Antimicrobial resistance of aerobes and facultative anaerobes isolated from the oral cavity

OBJECTIVES: This study evaluated the resistance to antimicrobials of aerobes and facultative anaerobes isolated from patients wearing complete dentures, patients with gingivitis and periodontitis, and periodontally health subjects. MATERIAL AND METHODS: Three hundred and four isolates were tested. The minimal inhibitory concentrations of the drugs were evaluated through the agar dilution method using Mueller-Hinton agar. RESULTS: The most active antimicrobial drugs were the carbapenems (meropenem and imipenem), and resistance to these drugs was restrict to 1.6-2.3% of the isolates, as well as ciprofloxacin and rifampin. Microbial resistance to ampicillin, amoxicillin/clavulanic acid, cefoxitin, cephalothin, amikacin, chloramphenicol and nalidixic acid was particularly high. In most cases, the resistance to β-lactams was mediated by the production of hydrolytic enzymes, especially in gram-negative enteric rods, while enterococci did not evidence production of these enzymes. The association amoxicillin/clavulanic acid was not effective in 28.3% of the tested isolates. CONCLUSIONS: The results of this investigation confirmed that the oral cavity of patients with periodontitis and gingivitis, and particularly edentulous patients wearing complete dentures could harbor microorganisms with several antimicrobial resistance markers, and these microorganisms are frequently implicated in multiresistant, systemic, oral or nosocomial infections

Resistance to tetracycline and β-lactams and distribution of resistance markers in enteric microorganisms and pseudomonads isolated from the oral cavity

This study evaluated the occurrence of enteric bacteria and pseudomonads resistant to tetracycline and β-lactams in the oral cavity of patients exhibiting gingivitis (n=89), periodontitis (n=79), periodontally healthy (n=50) and wearing complete dentures (n=41). Microbial identification and presence of resistance markers associated with the production of β-lactamases and tetracycline resistance were performed by using biochemical tests and PCR. Susceptibility tests were carried out in 201 isolates of enteric cocci and rods. Resistance to ampicillin, amoxicillin/clavulanic acid, imipenem, meropenem and tetracycline was detected in 57.4%, 34.6%, 2.4%, 1.9% and 36.5% of the isolates, respectively. β-lactamase production was observed in 41.2% of tested microorganisms, while the most commonly found β-lactamase genetic determinant was gene blaTEM. Tetracycline resistance was disseminated and a wide scope of tet genes were detected in all studied microbial genus

Ocorrência de Actinobacillus actinomycetemcomitans em pacientes com periodontite crônica, periodontite agressiva, pessoas saudáveis e crianças com gengivite em duas cidades do Estado de São Paulo, Brasil

The aim of this study was to determine the frequency of isolation of Actinobacillus actinomycetemcomitans (Aa) in 100 patients with chronic periodontitis, 14 patients with aggressive periodontitis, 142 pre-school children with gingivitis and 134 periodontally healthy subjects. Samples of subgingival plaque were taken using sterilized paper points introduced into periodontal pockets or gingival crevice for 60 seconds and inoculated on TSBV agar, which was incubated under anaerobiosis at 37ºC, for 4 days. Microbial identification was performed through biochemical methods and morphocellular and morphocolonial analysis. Aa was detected in 40.3% of healthy subjects, 68% of patients with chronic periodontitis, 92.86% of patients with aggressive periodontitis and 40.14% of children with gingivitis. The rate of recovery of Aa in the tested human groups proved to be higher than previously reported and in agreement with participation of this facultative anaerobe as a member of native microbiota of the periodontium and its relation with aggressive and chronic periodontitis in Brazil.Avaliou-se a ocorrência de Actinobacillus actinmycetemcomitans (Aa) em pacientes 100 pacientes com periodontite crônica, 14 com doença periodontal agressiva, 142 crianças com gengivite em idade pré-escolar e 134 indivíduos adultos saudáveis. Amostras de placa subgengival foram coletadas usando cones de papel estéreis introduzidos nas bolsas periodontais ou no sulco gengival por 60 segundos e inoculadas em ágar TSBV, que foram incubadas em anaerobiose a 37ºC, por 4 dias. A identificação microbiana foi realizada através de análises bioquímicas, morfocelulares e morfocoloniais. Aa foi detectado em 40,3% de indivíduos saudáveis, 68% de pacientes com periodontite crônica, 92,86% de pacientes com periodontite agressiva e 40,14% das crianças com gengivite. A taxa de ocorrência de Aa nos grupos testados provou ser mais alta do que a previamente descrita na literatura e que esse microrganismo é membro freqüente da microbiota de indivíduos adultos periodontalmente sadios e de crianças com idade pré-escolar com gengivite além de sua relação com a periodontite crônica e agressiva no Brasil

Surgical-Orthodontic Traction for Impacted Maxillary Canines: A Critical Review and Suggested Protocol

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical-orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages

Ferimento facial por projétil de arma de fogo: avaliação dos resultados e complicações de 52 pacientes tratados

