Oral health scales: design of an oral health scale of infectious potential

Objectives: In this paper we propose a new Global Oral Health Scale that will allow the infectious potential of the oral cavity, clinically manifest as local and focal infections, to be condensed into a single parameter. Study Design: Based on a number of oral health scales previously designed by our group, we designed a final version that incorporates dental and periodontal variables (some of them evaluated using corroborated objective indices) that reflect the presence of caries and periodontal disease. Results: The application of the proposed oral health scale requires the examination of 6 sites per tooth (mesio- buccal, medio-buccal, disto-buccal, disto-lingual, medio-lingual and mesio-lingual). The following variables are analysed: number of tooth surfaces with supragingival plaque, determined using the O'Leary index; number of teeth with caries and the severity of the caries; number of tooth surfaces with gingival inflammation, determined using the Ainamo and Bay index; and number of tooth surfaces with pockets >=4 mm and severity of the pockets. These variables are then grouped into 2 categories, dental and periodontal. The final grades of dental and peri - odontal health correspond to the grades assigned to a least 2 of the 3 variables analysed in each of these categories. The category (dental or periodontal) with the highest grade is the one that determines the grade of the Global Oral Health Scale. Conclusion: This scale could be particularly useful for the epidemiological studies comparing different populations and for analysis of the influence of distinct degrees of oral health on the development of certain systemic diseases

Control of drooling using transdermal scopolamine skin patches : a case report

Transdermal scopolamine has been shown to be very useful in the management of drooling, particularly in patients with neurological or neuropsychiatric disturbances or severe developmental disorders. In this paper, we present the case of a 24-year-old patient with a diagnosis of cerebral palsy and a severe problem of drooling, exacerbated by marked mandibular prognathism. After exclusion of other therapeutic alternatives, it was decided to use sustainedrelease transdermal scopolamine patches (Scopoderm TTS). This technique consists of the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24 hour period. The patient underwent periodic clinical and laboratory follow-up over a period of three years, achieving satisfactory results with no significant undesirable effects

Evaluation of an oral health scale of infectious potential using a telematic survey of visual diagnosis

Objective: To compare the results of a subjective estimation of oral health through review of a set of intraoral photographs with those of an objective oral health scale of infectious potential. Method : The pool of patients was made up of 100 adults. Using an infectious-potential scale based on dental and periodontal variables, we assigned 1 of the 4 grades of the scale (range, 0 to 3; 0 corresponds to an excellent oral health status and 3 to the poorest oral health status) to each subject. A total of 20 representative subjects were selected from the pool of patients, 5 subjects for each one of the grades of the scale, and a standardized photographic record was made. One thousand dentists practicing in Spain were sent the survey by e-mail and 174 completed forms were received. We then calculated the concordance of the oral health status indicated by the respondents after visualising the photographs on comparison with the results of the oral health scale of infectious potential; concordance was termed correct grade allocation (CGA). Results : The majority of respondents (69.1%) achieved a CGA in 8 to 12 cases and none achieved more than 15 CGAs. The poorest CGA rates were found with grades 1 and 2, with a mean of 1.74 ± 1.09 and 1.87 ± 1.18, respectively, out of a maximum of 5. The concordance in terms of CGA was high for grade 0 (70.5%), very low for grade 1 (10.8%), low for grade 2 (37.3%), and moderate for grade 3 (42.6%). Conclusion : In comparison with visual examination of the oral cavity, the use of objective scale that establishes a reliable diagnosis of oral health in terms of infectious potential was found to be advantageous

Pautas de profilaxis antibiótica de Endocarditis Bacteriana, recomendadas por los odontólogos en España

