Inmaculada Tomás

Periodontal health status and bacteraemia from daily oral activities: systematic review/meta‐analysis

AIM The aim of this study was to investigate the robustness of the observations on the influence of oral hygiene, gingival and periodontal status on the development of bacteraemia from everyday oral activities (B-EOA), analysing its prevalence, duration, magnitude and bacterial diversity. MATERIAL AND METHODS This systematic review/meta-analysis complies with PRISMA reporting guidelines. MEDLINE-PubMed, the Cochrane Library and Embase were explored for detecting studies on B-EOA. RESULTS There were 290 potentially eligible articles, of which 12 article on B-EOA fulfilled the inclusion criteria and were processed for data extraction (seven on toothbrushing, one on dental flossing and four on chewing). Evaluating the influence of plaque and gingival indices on the prevalence of bacteraemia following toothbrushing, the pooled odds ratios were 2.61 [95% confidence interval (CI) = 1.45-4.69] and 2.77 (95% CI = 1.50-5.11), respectively. None of five studies on bacteraemia following dental flossing and chewing revealed a statistically significant association between oral hygiene, gingival or periodontal status and the development of bacteraemia. CONCLUSIONS Meta-analysis showed that plaque accumulation and gingival inflammation scores significantly increased the prevalence of bacteraemia following toothbrushing. However, systematic review showed no relationship between oral hygiene, gingival and periodontal status and the development of B-chewing, and there is no evidence that gingival and periodontal health status affects B-flossing.

Subgingival microbiota in health compared to periodontitis and the influence of smoking

The etiology of periodontitis has traditionally been associated to a consortium of three bacterial species—the so-called “red-complex” of periodontal disease—which has been the target for most diagnostic and therapeutic strategies. However, other species have also been found to correlate with disease severity. In addition, the influence of smoking on periodontal microbiota is poorly understood. In the current manuscript, the composition of the subgingival microbiota in healthy individuals vs. patients with chronic periodontitis has been investigated using 16S pyrosequencing and the influence of smoking on periodontal composition has been examined. Subgingival bacterial communities were sampled from 82 patients: 22 non-smoking healthy controls, 28 non-smoking periodontal patients, and 32 smoking periodontal patients. Bacterial diversity was higher in periodontal patients than in healthy subjects, which could be interpreted as the consequence of a nutritionally richer environment or a reduced immune competence. Periodontal patients showed a significantly higher prevalence/relative abundance of “established” periopathogens but also other taxa whose role is not well-established and that should be targets for future research. These include Anaeroglobus, Bulleidia, Desulfobulbus, Filifactor, Mogibacterium, Phocaeicola, Schwartzia or TM7. The microbial community of smoking-associated periodontitis is less diverse and distinct from that of non-smokers, indicating that smoking has an influence on periodontal ecology. Interestingly, the high sequencing coverage allowed the detection at low proportions of periodontal pathogens in all healthy individuals, indicating that chronic periodontitis cannot be strictly considered an infectious disease but the outcome of a polymicrobial dysbiosis, where changes in the proportions of microbial consortia trigger the inflammatory and tissue-degradation responses of the host.

Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta‐analysis

Clin. Otolaryngol. 2012, 37, 99–106

Detection of transient bacteraemia following dental extractions by 16S rDNA pyrosequencing: a pilot study.

Objective The current manuscript aims to determine the prevalence, duration and bacterial diversity of bacteraemia following dental extractions using conventional culture-dependent methods and 16S rDNA pyrosequencing. Methods The study group included 8 patients undergoing dental extractions under general anaesthesia. Peripheral venous blood samples were collected at baseline, 30 seconds and 15 minutes after the dental extractions. Blood samples were analysed for bacteraemia applying conventional microbiological cultures under aerobic and anaerobic conditions as well as pyrosequencing using universal bacterial primers that target the 16S ribosomal DNA gene. Results Transient bacteremia was detected by culture-based methods in one sample at baseline time, in eight samples at 30 seconds, and in six samples at 15 minutes after surgical procedure; whereas bacteraemia was detected only in five blood samples at 30 seconds after dental extraction by using pyrosequencing. By applying conventional microbiological methods, a single microbial species was detected in six patients, and Streptococcus viridans was the most frequently cultured identified bacterium. By using pyrosequencing approaches however, the estimated blood microbial diversity after dental extractions was 13.4±1.7 bacterial families and 22.8±1.1 genera per sample. Conclusion The application of 16S rDNA pyrosequencing underestimated the prevalence and duration of bacteraemia following dental extractions, presumably due to not reaching the minimum DNA required for PCR amplification. However, this molecular technique, unlike conventional culture-dependent methods, revealed an extraordinarily high bacterial diversity of post-extraction bacteraemia. We propose that microorganisms recovered by culture may be only the tip of an iceberg of a really diverse microbiota whose viability and potential pathogenicity should be further studied.

