Idiopathic thrombocytopenic purpura presenting as post-extraction hemorrhage.

J Contemp Dent Pract. 2007;8(6):43-9

Authors: Martini MZ, Lopez JS, Gendler JL, da Fonseca EV, Soares HA, Franzi SA

AIM: The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. BACKGROUND: Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. REPORT: A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. SUMMARY: The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP.

PMID: 17846670 [PubMed - indexed for MEDLINE]

Severe hemorrhage during an incisional biopsy: a report of a case.

J Contemp Dent Pract. 2007;8(3):97-103

Authors: Cheng CK, Gaia BF, de Oliveira Neto HG, Martini MZ, Aburad A, Shinohara EH

BACKGROUND: Surgical procedures under local anesthesia are routinely employed by the dentist and are susceptible to significant complications which demand immediate care from the dental professional. REPORT: This report presents a case of severe arterial hemorrhage during a simple removal of a lesion during an incisional biopsy. SUMMARY: In the event of severe arterial hemorrhage in a conventional dental office, manual compression for containing the hemorrhage and use of an adequate light source to correctly visualize the origin of the bleeding is recommended. If visible, the dental surgeon must attempt to perform vascular ligature or an occlusive suture. If the hemorrhage cannot be controlled after these measures, the patient must be transported to a hospital while continuing local compression during transit.

PMID: 17351687 [PubMed - indexed for MEDLINE]

Oral surgery with fibrin sealants in patients with bleeding disorders: a case report.

J Contemp Dent Pract. 2006 Jul 1;7(3):106-12

Authors: Filho Ade M, dos Santos RS, Costa JR, Puppin AA, de Rezende RA, Beltrão GC

Surgical treatment of patients with bleeding disorders requires careful planning. The use of fibrin sealants following a dental extraction in a patient with von Willebrand's disease is presented in this report. A female patient with von Willebrand's disease had an extraction of a maxillary right third molar. After evaluation by the surgeon and the hematologist, the surgery was performed with a topical application of fibrin sealant and systemic administration of antifibrinolytic drugs. Hemostasis was obtained without replacement of plasma clotting factor. New techniques of achieving hemostasis in patients with bleeding disorders using fibrin sealants have been successfully used in oral surgery without replacement of plasma clotting factors or changes in anticoagulant therapy.

PMID: 16820814 [PubMed - indexed for MEDLINE]

Anesthetic management of a patient with Sturge-Weber syndrome undergoing oral surgery.

Anesth Prog. 2006;53(1):17-9

Authors: Yamashiro M, Furuya H

This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with Sturge-Weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. Periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. Deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. Periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. Gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. Periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site.

PMID: 16722280 [PubMed - indexed for MEDLINE]

Hereditary blood coagulation disorders: management and dental treatment.

J Dent Res. 2005 Nov;84(11):978-85

Authors: Gómez-Moreno G, Cutando-Soriano A, Arana C, Scully C

Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.

PMID: 16246926 [PubMed - indexed for MEDLINE]

For the dental patient. How medications can affect your oral health.

J Am Dent Assoc. 2005 Jun;136(6):831

Authors:

PMID: 16022050 [PubMed - indexed for MEDLINE]

Maxillofacial Fractures and Dental Trauma in a High School Soccer Goalkeeper: A Case Report.

