Survey analysis on dental infection control & occupational safety from India---1999 & 2010

The objective was to study knowledge, attitudes, practice (KAP) and needs regarding infection control measures using two cross-sectional surveys from 1999 and 2010 conducted in India. Both data collection instruments had only about 35 comparable variables in common. In 1999, there were 456 respondents (dentists) who completed a self-administered survey instrument compared to 272 respondents in 2010. Both the 1999 and 2010 samples were mutually independent with no overlap, had regional differences, and therefore, were not completely comparable for changes in KAP over time. While almost all respondents from both surveys felt that education in dental safety was needed and wanted mandatory dental safety curriculum in dental schools, severe inadequacies in dental safety knowledge, protection against immunizable diseases, and practice of universal precaution were noted. Data from the study demonstrated that there is a substantial opportunity to improve the knowledge, attitude and practice of dental infection control and occupational safety in India. Few respondents (27%) reported that the infectious disease status of a patient is always known and a significant number reported that they had the right to refuse care for patients of known infectious disease status. This indicates that Stigma in treating HIV/AIDS patients remains a concern, which in turn suggests that a stronger focus on educating dentists about dental safety and on stigma and infectious disease is needed. Information obtained from this study could be utilized for developing policies oriented towards increasing dental safety educational efforts, in both dental schools as curriculum, and for practicing dentists through professional updates or continuing dental education.^

Multiple brain abscess from dental origin: Case report and literature review

Background: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. Case report: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. Discussion: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance. © 2011 Springer-Verlag.

Photodynamic inactivation of biofilm: Taking a lightly colored approach to stubborn infection

Microbial biofilms are responsible for a variety of microbial infections in different parts of the body, such as urinary tract infections, catheter infections, middle-ear infections, gingivitis, caries, periodontitis, orthopedic implants, and so on. The microbial biofilm cells have properties and gene expression patterns distinct from planktonic cells, including phenotypic variations in enzymic activity, cell wall composition and surface structure, which increase the resistance to antibiotics and other antimicrobial treatments. There is consequently an urgent need for new approaches to attack biofilm-associated microorganisms, and antimicrobial photodynamic therapy (aPDT) may be a promising candidate. aPDT involves the combination of a nontoxic dye and low-intensity visible light which, in the presence of oxygen, produces cytotoxic reactive oxygen species. It has been demonstrated that many biofilms are susceptible to aPDT, particularly in dental disease. This review will focus on aspects of aPDT that are designed to increase efficiency against biofilms modalities to enhance penetration of photosensitizer into biofilm, and a combination of aPDT with biofilm-disrupting agents. © 2013 Informa UK Ltd.

A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice

In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.

Perfil genético de Enteroccocus faecalis isolados de infecção endodôntica primária no Brasil comparados a isolados orais e não-orais do Reino Unido e do Japão

Enterococcus faecalis (E. faecalis), conhecidamente patógeno oportunista, tem sido frequentemente associado a infecções sistêmicas graves. É também encontrado na cavidade oral, com destaque em infecção endodôntica refratária. O objetivo deste estudo foi avaliar características moleculares de E. faecalis isolados de infecção endodôntica primária no Brasil e comparar com isolados orais e não orais de pacientes do Reino Unido e do Japão, assim como E. faecalis resistentes à vancomicina. O presente estudo também investigou o relacionamento entre E. faecalis de diferentes origens (oral e não oral) e de diferentes áreas geográficas para obter uma melhor compreensão do envolvimento dos diferentes reservatórios no surgimento e propagação de clones virulentos, aqueles que possuem genes que conferem infectividade e virulência, assim como resistência aos antibióticos. Para tal, foram estudados E. faecalis isolados em infecções endodônticas no Brasil (n = 20) e orais no Reino Unido (n = 10), e em infecções não orais no Japão (n = 9). Além disso, 20 E. faecalis isolados ambientais do Hospital Universitário de Gales (Cardiff, Reino Unido), classificados como Enterococcus resistentes à vancomicina (VRE) também foram examinados. A Concentração Inibitória Mínima (CIM) dos isolados do Brasil foi obtida pelo método de diluição em agar de acordo com as recomendações do Clinical and Laboratory Standards Institute (CLSI). Reação em cadeia da polimerase (inglês - PCR) foi a técnica empregada para detectar os genes de virulência e aqueles associados à resistência aos antibióticos, enquanto Reação de Amplificação Aleatória de DNA Polimórfico (inglês - RAPD-PCR) foi escolhida para a tipagem molecular. Dentre os genes de virulência examinados, o gene que codifica a gelatinase gelE foi o mais prevalente entre os isolados (77-100%). Entre isolados orais, foram detectados os genes agg de substâncias de agregação, esp de proteína de evasão imune, cylB de citolisina, genes de resistência à tetraciclina tetM e tetL e à eritromicina ermB com diferentes prevalências. Os isolados clínicos hospitalares do Japão apresentaram perfil genético similar aos isolados orais, mas com maior prevalência de ermB e cylB. Todas as amostras de VRE foram positivas para os genes gelE, esp, agg, vanA, ermB e tetM, 95% foram positivos para cylB e 17% positivo para tetL. Todas as amostras foram negativas para ermA, asa373, vanB, vanC1 e vanC2/3. RAPD-PCR revelou agrupamento de VRE em comparação com outros isolados. Neste estudo, os isolados de E. faecalis de infecções orais apresentaram genes de resistência à tetraciclina, um antimicrobiano frequentemente usado no tratamento local de infecções dentárias, abrindo um debate muito importante sobre o papel e a eficácia desta droga para infecções orais. Claramente, são necessários mais estudos nesta área principalmente em relação à expressão de fatores de virulência entre isolados endodônticos para melhor nortear as estratégias de tratamento. As pressões externas no microambiente dos canais radiculares podem ser responsáveis pela seleção de espécies mais resistentes e virulentas. Por fim, embora isolados orais apresentem genes de virulência fundamentais para a patogenicidade, estes foram detectados em menor incidência em comparação com os isolados não-orais e VRE.

