Anders Heimdahl
Karolinska Institutet
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Archives of Oral Biology | 1980
Anders Heimdahl; L. von Konow; C. E. Nord
Abstract Five patients with orofacial infection which failed to respond to penicillin therapy are described. In each instance, β-lactamase producing Bacteroides strains were found. All strains were resistant to penicillin but sensitive to clindamycin and tinidazole. In two cases, extended surgical treatment cured the patient, but in the other three cases additional clindamycin therapy was required.
International Journal of Oral and Maxillofacial Surgery | 1989
Sören Eliasson; Anders Heimdahl; Åke Nordenram
Pathological changes related to impacted 3rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM (p less than 0.001). Other pathologic changes observed were resorption of the 2nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology | 1995
Per Jesslén; Lars Zetterqvist; Anders Heimdahl
A total of 67 teeth in 64 patients were treated with apicectomy and retrograde fillings. They were randomized to receive fillings of amalgam or glass ionomer cement in a comparative clinical study. Healing was evaluated clinically and radiographically after 1 and 5 years. Evaluation showed no difference in healing capacity between the two materials. Overall success rates in both groups were registered as 90% at 1 year and 85% at 5 years. Contamination with blood or saliva during insertion of the filling material did not affect healing adversely. The study shows that the 5-year follow-up result can be predicted in more than 95% of the cases at the 1-year follow-up. It can be concluded that glass ionomer cement is a valid alternative to amalgam as an apical sealant after apicectomy with equally good long-term clinical results.
Oral Surgery, Oral Medicine, Oral Pathology | 1989
Anders Heimdahl; Torsten Mattsson; Göran Dahllöf; Berith Lönnquist; Olle Ringdén
Before treatment of 181 patients with bone marrow transplantation (BMT) for leukemia, severe aplastic anemia, or metabolic disorders, the oral condition was examined clinically and roentgenologically. Fifty-three patients (29%) had chronic dental infections (osteitis) that needed treatment before BMT. In 10 of 181 cases (6%), BMT was postponed because of oral infections. Septicemia during the neutropenic phase was caused by oral microorganisms (alpha streptococci) in 24 of 59 (41%) patients with microbiologically proven septicemia. Septicemia with alpha streptococci was associated with graft-versus-host disease prophylaxis with methotrexate and subsequent increased frequency of oral ulcerations. No difference was observed in the frequency of reactivation of latent herpes simplex virus infection between different graft-versus-host disease prophylaxis regimens. Reactivation was more frequent in patients conditioned with total body irradiation than in patients conditioned without total body irradiation. Antiviral prophylaxis, with subsequent decreased frequency of oral herpes simplex reactivation, appeared to contribute to a low frequency of septicemia with alpha streptococci.
Oral Surgery, Oral Medicine, Oral Pathology | 1988
Göran Dahllöf; Monica Barr; Per Bolme; Thomas Modéer; Berit Lönnqvist; Olle Ringdén; Anders Heimdahl
The dental status of 16 children who had been treated with bone marrow transplantation (BMT) for serious bone marrow diseases was followed for up to 6 years. Several types of disturbances in dental development were observed in children who had been conditioned with total body irradiation (TBI) at 10 Gy before BMT. Thus, impaired root development that caused short V-shaped roots was found in all patients, a complete failure of root development and premature apical closure were found in five patients, enamel hypoplasia was observed in four patients, and microdontia was observed in three patients conditioned with TBI. Patients younger than 6 years of age at BMT exhibited the most severe and extensive dental aberrations. The TBI at 10 Gy appeared to be the major cause of the disturbances found.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology | 1998
Göran W. Gynther; Per Åke Köndell; Lars-Erik Moberg; Anders Heimdahl
The objective of this study was to retrospectively compare the outcomes of dental implant treatment with and without antibiotic prophylaxis. Two groups of patients with edentulous or partially edentulous maxillas or mandibles (or both) were treated with dental implants. One group, consisting of 147 patients (790 implants), was given prophylaxis with oral phenoxymethylpenicillin; 1 g of antibiotic was administered 1 hour preoperatively, and 1 g was administered every 8 hours for 10 days postoperatively. The other group, consisting of 132 patients (664 implants) was not given any antibiotics preoperatively or postoperatively. There were no significant differences with respect to early and late postoperative infections or with respect to implant survival between the two groups. It appears that antibiotic prophylaxis for routine dental implant surgery offers no advantage for the patient.
Oral Surgery, Oral Medicine, Oral Pathology | 1986
Tuula A. Makkonen; Jorma Tenovuo; Pekka Vilja; Anders Heimdahl
We analyzed the radiation-induced changes in the flow rate and protein composition of stimulated whole saliva in eleven patients treated for malignant conditions of the head and neck. In all patients the radiation field covered all major salivary glands and a large area of the oral mucosa. Paraffin-stimulated whole saliva samples were collected once 2 to 21 days before therapy and then after 20, 40, and 60 gray (Gy) cumulative dose of irradiation. Five patients also provided samples 6 months after the therapy. Hyposalivation or xerostomia occurred in all patients, although the pretreatment secretion rates were already relatively low. Salivary amylase activities decreased with increasing dose of radiation, especially when expressed as the amount of enzyme secreted per minute. Unusually high salivary concentrations of albumin, lactoferrin, lysozyme, salivary peroxidase, myeloperoxidase, and total protein were observed during the therapy, but most values slowly returned to pretreatment levels after cessation of radiation. It is concluded that the observed qualitative changes in whole saliva components are net effects caused by the cancer itself, radiation therapy given, systemic diseases, or medications, as well as mucosal inflammations.
