of treatment that an individual patient needs. These are the patient's lifespan, medical history, drug history, mental status, mobility, neuromuscular coordination, dental status, previous dental experience, the patient's or family's dental expectations as well as the economic status of the patient and the family. Before commencing treatment the dentist must also assess his/her own skills, the facilities in which he/she is working and the availability of equipment to carry out the dental procedures that may be required. Only when all of these considerations have been taken into account can rational dental care for an individual elderly person be planned and completed. The variation in what is rational is large. For one patient it may be no treatment at all and for another the most technologically sophisticated care dentistry can provide.     

The use of conscious sedation versus general anesthesia in modern dentistry: rising ethical dilemmas

Conscious sedation and general anesthesia have been in the use of the dental profession since the first half of the 19th century. Although seemingly appealing to use due to alleviation of pain and anxiety induced by the dental treatment, the alteration of consciousness level of dental patients is not without risk. Morbidity and mortality due to dental treatment performed under general anesthesia were investigated at the last decades of the 20th century. The mortality rates found in these investigations were surprisingly high comparing to researches of morbidity and mortality due to other medical procedures, performed under general anesthesia. Therefore, although general anesthesia is sometimes the only way to treat certain patients, maintaining strict indications for dental treatment under general anesthesia is necessary. Conscious sedation was found as a safer alternative for achieving a level of consciousness enabling dental treatment in those patients who are unable to receive treatment in normal dental clinic settings. We therefore believe that conscious sedation should be the golden standard for the treatment of those patients. The practicing of dentistry in patients who have need of dental treatment under special settings such as general anesthesia and sedation raises ethical dilemmas to the caregiver. The following review will summarize the available data on morbidity and mortality due to dental treatment given under general anesthesia and conscious sedation. The ethical questions arising from their practicing will be discussed and some answers shall be proposed.     

Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.     

Drugs for pain management in dentistry

Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must be able to diagnose the source of pain and have strategies for its management. The '3-D' principle — diagnosis, dental treatment and drugs — should be used to manage pain. The first, and most important, step is to diagnose the condition causing the pain and identify what caused that condition. Appropriate dental treatment should then be undertaken to remove the cause of the condition as this usually provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental treatment. Most painful problems that require analgesics will be due to inflammation. Pain management drugs include non-narcotic analgesics (e.g., non-steroidal anti-inflammatory drugs, paracetamol, etc) or opioids (i.e., narcotics). Non-steroidal anti-inflammatory drugs (NSAIDs) provide excellent pain relief due to their anti-inflammatory and analgesic action. The most common NSAIDs are aspirin and ibuprofen. Paracetamol gives very effective analgesia but has little anti-inflammatory action. The opioids are powerful analgesics but have significant side effects and therefore they should be reserved for severe pain only. The most commonly-used opioid is codeine, usually in combination with paracetamol. Corticosteroids can also be used for managing inflammation but their use in dentistry is limited to a few very specific situations.     

The medically compromised patient: Are dental implants a feasible option?

In healthy subjects, dental implants have evolved to be a common therapy to solve problems related to stability and retention of dentures as well as to replace failing teeth. Although dental implants are applied in medically compromised patients, it is often not well known whether this therapy is also feasible in these patients, whether the risk of implant failure and developing peri‐implantitis is increased, and what specific preventive measures, if any, have to be taken when applying dental implants in these patients. Generally speaking, as was the conclusion by the leading review of Diz, Scully, and Sanz on placement of dental implants in medically compromised patients (J Dent, 41, 2013, 195), in a few disorders implant survival may be lower, and the risk of a compromised peri‐implant health and its related complications be greater, but the degree of systemic disease control outweighs the nature of the disorder rather than the risk accompanying dental implant treatment. So, as dental implant treatment is accompanied by significant functional benefits and improved oral health‐related quality of life, dental implant therapy is a feasible treatment in almost any medically compromised patient when the required preventive measures are taken and follow‐up care is at a high level.     

