Yehuda Zadik

Systematic review of natural agents for the management of oral mucositis in cancer patients

PurposeThe aim of this study was to review the available literature and define clinical practice guidelines for the use of natural agents for the prevention and treatment of oral mucositis.MethodsA systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible.ResultsA total of 49 papers across 15 interventions were examined. A new suggestion was developed in favor of systemic zinc supplements administered orally in the prevention of oral mucositis in oral cancer patients receiving radiation therapy or chemoradiation (Level III evidence). A recommendation was made against the use of intravenous glutamine for the prevention of oral mucositis in patients receiving high-dose chemotherapy prior to hematopoietic stem cell transplant (Level II evidence). No guideline was possible for any other agent, due to inadequate and/or conflicting evidence.ConclusionsOf the various natural agents reviewed here, the available evidence supported a guideline only for two agents: a suggestion in favor of zinc and a recommendation against glutamine, in the treatment settings listed above. Well-designed studies of other natural agents are warranted.

Erectile Dysfunction Might Be Associated With Chronic Periodontal Disease: Two Ends of the Cardiovascular Spectrum

INTRODUCTION Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. AIM To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. METHODS The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. RESULTS The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. CONCLUSIONS ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians

PURPOSE To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. PATIENTS AND METHODS This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. RESULTS Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. CONCLUSION In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

Periodontal disease might be associated even with impaired fasting glucose.

Objective To determine whether there is an association between fasting plasma glucose level and periodontal condition in a non-diabetic male population.Methods Data of periodic medical examinations of 815 non-diabetic male adults (mean age 38.1 ± 7.0 years) were analysed. Blood samples were drawn from each subject following a 14-hour fast. The distance between the cement-enamel-junction to alveolar bone crest was measured at inter-proximal sites on two standardised posterior bitewing radiographs.Results Higher prevalence of alveolar bone loss was found among individuals with a fasting glucose level of ≥100 mg/dL than among individuals with <100 mg/dL (p = 0.032) and among individuals with BMI ≥25 than among individuals with BMI <25 (p = 0.025). Associations were found between bone loss prevalence and serum triglyceride levels of ≥ 200mg/dL, total cholesterol level of ≥ 200mg/dL and LDL-cholesterol level of ≥130mg/dL (p = 0.010, p <0.001, p = 0.009, respectively).Conclusions In the studied non-diabetic adult population, periodontal disease was associated with impaired glucose level. Periodontal disease could serve as a predictor for future diabetes mellitus, or play a possible role in the glucose imbalance and diabetes mellitus development.

Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for prevention of infective endocarditis

OBJECTIVES Our aim was to evaluate the knowledge and implementations of the 2007 American Heart Association guidelines for the prevention of infective endocarditis (IE) among practicing Israeli dentists, 12 months after their publication. STUDY DESIGN A total of 118 dentists completed a questionnaire regarding required antibiotic prophylaxis for 10 specific cardiac patient subtypes before invasive dental treatment, prophylactic need in at-risk patients for IE in 10 dental procedures, and prophylactic regimen for nonallergic patients. RESULTS Correct answer response for cardiac conditions was 81.3% (highest failure: mitral valve prolapse [MVP] with regurgitation). There was a consensus among the participants regarding antibiotic regimen for high-risk patients during several dental procedures, such as intraoral radiography, tooth extraction, and periodontal surgery, but a controversy for other procedures. The procedures of disagreement were endodontic treatment, tooth preparation with oral impressions, and restoration of class II caries lesion. Correct antimicrobial agent, dose, and timing were prescribed by 99%, 93.8%, and 100% of the respondents, respectively. CONCLUSIONS Relatively high level of knowledge of the new guidelines was found among dentists, reflecting both familiarity of the practitioners with the guidelines and acceptance of guidelines. Prophylactic need is ambiguous during restorative, endodontic and prosthetic procedures. Educational resources should emphasize these guidelines, specifically the reduced risk level for MVP with regurgitation patients.

Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients

PurposeThe aim of this systematic review was to analyze the available literature and define clinical practice guidelines for the use of the following agents for the prevention and treatment of oral mucositis (OM): allopurinol, midline mucosa-sparing radiation blocks, payayor, pentoxifylline, timing of radiation therapy (RT) (morning versus late afternoon), pilocarpine, bethanechol, chewing gum, propantheline, and tetrachlorodecaoxide.MethodsA systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, no guideline possible.ResultsA total of 32 papers across 10 interventions were examined. New suggestions were developed against the use of systemic pilocarpine administered orally for prevention of OM during RT in head and neck cancer patients and in patients receiving high-dose chemotherapy, with or without total body irradiation, prior to hematopoietic stem cell transplantation. A suggestion was also made against the use of systemic pentoxifylline administered orally for the prevention of OM in patients undergoing bone marrow transplantation. No guideline was possible for any other agent reviewed due to inadequate and/or conflicting evidence.ConclusionsNone of the agents reviewed was determined to be effective for the prevention or treatment of OM. Two agents, pilocarpine and pentoxifylline, were determined to be ineffective, in the populations listed above. Additional well-designed research is needed on other interventions.

