A. van Nieuw Amerongen

Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients.

ObjectiveTo investigate salivary flow and frequency of oral mucositis in intensive care unit patients compared with patients admitted because of elective coronary artery bypass graft (CABG) surgery. In addition, the pattern of oropharyngeal colonization was investigated in these patients. DesignProspective study. SettingMixed intensive care unit and cardiosurgical ward. PatientsIn this study, 24 ventilated intensive care unit patients and 20 CABG patients were included. Measurements and Main ResultsTwo dental hygienists examined intensive care unit patients for the presence of periodontal disease and mucositis at admission and subsequently every week during their stay in the intensive care unit. At the same time, stimulated salivary flow and salivary total immunoglobulin A output were measured. Oropharyngeal cultures were obtained as well. CABG patients were examined the day before the operation, 1 day, 1 wk, and 2 wks after the operation. The following results were obtained: a) temporarily reduced postoperative stimulated salivary flow and total salivary immunoglobulin A output in CABG patients and nearly absent stimulated salivary flow in intensive care unit patients; b) oropharyngeal colonization with potentially pathogenic microorganisms in intensive care unit and not in CABG patients; and c) the increase in mucositis index in intensive care unit patients paralleled the increase in potentially pathogenic microorganism oropharyngeal colonization, especially Enterobacteriaceae and Pseudomonas aeruginosa. ConclusionsAbsence of adequate salivary flow in intubated intensive care unit patients causes severe xerostomia, which may contribute to the development of mucositis and oropharyngeal colonization with Gram-negative bacteria.

Bactericidal activity of LFchimera is stronger and less sensitive to ionic strength than its constituent lactoferricin and lactoferrampin peptides

The innate immunity factor lactoferrin harbours two antimicrobial moieties, lactoferricin and lactoferrampin, situated in close proximity in the N1 domain of the molecule. Most likely they cooperate in many of the beneficial activities of lactoferrin. To investigate whether chimerization of both peptides forms a functional unit we designed a chimerical structure containing lactoferricin amino acids 17-30 and lactoferrampin amino acids 265-284. The bactericidal activity of this LFchimera was found to be drastically stronger than that of the constituent peptides, as was demonstrated by the need for lower dose, shorter incubation time and less ionic strength dependency. Likewise, strongly enhanced interaction with negatively charged model membranes was found for the LFchimera relative to the constituent peptides. Thus, chimerization of the two antimicrobial peptides resembling their structural orientation in the native molecule strikingly improves their biological activity.

Voeding bij smaak- en reukstoornissen

Er bestaat een nauwe samenhang tussen de reukgewaarwording en smaakgewaarwording.Wanneer het reukorgaan niet goed functioneert, gaat dit meestal gepaard met smaakverlies. Naast de vier basiskwaliteiten zout, zuur, zoet en bitter kan een vijfde smaakkwaliteit worden onderscheiden: umami. Behalve de reuk beinvloedt ook speeksel de smaak-gewaarwording. Vele chemosensorische stoornissen die leiden tot een gestoorde smaak zijn in feite reukstoornissen. Tijdelijke stoornissen dienen te worden onderscheiden van meer permanente veranderingen. Behandeling kan bestaan uit medicatie en eventueel chirurgie.

Bijwerkingen van geneesmiddelen in het orofaciale gebied

De tandarts moet op de hoogte zijn van de contra-indicaties, interacties en bijwerkingen van de geneesmiddelen die hij zelf voorschrijft, die andere behandelaars voorschrijven en van vrij verkrijgbare (genees)middelen die de patient gebruikt. Verder moet de tandarts kunnen inschatten of de door de patient gebruikte (genees)middelen gevolgen hebben voor het tandheelkundig handelen.