J Athl Train. 2005 Jun;40(2):116-119

Authors: Mihalik JP, Myers JB, Sell TC, Anish EJ

Objective: To present the case of a 17-year-old male soccer goalkeeper who sustained maxillofacial fractures and dental trauma after being struck in the face by an opponent's knee.Background: Because of the nature of the sport and a lack of protective headgear, soccer players are at risk for sustaining maxillofacial trauma. Facial injuries can complicate the routine management of on-field medical emergencies often encountered by certified athletic trainers. The appropriate management of maxillofacial trauma on the playing field may help to reduce both the immediate and long-term morbidity and mortality associated with these injuries.Differential Diagnosis: Lacerated superior labial artery, lacerated upper lip, dental fractures, maxillofacial fractures, orbital blowout fracture, closed head injury, cervical spine injury, cerebrovascular accident.Treatment: The athlete received immediate on-field medical care and was subsequently transported to the hospital, where diagnostic testing was performed and further treatment was provided. Hospital inpatient management included dental and plastic surgery. After discharge from the hospital, the athlete underwent several additional dental procedures, including gingival surgery and nonsurgical endodontic treatments. The fractures were followed closely to assure that adequate healing had occurred. The athlete did not return to soccer.Uniqueness: Certified athletic trainers need to be prepared for on-field medical emergencies. Bleeding associated with maxillofacial trauma can complicate basic medical interventions such as airway maintenance. Inappropriate on-field management may result in unnecessary morbidity and mortality for the injured athlete. Therefore, immediate recognition of the severity of the injury is needed in order to institute appropriate airway-management strategies.Conclusions: It is sometimes necessary to consider nonstandard methods of airway management in order to first address heavy bleeding that may be associated with facial trauma. Achieving hemostasis is essential in order to prevent potentially life-threatening complications related to hemorrhage, such as airway obstruction and hypovolemic shock.

PMID: 15970958 [PubMed - as supplied by publisher]

Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis.

Med J Aust. 2004 Nov 1;181(9):492-7

Authors: Baker RI, Coughlin PB, Gallus AS, Harper PL, Salem HH, Wood EM,

For most warfarin indications, the target maintenance international normalised ratio (INR) is 2-3. Risk factors for bleeding complications with warfarin use include age, history of past bleeding and specific comorbid conditions. To reverse the effects of warfarin, vitamin K(1) can be given. Immediate reversal is achieved with a prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP). Vitamin K(1) is essential for sustaining the reversal achieved by PCC and FFP. When oral vitamin K(1) is used for warfarin reversal, the injectable formulation of vitamin K(1) is preferable to tablets because of its flexible dosing; this formulation can be given orally or injected. To temporarily reverse the effect of warfarin when there is a need to continue warfarin therapy, vitamin K(1) should be given in a dose that will quickly lower the INR to a safe, but not subtherapeutic, range and will not cause resistance once warfarin is reinstated. Prothrombinex-HT is the only PCC approved in Australia and New Zealand for warfarin reversal. It contains factors II, IX and X, and low levels of factor VII. FFP should be added to Prothrombinex-HT as a source of factor VII when used for warfarin reversal. Simple dental or dermatological procedures may not require interruption to warfarin therapy. If necessary, warfarin therapy can be withheld 5 days before elective surgery, when the INR usually falls to below 1.5 and surgery can be conducted safely. Bridging anticoagulation therapy for patients at high risk for thromboembolism should be undertaken in consultation with the relevant experts.

PMID: 15516194 [PubMed - indexed for MEDLINE]

Acute obstruction of an endotracheal tube: a case report.

Anesth Prog. 2004;51(2):62-4

Authors: Park C, Kim H, Yum K

This report describes a case of sudden ventilatory failure, originally diagnosed as bronchospasm, in a child during general anesthesia. A blood clot impaction in the nasotracheal tube was detected using flexible fiberoptic bronchoscopy. The clot was successfully treated as a result of its passage. We hope this report will stress to dental anesthesiologists the intraoperative importance of fiberoptic bronchoscopy not only as an intubation-aiding device but also as a diagnostic and therapeutic tool.

PMID: 15366320 [PubMed - indexed for MEDLINE]

Coagulation derangements in oral and maxillofacial surgery in patients with a documented cancer: a follow-up study after surgery.

J Dent Res. 2003 Nov;82(11):864-5

Authors: Borriello C, Colella G, De Lucia D, Molinari AM, De Francesco F

PMID: 14578495 [PubMed - indexed for MEDLINE]

Herbal nutriceuticals: a primer for dentists and dental hygienists.

