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Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

At least 127 records · Page 7Linked to original sources
PubMed1992

The development of osteoradionecrosis from sites of periodontal disease activity: report of 3 cases.

Osteoradionecrosis may develop following radiation therapy that involves bone, and most particularly following treatment of cancers within the head and neck. The mandible is at greatest risk of osteoradionecrosis because of the nature of its blood supply and its dense bone configuration. This paper describes 3 cases which demonstrate the development of osteoradionecrosis in the mandible from sites of periodontal disease activity following external beam radiotherapy. The pathogenesis of these events is reviewed, and recommendations for their management are discussed. A proposal for the use of chlorhexidine digluconate and hyperbaric oxygen in the periodontal management of this condition is outlined.

Aged↗
PubMed1992

The risk of transmission of human immunodeficiency virus in dental practice.

After a decade of study of the acquired immunodeficiency syndrome (AIDS) there is evidence to address the concerns of dental staff about possible transmission of human immunodeficiency virus (HIV). This paper reviews that evidence which demonstrates an extremely low risk of transmission of HIV to staff and patients. Only a few isolated cases have implicated transmission during dental practice, however, there are no proven cases where seroconversion has been demonstrated in relation to an exposure during dental treatment.

Dental Staff↗
PubMed1992

Non-A, non-B hepatitis and dentistry: a status report for the American Journal of Dentistry.

The recent identification of one of the causes of non-A, non-B hepatitis (NANBH) has led to an improved understanding of the epidemiology and possible clinical manifestations of this infectious disorder. NANBH is of some concern to dental personnel since the causative agents may be transmitted to health care workers and there is no effective immunization against NANBH. Current recommendations for cross infection control in the dental workplace must apply to NANBH.

Dental Staff↗
PubMed1992

Mammalian bites: risk and management.

Human and animal bites can result in bacterial infection of the wound, and may be associated with the transmission of viral pathogens, including blood borne pathogens. The management of bite injuries requires local wound care, antibiotics if appropriate and prophylaxis against transmission of tetanus and viral pathogens including Hepatitis B virus. A review of bite injuries and management is presented.

Animals↗
PubMed1992

The role of saliva in oral health and the causes and effects of xerostomia.

Saliva is an extremely vital fluid in the maintenance of oral homeostasis. Its reduction predisposes individuals to oral symptoms and oral disease. The dental practitioner must be aware of the importance of saliva and be involved in the recognition and diagnosis of problems in salivary function. No other health care worker is more able to thoroughly assess the oral environment and to recognize these oral complications.

Humans↗
PubMed1992

Temporomandibular disorders, facial pain and headache following motor vehicle accidents.

Temporomandibular disorders are known to be a possible sequela of motor vehicle accidents, particularly when flexion-extension injury occurs. This paper recognizes the relationship between cervical injury and dysfunction, and temporomandibular dysfunction and headache. The literature related to motor vehicle accidents, whiplash injury, and temporomandibular dysfunction is reviewed, and the etiology, prognosis and management of the trauma associated with head and neck pain and dysfunction are presented.

Accidents, Traffic↗
PubMed1992

Management of xerostomia.

Xerostomia (dry mouth) is an unpleasant condition that is common after radiotherapy to the head and neck, although it may have other causes. A review of the management of xerostomia, as well as the prevention and management of the oral soft tissue and dental complications resulting from xerostomia, is provided.

Candidiasis, Oral↗
PubMed1991

Herpes simplex virus in immunocompromised patients: growing evidence of drug resistance.

Antiviral drugs have proven effective in treatment of herpesvirus infections and in prevention of reactivation of latent virus. The prototype drug is acyclovir. Herpes simplex virus (HSV) is susceptible to acyclovir. There is increasing evidence in immunocompromised patients of acyclovir-resistant HSV causing clinical disease. Mechanisms of HSV resistance to acyclovir are known. These findings have implications for the future development and clinical use of antiviral drugs.

Acyclovir↗
PubMed1991

The efficacy of chlorhexidine gel in reduction of Streptococcus mutans and Lactobacillus species in patients treated with radiation therapy.

Xerostomia may develop in patients with cancer who receive radiotherapy that includes the salivary glands in the field. These patients are at high risk of rampant dental caries. Streptococcus mutans and Lactobacillus species have been associated with dental caries. Quantitative counts of these organisms demonstrated high caries risk due to streptococci in 66% and due to lactobacilli in 100% of patients studied. Use of chlorhexidine rinse was shown to reduce S. mutans counts 1.1 logs and lactobacilli 1.1 logs. The use of chlorhexidine gel resulted in a reduction of S. mutans 1.2 logs and lactobacilli 2.2 logs. In the subjects using the rinse, caries risk due to streptococci was reduced to low levels in 44% and due to lactobacilli in only one subject, with reduction to moderate risk in one third and no change in risk in the remaining patients. The use of chlorhexidine gel was found to reduce the caries risk associated with streptococci to low levels in all patients, and the risk associated with lactobacilli to low and moderate risk in two thirds of patients.