Masseter muscle hypertrophy - case report

Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both males and females after puberty. Its etiology remains unknown. Limitations on mouth opening and also tension in the region of the hypertrophied muscle are symptoms reported. This paper reports a case of masseter muscle hypertrophy diagnosed using imaging modalities such as conventional radiography, computed tomography and magnetic resonance imaging scans. The familiarity with this condition is important to settle the differential diagnosis with other pathologies such as parotid gland tumors and dental infection.

Extensive Cervical Necrotizing Fasciitis of Odontogenic Origin

Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.

Biosecurity in public and private office

Biosecurity is currently a concern for all health-related services, including dentistry, since infection control has a relevant importance. In dental practice, health-related occupations have contact with a great number of individuals who are potentially capable to transmit pathogens. This study comprised a descriptive evaluation of the universal precaution measures for infection control adopted by dental practitioners working at public and private offices in the city of Araçatuba, SP. Data collection was performed by a quiz with questions about individual and collective protection equipments. The results showed that the use of caps was reported by 55% of the professionals working at the public sector and 90% for the private sector. The use of masks and gloves was reported by all professionals surveyed; nevertheless, glove change between patients was not reported by 40% of professionals working at the public sector. There were more flaws in public offices as to the use of protective barriers, since except for the use of gloves, gowns and masks, the frequency of use of those barriers was smaller than at private offices.

Orbital Abscess during Endodontic Treatment: A Case Report

Introduction: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. Methods: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. Results: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. Conclusions: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease. (J Endod 2012;38:1541-1543)

Bacterial Meningitis After Sinus Surgery in Five Adult Horses.

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.

Análise comparativa das alterações periapicais diagnosticadas pela técnica radiográfica do paralelismo e pelo mapeamento tomográfico cintilográfico (com e sem blindador de raios gama)

O diagnóstico precoce de focos de infecção dentários é de fundamental importância para prevenir a ocorrência de maiores injúrias locais ou sistêmicas. Dentre os diversos métodos utilizados para complementar os achados radiológicos das alterações dentoalveolares surge uma alternativa: a cintilografia tomográfica (SPECT/CT), que permite a fusão de achados morfológicos com alterações metabólicas. Com o objetivo de estabelecer o diagnóstico precoce e acurado de processos infecciosos dentários, foram estudadas 320 áreas dentárias em mandíbula e maxila em (10 pacientes de ambos os sexos selecionados por meio de exames clínicos e radiológicos convencionais, seguidos de cintilografia tomográfica com e sem aparato blindador de raios gama. Os exames cintilográficos foram realizados no Serviço de Medicina Nuclear do Hospital Israelita Albert Einstein (HIAE). Para isso, foi administrado para cada paciente o radiofármaco tecnécio 99- metilenodifosfonato (99mTc-MDP) via endovenosa com a dose de 37mBq/3Kg de peso corporal do paciente. Após o período de acúmulo de três horas, foi realizado o protocolo de aquisição de imagens. Todas as imagens foram analisadas por um médico nuclear e um endodontista, com experiência em cintilografia tomográfica. O resultado obtido por meio do exame radiográfico intrabucal pela técnica periapical digital mostraram 6 imagens positivas, em um total de 1,87% da amostra; exame do mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gâma revelou 9 imagens positivas, correspondendo a 2,81% do total de áreas estudadas, havendo diferença estatisticamente significante ao nível de 95% pelo teste qui-quadrado. Pode-se concluir que o SPECT/CT permitiu identificar as alterações periapicais em maior número quando comparadas ao exame radiográfico periapical e ao mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gama; o exame de SPCET/CT além de mostrar imagens mais detalhadas, permitiu também localizar com exatidão as áreas alteradas.

An infection control protocol: effectiveness of immersion solutions to reduce the microbial growth on dental prostheses

This investigation evaluated the effectiveness of an infection control protocol for cleansing and disinfecting removable dental prostheses. Sixty-four dentures were rubbed with sterile cotton swab immediately after they had been taken from patients' mouths. Samples were individually placed in the culture medium and immediately incubated at 37 +/- 2 degreesC. The dentures were scrubbed for 1 min with 4% chlorhexidine, rinsed for 1 min in sterile water and placed for 10 min in one of the following immersion solutions: 4% chlorhexidine gluconate, 1% sodium hypochlorite, Biocide (iodophors) and Amosan (alkaline peroxide). After the disinfection procedures, the dentures were immersed in sterile water for 3 min, reswabbed and the samples were incubated. All samples obtained in the initial culture were contaminated with micro-organisms. All the lower dentures immersed in Biocide showed positive growth, and the upper dentures were positive for growth in six of eight dentures. The 4% chlorhexidine gluconate, 1% sodium hypochlorite and Amosan solutions have been proved effective to reduce the growth of the micro-organisms in the 10 min immersion period. The protocol evaluated in this study seems to be a viable method to prevent cross-contamination between dental personnel and patients.