J Contemp Dent Pract. 2001 May 15;2(2):1-24

Authors: Meredith MJ

Herbs have been in use for centuries to prevent and control disease. In recent history demand by the public for herbal supplements has created a multimillion-dollar industry. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. A matter for public concern is that herbal supplements are currently independent of regulation by the Federal Drug Administration (FDA). The FDA considers herbal products to be dietary supplements, not drugs. The National Toxicology Program has recently started to examine the composition and standardization of commercial preparations to identify potential health hazards from contaminants or product over use. Many herbal preparations have significant pharmacological effects. The problem that arises for the dental professional is the effect these products have in concert with prescription medications as well as effects on the patient's general response to medication and dental treatment. Drug interactions with the large number of commercially available herbal products can be grouped by the mechanism of most common interactions. These major types of reactions are: (1) alteration of drug metabolizing enzyme activity, (2) interactions with the blood clotting process, and (3) alteration of the inflammatory and immune response. The widespread use of herbal supplements makes it essential that healthcare providers become informed about this aspect of a patient's personal health practices.

PMID: 12167930 [PubMed - indexed for MEDLINE]

Does low-dose aspirin therapy complicate oral surgical procedures?

J Am Dent Assoc. 2000 Mar;131(3):331-5

Authors: Ardekian L, Gaspar R, Peled M, Brener B, Laufer D

BACKGROUND: The fear of uncontrolled bleeding often prompts medical practitioners to stop aspirin intake for seven to 10 days before any surgical procedure. The authors initiated this study to evaluate the effect of aspirin on bleeding in patients undergoing oral surgery. METHODS: The study group consisted of 39 patients who were scheduled to undergo dental extractions. All patients were receiving 100 milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test. In addition, the amount of bleeding during the procedure was measured. RESULTS: The mean (+/- standard deviation) bleeding time was 1.8 +/- 0.47 minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.1 +/- 0.65 minutes. The difference was statistically significant (P = .004). However, both groups were within the normal bleeding time range, and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intraoperative or postoperative bleeding were noted. CONCLUSION: Low-dose aspirin therapy should not be stopped before oral surgery. Local hemostasis is sufficient to control bleeding. CLINICAL IMPLICATIONS: Patients receiving aspirin therapy to prevent blood clot formation may be subject to emboli formation if the treatment is stopped. The results of this study show that aspirin therapy should be continued throughout oral surgical procedures. Local measures are sufficient to control any bleeding during surgery.

PMID: 10715924 [PubMed - indexed for MEDLINE]

Effect of beta-adrenoreceptor blockade with nadolol on the duration of local anesthesia.

J Am Dent Assoc. 1999 Dec;130(12):1773-80

Authors: Zhang C, Banting DW, Gelb AW, Hamilton JT

BACKGROUND: beta-adrenoreceptor blockers, or beta-blockers, are drugs commonly prescribed for hypertension, angina and migraine headaches. In a patient taking beta-blocker medication, administration of a local anesthetic containing a vasoconstrictor could result in an adverse interaction. METHODS: The authors conducted a double-blind, randomized, crossover, placebo-controlled study to test the hypothesis that a nonselective beta-blocker--nadolol--enhances vasoconstriction induced by the epinephrine contained in local anesthetic, thus resulting in an increased duration of anesthesia. Ten healthy male volunteers were given either a placebo or a single, standard oral dose of nadolol (80 milligrams). The upper lateral incisor teeth were anesthetized using lidocaine with or without epinephrine. RESULTS: The mean duration of pulpal and soft-tissue anesthesia was increased in subjects who took nadolol compared with those who took placebo by 17 minutes (58 percent) and 16.5 minutes (19 percent), respectively, when they received 1 milliliter of lidocaine containing 1:100,000 epinephrine. These differences were both clinically and statistically significant (P = .007). Using lidocaine without epinephrine produced no clinically or statistically significant difference in duration of pulpal or soft-tissue anesthesia in the two groups of subjects. The authors noted no significant changes in blood pressure or pulse rate. CONCLUSIONS: Administration of local anesthetic containing epinephrine to subjects receiving a beta-blocker increased the duration of pulpal and soft-tissue anesthesia. There was no difference in duration of anesthesia between groups when local anesthetic without epinephrine was used. CLINICAL IMPLICATIONS: Use of local anesthetic containing a vasoconstrictor should be avoided in patients taking beta-blocker medication because of a possible adverse drug interaction. However, when a vasoconstrictor is indicated for hemostasis, the local anesthetic should be administered slowly and in small amounts as pulse rate and blood pressure are being monitored. The patient should be informed that the duration of anesthesia might be prolonged.

