Acute focal infections of dental origin

This article describes the most important pus‐producing acute oral infections (dental infections) that can spread extra‐orally. Most of these infections are spread by bacteria entering the bloodstream. However, dental infections have a number of other pathways for dissemination. By forming abscesses or phlegmon they can reach facial spaces that communicate with each other and then spread downwards to the mediastinum or upwards to the brain. In such cases dental infections can become, if not properly treated, life‐threatening. It seems that early diagnosis and treatment are imperative, and potentially infectious foci should be traced and eliminated. Dental hygiene and prophylaxis to prevent dental biofilm formation are important measures to reduce the risk of these calamities. The more compromised the host defense is, the more importance should be put on these measures. Although commensal bacteria are often involved in these infections, attention should also be paid to specific periodontal pathogens, and a proper microbial diagnosis, obtained using molecular methods plus bacterial sensitivity testing, can provide the patient with optimal care. Drainage of pus must be established where possible so that the optimal effect of antibiotics can be achieved. Penicillin is still the drug of first choice in settings where suspicion of methicillin‐resistant Staphylococcus aureus is low.     

Urban air pollution and mortality in a cohort of Norwegian men

We investigated the association between total and cause-specific mortality and individual measures of long-term air pollution exposure in a cohort of Norwegian men followed from 1972-1973 through 1998. Data from a follow-up study on cardiovascular risk factors among 16,209 men 40-49 years of age living in Oslo, Norway, in 1972-1973 were linked with data from the Norwegian Death Register and with estimates of average yearly air pollution levels at the participants' home addresses from 1974 to 1998. Cox proportional-hazards regression was used to estimate associations between exposure and total and cause-specific mortality. During the follow-up time 4,227 men died from a disease corresponding to an ICD-9 (International Classification of Diseases, Revision 9) code < 800. Controlling for a number of potential confounders, the adjusted risk ratio for dying was 1.08 [95% confidence interval (CI), 1.06-1.11] for a 10- microg/m3 increase in average exposure to nitrogen oxides (NOx) at the home address from 1974 through 1978. Corresponding adjusted risk ratios for dying from a respiratory disease other than lung cancer were 1.16 (95% CI, 1.06-1.26); from lung cancer, 1.11 (95% CI, 1.03-1.19); from ischemic heart diseases, 1.08 (95% CI, 1.03-1.12); and from cerebrovascular diseases, 1.04 (95% CI, 0.94-1.15). The findings indicate that urban air pollution may increase the risk of dying. The effect seemed to be strongest for deaths from respiratory diseases other than lung cancer.     

Secular trends in adiposity in Norwegian 9-year-olds from 1999-2000 to 2005

Background  

Due to the negative health consequences of childhood obesity monitoring trends in body mass and adiposity is essential. The purpose of this study was to describe secular trends in the prevalence of overweight and obesity among 9-year-old children, and to study changes in adiposity and fat distribution by investigating changes in waist circumference (WC) and skinfold thicknesses.     

Electrophoresis of whole-cell soluble proteins of microorganisms isolated from bacteremias in endodontic therapy

We have previously demonstrated that anaerobic bacteria are the microorganisms most frequently isolated from blood following endodontic therapy of teeth with apical periodontitis. Phenotypic characterisation of the isolates suggested that the bacteria in the blood originated from the root canal. The present experiment using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was carried out in an effort to verify these findings, and to further study the microorganisms involved in endodontic bacteremias. Soluble cellular proteins were extracted from 11 reference strains and 26 bacterial isolates recovered from the root canal and blood. These included Propionibacterium acnes, Peptostreptococcus prevotii, Fusobacterium nucleatum, Prevotella intermedia, Actinomyces israelii, Streptococcus intermedius, Streptococcus sanguis. The electrophoretic patterns mostly confirmed the identity of the isolates as determined by the biochemical and antimicrobial resistance tests. Furthermore, with this typing method the species Prevotella intermedia and Prevotella nigrescens could be differentiated. These species had been recovered from both root canal and blood. Also, differences between subspecies of Fusobacterium nucleatum became evident with SDS-PAGE, and the results indicated that the organism recovered from the root canal and blood was Fusobacterium nucleatum subsp. vincentii. The electrophoretic patterns of the different organisms isolated from the root canal and the blood were similar, providing further evidence that the bacteria found in the blood originated from the root canal.     