Traumas faciais em decorrência de ferimento por projétil de arma de fogo produzem lesões pérfuro-contuso que podem variar de acordo com o calibre da arma usada, da distância a partir do qual o paciente é baleado e da textura do tecido atingido. O tratamento de lesões maxilo-faciais por projétil de arma de fogo é ainda controverso em relação ao momento ótimo para a intervenção. A maioria dos autores recomenda tratamento conservador como a restauração oclusal e bloqueio maxilomandibular; postulamos que muitas lesões faciais por projétil de arma de fogo podem ser tratadas precocemente com técnicas de cirurgia aberta e fixação com sistemas de placas e parafusos. Nesse sentido, estudo retrospectivo de 12 anos - 2001 a 2012 - foi realizado buscando avaliar os resultados e complicações nos pacientes tratados por ferimentos por projétil de arma de fogo no esqueleto facial, tendo como elemento comparativo o tratamento indicado/realizado para os mesmos, tanto os pacientes que receberam reparo imediato e redução aberta e os que receberam tratamento cirúrgico fechado. Justifica-se a realização deste trabalho, já que ferimentos por projétil de arma de fogo faciais normalmente são associados com fraturas expostas que requerem intervenção cirúrgica imediata para limitação do dano e que em muitos casos podem ser tratados primariamente de forma definitiva, destinado a reparar o osso e os tecidos moles tão logo as condições clínicas permitam. De acordo com os resultados obtidos os pacientes vítimas de PAF facial podem ser tratados na urgência primariamente de forma aberta, pois os índices de complicação comparativamente ao grupo tratado de forma eletiva tardiamente foram similaresFacial trauma due to injury by gunshot wounds produce penetrating injuries that may vary according to the caliber of the weapon used, the distance from which the patient is shot and tissue texture achieved. The treatment of maxillofacial injuries by projectile weapon-of-fire is still controversial regarding the optimal time for intervention. Most authors recommend conservative treatments such as occlusal restoration and lock jaw; postulate that many facial injuries by projectile weapon fire-can be treated early with open surgical techniques and fixation with plates and screws systems. Accordingly, retrospective study of 12 years - from 2001 to 2012 - was held aiming to evaluate the results and complications in patients treated for injuries projectile weapon fire-in facial skeleton, taking as a baseline the indicated treatment / performed for same with patients who received immediate repair and open reduction and those receiving surgery closed. Justified this work, since injuries projectile weapon fire-are typically associated with facial fractures requiring immediate surgical intervention for damage limitation and that in many cases can be definitively treated primarily aimed at repair the bone and soft tissues as soon as clinical conditions permit. According to the results obtained for patients suffering from PAF face can be treated in an open urgency primarily because the complication rates compared to the group treated electively later were simila

Análise da perda volêmica em pacientes submetidos a expansão rápida de maxila assistida cirurgicamente

As cirurgias ortognáticas são procedimentos executados com frequência e complicações como lesões arteriovenosas ou mesmo pelo tempo cirúrgico, podem ocasionar hipovolemia. A necessidade de reposição do volume sanguíneo por meio da infusão de soluções cristalóides, colóides ou até a transfusão de sangue é sempre considerada. Assim, propôs-se neste estudo quantificar a perda sanguínea, bem como avaliar a necessidade da transfusão sanguínea em 19 pacientes submetidos à expansão rápida de maxila assistida cirurgicamente. Foram avaliados os valores de pressão arterial média, tempo de procedimento cirúrgico, gênero, perda volêmica intra-operatória e classificação ASA. Pode-se concluir que a hipovolemia e a requisição de transfusão de sangue nestas cirurgias foram pequenas, entretanto, os profissionais devem sempre estar atentos quanto ao tempo cirúrgico e ao aprimoramento da técnica cirúrgicaOrthognathic surgeries are procedures performed at a frequency quite considerable and now, at the expense of complexity with regard to the complications inherent in the technique, such as arteriovenous injuries or even the time of surgery, can cause a severe hypovolemia. The need for replacement of blood by infusion of crystalloid solutions, colloids or by blood transfusion is always considered. Thus, we proposed this study to quantify the blood loss, and assess the need for blood transfusion in 19 patients undergoing to surgical assisted rapid maxillary expansion. The values of mean arterial pressure, duration of surgery, gender, ASA classification and volume loss. It can be concluded that hypovolemia and the request for blood transfusion in these surgeries were small, however, professionals should always be alert as to the time of surgical procedure and the development of a meticulous surgical techniqueCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Implicações clínicas da doença de Lyme em região facial: revisão da literatura

Lyme disease (LD) is a systemic infl ammatory changes resulting from direct action and the immune response to the spirochete Borrelia burgdoferi transmitted by inoculation of the fl ow of the genus Ixodes tick and is most commonly found in North America, Europe and Asia. This disease can lead to facial and peripheral neurological manifestations, such as Bell’s palsy, eye changes, disorders in the temporo-mandibular joint in addition to paresthesia of superior and inferior alveolar nerves. In Brazil, the diagnosis of LD is primarily based on clinical presentation, the erythema migrans skin, and epidemiological information of the patient. Recognition of the onset of the DL by health professionals is essential for the correct antibiotic treatment preventing the progression of the disease, and also relevant preventive guidelines for those living or working in endemic areas.Doença de Lyme (DL) é uma alteração infl amatória sistêmica resultante da ação direta e da resposta imune à espiroqueta Borrelia burgdoferi transmitida pela inoculação na corrente circulatória por carrapato do gênero Ixodes, sendo mais comumente encontrada na América do Norte, Europa e Ásia. Essa enfermidade pode levar a manifestações neurológicas periféricas e faciais, tais como paralisia de Bell, alterações oftalmológicas, desordens na articulação temporo-mandibular além de parestesia de nervos alveolares superiores e inferiores. No Brasil, o diagnóstico da DL é primeiramente baseado na apresentação clínica, com o eritema migrans cutâneo, e informa- ções epidemiológicas do paciente. O reconhecimento das primeiras manifestações da DL por profi ssionais de saúde é essencial para o correto tratamento antibiótico impedindo a progressão da doença, sendo também relevante orientações preventivas para aqueles que vivem ou trabalham em áreas endêmicas