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The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment.

This study evaluated the rubber dam as an infection control barrier during standard restorative procedures. Microbial collection was performed during preparation and placement of amalgam and composite resin restorations with and without the rubber dam, and during handpiece and air-water syringe spraying with and without the rubber dam. The results showed a significant reduction in microorganisms with the use of the rubber dam--70% to 88% and 95% to 99%, respectively; and 90% to 98% when all data were combined. These results indicate that using the rubber dam is a method of reducing microbial contamination at the primary source. Used with gloves, mask, and protective eyewear, the rubber dam provides an excellent barrier to the potential spread of infectious disease in the dental office.

Bacteria↗

Antimicrobial activity of garlic, tea tree oil, and chlorhexidine against oral microorganisms.

OBJECTIVE: To compare the antimicrobial activity of tea tree oil, garlic, and chlorhexidine solutions against oral microorganisms. METHOD: The five-week study consisted of thirty subjects. The first week was considered baseline. All subjects used a control solution (second week), and were randomly divided into the three groups (third week): G1-0.12% chlorhexidine; G2 - 2.5% garlic (Allium sativum, L.); and G3 - 0.2% tea tree oil (Melaleuca alternifolia). Dishes containing blood agar and Mitis Salivarius Bacitracin agar (MSB) were inoculated with the subjects' saliva (collected twice a week). Total microorganisms and mutans streptococci were counted in blood agar and MSB, respectively. RESULTS: Chlorhexidine and garlic groups showed antimicrobial activity against mutans streptococci, but not against other oral microorganisms. The tea tree oil group showed antimicrobial activity against mutans streptococci and other oral microorganisms. Maintenance of reduced levels of microorganisms was observed only for garlic and tea tree oil during the two consecutive weeks (fourth and fifth). Unpleasant taste (chlorhexidine 40%, tea tree oil 30%, garlic 100%), burning sensation (chlorhexidine 40%, tea tree oil 60%, garlic 100%), bad breath (chlorhexidine 40%, tea tree oil 20%, garlic 90%), and nausea (chlorhexidine 0%, tea tree oil 10%, garlic 30%) were reported. CONCLUSION: Garlic and tea tree oil might be an alternative to chlorhexidine.

Adolescent↗

Nutritional determinants of the ecology of the oral flora.

Consideration of nutritional factors as determinants of oral microbial ecology leads to the conclusion that endogenous factors play a dominant role. It is the interactions between specific microorganisms and nutritional and other factors provided by the host that selectively determine the kinds of microorganisms which willinitially reside in the oral cavity and the sites which they will colonize. The persistence of these original "colonists" in their respective ecologic niches will depend in part on the accessibility of endogenous nutrients variously provided by saliva, tissue exudates, crevicular fluids, or degenerating host cells. It will also depend on their response to and interaction with microorganisms which immigrate to that site subsequently. The microbial ecology of a given site is therefore rarely uncomplicated, the notable exception occurring at the most microscopic level where one may encounter microcolonies of individual species within more heterogenous populations of microorganisms. The extent of this heterogeneity quantitatively and qualitatively is a reflection of the degree to which the interactions between the resident flora and the new arrivals, plus the local environmental changes which they both generate, serve to promote or to discourage the survival and growth of the individual species. This element of heterogeneity in a dynamic system with its inherent potential for variation makes it possible for relatively minor changes in local environmental conditions to result in significant differences in the microflora between one site and another even though they may be in close proximity to each other. Once this concept is appreciated it becomes easy to understand how disease processes such as dental caries may affect specific areas of a tooth while nearby areas are unaffected. The effects of exogenous nutrients on the ecology of the oral microbiota, nevertheless cannot be ignored. The diet may modulate such endogenous factors as the salivary secretions and the local resistance of the gingival tissues to infections. Although at our present state of knowledge the direct influence of dietary proteins and fats on the oral microbiota is thought to be of relatively minor consequence, dietary carbohydrates are of major ecological significance. Dietary sugars provide readily available substrates for the oral microorganisms, most of which depend on carbohydrates for energy sources. The metabolism of dietary sucrose by S. sanguis and S. mutans with the productions of acids and intracellular and extracellular polysaccharides has specific influence on the microbial composition, metabolic activities, and mass of coronal plaque. The ready availability of dietary carbohydrates undoubtedly influences the microflora of other parts of the oral cavity as well, eic species or indirectly through the interactions of other organisms with them...