Tetracycline-resistant micro-organisms recovered from patients with refractory periodontal disease

Abstract Tetracycline in combination with scaling and root planing is frequently used to treat refractory periodontal disease. This study examined tetracycline resistance in bacteria recovered from periodontal pockets of patients with refractory periodontitis. Bacterial isolates resistant to 10 μg/ml of tetracycline were isolated from plaque samples of 17 patients, of whom 6 had received tetracycline within 8 weeks prior to sampling. Minimal inhibitory concentrations (MICs) of tetracycline and minocycline were determined by agar dilution. In the 6 patients who had received tetracycline, a mean of 22.9% (±38.2) of the total cultivable subgingival flora were resistant to tetracycline, compared with a mean of 7.2% (±8.5) in the untreated group. Although various organisms were isolated, in most patients, the tetracycline-resistant organisms were dominated by Streptococcus spp. Overgrowth of Candida was found in one patient, and of Enterobacteriaceae in another patient, while small numbers of yeast or Staphylococcus spp. were isolated from the plaque samples of 9 others. 3 out of 4 patients who did not respond to tetracycline treatment had a variety of tetracycline-resistant anaerobic Gram-negative rods present. No correlation was found between increased proportions of tetracycline resistance in the whole bacterial sample and the presence of resistant periodontal pathogens.     

Possible transmittance of A. actinomycetemcomitans from a dog to a child with rapidly destructive periodontitis

This study was designed to detect a possible exogenous source of oral A. actinomycetemcomitans in a family where the 2 children suffered from Papillon-Lefévre syndrome (PLS). Every month for 1 yr subgingival dental plaque samples were obtained from the 2 children, their parents, grandparents and their pet dog. Dental plaque samples were also obtained from a 12-yr-old boy whose family had owned a dog from the same litter as the PLS family. Dispersed and diluted plaque samples were cultured anaerobically on Slots medium and A. actinomycetemcomitans was identified by standard criteria. The various A. actinomycetemcomitans wild strains were mass cultivated and their total genomes compared after DNA restriction endonuclease mapping in 2 different electrophoretic gels, using ECO RI, HIND III and BAM HI. Only the plaque samples from 1 of the PLS children, the pet dog and the 12-yr-old boy produced A. actinomycetemcomitans . The restriction endonucleases could not distinguish between the A. actinomycetemcomitans wild strains from the PLS child and those from the family dog or the 12-yr-old boy. However, the methods could readily differentiate between both reference strains and wild strains, indicating that transfer of A. actinomycetemcomitans from dog to the PLS child had taken place.     

The Effect of Anesthesia on Intraoperative and Postoperative Bleeding during Abdominal Prostatectomies: A Comparison of Neurolept Anesthesia, Halothane Anesthesia and Epidural Anesthesia

Intraoperative blood loss was measured during abdominal prostatectomies in 213 patients anesthetized with neurolept anesthesia, halothane anesthesia and epidural anesthesia. In 55 of these patients, postoperative bleeding was also measured. The average intraoperative blood loss with neurolept anesthesia was 8.2 ± 5 ml/min, with halothane anesthesia 6.6 ± 6.3 ml/min and with epidural anesthesia 3.8 ± 2.3 ml/min. The difference of blood loss in the epidural group and in the groups receiving general anesthesia is highly significant.
Average systolic and diastolic blood pressures were lower during operation in the epidural group than in the other two groups. Statistical analyses failed, however, to show a significant correlation between blood pressures and blood loss in the individual patient. Thus, the ultimate explanation for the diminished bleeding associated with epidural anesthesia is not definitely ascertained. The average postoperative bleeding was not significantly different among the three anesthetic groups.     

Helmet use and risk of head injuries in alpine skiers and snowboarders

Context  Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders. Objective  To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors. Design, Setting, and Participants  Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort's anticipated injury count based on earlier years. Main Outcome Measure  Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries. Results  Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91). Conclusion  Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.