Management of drooling in disabled patients with scopolamine patches.

AIM To evaluate the efficacy of scopolamine administered transdermally for the treatment of drooling in severely disabled patients. METHODS A prospective, randomized, double-blind, crossover, placebo-controlled clinical trial was designed. The study group consisted of 30 handicapped patients with persistent drooling. The exclusion criteria were the specific contra-indications of scopolamine. Severity of drooling was quantified using a modified Thomas-Stonell and Greenberg visual scale simplified into three grades: 1 = dry; 2 = mild/moderate; 3 = severe/fulsome. The frequency of drooling was estimated using the number of bibs used each day. The baseline observational phase was followed by the application of a 1.5 mg scopolamine (Scopoderm TTS; Novartis Consumer Healthcare, UK) or placebo patch every 72 h for a fortnight. This was followed by a 1 week washout period and then crossover of assignments for 2 weeks. RESULTS At baseline, 77% of patients showed grade 3 of drooling. The placebo administration showed no significant reduction in drooling. We found a significant drooling reduction (P < 0.005) in the scopolamine group in the 1 and 2 week controls (69% and 80% respectively <or= grade 3). The mean number of bibs/day decreased during the scopolamine phase from 6/day at baseline to 3/day at the 2 week control. Four patients (13.3%) dropped out because of scopolamine side effects and minor adverse reactions were observed in three other patients. No blood alterations were found during the study period. CONCLUSION Scopolamine can be useful to control drooling in severely disabled patients although it requires appropriate patient selection and is not free from adverse effects.

In vivo bactericidal effect of 0.2% chlorhexidine but not 0.12% on salivary obligate anaerobes

OBJECTIVES To evaluate the in vivo antimicrobial activity on the salivary flora of a single mouthrinse of chlorhexidine (CHX) digluconate, analysing the influence of its concentration (0.2% versus 0.12%). METHODS The study group was formed of 20 adult volunteers with a good oral health status. Non-stimulated saliva samples were collected under basal conditions and at 30s and 1h after a single mouthrinse with sterile water, 0.2% or 0.12% CHX digluconate. Serial dilutions were then performed and the resulting samples were cultured on conventional culture media for aerobes/facultative anaerobes and obligate anaerobes. The number of colony forming units (CFU/ml) was then determined and the results expressed on a decimal log scale (log(10)CFU/ml). RESULTS A significant reduction in the total bacterial population was observed at 30s and 1h after the mouthrinse with both CHX concentrations; this antimicrobial activity was more pronounced on the obligate anaerobes. The antimicrobial activity of 0.2% CHX on the salivary flora at 30s and 1h after the mouthrinse was significantly greater than that of 0.12% CHX. Only 0.2% CHX showed bactericidal activity (differential factor> or =3 log(10)CFU/ml) against salivary obligate anaerobes. CONCLUSION The greater antimicrobial activity of 0.2% CHX confirms the influence of the concentration on its antibacterial activity. In consequence, the CHX concentration seems to be an important factor to guarantee a high antibacterial activity in those clinical situations where it is required.

Factors related to late stage diagnosis of oral squamous cell carcinoma.

Aims: To identify factors related to advanced-stage diagnosis of oral cancer to disclose high-risk groups and facilitate early detection strategies. Study design: An ambispective cohort study on 88 consecutive patients treated from January 1998 to December 2003. Inclusion criteria: pathological diagnosis of OSCC (primary tumour) at any oral site and suffering from a tumour at any TNM stage. Variables considered: age, gender, smoking history, alcohol usage, tumour site, macroscopic pattern of the lesion, co-existing precancerous lesion, degree of differentiation, diagnostic delay and TNM stage. Results: A total of 88 patients (mean age 60±11.3; 65.9% males) entered the study. Most patients (54.5%) suffered no delayed diagnosis and 45.5% of the carcinomas were diagnosed at early stages (I-II). The most frequent clinical lesions were ulcers (70.5%). Most cases were well- and moderately-differentiated (91%). Univariate analyses revealed strong associations between advanced stages and moderate-poor differentiation (OR=4.2; 95%CI=1.6-10.9) or tumour site (floor of the mouth (OR=3.6; 95%CI=1.2-11.1); gingivae (OR=8.8; 95%CI=2.0-38.2); and retromolar trigone (OR=8.8; 95%CI=1.5-49.1)). Regression analysis recognised the site of the tumour and the degree of differentiation as significantly associated to high risk of late-stage diagnosis. Conclusions: Screening programmes designed to detect asymptomatic oral cancers should be prioritized. Educational interventions on the population and on the professionals should include a sound knowledge of the disease presentation, specifically on sites like floor of the mouth, gingivae and retromolar trigone. More studies are needed in order to analyse the part of tumour biology on the extension of the disease at the time of diagnosis. Key words: Oral cancer, advanced-stage, diagnosis, cohort study.