Adhesiveness↗

Valuation of exfoliative cytology as prediction factor in oral mucosa lesions.

The aim of this study was immunolabeling oncoproteins Ck14, p53, p21 and Bcl-2 in order to evaluate their expression in premalignant and malignant stomatological lesions in oral epithelial, and to compare this expression with exfoliative cytology alterations in the same patients. It was studied biopsies and cytologies of 13 subjects with oral lichen planus, with or without Human Papilloma Virus (HPV), leukoplakia and squamous cell carcinoma clinically diagnosed and confirmed by anatomopathological studies. The oral lichen planus lesion presented binuclei orange cells; and in leukoplakia lesions only orange stained was observed; meanwhile koilocytes, inflammatory cells, enlarge nuclear volume and pathogenic microorganisms were observed in the HPV infections and squamous cells carcinoma (SCC). The Ck14, p53, p21 and Bcl-2 proteins were found modified in the leukoplakia, oral lichen planus and cancer. Cytological alterations and positive immunolabeling or over-expression of Ck14 cytokeratine in the upper epithelial stratus should be indicator of malignant transformations as doing subsequence exams.

Adult↗

[The adaptive responses of human oral microorganisms to sorbitol].

It was the goal of this study to evaluate the extent to which sorbitol is metabolized by the oral microflora of persons adapted to this sugar substitute (diabetics). Resting saliva of 25 test persons with juvenile diabetes mellitus was incubated with sorbitol or sucrose in the Warburg-system both under aerobic and under anaerobic conditions. Saliva of 25 healthy persons served as control. Sorbitol was metabolized faster and to a higher total amount in the diabetic group. These results indicate that if sorbitol is offered continuously, the oral microflora will adapt and will metabolize sorbitol to a considerably higher extent.

Adaptation, Physiological↗

Bacterial counts in carious dentine under restorations: 2-year in vivo effects.

Little is known about the long-term effects of fluoride-releasing materials on carious dentine in vivo. The aim was to investigate the 2-year influence of a resin-modified glass ionomer cement (RM-GIC) and amalgam on the bacteriological counts of carious dentine that remained under class I restorations. To enable a split-mouth design, 33 molar pairs in 33 patients (mean age 15.1 years, SD 1.4) were selected, based on clinically and radiographically diagnosed occlusal dentine caries. The enamel of the carious molars was removed, and the carious dentine was sampled under aseptic conditions just beneath the dentinoenamel junction. The molars were alternately restored with RM-GIC or amalgam without further removal of carious dentine. The samples were processed for microbiological determination of total viable counts (TVC), mutans streptococci (MS), and lactobacilli (LB). The molar pairs of 25 patients were reevaluated after 2 years using the same clinical techniques and were permanently restored after complete caries removal. Both materials showed a substantial decrease in numbers of TVC and LB of the carious dentine after the 2-year period. Compared to amalgam, the decrease in the numbers of LB was significantly more pronounced for RM-GIC. No microorganisms were detected in only 11 molars (6 RM-GIC and 5 amalgam) after the 2-year period. Based on this study, we suggest that complete removal of carious dentine is still the best conservative treatment, irrespective of the restorative material used.

Adolescent↗

Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease.