Drugs for pain management in dentistry

Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must be able to diagnose the source of pain and have strategies for its management. The ‘3‐D’ principle — diagnosis, dental treatment and drugs — should be used to manage pain. The first, and most important, step is to diagnose the condition causing the pain and identify what caused that condition. Appropriate dental treatment should then be undertaken to remove the cause of the condition as this usually provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental treatment. Most painful problems that require analgesics will be due to inflammation. Pain management drugs include non‐narcotic analgesics (e.g., non‐steroidal anti‐inflammatory drugs, paracetamol, etc) or opioids (i.e., narcotics). Non‐steroidal anti‐inflammatory drugs (NSAIDs) provide excellent pain relief due to their anti‐inflammatory and analgesic action. The most common NSAIDs are aspirin and ibuprofen. Paracetamol gives very effective analgesia but has little anti‐inflammatory action. The opioids are powerful analgesics but have significant side effects and therefore they should be reserved for severe pain only. The most commonly‐used opioid is codeine, usually in combination with paracetamol. Corticosteroids can also be used for managing inflammation but their use in dentistry is limited to a few very specific situations.     

Dental treatment in a patient with epidermolysis bullosa

Epidermolysis bullosa (EB) is a rare inherited group of genodermatoses characterized by mucocutaneous fragility and blister formation, either spontaneously or as a result of minimal mechanical trauma. The repetition of these episodes in the oral cavity leads to atrophy of the mucosa, causing microstomia, ankyloglossia, tongue denudation, and vestibule obliteration, characteristics that make dental treatment difficult. Patients with EB are at high risk for caries due to the presence of dental anomalies; they also tend to have a soft diet and difficulties with mechanical removal of the dental biofilm. This case report presents a patient diagnosed with EB and describes the difficulties faced by the clinician during dental treatment as well as the measures adopted to safely manage the patient's dental care.     

Mobile and portable dentistry: alternative treatment services for the elderly

With the rapidly expanding geriatric population in the United States, the demand for geriatric dentistry is rising. With the financial, transportation, and motivational barriers the geriatric population faces, it can be difficult for them to seek dental treatment in a traditional setting. Mobile and portable dental units can be used as alternative methods to provide dental care to the geriatric population. Mobile and portable dental units offer advantages such as providing community outreach, increasing personal satisfaction for geriatric clients and dental professionals, and providing dental care to those who would otherwise not receive treatment due to some of the barriers. Although mobile and portable dental units are ideal for long-term facilities, disadvantages do exist in implementing the use of these systems. These include the initial cost of implementing such a unit, limitation of treatment options, the number of clients seen in a day, and maintenance for the unit. Until more research can be done to find ways to improve the quality of dental care for the geriatric population, these units seem to be a reasonable alternative to the traditional approach to providing the elderly with the dental care they require.     

An update on clinical regenerative endodontics

Endodontic management of immature permanent teeth with necrotic pulps is both a clinical problem for dental practitioners and a public health care problem. Although it is feasible to perform apexification procedures, the long‐term survival of these teeth is questionable due to thin, incompletely formed dentinal walls. Regenerative endodontic procedures have emerged as a viable treatment alternative for these teeth. This review summarizes the evolution of these procedures while presenting recent advances, including treatment protocol modifications based on translational studies and future bioengineering approaches.     

Differentiating anxiety-panic disorders from psychologic dental anxiety

It has always been believed that fear and anxiety of dental treatment was a simple continuum of experience that occurs in mild, moderate, or severe form. Past and present studies that attempt to both trace etiology and measure it reflect this view. The numerous studies that are concerned with methods of management are based on this accepted philosophy regarding the etiology of dental fear and anxiety. To a large extent, this may be true. However, there are some notable exceptions, and it is these cases that present the greatest management problem. Omitting the symptoms of fear and anxiety related to physical illness, drug withdrawal, or major mental illness, they present anxiety as a unidimensional learned problem usually conditioned by externally negative forces or experiences. They postulate that the fear and anxiety seen is due to a variety of factors. The interpretation of the definitions of fear, anxiety, and phobias by many in the profession that are presented in this issue also reflect the view that fear, anxiety, and phobias are learned or conditioned responses. This single-minded view has determined much of our understanding and subsequent management of this problem in dentistry.     

