Oral malodor in dogs: measurement using a sulfide monitor

In 28 dogs, oral malodor was assessed organoleptically (0-3 scale) and by measurement of volatile sulfur components (VSC), using two positions ('intraoral' and 'tooth surface') for sampling VSC. Significant correlations were found between: intraoral and tooth surface VSC collection positions (p < 0.0001) and between organoleptic and tooth surface VSC data (p < 0.0001). VSC measurement is a sensitive, repeatable and non-subjective method of assessing oral malodor in dogs.     

Bronchiectasis in association with coeliac disease

Pancreatic abscesses are a frequent complication of acute pancreatitis and their percutaneous drainage is usually accepted. A 76 years-old male patient admitted for acute pancreatitis (Ranson 3 at admission) has been treated with conservative therapy and percutaneous US directed drainage of the abscess, located between the tail of the pancreas and the gastric fundus. This kind of drainage was able to empty the abscess satisfactorily but it caused the onset of a gastrocutaneous fistula. This one was sutured on the gastric side by metal clips placed by gastroscopy. The patient was discharged on the 60th day in a good condition. An X-ray investigation with gastrografine before the drainage removal is therefore recommended.     

Treatment paradigms in periodontal disease

The prevailing treatment paradigm in periodontal disease relies on debriding the tooth surfaces to keep the bacterial load below the level that triggers tissue loss. When debridement cannot be easily accomplished because of deep pocketing, access surgery is recommended. The debridement approach that involves access surgery is successful in 80% to 85% of patients. Patients who do not respond are often treated with systemic antibiotics. This paradigm, which is based on the nonspecific plaque hypothesis, is labor-intensive and relies on antibiotics only as a last resort. This nonspecific treatment paradigm is in contrast with the specific plaque hypothesis, which states that a limited number of bacterial species are specifically involved in most forms of periodontal disease. Some studies have significantly associated anaerobic bacteria with advanced forms of periodontal disease. These observations led us to hypothesize that most forms of periodontal disease are anaerobic infections, which can be treated by antimicrobials such as metronidazole or clindamycin. Three double-blind studies have shown that 1 to 2 weeks of unsupervised use of metronidazole-plus-debridement was significantly better than placebo-plus-debridement in reducing the need for periodontal surgery. These findings suggest that treatments based on the specific plaque hypothesis give clinicians and patients a choice regarding treatment options in periodontal disease.     

Molecular epidemiology of oral treponemes associated with periodontal disease

Periodontitis, a disease responsible for tooth loss worldwide, is characterized by chronic inflammation of the periodontium, eventually leading to destruction of periodontal ligaments and supporting alveolar bone. Spirochetes, identified by dark-field microscopy as being the most predominant bacteria in advanced lesions, are thought to play a causative role. Various spirochetal morphotypes were observed, but most of these morphotypes are as yet uncultivable. To assess the role of these organisms we designed oligonucleotide probes for the identification of both cultivable and so far uncultivable spirochetes in periodontitis patients. Subgingival plaque specimens taken from diseased sites (n = 200) and healthy control sites (n = 44) from 53 patients with rapidly progressive periodontitis (RPP) were submitted to direct in situ hybridization or dot blot hybridization after prior amplification with eubacterial primers. Spirochetes were found in all patients, but their distributions varied considerably. Parallel use of oligonucleotide probes specific for cultivable or so far uncultivable treponemes suggested the presence of novel yet unknown organisms at a high frequency. These uncultivable treponemes were visualized by fluorescence in situ hybridization, and their morphologies, sizes, and numbers could be estimated. All RPP patients included in this study harbored oral treponemes that represent either novel species, e.g., Treponema maltophilum, or uncultivable phylotypes. Therefore, it is necessary to include these organisms in etiologic considerations and to strengthen efforts to cultivate these as yet uncultivable treponemes.     