The effect of short dental trauma lecture on knowledge of high-risk population: an intervention study of 336 young adults.

AIM The purpose of this interventional study was to evaluate the effect of a short dental trauma lecture on knowledge of first-aid management of dental avulsion among high-risk population. METHODS A total of 336 army recruits were randomly assigned to two groups. To evaluate the level of knowledge, we used a structured questionnaire, adapted from Andersson et al. (Dent Traumatol, 22, 2006, 57) and translated to Hebrew. The control group (n = 137) answered the questionnaire. The intervention group (n = 199) received a 60-min slides lecture by a (military) dental practitioner, regarding general concepts of body injuries, facial and oral injuries and practise first-aid management of these injuries. The intervention group filled the same questionnaire following this lecture. RESULTS General knowledge of emergency treatment of injuries to other parts of the body was rather good for all participants; however, the level of knowledge was significantly higher in the intervention group (P < 0.05). General knowledge regarding tooth and avulsion was quite disappointing in the control group but was significantly higher in the intervention group (P < 0.001). The same was observed when interpreting the results regarding special knowledge of avulsion first-aid management: How to clean the tooth before replantation, extra-alveolar time and storage method and medium (P < 0.001). CONCLUSIONS The present study revealed excellent results following a short dental trauma instruction lecture. As raising the public awareness on the subject of dealing with dental trauma is important for the prognosis of the tooth, this way of improving knowledge to high-risk populations should be further examined in long-term studies.

Barodontalgia: what have we learned in the past decade?

This article reviews the current knowledge regarding barodontalgia, a barometric pressure-related oral (dental and other) pain. Contemporary classification, prevalence, and incidence, features, etiology, and diagnosis of this entity are presented regarding flight and diving conditions. Summarizing the past decade data, three-fourths of episodes were described as severe, sharp, and localized pain. Barodontalgia affects 11.9% of divers and 11.0% of military aircrews with a rate of 5 episodes/1,000 flight-years. Upper and lower dentitions were affected equally in flight, but more upper than lower dentition were affected in diving. The most prevalent etiologic pathologies for in-flight dental pain were faulty dental restorations (including dental barotrauma) and dental caries without pulp involvement (29.2%), necrotic pulp/periapical inflammation (27.8%), vital pulp pathology (13.9%), recent dental treatment (11.1%), and barosinusitis (9.7%). This review refutes 3 generally accepted conventions: According to the results, the current in-flight barodontalgia incidence is similar to the incidence in the first half of the 20th century, the weighted incidence of barodontalgia among aircrews are similar to the weighted incidence among divers, and the role of facial barotrauma in the etiology of in-flight barodontalgia is minor.

Colonization of Candida: prevalence among tongue-pierced and non-pierced immunocompetent adults

OBJECTIVE To evaluate the colonization of Candida at the tongue-piercing site of immunocompetent individuals. SUBJECTS AND METHODS Swabs samples were obtained from the anterior lingual mucosa of healthy young adults with tongue piercing (N = 115); 86 subjects with (non-intra-oral) facial piercing served as a comparison group. Candida colonization was examined by light microscopy after 5-day incubation. Positive specimens were re-cultured on Chromagar Candida plates for species identifying. RESULTS Candida colonization was more prevalent among tongue-pierced (20.0%) than facial-pierced subjects (9.4%; P = 0.048). All colonies were of Candida albicans. No difference was found between current tongue ornament wearers (21.2%) and non-wearers (19.5%; P = 0.803). In multivariate analysis, the only significantly positive influencing factors on colonization were tongue piercing (P = 0.034) and daily smoking of more than 10 cigarettes (P = 0.024). CONCLUSIONS Piercing of the tongue was found to be a risk factor for colonization of Candida albicans, without an influence of whether or not an ornament is in place.

Development of the MASCC/ISOO Clinical Practice Guidelines for Mucositis: considerations underlying the process

The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) recently conducted a systematic review to update the MASCC/ISOO clinical practice guidelines for oral and gastrointestinal mucositis. Here, we discuss the details of some considerations underlying the process used.