This study was undertaken to evaluate the microbiological and clinical effects of a subgingivally applied mixture of H2O2-NaCl and NaHCO3 followed by subgingival irrigation with 1% Betadine in the treatment of periodontal disease. 20 adults with moderate to severe periodontal disease were included in a split mouth design study. All patients were given oral hygiene instruction and were subjected to supragingival scaling in all 4 quadrants, and subgingival scaling and root planing of half the dentition. 10 patients were instructed to use the chemical antimicrobial mixture twice a day instead of dentifrice, and also received professional application of the mixture once every 14 days for 3 months in connection with reinstruction in oral hygiene procedures. The remaining 10 patients received oral hygiene instructions combined with professional tooth cleaning without use of chemicals once every 14 days during a 3-month period. The effect of treatment was evaluated by monitoring the subgingival microflora, clinical periodontal parameters, and by computer assisted subtraction analysis of serial standardized radiographs to determine changes in mass of the supporting alveolar bone. The present study revealed that subgingival debridement combined with mechanical plaque control resulted in decreased numbers of subgingival microorganisms including spirochetes and motile rods, and arrested the progressive breakdown of the periodontal tissues. Topical antimicrobial agents used in combination with subgingival scaling further reduced the subgingival microflora and substantially improved early periodontal healing including gain of probing attachment level and gain in radiographic alveolar bone mass during the 12 months of observation. No clinical improvement but a tendency to further periodontal breakdown was found in the unscaled quadrants, even in those which were subjected to a personal application of the topical antimicrobial mixture. This study indicates that professional and personal subgingival application of a mixture of H2O2-NaCl and NaHCo3 will significantly enhance the microbiological and clinical effects of periodontal scaling and root planing. These agents, and the topical mode of antimicrobial therapy seem promising in the management of human periodontal diseases.

Administration, Topical↗

Elevated cortisol levels in whole saliva in HIV infected individuals.

Free cortisol concentrations in unstimulated whole saliva samples, collected at 10.00 to 11.00 h, from 23 unmedicated HIV-positive patients and 14 control subjects were measured by radioimmunoassay. Mean cortisol level (nmol/l +/- SD) was significantly higher in the HIV patients than in control subjects (27.4 +/0 9.3 vs. 10.1 +/- 3.5). Two HIV patients with pseudomembranous candidiasis had the highest saliva cortisol concentrations (mean of 48.5 nmol/l). Two other HIV patients (one with Kaposi's sarcoma and the other with periodontitis) had a mean cortisol value of 29.9 nmol/l. The possibility of plasma contamination of whole saliva in the HIV patients with inflammatory oral mucosal lesions notwithstanding, our findings suggest an increased oral burden of cortisol in both the asymptomatic and symptomatic HIV-infected individuals. Glucocorticoids caused immunosuppression, provide selective growth advantage to various microorganisms including the fungi, and enhance replication or reactivation of latent viruses (e.g. EBV, CMV, Kaposi's sarcoma-associated herpes viruses). Our findings suggest a need to evaluate the relevance of endogenous glucocorticoid excess in blood and saliva to the causation of some major AIDS-associated oral lesions such as candidiasis, Kaposi's sarcoma, oral hairy leukoplakia and necrotizing gingivitis.

AIDS-Related Opportunistic Infections↗

Antigen activation of THP-1 human monocytic cells after stimulation with lipopolysaccharide from oral microorganisms and granulocyte-macrophage colony-stimulating factor.

