Linking postdoctoral general dentistry programs with private practice settings.
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Accreditation↗
Biomedical subjects
S W Redding
Publications and source records attributed to S W Redding.
Detection and significance of fluconazole resistance in oropharyngeal candidiasis in human immunodeficiency virus-infected patients.
The epidemiology and clinical significance of fluconazole resistance were assessed in a cohort of advanced human immunodeficiency virus (HIV)-infected patients with recurrent oropharyngeal candidiasis. Fifty patients were prospectively evaluated using a novel method of detecting fluconazole resistance with chromogenic media containing fluconazole; results were confirmed with macrobroth testing. Resistant yeasts, defined as MICs > or = 8 micrograms/mL, were detected in 16 (32%) of 50 patients: 7 (14%) had resistant Candida albicans, 7 (14%) had resistant non-C. albicans yeast, and 2 (4%) had mixed resistant yeasts. MICs were > or = 32 in 11 of 16 isolates. Previous fluconazole use and severe immunosuppression were risk factors for resistance. However, 5 of 26 patients had resistant isolates with no prior fluconazole use, and all were severely immunosuppressed. Despite the high prevalence of resistance, 48 patients clinically responded to fluconazole. Fluconazole-resistant C. albicans and non-C. albicans yeast infections are common in patients with advanced immunodeficiency, but clinical efficacy of fluconazole remains high.
AIDS-Related Opportunistic Infections↗
Simple method for detecting fluconazole-resistant yeasts with chromogenic agar.
A method for detecting fluconazole-resistant yeasts was developed that uses chromogenic agar containing fluconazole. Yeasts were plated on media with fluconazole at 0, 8, and 16 micrograms/ml. On media without fluconazole, normal growth of susceptible yeasts (defined as those having a fluconazole MIC of < 8 micrograms/ml) was detected, while fluconazole-containing media suppressed susceptible strains and normal colonies of resistant yeasts (fluconazole MICs of > or = 8 micrograms/ml) were detected. This method was used to screen for resistance in oropharyngeal candidiasis. Isolates having fluconazole MICs of > or = 8 micrograms/ml and < 8 micrograms/ml were correctly predicted in 43 of 45 cultures and 115 of 116 cultures, respectively. This screening method appears to be rapid and sensitive for detection of fluconazole-resistant yeasts.
Agar↗
PGY1: what is it and why is it important?
The interest in a year of additional training for the practice of dentistry has grown over the past fifteen years. Debates at national conferences and careful study by committees of professional organizations led to the recommendation that over the next five to ten year period the profession should move toward creating a postgraduate experience for each graduate prior to independent practice. While study of this issue will undoubtedly continue, it behooves us to proceed with the process of expanding the number of postgraduate positions, first, to meet the demand by graduating students who are voluntarily selecting a year of additional training, and later, so we are at a position to fully consider such a year as mandatory for independent practice. If we use the next five to ten years productively, we can create an environment where the public and the graduates will benefit from this additional year of training.
Accreditation↗
Variations in fluconazole susceptibility and electrophoretic karyotype among oral isolates of Candida albicans from patients with AIDS and oral candidiasis.
DNA subtyping by pulsed-field gel electrophoresis and in vitro susceptibility testing were used to study strain variation and fluconazole resistance in Candida albicans isolates from patients with AIDS undergoing azole (fluconazole and clotrimazole) therapy for oropharyngeal candidiasis. A total of 29 patients suffered 71 episodes of oropharyngeal candidiasis. Overall, 121 isolates of C. albicans recovered throughout the course of treatment of each infection were available for further characterization. DNA subtyping revealed a total of 61 different DNA subtypes. In vitro susceptibility testing of the 121 isolates by using proposed standard methods of the National Committee for Clinical Laboratory Standards revealed MICs of fluconazole ranging from < or = 0.125 to > 64 micrograms/ml. The MIC for 50% of isolates tested was 0.25 microgram/ml, and the MIC for 90% of isolates tested was 8.0 micrograms/ml. MICs were > or = 64 micrograms/ml for only 7.4% of the isolates tested. The majority (62%) of the patients with oropharyngeal candidiasis and undergoing azole therapy were infected or colonized with more than one DNA subtype, and the introduction or selection of strains with a more resistant DNA subtype during the course of fluconazole therapy was not uncommon. With one exception, this did not appear to have an adverse effect on clinical outcome. In contrast, for patients with AIDS and oropharyngeal candidiasis infected with a single DNA subtype of C. albicans, an increase in fluconazole MICs for the infecting strain was rarely demonstrated over the course of therapy.