Oral disease epidemiologic illness indices and oral health measures--traditional concepts are supplemented by new socio-dental indicators

The approach to patients with chronic cough has been well defined and evaluated in the literature through a number of prospective studies. Meticulous attention to detail of the afferent loop of the cough reflex has helped identify the cause of cough in most patients. The most common causes appear to be similar in both children and adults and include asthma, postnasal drip syndromes, gastroesophageal reflux diseases, and aspiration. In children, recurrent viral infections and infections with atypical organisms also are very prevalent. Specific therapy directed at the cause alleviates the cough in most patients. In some patients, there may be more than one cause of cough. Invasive testing (eg, bronchoscopy and esophageal pH probing) is rarely necessary. In patients in whom a specific cause cannot be identified or in whom cough modifiers are necessary while specific therapy is taking hold, antitussives of both the narcotic and nonnarcotic variety are helpful.     

Oral submucous fibrosis: an unusual disease

More then ten year follow up of 154 patients with Itsenko-Cushing disease (ICD) is presented, of whom in 69-one sided and in 89-bilateral transcatheteric transvenous adrenal glands destruction (TTAGD) was done. In 50% of them the remission of disease for a period of 5-10 years was observed.     

Nonsteroidal anti-inflammatory agents: potential modifiers of periodontal disease progression

The most recent studies of NSAIDs as potential modifiers of periodontal disease progression are reviewed. These studies indicate that NSAIDs have the ability to alter or control the progression of periodontal disease. Reductions in gingival inflammation and in bone loss have been observed following the administration of various NSAIDs. In some cases, bone gain has been achieved. More research is required to determine the possible long-term side effects associated with the chronic usage of NSAIDs, as well as to achieve consensus on the most effective drug for the control of periodontal disease. Until this occurs, and this application of NSAIDs receives government approval, the use of these drugs to control periodontal disease is not recommended.     

Somatic Fas mutations in non-Hodgkin's lymphoma: association with extranodal disease and autoimmunity

Fas (APO-1/CD95) is a cell-surface receptor involved in cell death signaling. Germline mutations in the Fas gene have been associated with autoimmune lymphoproliferative syndrome, and somatic Fas mutations have been found in multiple myeloma. We have examined the entire coding region and all splice sites of the Fas gene in 150 cases of non-Hodgkin's lymphoma. Overall, mutations were identified in 16 of the tumors (11%). Missense mutations within the death domain of the receptor were associated with retention of the wild-type allele, indicating a dominant-negative mechanism, whereas missense mutations outside the death domain were associated with allelic loss. Fas mutations were identified in 3 (60%) MALT-type lymphomas, 9 (21%) diffuse large B-cell lymphomas, 2 (6%) follicle center cell lymphomas, 1 (50%) anaplastic large cell lymphoma, and 1 unusual case of B-cell chronic lymphocytic leukemia with a marked tropism for skin. Among the 16 patients with somatic Fas mutations, 15 showed extranodal disease at presentation, and 6 relapsed in extranodal areas. Ten of 13 evaluable patients showed features suggestive of autoreactive disease. Our data indicate that somatic disruption of Fas may play a role in the pathogenesis of some lymphomas, and suggest a link between Fas mutation, cancer and autoimmunity.     

Lymphoma in patients with rheumatoid arthritis: association with the disease state or methotrexate treatment

Although long-term clinical studies have shown no excessive risk of lymphoma in rheumatoid arthritis (RA) patients treated with methotrexate (MTX), an increasing number of reports of this association continue to appear. We describe two cases, review the cases in the world's literature, and summarize their important characteristics. Possible oncogenic mechanisms are discussed. Most lymphoproliferation cases presented here have features of immunosuppression-associated lymphoma. The immunosuppressed state is attributable to a combination of factors, such as RA itself and the actions of MTX. The risk factors for RA patients to develop lymphoma while on MTX include severe disease, intense immunosuppression, genetic predisposition, and an increased frequency of latent infection with prooncogenic viruses such as Epstein-Barr virus (EBV). The spontaneous remission of lymphomas in eight RA patients after MTX was stopped highlights the likely causative role of the drug in the development of these malignancies. If the clinical situation permits, a period of observation for spontaneous remission after MTX is stopped is advisable. The physicians caring for RA patients on MTX should maintain a high surveillance for signs and symptoms suggestive of lymphoma.     