PMID: 10599182 [PubMed - indexed for MEDLINE]

Rheumatoid arthritis: a review and suggested dental care considerations.

J Am Dent Assoc. 1999 May;130(5):689-98

Authors: Treister N, Glick M

BACKGROUND: Rheumatoid arthritis, or RA, is a chronic multisystem disease of presumed autoimmune etiology. It is estimated that arthritis and other rheumatic conditions affect 42.7 million Americans. Medical complications due to RA and its treatment may affect the provision of oral health care. METHODS: The authors undertook an extensive review of the English literature relating to RA and dental care. They used primarily MEDLINE searches, which included such key words as "rheumatoid arthritis" and "dental care" and subsequent appropriate subheadings. While the MEDLINE search spanned the years from 1975 to the present, the most recent literature was prioritized. Appropriate medical and dental textbooks were also used. The authors extrapolated information from selected texts based on its relevance to dentistry, oral health and the role of the dental provider in the overall treatment of RA patients. RESULTS: The authors reviewed nearly 200 articles and seven textbooks. Their determination of the texts' relevance to oral health care was based on content, significance, quality, journal in which articles were published and year of publication. Major features of RA--including its diagnosis, pathophysiology, clinical features and medical treatment--were identified, as well as complications due to treatment modalities and various related oral manifestations and conditions. CONCLUSIONS: Medical complications due to RA and its treatment can affect oral health care. Oral health care providers need to recognize and identify modifications of dental care based on the medical status of patients with RA. Furthermore, oral health care providers play an important role in the overall care of these patients as it release to early recognition, as well as control of the disease. CLINICAL IMPLICATIONS: In most patients with RA, the condition will necessitate few or no changes in routine dental care. However, considerations include the patient's ability to maintain adequate oral hygiene, xerostomia and its related complications, the patient's susceptibility to infections, impaired hemostasis, and untoward drug actions and interactions. Patients with RA may require antibiotic prophylaxis owing to joint replacement and/or immune suppression, glucocorticosteroid replacement therapy and modifications in oral hygiene procedures. Intra- and extraoral conditions such as ulcerations, gingival overgrowth, disease-associated periodontitis and temporomandibular pathology also need to be recognized.

PMID: 10332134 [PubMed - indexed for MEDLINE]

Eleven myths of dentoalveolar surgery.

J Am Dent Assoc. 1998 Sep;129(9):1271-9

Authors: Alexander RE

Through the years, dentists who perform dentoalveolar surgery have perpetuated many myths and other unproven beliefs from one generation to another. Sometimes, these beliefs originated in older textbooks, while others were given birth by mentors sharing anecdotal experiences with their students. Even today, many of these scientifically unsupported statements are perpetuated in surgical textbooks and in continuing education forums and are passed on to students in dental schools. In today's evolving environment of evidence-based medicine and dentistry, these anecdotal observations do not withstand scrutiny. The purpose of this article is to review the more common surgical myths and to test their validity against scientific evidence.

PMID: 9766108 [PubMed - indexed for MEDLINE]

Pilot study on the safety and efficacy of desmopressin for the treatment or prevention of bleeding in patients with hematologic malignancies.