Patients' Perception of Recovery After Third Molar Surgery Following Postoperative Treatment With Moxifloxacin Versus Amoxicillin and Clavulanic Acid: A Randomized, Double-Blind, Controlled Study

PURPOSE To analyze the impact of the postoperative administration of moxifloxacin (MXF) on oral function and quality of life after third molar (TM) surgery. MATERIALS AND METHODS A single-center, prospective, randomized, double-blind, controlled clinical trial was designed. The study population consisted of 100 patients who underwent impacted TM extractions. Patients were distributed into 2 groups of 50 individuals each. Postoperatively, one group was administered MXF (400 mg/24 hours for 5 days); the positive control group received amoxicillin and clavulanic acid (AMX-CLV) (500/125 mg/8 hours for 5 days). Follow-up was performed for 7 postoperative days, during which the patient recorded information on pain, the use of rescue analgesia, undesirable effects of the medication, difficulty in speaking, difficulty in chewing, diet consistency, difficulty performing oral hygiene, asthenia, time in bed, going out of the house, and returning to work. RESULTS The administration of MFX was significantly associated with headache, and AMX-CLV was significantly associated with diarrhea. Greater difficulty in chewing and performing oral hygiene was observed in the AMX-CLV group compared with the MXF group. The percentage of patients who tolerated a diet of normal consistency was significantly higher in the MXF group compared with the AMX-CLV group. During the first 4 days of follow-up, the percentage of patients who returned to work was significantly higher in the MXF group than in the AMX-CLV group. CONCLUSIONS Moxifloxacin shortens the period of postoperative recovery in terms of oral function and return to work. Therefore, MXF could be a useful option in TM surgery when antibiotics are indicated, particularly if patients are allergic to beta-lactams, their oral flora is resistant to macrolides, or they are intolerant of either of these antibiotics.

Chlorhexidine Substantivity on Salivary Flora and Plaque-Like Biofilm: An In Situ Model

Objective To evaluate the in situ antibacterial activity of a mouthrinse with 0.2% Chlorhexidine (M-0.2% CHX) on undisturbed de novo plaque-like biofilm (PL-biofilm) and on salivary flora up to 7 hours after its application. Methods A special acrylic appliance was designed, with 3 inserted glass disks on each buccal side, allowing for PL-biofilm growth. Fifteen healthy volunteers wore the appliance for 48 hours and then performed an M-0.2% CHX; disks were removed at 30 seconds and 1, 3, 5 and 7 hours after the mouth-rinsing. Applying a washout period, saliva samples were collected from each volunteer at 30 seconds and 1, 3, 5 and 7 hours after performing an M-0.2% CHX. The PL-biofilm and saliva samples were analysed by confocal laser scanning and epifluorescence microscopes, respectively. Results At 30 seconds after M-0.2% CHX, the levels of viable bacteria detected in saliva were significantly lower than those observed in PL-biofilm. The difference in the percentage of live bacteria detected in saliva was significantly higher than that observed in PL-biofilm at 5 and 7 hours after M-0.2% CHX. Conclusion After a single mouthrinse of the 0.2% CHX formulation tested in the present study, the 2-day PL-biofilm presented a significantly higher resistance to this antiseptic in situ than that observed in salivary flora. However, this 0.2% CHX formulation showed a higher substantivity on PL-biofilm than on salivary flora at 5 and 7 hours after mouth-rinsing, which could be related to the slower growth rate of PL-biofilm and the possible reservoir function for antimicrobial agents associated with the undisturbed de novo PL-biofilm.

Relationship between the oral cavity and cardiovascular diseases and metabolic syndrome

The components of the human body are closely interdependent; as a result, disease conditions in some organs or components can influence the development of disease in other body locations. The effect of oral health upon health in general has been investigated for decades by many epidemiological studies. In this context, there appears to be a clear relationship between deficient oral hygiene and different systemic disorders such as cardiovascular disease and metabolic syndrome. The precise relationship between them is the subject of ongoing research, and a variety of theories have been proposed, though most of them postulate the mediation of an inflammatory response. This association between the oral cavity and disease in general requires further study, and health professionals should be made aware of the importance of adopting measures destined to promote correct oral health. The present study conducts a Medline search with the purpose of offering an update on the relationship between oral diseases and cardiovascular diseases, together with an evaluation of the bidirectional relationship between metabolic syndrome and periodontal disease. Most authors effectively describe a moderate association between the oral cavity and cardiovascular diseases, though they also report a lack of scientific evidence that oral alterations constitute an independent cause of cardiovascular diseases, or that their adequate treatment can contribute to prevent such diseases. In the case of metabolic syndrome, obesity and particularly diabetes mellitus may be associated to an increased susceptibility to periodontitis. However, it is not clear whether periodontal treatment is able to improve the systemic conditions of these patients. Key words:Cardiovascular diseases, periodontitis, metabolic syndrome, obesity, diabetes mellitus.