A human THP-1 monocyte cell line culture system has been utilized to evaluate the morphological changes in THP-1 cells and to measure expression of activation antigens (CD-11b, CD-11c, CD-14, CD-35, CD-68, CD-71 and HLA-DR) as evidence of maturation of THP-1 cells in response to stimulation by lipopolysaccharide (LPS) from the oral microorganisms, Fusobacterium nucleatum and Porphyromonas gingivalis, and granulocyte-macrophage colony-stimulating factor. THP-1 cells were stimulated with LPS (1 microgram/ml) of P. gingivalis or F. nucleatum for different time periods (1, 2, 4 and 7 d). Detection of different activation antigens on THP-1 cells was performed by indirect immunohistochemical staining followed by light microscopy. Confirmational studies were performed in parallel using indirect immunofluorescence and immunogold electron microscopy for detection of the corresponding activation antigens. Expression of different activation antigens by resting THP-1 cells revealed HLA-DR to be on 3% of the cells; CD-11b, 9%; CD-11c, 8%; CD-14, 22%; CD-35, 9% and CD-68, 7%. The CD-71 activation antigen was not expressed in untreated THP-1 cells. LPS stimulation increased expression of all activation antigens. A significant (p < 0.05) increase in expression of CD-11b, CD-11c, CD-14, CD-35, CD-68 and CD-71 was observed when GM-CSF (50 IU/ml) was supplemented during the treatment of THP-1 cells with LPS of F. nucleatum or P. gingivalis. Activation and differentiation of THP-1 cells by LPS from oral microorganisms in the presence of GM-CSF supports a role for human macrophages in acute and chronic periodontal diseases and may explain the clinically observable periodontal exacerbations in some patients after GM-CSF therapy.

Antigens, CD↗

Requirement for intercellular adhesion molecule 1 and caveolae in invasion of human oral epithelial cells by Porphyromonas gingivalis.

Porphyromonas gingivalis, a periodontopathic bacterium, is known to invade oral epithelial cells in periodontal lesions, although the mechanism is unclear. In the present study, goat polyclonal anti-intercellular adhesion molecule 1 (anti-ICAM-1) antibody inhibited the invasion of P. gingivalis into KB cells (human oral epithelial cells). Further, the P. gingivalis fimbria, a pathogenic adhesion molecule, bound to recombinant human ICAM-1, as shown by enzyme-linked immunosorbent assay. P. gingivalis was also found to colocalize with ICAM-1 on KB cells, as seen with an immunofluorescence microscope, and the knockdown of ICAM-1 in KB cells resulted in the inhibition of P. gingivalis invasion by RNA interference. In addition, methyl-beta-cyclodextrin, a cholesterol-binding agent, inhibited the colocalization of P. gingivalis with ICAM-1 and invasion by the microorganism. The colocalization of caveolin-1, a caveolar marker protein, on KB cells with P. gingivalis was also shown, and the knockdown of caveolin-1 in KB cells caused a reduced level of P. gingivalis invasion. These results suggest that ICAM-1 and caveolae are required for the invasion of P. gingivalis into human oral epithelial cells, and these molecules appear to be associated with the primary stages of the development and progression of chronic periodontitis.

Animals↗

Adherence of skin bacteria to human epithelial cells.

Aerobic and anaerobic bacteria isolated from human axillae were tested for their capacity to adhere to buccal epithelial cells, immortalized human epithelial (HEp-2) cells, and undifferentiated and differentiated human epithelial cells. In general, both aerobic and anaerobic diphtheroids adhered better to differentiated human epithelial cells than to HEp-2 and undifferentiated human epithelial cells (P less than 0.05). Mannose, galactose, fucose, N-acetyl-D-glucosamine, and fibronectin were also assayed for their capacity to inhibit the adherence of diphtheroids to human epithelial cells. A great deal of variability was observed in the capacity of the latter compounds to inhibit the attachment of aerobic diphtheroids to undifferentiated and differentiated epithelial cells. Overall, mannose appeared to be best at inhibiting the adherence of the aerobic diphtheroids to undifferentiated human epithelial cells. Galactose, fucose, N-acetyl-D-glucosamine, and fibronectin showed a greater capacity to inhibit attachment of aerobic diphtheroids to differentiated than to undifferentiated human epithelial cells. The inhibition of adherence to differentiated human epithelial cells varied with the microorganism and the compound tested; however, the highest and most consistent inhibition of adherence (76.1 to 88.6%) was observed with a 5% solution of N-acetyl-D-glucosamine. The in vitro adherence and adherence inhibition assays presented here demonstrate that a number of adhesins and receptors are involved in the adherence of skin bacteria to human epithelial cells and receptors on human epithelial cells are apparently altered during differentiation.