Oral findings in patients with active or inactive Crohn''s disease

The frequency and type of oral mucosal lesions, dental infections, and salivary constituents were evaluated in 53 patients with Crohn's disease, who were divided into inactive, mildly active, and severely active groups on the basis of clinical and endoscopic criteria. Buccal biopsies from nine patients with active disease showed morphologic changes that suggested Crohn's disease-related lesions. Panoramic radiographs revealed more infectious foci in the teeth of patients with active Crohn's disease than in patients with inactive disease. Salivary flow rate, buffering capacity, total protein, amylase, and IgA and IgG concentrations did not differ with respect to the activity of Crohn's disease. The observed mucosal inflammation in patients with active Crohn's disease, although high in frequency, was mild and did not need therapy, but the great number of dental infections in association with the activity of Crohn's disease should be taken into account in the treatment of these patients.     

Association of age and body weight with periodontal disease in North American dogs

Thirteen hundred and fifty dogs were examined under anesthesia at veterinary hospitals in the USA and Canada. Periodontal health was recorded in detail. Teeth were frequently absent (particularly lower third molar, upper and lower first premolars, and incisor teeth). Calculus was most extensive on the upper fourth premolar and molar teeth. Missing teeth, mobility of remaining teeth, extent of calculus and gingival inflammation, and furcation exposure and attachment loss all were more common in small dogs compared with larger dogs, and in order dogs compared with younger dogs.     

The role of risk factors for periodontal disease in patients with rheumatoid arthritis

This paper summarises the methods and some of the findings of a large cohort study of dementia and cognitive decline in subjects aged over 75 years in Cambridge, particularly regarding the incidence wave. From a sample of 1968 subjects previously studied in a prevalence study in 1985-1987, survivors were restudied at 2.4 years, in a two-stage design employing the Mini; Mental State Examination (MMSE) and the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). High incidence rates of dementia were found, which rose steeply with age, particularly for Alzheimer's disease. New minimal dementia and milder cognitive impairment were also common. Cognitive decline on the MMSE showed a near normal, non-bimodal distribution. The sample has since been restudied at intervals for a total of up to 9 years to document longitudinal cognitive change. Brains have been obtained for post mortem neuropathological and molecular biological study, particularly of the early sequential changes associated with cognitive decline and dementia.     

A murine model of accelerated periodontal disease in diabetes

Diabetes is a risk factor for periodontal disease in humans. In hyperglycemia, glycoxidation of proteins and lipids results in the formation of advanced glycation endproducts, or AGEs. The accumulation of AGEs in the plasma and tissues, and their interaction with their cellular receptor for AGE (RAGE), has been implicated in diabetic complications. In order to establish a model with which to delineate the specific host response factors that underlie the development of periodontal disease in diabetes, male C57BL/6J mice were rendered diabetic with streptozotocin. One month after documentation of diabetes or control state, mice were inoculated with the human periodontal pathogen Porphyromonas gingivalis, strain 381 (P. gingivalis) or treated with vehicle. Infection with P. gingivalis was achieved, as demonstrated by infiltration of gingival tissue with granulocytes, presence of DNA specific for P. gingivalis as well as increased serum antibody titer to P. gingivalis. At 2 and 3 months after infection, increased alveolar bone loss was demonstrated in P. gingivalis-inoculated diabetic vs. non-diabetic mice, along with enhanced tissue-destructive capacity, as demonstrated by increased collagenolytic activity in gingival extracts. Consistent with an important role for AGE-RAGE interaction, increased AGE deposition and expression of vascular and monocyte RAGE were demonstrated in diabetic gingiva compared with non-diabetic controls. Taken together, these data indicate that we have established a murine model of enhanced periodontal disease in diabetes. This model will serve to delineate molecular mechanisms which account for the increased susceptibility of diabetic patients to periodontal disease.     