Acquired Immunodeficiency Syndrome↗
The effect of competency-based dental education on postdoctoral general dentistry.
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Clinical Competence↗
Radiation-induced increased platelet-activating factor activity in mixed saliva.
BACKGROUND: Platelet-activating factor (PAF), a family of structurally-related phospholipid mediators of inflammation, is present in normal human mixed saliva; however, its role in oral biology and the homeostasis of oral host defense mechanisms remains to be established. EXPERIMENTAL DESIGN: The current study was designed to evaluate the salivary levels of PAF in patients with oral mucositis that developed as a complication of head and neck irradiation for oral cancer. PAF activity was assessed in platelet bioassay and expressed relative to the activity of authentic PAF, 1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine (C16:0-AGEPC). RESULTS: A significant increase in salivary PAF levels was observed in patients with mucositis (47,032 +/- 12,731 C16:0-AGEPC fmole equivalents/ml of saliva, mean +/- SE, N = 7) as compared with normal subjects (5,568 +/- 1,135 C16:0-AGEPC fmole equivalents/ml of saliva, N = 27). Phospholipid fractionation of the PAF isolated from the saliva of patients with mucositis by reverse phase high performance liquid chromatography revealed a single peak of activity that corresponded with the elution profile of C16:0-AGEPC, the most biologically active molecular species of PAF. In contrast, the PAF isolated from normal human mixed saliva contained multiple molecular species of PAF. CONCLUSIONS: These results suggest that this potent phospholipid inflammatory mediator may play a role in the inflammation and tissue injury associated with mucositis resulting from radiation treatment for oral cancer.
Humans↗
Clinical evaluation of MGI 209, an anesthetic, film-forming agent for relief from painful oral ulcers associated with chemotherapy.
PURPOSE: This open-label, multicenter trial evaluated the efficacy of a mucoadherent, anesthetic medication (MGI 209) for relief from painful oral ulcers associated with cytotoxic chemotherapy. PATIENTS AND METHODS: Twenty-eight eligible cancer patients who had up to five discrete oral ulcers (total area < or = 5 cm2) completed this study. Mean age was 53.5 years (range, 21 to 81). Subjective assessments of oral discomfort before and after an orange juice pain challenge (OJPC), which was measured using a visual analog scale (VAS), and visual estimates of the amount of MGI 209 that remained on treated ulcers were collected at (1) baseline (before MGI 209 treatment); and (2) 30, 60, 120, and 180 minutes posttreatment. RESULTS: Most subjects had low VAS scores (4 or less), which was indicative of oral discomfort, at baseline before and after the OJPC. At 30, 60, 120, and 180 minutes after MGI 209 treatment, most subjects had high VAS scores before and after an OJPC compared with baseline scores, which was indicative of a substantial increase in oral comfort; these differences were statistically significant (P < .0001). Mean percent of MGI 209 estimated to remain on ulcers at the previously mentioned times was 93.7%, 90.3%, 79.6%, and 71.3% of the total amount applied, respectively. CONCLUSION: Benzocaine hydrochloride in combination with the protective, mucoadherent film-coating relieved discomfort for at least 3 hours even with exposure to an irritating beverage. MGI 209 treatment should allow patients with chemotherapy-induced oral ulcers to drink and eat with significantly diminished pain or no pain.
Adult↗
Diagnosis and management of orofacial herpes simplex virus infections.
HSV disease remains a significant problem for the dental profession because of its widespread occurrence and ready transmission. Fortunately, available diagnostic techniques are highly sensitive and specific, antiviral therapy is effective in limiting the course of infection, and contemporary infection control procedures adequately safeguard dental personnel and the patient. Unfortunately, there is still a large segment of the population already infected with HSV-1 and the number of immunosuppressed latently infected patients continues to increase. Thus, patients will continue to need the help of the knowledgeable and willing dentist who can diagnose HSV-1 infection, provide effective treatment, and prevent transmission.
Facial Dermatoses↗
The San Antonio AEGD/GPR model: historical and financial perspectives.
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Education, Dental, Graduate↗
Oral herpes simplex virus infection in patients receiving head and neck radiation.