The effects of drugs on the oral cavity

As shown by the growing numbers of users attending the public drug addiction services, drug abuse is a phenomenon that is constantly spreading. It is important that dentists are aware of the oral problems linked to drug abuse. This study examines the general effects and oral implications of the illegal substances used by the majority of drug addicts. The main dental complications of cannabinoids are the increased incidence of squamous cell carcinomas of the oral cavity, the presence of xerostomia and severe gingivitis. Depending on how it is taken, cocaine may cause ischemic necrosis of the palate, inflammation, ulceration and gingival retraction, as well as an increased incidence of bruxism. Hallucinogens have few direct oral effects, but among these it is worth recalling xerostomia, increased bruxism and oral problems linked to malnutrition caused by ecstasy. Turning to the opioids, heroin is the drug primarily used by the majority of drug addicts. Its oral effects mainly take the form of dental decay, showing a particular form and extent linked either directly or indirectly to heroin use. This results in "typical" or "atypical" caries pathologies directly linked to the effects of heroin. Given the extent of this phenomenon, it is important that dentists are aware of the problems linked to drug abuse that they may have to treat.     

D-氨基酸对细菌生物膜分散作用的研究进展

细菌是导致感染性疾病的主要来源,细菌分泌的胞外多糖等物质聚集可形成致密的生物膜,使抗生素难以对其发挥杀菌作用,甚至可产生耐药性。细菌生物膜的存在给临床治疗增加了难度。口腔牙菌斑生物膜是龋病发生发展的始动因素,因此,有效清除和控制牙菌斑生物膜是防治龋病的关键。D-氨基酸作为细菌生物膜信号分子,能促进生物膜分散,进而促进抗菌药物发挥杀菌作用。文章就D-氨基酸对细菌生物膜分散作用的研究进展做一综述,为临床上清除牙菌斑生物膜的治疗方案提供新的思路。     

Some problems with anticoagulants in dental surgery.

Anticoagulants have been used to reduce the risk of embolic and thrombotic complications in patients at risk since the discovery of the coumarin drug warfarin sodium in 1941. Since then, both the spectrum of disease for which anticoagulation is recommended and the range of anticoagulants has widened. In addition to treatment with conventional anticoagulant drugs, many patients nowadays have an additional bleeding defect due to the therapeutic use of daily low-dose aspirin therapy, either alone or in combination with other drugs. The aim of this report is to highlight some of the important aspects of anticoagulant therapy and its relevance to dental treatment.     

Interpretations of DMF registrations of Norwegian recruits with emphasis on previous treatment experience

abstract The results from a DMF registration of 235 Nonvegian recruits are presented with emphasis on groups with differences in dental treatment prior to the time of examination. Eighty-one per cent of the recruits had attended school dental services regularly between the ages of 7 and 14 years. About half of these continued regular dental treatment until they entered the armed forces at ages 18–20, while 13 % did not seek dental treatment. The DMFS and DMFT counts were similar for all groups in the present study. The D/F, M/F and DM/F ratios have been assessed and it is suggested that these ratios may be useful in evaluating the effects of previous treatment as well as the present need for dental care.     

Interpretations of DMF registrations of Norwegian recruits with emphasis on previous treatment experience

abstract The results from a DMF registration of 235 Nonvegian recruits are presented with emphasis on groups with differences in dental treatment prior to the time of examination. Eighty-one per cent of the recruits had attended school dental services regularly between the ages of 7 and 14 years. About half of these continued regular dental treatment until they entered the armed forces at ages 18–20, while 13 % did not seek dental treatment. The DMFS and DMFT counts were similar for all groups in the present study. The D/F, M/F and DM/F ratios have been assessed and it is suggested that these ratios may be useful in evaluating the effects of previous treatment as well as the present need for dental care.