Haematologica. 1997 Sep-Oct;82(5):584-7

Authors: Castaman G, Bona ED, Schiavotto C, Trentin L, D'Emilio A, Rodeghiero F

BACKGROUND AND OBJECTIVES: Desmopressin is the treatment of choice for patients with von Willebrand's disease and mild hemophilia A. This compound is also useful in other congenital and acquired disorders of hemostasis, reducing the need for blood derivatives with the inherent risks of infections and alloimmunization. The following article presents a pilot study on the safety and efficacy of desmopressin for the treatment or prevention of bleeding in 15 patients with thrombocytopenia associated with hematologic malignancies. METHODS: Cases were consecutively recruited from February to June 1995. Fifteen patients were treated with desmopressin for prevention or treatment of bleeding. Desmopressin was diluted in 100 mL of isotonic saline and infused for 30 minutes. Bleeding time (BT) was carried out using the Simplate II device, making two standardized incisions on the forearm: the mean between the two incisions was recorded. RESULTS: Significant reduction of BT was observed in three out of four patients with myelodysplastic syndrome who were successfully treated for active bleeding or dental extraction. In the remaining patients, the effect of desmopressin on BT was not tested. Nevertheless, in all of them bleeding mainly due to epistaxis or persistent gum oozing was stopped by a single infusion of desmopressin. In three patients, desmopressin infusion had been successfully administered on a different occasion. No side effects were observed. INTERPRETATION AND CONCLUSIONS: Desmopressin could be a safe and immediately effective option for the treatment or prevention of bleeding in selected patients with hematologic malignancies.

PMID: 9407726 [PubMed - indexed for MEDLINE]

Using the international normalized ratio to standardize prothrombin time.

J Am Dent Assoc. 1997 Aug;128(8):1121-2

Authors: Stern R, Karlis V, Kinney L, Glickman R

The international normalized ratio, or INR, was introduced in 1983 by the World Health Organization, or WHO, Committee on Biological Standards to more accurately assess patients receiving anticoagulation therapy. The INR mandates the universal standardization of prothrombin time. This article describes the method used to calculate INR, as well as its clinical relevance to the practice of dentistry.

PMID: 9260421 [PubMed - indexed for MEDLINE]

Medical considerations for dental care of patients with alcohol-related liver disease.

J Am Dent Assoc. 1997 Jan;128(1):61-70

Authors: Glick M

More than 7 percent of all adults in the United States have met diagnostic criteria for alcohol abuse and alcohol dependence. Many of these people and even occasional users of alcohol may exhibit medical complexities, particularly liver disease, that can adversely affect provision of routine dental care. This article highlights some of the important clinical topics associated with alcoholic liver disease as it relates to dental care and provides guidelines on treatment of affected people.

PMID: 9002403 [PubMed - indexed for MEDLINE]

FimA, a major virulence factor associated with Streptococcus parasanguis endocarditis.

Infect Immun. 1995 Dec;63(12):4669-74

Authors: Burnette-Curley D, Wells V, Viscount H, Munro CL, Fenno JC, Fives-Taylor P, Macrina FL

Adherence of microorganisms to damaged heart tissue is a crucial event in the pathogenesis of infective endocarditis. In the present study, we investigated the role of the FimA protein as a potential virulence factor associated with Streptococcus parasanguis endocarditis. FimA is a 36-kDa surface protein that is a recognized adhesin in the oral cavity where it mediates adherence to the salivary pellicle. An insertion mutant and a deletion mutant of S. parasanguis were employed in the rat model of endocarditis to determine the relevance of FimA in endocarditis pathogenesis. Catheterized rats were infected with either the fimA deletion mutant VT929, the fimA insertion mutant VT930, or the isogenic, wild-type S. parasanguis FW213. Rats inoculated with FW213 developed endocarditis more frequently (50.9%) than animals inoculated with either the deletion mutant (2.7%) or the insertion mutant (7.6%) (P < 0.001). A series of in vitro assays were performed to explore the mechanism(s) by which FimA enhanced the infectivity of S. parasanguis. FimA did not inhibit the uptake or the subsequent killing of S. parasanguis by phagocytic granulocytes. Similarly, FimA did not play a role in the adherence to or the aggregation of platelets. Significant differences were noted between FW213 and VT929 (P < 0.05) and FW213 and VT930 (P < 0.001) in their abilities to bind to fibrin monolayers. The mean percent adherence of FW213 to fibrin monolayers (2.1%) was greater than those of VT929 (0.5%) and VT930 (0.12%). Taken together, these results indicate that FimA is a major virulence determinant associated with S. parasanguis endocarditis and further suggest that its role is associated with initial colonization of damaged heart tissue.