Bacteria, Aerobic↗

Fibrinogenolytic and fibrinolytic activity in oral microorganisms.

Samples were taken from blood accumulated in dental alveoli after surgical removal of mandibular third molars, from subgingival plaque of teeth with advanced periodontal destructions, from teeth with infected necrotic pulps, and from subjects suffering from angular cheilitis. Of the microorganisms subcultured from these samples, 116 strains were assayed for enzymes degrading fibrinogen and fibrin. Enzymes degrading fibrinogen were assayed with the thin-layer enzyme assay cultivation technique. This assay involves the cultivation of microorganisms on culture agars applied over fibrinogen-coated polystyrene surfaces. Enzymes degrading fibrin were assayed with both a plate assay and a tube assay, in which fibrin was mixed with a microbial culture medium. Microorganisms degrading fibrinogen or fibrin or both were isolated from all sampling sites. Activity was mainly detected in strains of Actinomyces, Bacteroides, Fusobacterium, Peptococcus, Propionibacterium, and Staphylococcus aureus. Most Fusobacterium strains degraded fibrinogen only. Enzymes degrading fibrinogen as well as enzymes degrading fibrin via activation of plasminogen were revealed in strains of Clostridium, S. aureus, and Streptococcus pyogenes. It was generally found that fibrinogen was degraded by more strains than was fibrin, which indicates that different proteases may be involved.

Bacteria↗

[The distribution and prevalence of Haemophilus actinomycetemcomitans in the oral cavity].

The prevalence and distribution of Haemophilus actinomycetemcomitans (H.a.) were studied in 3292 specimens of subgingival plaque on the four subgingival aspects of all teeth of the dental arch, 150 specimens from the mucosal surface (tongue and cheek) and 30 saliva specimens in 30 subjects. The sample population of 30 subjects was subdivided into three groups: 10 normal subjects, 10 subjects with localised juvenile periodontitis (SLJP) and 10 subjects with adult chronic periodontitis (SACP). The prevalences of H.a. in subgingival areas of each group mentioned were 30%, 90% and 60% respectively. Scores for prevalence obtained with other types of specimens proved to be lower except for saliva specimens which appear to be a less representative marker of subgingival prevalence of H.a.. Histograms for the distribution of H.a. revealed a predominance of this microorganism on the proximal surface of molar teeth in the three groups of patients. Only the SLJP also exhibited a high prevalence on the proximal aspect of the incisor teeth. The wide distribution of H.a. in all of the clinical groups studied suggests that this bacterium is not a good marker of periodontal disease and that it is necessary to define the most characteristic phenotypes and genotypes.

Actinobacillus Infections↗

Aanerobic isolates in hemovac lines.

Seventeen of 68 patients (25 percent) who required the use of hemovac drainage system after major head and neck procedures had positive anaerobic islates. Co-isolation of aerobic (94 percent) and other anaerobic (29 percent) microorganisms are common. There was an increased rate of psoitive anaerobic islates with procedures requiring exposure of mucosa. Radiotherapy, except in doses greater than 6,800 rads, did not affect the culture rate. Eight of 17 patients (47 percent) with positive anaerobic isolates had infectious-related complications while five of 51 patients (10 percent) with negative cultures had similar complications. Positive anaerobic isolates in hemovac lines can be correlated with pathogens isolated from subsequent complications.

Adult↗

Influence of oral hygiene on the mucosal conditions beneath bridge pontics.