El propósito del presente estudio fue conocer las pautas de profilaxis antibiótica de Endocarditis Bacteriana (EB) recomendadas por los odontólogos en España. Se preguntó a través de una llamada telefónica, cuál era el régimen profiláctico que se debía administrar a un paciente de riesgo de EB antes de someterse a una exodoncia. La información se obtuvo de 400 odontólogos seleccionados aleatoriamente y distribuidos por todo el territorio español. A 200 se les preguntó sobre la pauta recomendada en pacientes no alérgicos a la penicilina y, a los 200 restantes, sobre la aplicada en los alérgicos a la penicilina.Del total de encuestados, 182 (45,5%) no sugirieron ningún régimen profiláctico, de éstos el 74,7% señalaron la necesidad de una cita para una exploración previa y el 25,3% refirieron al paciente a su médico general o cardiólogo. De los 97 odontólogos que recomendaron antibióticos para pacientes no alérgicos a la penicilina, solamente 30 (30,9%) contestaron correctamente algún régimen profiláctico de los publicados por la Asociación Americana de Cardiología o la Sociedad Británica de Quimioterapia Antimicrobiana. Para pacientes alérgicos a la penicilina, el 68,2% de los odontólogos recomendaron eritromicina como antibiótico de elección, y el 17,6% clindamicina. Sin embargo, menos del 30% prescribieron estos antibióticos en las posologías correctas. Estos resultados demuestran una importante carencia de conocimientos entre los odontólogos españoles sobre las pautas de profilaxis de EB para pacientes de riesgo que van a someterse a una manipulación dental.The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an 'at risk' patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for 'at risk' patients before dental procedures among Spanish GDPs

In Vivo Antiplaque Effect of Three Edible Toothpastes

Objectives: The objective of this study was to analyse the antibacterial and antiplaque activity of three edible toothpastes with the widest worldwide distribution: KidScents™, which contains essential oils; Browning B&B™,, with medicinal plants; and Wysong Probiodent™, which contains probiotics. Study Design: The study group was formed of twenty healthy volunteers (dental students) with a good oral health status. Using a balanced randomisation system, all volunteers performed toothbrushing with four products (the three edible toothpastes and water) at intervals of one week. Bacterial vitality in the saliva was analysed by epifluorescence microscopy and plaque regrowth was evaluated using the Turesky-Quigley-Hein plaque index. Results: Bacterial vitality in the saliva was significantly higher after toothbrushing with water (positive control) than with the three toothpastes (P=0.002, P=0.003 and P<0.001, respectively). The plaque index was significantly higher after using these three toothpastes than after toothbrushing with water (P=0.047, P=0.032 and P<0.001, respectively). Conclusions: The three edible toothpastes analysed have some antimicrobial activity but favour plaque regrowth

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction

Objective: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. Study design: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C- telopeptide (CTX) levels were measured. Results: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. Conclusion: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis

Valor predictivo de la candidiasis oral como marcador de evolución a SIDA

Objetivo: Determinar la validez de la candidiasis oral (CO) como marcador clinico de evolucion en los pacientes infectados por el Virus de la Inmunodeficiencia Humana. Diseno del estudio: En 1992, se efectuo una exploracion oral a un colectivo de 200 pacientes infectados por VIH, con una edad media de 36,8'}7 anos (rango 25-46 anos) para establecer el diagnostico de CO. Se registraron las variables edad, sexo, tiempo de evolucion de la enfermedad, conducta de riesgo, numero de linfocitos CD4/'ÊL, estadio clinico y tratamiento antirretroviral. De los 200 pacientes del grupo de estudio, 157 no cumplian criterios de SIDA en el momento de la exploracion basal y a estos se les efectuo un seguimiento semestral hasta que cumplieron dichos criterios, concluyendo el estudio al final de 2001. Resultados: De los 157 pacientes seleccionados, 71 (45,2%) no presentaron CO y de estos el 28,7% evoluciono a SIDA durante el periodo de seguimiento. De los 86 (54,8%) pacientes con CO, el 48,2% evoluciono a SIDA (RR=2,71). Al trasladar el origen del estudio al ano 1997 cuando se inicio la administracion de la terapia antirretroviral de alta eficacia (TAAE), no se observaron diferencias en el porcentaje de pacientes que evolucionaron a SIDA en relacion a la existencia o no de CO en la exploracion basal. El analisis multivariante demostro que la asociacion de la variable de exposicion CO con la evolucion a SIDA no alcanzo un valor predictivo. Conclusiones: El valor pronostico a largo plazo de la CO, no se ha determinado en pacientes que reciben terapia antirretroviral de alta eficacia (TAAE). La recuperacion inmunologica y la disminucion de enfermedades oportunistas observadas tras la administracion de TAAE, hacen que muchos pacientes que alcanzaron la condicion de SIDA no cumplan en la actualidad dichos criterios, lo que obliga a renovar la propia definición del síndrome para poder evaluar marcadores de pronóstico.Objective: To determine the validity of oral candidiasis (OC) as a clinical marker of progression in patients with human immunodeficiency virus infection. Study design: In 1992, an oral examination was carried out on a group of 200 HIV-infected patients with a mean age of 36.8 ± 7 years (range 25-46 years) to establish the diagnosis of OC. The following variables were recorded: age, sex, duration of the disease, risk behaviour, CD4 lymphocyte count, clinical stage and antiretroviral treatment. Of the 200 patients in the group evaluated, 157 did not fulfil the criteria for AIDS at the time of the baseline examination; these patients constitute the study group and underwent 6-monthly follow-up until they fulfilled these criteria. The study was concluded at the end of 2001. Results: Of the 157 patients selected, 71 (45.2%) did not present OC and, of these, 28.7% progressed to AIDS during the followup period. Of the 86 (54.8%) patients with OC, 48.2% progressed to AIDS (RR= 2.71). If the start date of the study was taken as 1997, when highly active antiretroviral therapy (HAART) was introduced, no differences were found in the percentage of patients who progressed to AIDS with respect to the presence or absence of OC at the baseline examination. Multivariate analysis demonstrated that the association of the presence of OC with progression to AIDS did not reach a predictive value. Conclusions: The long-term prognostic value of OC has not been established in patients receiving highly active antiretroviral therapy (HAART). The immunological recovery and the reduction in the number of opportunistic diseases observed after the administration of HAART means that many patients who developed AIDS do not currently satisfy these criteria, making a review of the definition of the syndrome itself a necessity in order to be able to evaluate prognostic markers