PMID: 7591121 [PubMed - indexed for MEDLINE]

Phenotypic characterization of Streptococcus sanguis virulence factors associated with bacterial endocarditis.

Infect Immun. 1990 Feb;58(2):515-22

Authors: Herzberg MC, Gong K, MacFarlane GD, Erickson PR, Soberay AH, Krebsbach PH, Manjula G, Schilling K, Bowen WH

Certain strains of Streptococcus sanguis adhere (Adh+) selectively to human platelets and, in plasma, induce them to aggregate (Agg+) into in vitro thrombi. In this study, we examined 18 recent endocarditis and dental plaque isolates of microorganisms that were biotyped as S. sanguis for coexpression of platelet interactivity phenotypes with another possible virulence factor in bacterial endocarditis, dextran synthesis. Detectable production of extracellular glucosyltransferase ranged from 0.2 to 66 mU/mg of culture fluid for 10 representative strains tested. Production of extracellular or cell-associated glucosyltransferase, fructosyltransferase, and soluble or insoluble dextrans was not necessarily coexpressed with platelet interactivity phenotypes, since the levels of production of soluble and insoluble dextrans varied among representative Adh+ Agg+ and Adh- Agg- strains. Analysis of a second panel of 38 fresh dental plaque isolates showed that S. sanguis distributes in a reproducible manner into the possible phenotype groups. Strains with different platelet interactivity phenotypes were distinguished with a panel of four murine monoclonal antibodies (MAbs) raised against Adh+ Agg+ strain 133-79 and screened to rule out artifactual reactions with antigenic components in culture media. The MAbs reacted selectively with Adh+ Agg+ strains in a direct-binding, whole-cell, enzyme-linked immunosorbent assay and also inhibited their interactions with platelets. Analysis of minimal tryptic digests of many strains, including variants that failed to bind the MAbs, suggested that some noninteractivity phenotypes possess cryptic surface determinants. Since the ability to adhere to platelets and induce them to aggregate is relatively stable, these traits may be useful in a phenotyping scheme for these Lancefield nontypeable streptococci.

PMID: 2137112 [PubMed - indexed for MEDLINE]

Hard tissue barrier formation in pulpotomized monkey teeth capped with cyanoacrylate or calcium hydroxide for 10 and 60 minutes.

J Dent Res. 1987 Jun;66(6):1166-74

Authors: Cvek M, Granath L, Cleaton-Jones P, Austin J

Monkey incisor teeth were pulpotomized in groups of 10. After physiological hemostasis, the pulps of group I were covered with isobutyl cyanoacrylate, and those of groups II and III with calcium hydroxide for 10 and 60 minutes, respectively, whereafter this compound was washed away and the wound surfaces covered with Teflon. In group IV, calcium hydroxide was used as a positive control, and Teflon as a negative control in group V. The animals were killed after 12 weeks and the teeth removed in tissue blocks. The material was processed and evaluated histologically with respect to location and continuity of a hard tissue barrier, type of newly formed hard tissue, state of the pulp, and presence of stainable bacteria in the coronal cavity. Seven of nine teeth in group I showed a hard tissue barrier. The corresponding figure for group II was eight out of 10 teeth. All teeth in groups III and IV had a barrier. The incidence of a continuous barrier increased from group I through group IV, as did the incidence of its location below the level of the original wound surface. The condition of the pulp was related to the presence of bacteria and the continuity of the barrier to the presence of inflammation. There was no bridging in group V. The results support the theory that a low-grade irritation is responsible for the formation of a hard tissue barrier in exposed pulps.