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Adult↗
The prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus.
The purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with SLE, to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment. The hospital records of 112 patients with SLE were reviewed and screened for endocarditis, heart murmurs, and other valvular pathosis. Two of the 112 patients had confirmed cases of bacterial endocarditis. This prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease. The high prevalence of endocarditis in this population of patients with SLE suggests that according to present perspectives on patient management, patients with SLE should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia.
Adolescent↗
The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery.
Acceptance of the use of glucocorticosteroids in density to control postsurgical inflammation has been impaired by concerns over side effects, adrenal suppression, and efficacy. The pattern of administration generally used is characterized as short-term, high-dose or pulse therapy, which has not been associated with significant side effects or adrenal suppression beyond 10 days. The selection of an appropriate glucocorticosteroid with minimal mineralocorticoid activity and extended biological activity is desirable. Oral and parenteral dosing are possible, and the latter can be administered as acetates (repository) or esters. The efficacy of glucocorticosteroids in reducing pain, swelling, and trismus after third molar surgery is difficult to ascertain because of methodological inconsistencies between investigations. In general, studies that used low dosing schedules have failed to produce dramatic and prolonged results. High-dosing intravenous (IV) studies have demonstrated significant short-term improvements, but the effects were not sustained. Combining IV administration with multiple oral dosing or a single intramuscular (IM) dose may be required to extend short-term improvement. High-dosing IM studies have shown significant and sustained anti-inflammatory effects with a single dose administered either pre- or post-operatively.
Glucocorticoids↗
Role of herpes simplex virus reactivation in chemotherapy-induced oral mucositis.
Reactivation of oral herpes simplex virus (HSV) is very common in patients receiving cytotoxic chemotherapy or bone marrow transplantation. Numerous studies have shown the incidence rate of reactivation to be between 50% and 90% in these populations. Other studies have attempted to correlate oral mucositis and HSV reactivation. From 37% to 68% of all oral mucositis lesions were culture positive in mixed populations of chemotherapy and bone marrow transplant patients. The lesions that were culture positive tended to be more severe than those that were culture negative. These lesions were also atypical in that they involved any perioral and intraoral surface. Patients receiving cytotoxic chemotherapy should have any mucositis lesions evaluated for HSV, including laboratory testing, and should be treated aggressively with acyclovir. Certain groups, such as bone marrow transplant and leukemia patients who are seropositive, should be considered for acyclovir prophylaxis.
Antineoplastic Agents↗
Acyclovir prophylaxis for oral herpes simplex virus infection in patients with bone marrow transplants.
Reactivation of herpes simplex virus (HSV) appears to play a significant role in oral mucositis resulting from bone marrow transplantation. The acyclic guanosine derivative acyclovir has been shown to be effective in treating and protecting against HSV infection in this group. The purpose of this study was to determine the role of HSV reactivation in oral mucositis in patients undergoing bone marrow transplantation who were seronegative for HSV or who received acyclovir prophylaxis. The results suggest that HSV plays an insignificant role in oral mucositis in these patients.
Acyclovir↗
Intravascular angiomatosis (Masson's lesion).
Intravascular angiomatosis, also known as Massons' lesion, is a relatively uncommon, although important, tumor because it clinically mimics such benign lesions as mucocele, pyogenic granuloma, and hemangioma, as well as malignant neoplasms such as angiosarcoma and Kaposi's sarcoma. More important is the potential for misdiagnosis at the histological level that poses a significant problem to those unfamiliar with this lesion. This article reviews the literature on perioral intravascular angiomatosis and presents five additional cases.
Adult↗
Systemic lupus erythematosus: a consideration for antimicrobial prophylaxis.
Endothelial damage to heart valves, similar to that seen with rheumatic heart disease, occurs in 50% of all patients with systemic lupus erythematosus. Bacterial endocarditis is a consequence in 1% to 4% of these patients. This rate is greater than the incidence of endocarditis after rheumatic heart disease and compares favorably with the incidence of endocarditis in patients with prosthetic heart valves. At present, it is not possible to accurately delineate the subpopulation of patients with SLE that is at risk for this disease; hence, it is recommended that antibiotic prophylaxis (standard regimen suggested by the American Heart Association) be considered for all patients with systemic lupus erythematosus undergoing dental procedures associated with transient bacteremias.
Anti-Bacterial Agents↗