Adult↗
PubMed1991

HIV infection: clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma.

The clinical findings of patients with oral Kaposi's sarcoma are reviewed. These oral findings commonly included candidiasis, hairy leukoplakia, gingivitis associated with human immunodeficiency virus (HIV), periodontitis, and other symptoms, including xerostomia. The other common symptoms of HIV disease that may be of importance in leading to a diagnosis are reviewed in this patient group. Treatment by local radiotherapy or by intralesional vinblastine of these oral Kaposi's sarcomas resulted in successful palliation, with more than 50% regression of the lesions in 80% of the patients treated.

Adult↗
PubMed1991

Viral serology after bone marrow transplantation.

Bone marrow transplantation (BMT) may change the recipient's pretransplant serostatus for herpes group viruses. We reviewed 68 patient records (1 year's transplants) to determine how frequently this occurs. Only 7 had data on serostatus before as well as at days 20 to 35 and greater than 100 after BMT. Serostatus was assessed by complement fixation and ELISA. All patients received a variety of blood-product support after BMT. One patient converted from anti-varicella zoster virus (VZV) positive to negative after BMT and developed clinical chickenpox; an additional patient converted from anti-VZV negative to positive after BMT but reverted to seronegative by day 102. One patient converted from anti-cytomegalovirus (CMV) positive pre-BMT to persistently anti-CMV negative post-BMT (donor: anti-CMV negative). Two patients had a greater than 4-fold fall in anti-herpes simplex (HSV) antibody post-BMT, and both shed HSV after BMT. Most seronegative recipients of marrow from seropositive donors developed herpesvirus antibodies. We conclude that the herpesvirus serostatus of BMT recipients should be determined again after BMT to aid in decisions about antiviral prophylaxis and diagnosis of clinical disease.

Adult↗
PubMed1991

Hairy leukoplakia-like lesions following bone-marrow transplantation.

Hairy leukoplakia (HL) also occurs in immunosuppressed post-bone-marrow transplantation patients, and in the presence or absence of Epstein-Barr virus. It may not always be diagnostic of HIV positivity. However, HIV status should still be determined in patients with HL.

Adolescent↗
PubMed1991

Antiviral therapeutics in dentistry.

Rapid progress is being made in the development of antiviral therapy. This review restricts its focus to antivirals that may be used by dental practitioners, principally those agents active in herpesvirus infections.

Acyclovir↗
PubMed1991

Hepatitis B and HIV infections in dental professionals: effectiveness of infection control procedures.

In a survey carried out in 1987 and 1988 in Vancouver British Columbia, 704 dental professionals filled out an anonymous questionnaire and submitted a blood sample. Of those not immunized, 11% had infection with Hepatitis B, with dentists having a rate of 18%, significantly higher than other dental workers. Two carriers of HBsAg were detected and no individuals showed evidence of HIV infection. There were no differences in infection rates by the specific infection control practices. Oriental dental-care workers had a significantly higher rate of infection than other races surveyed. In a multivariate model, race and the number of years in practice were the only significant factors in predicting infection. The use of gloves did not show a protective effect, although a threefold protection rate for gloves is the smallest difference that could be reliably detected. The immunization rate with Hepatitis B vaccine averaged 46%, with fewer dentists being immunized than hygienists. Seroconversion rates were lower in older individuals. Dental professionals had a high risk of Hepatitis B and had not been adequately immunized. Reliance on gloves for operator protection appears to be inadequate.

Adult↗
PubMed1990

Recognition of oral lesions of HIV infection. 1. Candidosis.

Oral problems are often the first significant clinical manifestations of infection with human immunodeficiency virus (HIV). Their early recognition affords the best opportunity for effective therapeutic intervention of HIV infection and opportunistic infections, as well as for oral health education in order to avoid future problems. This also provides optimal time for behaviour modification and coming to terms with the psychosocial consequences of HIV disease. This series of three articles presents a pictorial review and update on the oral manifestations of HIV infection.

Candidiasis, Oral↗
PubMed1990

Clinical study of herpes simplex virus infection in leukemia.

Twenty-nine patients with leukemia were observed for the development of and recovery from oral herpes simplex virus (HSV) lesions. In patients with seropositive test results, lymphocyte and monocyte counts may provide a guide to predict the onset of HSV infections and to indicate when to institute acyclovir prophylaxis. When HSV developed, acyclovir was effective in preventing progression of the lesions, which did not resolve until white cell counts had recovered.

Acyclovir↗