PMID: 3476588 [PubMed - indexed for MEDLINE]

Fibrinogenolytic and fibrinolytic activity in oral microorganisms.

J Clin Microbiol. 1983 May;17(5):759-67

Authors: Wikstr&#xF6;m MB, Dahlén G, Linde A

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.

PMID: 6345573 [PubMed - indexed for MEDLINE]

Potential hazards and artifacts of ferromagnetic and nonferromagnetic surgical and dental materials and devices in nuclear magnetic resonance imaging.

Radiology. 1983 Apr;147(1):139-48

Authors: New PF, Rosen BR, Brady TJ, Buonanno FS, Kistler JP, Burt CT, Hinshaw WS, Newhouse JH, Pohost GM, Taveras JM

The risks to patients with metal surgical implants who are undergoing nuclear magnetic resonance (NMR) imaging and the artifacts caused by such implants were studied. Twenty-one aneurysm and other hemostatic clips and a variety of other materials (e.g., dental amalgam, 14 karat gold) were used. Longitudinal forces and torques were found to be exerted upon 16 of the 21 clips. With five aneurysm clips, forces and torques sufficient to produce risk of hemorrhage from dislocation of the clip from the vessel or aneurysm, or cerebral injury by clip displacement without dislodgement were identified. The induced ferromagnetism was shown to be related to the composition of the alloys from which the clips were manufactured. Clips with 10-14% nickel are evidently without sufficient induced ferromagnetism to cause hazard. The extent of NMR imaging artifacts was greater for materials with measurable ferromagnetic properties, but metals without measurable ferromagnetism in our tests also resulted in significant artifacts. Dental amalgam and 14 karat gold produced no imaging artifacts, but stainless steels in dentures and orthodontic braces produced extensive artifacts in the facial region.

PMID: 6828719 [PubMed - indexed for MEDLINE]

A new life-long hemorrhagic disorder due to excess plasminogen activator.

Blood. 1983 Feb;61(2):267-75

Authors: Booth NA, Bennett B, Wijngaards G, Grieve JH

A life-long bleeding disorder is described, characterized by hemorrhage occurring after surgery, injury, or dental extraction, and finally by spontaneous intracerebral bleeding. No abnormality of platelet function or plasma coagulation was demonstrable, but grossly enhanced overall fibrinolytic activity was present. The patient had, additionally, a hyperlipidemia with gross arterial atheroma and a family history of myocardial infarction but not of any hemorrhagic disorder. Laboratory studies led to the conclusion that the enhanced fibrinolysis was due to consistently greatly raised levels of a plasma plasminogen activator physically and immunologically related to that in human tissues and blood vessel endothelium. No deficiency of any known inhibitor of fibrinolysis was detected. Free plasmin was not detectable in functional assays but continuous intravascular plasmin generation clearly occurred as evidenced by presence of plasmin-alpha 2-antiplasmin complexes and of fibrin/fibrinogen-related antigens. Excessive production of plasminogen activator appeared to have occurred throughout life and to be independent of the hyperlipidemia. The pathologically increased fibrinolytic activity may have accounted for the complete absence of detectable thrombotic vascular occlusion at autopsy despite extensive arterial disease with severe narrowing of coronary and cerebral arteries.

PMID: 6681588 [PubMed - indexed for MEDLINE]

Human pulp capping with isobutyl cyanoacrylate.

J Dent Res. 1972 Jan-Feb;51(1):58-61

Authors: Bhaskar SN, Beasley JD, Ward JP, Cutright DE

PMID: 4500435 [PubMed - indexed for MEDLINE]