Vascular endothelial growth factor in human periodontal disease

Vascular endothelial growth factor (VEGF) is a multifunctional angiogenic cytokine of importance in inflammation and wound healing but its presence in chronic inflammatory periodontal disease has never been reported. The aims of this study were to investigate the presence of VEGF in human periodontal tissue and gingival crevicular fluid (GCF) in periodontal health and disease. VEGF in tissue was localized by immunohistochemistry. GCF and unstimulated saliva were collected from patients and clinically healthy subjects and VEGF was assessed by using an ELISA. VEGF was detected within vascular endothelial cells, neutrophils, plasma cells and junctional, pocket and gingival epithelium. In periodontitis patients, the volume of GCF and total amount of VEGF collected from diseased sites were both greater than from clinically healthy sites (Wilcoxon test p < 0.01). However, the concentration of VEGF per unit volume of GCF was higher at healthy sites compared with diseased sites (Wilcoxon test p < 0.05). Higher concentrations of VEGF were detected in healthy sites in patients compared with similar sites in clinically healthy subjects (Mann-Whitney U-test p < 0.05). A logistic regression approach indicated that there was variation in VEGF between subjects (p < 0.01), and that age (p < 0.05), plaque (p < 0.05) and pocket depth (p < 0.07) were explanatory variables. VEGF was also detected in all saliva samples and was significantly higher in patients than in healthy controls (p < 0.05). This study suggests that VEGF could be relevant to angiogenic processes in healthy as well as diseased periodontal tissue and that the periodontal status influences the salivary level of VEGF.     

Oral manifestations of HIV disease

Oral disease is frequently associated with HIV. While nearly all oral disorders associated with HIV infection also occur in other conditions characterized by immunosuppression, no other condition is associated with as wide and significant a spectrum of oral disease as is HIV infection. Many HIV-associated oral disorders occur early in HIV infection, not infrequently as the presenting sign or symptom. Thus, early detection of associated oral disease should, in many cases, result in earlier diagnosis of HIV infection. Likewise, awareness of the variety of oral disorders which can develop throughout the course of HIV infection, and coordination of health care services between physician and dentist, should improve overall health and comfort of the patient. This paper reviews the clinical, diagnostic and therapeutic aspects of HIV-associated oral disorders.     

Treatment of periodontal disease in diabetics reduces glycated hemoglobin

Periodontal disease is a common infection-induced inflammatory disease among individuals suffering from diabetes mellitus. The purpose of this study was to assess the effects of treatment of periodontal disease on the level of metabolic control of diabetes. A total of 113 Native Americans (81 females and 32 males) suffering from periodontal disease and non-insulin dependent diabetes mellitus (NIDDM) were randomized into 5 treatment groups. Periodontal treatment included ultrasonic scaling and curettage combined with one of the following antimicrobial regimens: 1) topical water and systemic doxycycline, 100 mg for 2 weeks; 2) topical 0.12% chlorhexidine (CHX) and systemic doxycycline, 100 mg for 2 weeks; 3) topical povidone-iodine and systemic doxycycline, 100 mg for 2 weeks; 4) topical 0.12% CHX and placebo; and 5) topical water and placebo (control group). Assessments were performed prior to and at 3 and 6 months after treatment and included probing depth (PD), clinical attachment level (CAL), detection of Porphyromonas gingivalis in subgingival plaque and determination of serum glucose and glycated hemoglobin (HbA1c). After treatment all study groups showed clinical and microbial improvement. The doxycycline-treated groups showed the greatest reduction in probing depth and subgingival Porphyromonas gingivalis compared to the control group. In addition, all 3 groups receiving systemic doxycycline showed, at 3 months, significant reductions (P < or = 0.04) in mean HbA1c reaching nearly 10% from the pretreatment value. Effective treatment of periodontal infection and reduction of periodontal inflammation is associated with a reduction in level of glycated hemoglobin. Control of periodontal infections should thus be an important part of the overall management of diabetes mellitus patients.