Oral health status in patients with moderate-severe and terminal renal failure

Objetivos. Evaluar el estado de salud oral de pacientes con insuficiencia renal crónica moderada/severa (IRC-MD) y con fallo renal terminal (FRT). Diseño. El grupo de estudio lo constituyeron 50 pacientes: 22 (44%) con IRC-MD y 28 (56%) con FRT incluidos en un programa de hemodiálisis. Los controles (n= 64) tenían características similares en relación al sexo, edad, peso y nivel educacional. Se realizó una exploración intraoral a todos los participantes recogiendo información acerca de: número de dientes cariados, ausentes y obturados; acúmulo de placa supragingival; acúmulo de cálculo; profundidad de bolsas periodontales en los dientes de Ramfjord; y pérdida de inserción. Resultados. No se detectaron diferencias significativas en los valores del índice CAO entre pacientes y controles. El número medio de dientes cariados fue inferior en los pacientes que en los controles (p= 0,052). En los pacientes, el nú- mero medio de dientes ausentes fue mayor que en los controles (p= 0,002). Había 12 pacientes y 7 controles totalmente edéntulos. El número medio de dientes obturados fue significativamente inferior en los pacientes que en los controles (p< 0,001). El acúmulo de placa supragingival y la pérdida de inserción fue significativamente mayor en los pacientes que en los controles (p= 0,006 y p< 0,001, respectivamente). No se encontraron diferencias significativas en relación al acúmulo de cálculo ni a la presencia de bolsas periodontales entre ambos grupos. El valor del índice CAO, el número medio de dientes cariados y el de obturados fue significativamente superior en los pacientes IRC-MD que en los pacientes FRT (p= 0,004, p= 0,030 y p= 0,006, respectivamente). Conclusión. Los pacientes con IRC tienen menor prevalencia de caries, más placa supragingival, más dientes con pérdida de inserción y más ausencias dentarias, que los controles sanos. La prevalencia de caries está condicionada por la severidad de la insuficiencia y/o por el tratamiento de hemodiálisis

Minor salivary gland biopsy in Sjögren's syndrome: a review and introduction of a new tool to ease the procedure

Objectives: To review the existing techniques for minor salivary gland biopsy (MSGB) in the lip and to suggest a new approach to ease the procedure and reduce post-operative complications. Study Design: A comprehensive literature review and a descriptive study of a new surgical technique. Results: Diverse incisions have been suggested for MSGB with different designs (ellipse, circular, linear), different directions (parallel, oblique, vertical) and a wide range of lengths (from 1 mm up to 3 cm), but no comparative studies supporting the advantages of a particular type of incision over the others could be retrieved. A variety of features of the existing techniques for MSGB are linked to undesired events and surgical complications which could be minimized by modifying certain aspects of these procedures. The technique described, together with the use of the S forceps, represents a significant improvement over the already described chalazion forceps because it allows for a better access and positioning of the lower lip, improves the ergonomic conditions of the assistant, and facilitates the identification of lip areas with more superficial gland lobules. Conclusions: The suggested approach for lip MSGB includes a specifically designed instrument whose performance during lip biopsy may contribute to minimize post-operative complications