The Lancet | 1984
Olle Ringdén; Anders Heimdahl; Berit Lönnqvist; Anna-Stina Malmborg; Henryk Wilczek
SIR,-Dr Cohen and his colleagues (Dec 24/31, p 1452) and Dr Henslee and colleagues (Feb 18, p 393) have reported on streptococcal septicaemia in bone marrow transplant (BMT) recipients. Cohen et al suggested that Hickman catheters or oral ulcerations, caused by conditioning treatment, could provide entry points for infection by viridans streptococci. Henslee et al discussed the risk of contaminating the marrow during manipulation. We suggest that oral herpes simplex virus ulceration may be another entry point for septicaemia caused by viridans streptococci that normally reside in the mouth. From the start ofour BMT programme in leukaemia in 1980 until April, 1982, septicaemia by viridans streptococci was observed during the neutropenic phase (neutrophil count <0’ 5 x z/1) after transplantation in 8 out of 30 consecutive leukaemic patients receiving marrow from HLA-identical siblings. In May, 1982, a randomised double-blind trial of acyclovir versus placebo was started. Furthermore, from this date active diagnosis of herpes . simplex virus infections resulted in a prompt treatment with acyclovir. From May, 1982, until March, 1984, none of 30 patients have experienced viridans streptococcal septicaemia (p<0-01). The incidence of septicaemia caused by other microorganisms during the neutropenic period was 6/30 in each patient group. In March, 1982, a randomised trial comparing prophylaxis for graft-versus-host disease with cyclosporin or methotrexate was also started at our centre. This is mentioned because cyclosporin may be associated with less mucosal inflammation than methotrexate. No viridans streptococcal septicaemia has been observed, not even in the patients treated with methotrexate, since the introduction of acyclovir. There were essentially no other differences between patients transplanted before or after May, 1982, in respect clinical status, conditioning, mouth care, or antimicrobial therapy. We believe that the major reason for the decreased incidence of viridans streptococcal septicaemia was more active treatment of oral herpes simplex infections by acyclovir.
Clinical Infectious Diseases | 1999
Gunnar Hall; Anders Heimdahl; Carl Erik Nord
The use of antibiotic prophylaxis in patients predisposed to infective endocarditis (IE) who are undergoing oral surgery procedures is widely accepted. Because there have been no controlled clinical trials of antibiotic regimens for the prevention of endocarditis in humans, recommendations are based on the results of prophylaxis studies in animal models of endocarditis, in vitro susceptibility data of pathogens that cause endocarditis, procedure-related studies of bacteremia, and studies of the efficacy of antimicrobial prophylaxis for prevention of postsurgical bacteremia. Minimizing the occurrence of postoperative bacteremia has been considered the most important factor in the prevention of IE, and the results of several clinical studies using conventional blood culture systems have demonstrated a marked reduction in bacteremia following dental extraction with the use of antibiotic prophylaxis. In recent studies using lysing and filtration of blood, prophylactic administration of penicillin V, amoxicillin, erythromycin, clindamycin, or cefaclor did not reduce the incidence or the magnitude of bacteremia after dental extraction, as compared to placebo. The antimicrobial mechanism of protection for IE is apparently different from a mere killing in blood. The implications of this for prophylaxis for IE in humans is still not fully understood, but studies of animals suggest that the protective effect may be exerted by inhibiting bacterial growth on the vegetations, thus allowing host defense mechanisms to gradually eliminate the bacteria from the valves. Microorganisms circulating in blood may settle on heart valves that are damaged or rendered defective by acquired or congenital disease and thereby cause IE. The disease remains prevalent, with approximately the same incidence as 40 years ago, and is associated with a mortality rate between 15% and 30%, despite advances in antimicrobial therapy and cardiovascular surgery. Dental treatment has often been regarded as a major cause of the disease, mainly because of the high frequency of bacteremia after various oral invasive procedures and because of the high recovery rate of viridans streptococci in IE cases [1, 2]. The concept of antibiotic prophylaxis for IE in patients with underlying heart disease has been widely accepted, and guidelines and specific antibiotic regimens have been recommended by various national boards [3, 4]. For ethical as well as practical reasons, there has been no clinical documentation of the efficacy of antibiotics in preventing IE in humans, and therefore the guidelines are based mainly on data from experimental animal models, pharmacokinetic studies, bacterial susceptibility studies, clinical experience, and studies of procedure-related bacteremia and the efficacy of antimicrobial prophylaxis for bacteremia. In animal studies, prophylactic administration of antibiotics has been attributed to effects such as rapid bacterial killing in blood, decreased bacterial adhesion to heart valves, and inhibition of bacterial growth on the heart valves, whereas studies in humans have mainly focused on the preventive effect on postsurgical bacteremia. Results of clinical studies have indicated an immediate and marked reduction in bacteremia following dental extraction when prophylactic antibiotics were used, whereas other studies have questioned the efficacy of antibiotic prophylaxis for postextraction bacteremia. Herein, we review the data published concerning bacteremia after oral surgical procedures and antibiotic prophylaxis.
European Journal of Clinical Microbiology & Infectious Diseases | 1996
Gunnar Hall; Anders Heimdahl; C. E. Nord
This study was undertaken to investigate the effects of prophylactic administration of cefaclor on bacteremia after dental extraction. Thirty-nine patients were randomly assigned to receive either 1 g cefaclor (19 patients) or placebo (20 patients) 1 h prior to dental extraction. Blood samples for microbiological investigation were collected before, during, and 10 min after surgery, and were processed by lysis filtration under anaerobic conditions. The incidence of bacteremia with viridans streptococci was 79% in the cefaclor group and 50% in the placebo group during extraction. No difference in the incidence or magnitude of bacteremia was observed when the two patient groups were compared.