The purpose of the present study was to elucidate the relationship between the oral hygiene at the bridge pontic and the inflammatory changes in the adjacent mucosa. The study consisted of three 4-wk periods with different hygienic measures: 1) no oral hygiene around and beneath the pontic, 2) thorough hygiene using toothbrush and toothpicks and 3) thorough hygiene using a toothbrush and dental floss every day. The amount of accumulated bacterial deposits on the pontic and the inflammation in the pontic area were estimated using quantitative microbiologic tests, and clinical and histologic examinations. When dental floss had been used the mucosa was healthy while it showed mild or moderate inflammation after the other experimental periods. There was a high correlation between the amount of mucosal exudate and the inflammation in the mucosa as measured by a modified Gingival Index. Daily use of dental floss resulted in a significantly lower number of microorganisms per mm2 compared with the other hygienic measures. Histologic sections of the biopsies showed changes in form of parakeratosis with thinning or loss of stratum corneum. The investigations have demonstrated that insufficient oral hygiene is an important factor in the development of inflammatory changes in the oral mucosa beneath bridge pontics. Regular use of dental floss ought to be a part of the oral hygiene regimen in patients wearing fixed bridges.

Adult↗

[The nonspecific resistance of the oral cavity in preschool children during the prevention of dental caries with fluoridated salt].

Nonspecific resistance of the oral cavity was studied from microorganism adsorption in children using fluorinated table salt for the prevention of dental caries. Epitheliocytes with a high adsorption capacity were detected in smears from preschool children using fluorinated salt for 2 and 3 years 1.5 and 1.6 times more often, respectively, than in those using common salt. Nonspecific resistance of the oral cavity of preschool children whose ration included fluorinated salt for 2 and 3 years was considered good in 95.1 +/- 2.15% and 100% of cases, respectively, as against 62.57 +/- 7.67% in children not included in the prophylactic program.

Child, Preschool↗

Salivary defense factors and oral health in patients with common variable immunodeficiency.

Studies of oral health in patients with common variable immunodeficiency have given controversial results. Obviously, one major factor modifying the oral health of these patients is saliva, in which the antibody-mediated defense is remarkably impaired compared to that of healthy subjects. However, the occurrence of nonimmunoglobulin (innate) antimicrobial agents in saliva of these patients is virtually unknown. Therefore, we analyzed both immune (total IgA, IgG, IgM, anti-Streptococcus mutans IgA, IgG, and IgM antibodies) and nonimmune (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate, and agglutinins) factors in whole saliva of 15 patients with common variable immunodeficiency. All patients were on Ig-replacement therapy (median duration, 10 years; range, 2-25 years), which had normalized their IgG but not their IgA or IgM levels both in serum and in saliva. Also, comprehensive clinical and microbiological analyses were made. The control group comprised 15 age- and sex-matched immunologically healthy subjects. The results showed no notable differences in dental caries, periodontal diseases, or salivary microorganisms but the patients had a history of more frequent oral mucosal lesions and respiratory infections. All innate, nonimmune salivary defense factors were equally abundant in the patients as in the controls, in many cases even at somewhat higher concentrations. These findings suggest that in spite of immunodeficiency, patients with common variable immunodeficiency display normal, perhaps even slightly elevated, levels of nonimmunoglobulin defense factors in whole saliva.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Molecular cloning of foot and mouth disease virus genome and nucleotide sequences in the structural protein genes.

Foot and mouth disease virus (FMDV), of the family Picornaviridae, consists of a single-stranded RNA (approximately 8,000 nucleotides), the translation of which is initiated on the 3' side of a 150-nucleotide poly(C) tract and yields a single polyprotein which is processed by host cell proteases into four primary products (Fig. 1). One or more virus-specified proteases further cleave these into the final products, the capsid proteins (VP1-4) being derived from the precursor p88 (for review see ref. 5). There are seven serotypes of the virus and as it has been shown that the immunizing activity of FMDV particles is associated primarily with VP1 (refs 6, 7), it seems likely that antigenic variation in FMDV is a result of changes in the structure of this protein. To further our understanding of this variation and as a first step in the possible development of FMDV vaccines from genetically manipulated microorganisms, we report here the construction and analysis of recombinant plasmids containing cDNA copies of the RNA. Comparison of the deduced amino acid sequence with the known polypeptide sequences shows that the NH2-termini of VP2 and VP3 are conserved between the A and O serotypes whereas that of VP1 (the immunizing antigen) varies by as much as 42% between serotypes.

Amino Acid Sequence↗