Role of professional expertise in the decision-making process for periodontally compromised teeth.

The objective of this study was to evaluate factors that may influence decision-making with regard to extraction or maintenance of periodontally compromised teeth. A questionnaire with 2 distinct clinical scenarios, each including a radiographic image, was provided to students in their final year of dental school and practicing dentists. The participants were asked to record the action that they would take in each case (tooth maintenance vs extraction) and provide a justification for their decision. The questionnaires were answered by 158 dental students and 57 dentists (N = 215). Among the sample as a whole, 31.16% of participants recommended extraction in scenario 1, while only 5.58% recommended that action in scenario 2. In scenario 1, there was a statistically significant difference in the recommendations of the dental students and the dentists, with the former group significantly more disposed to conservative action, that is, maintenance of the tooth (P < 0.001; chi-square test). When the actions recommended by participants specializing in implants or periodontics (or both) were compared with those recommended by other specialists, there was a statistically significant difference between the groups regarding maintenance and extraction (P = 0.012; Fisher exact test), with the former group recommending fewer extractions. When the responses were evaluated in terms of the participants' years of specialty practice, it was observed that professionals with fewer than 20 years of practice were more conservative in their decisions, choosing tooth maintenance significantly more often than specialists with longer experience (P = 0.031; Fisher exact test). Among the majority of both dental students and practicing dentists, the decision in both scenarios was to maintain the compromised teeth; however, the results suggested that that both the years of experience of the individual and the specialty of the practitioner can influence decision-making.

Expression of Inflammatory Markers RANK, MMP-9 and PTHrP in Chronic Apical Periodontitis from People Living with HIV Undergoing Antiretroviral Therapy.

To compare the expression of the receptor activator of nuclear factor-kappa B (RANK), matrix metalloproteinase 9 (MMP-9) and parathyroid hormone-related protein (PTHrP) in primary chronic apical periodontitis lesions (CAPLs) between people living with HIV (PLWHIV) undergoing antiretroviral therapy (ART) and HIV- individuals, 32 CAPLs (16 lesions from each group) were submitted to histopathological and immunohistochemical analyses and compared between groups. The majority of the PLWHIV group had undetectable plasma viral loads (n = 13; 81.3%). The means of TCD4+ lymphocytes, exposure to HIV-1 and the time of the use of ART were 542.1 cells/mm3 (SD = 256.4), 6.3 years (SD = 2.9) and 5.0 years (SD = 2.5), respectively. Of all variables studied, only histopathological diagnosis showed a significant difference between groups (LWHIV: granuloma n = 11 (68.0%); cyst n = 5 (31.2%); HIV-: granuloma n = 15 (93.8%); cyst n = 1 (6.2%); p = 0.015). When comparing the expressions of the three inflammatory markers between the groups, no significant differences were seen. There was no difference in the expression of RANK, PTHrP and MMP-9 in primary chronic apical periodontitis lesions between PLWHIV under ART and HIV- individuals.

Staphylococcus hominis subspecies can be identified by SDS-PAGE or MALDI-TOF MS profiles.

Staphylococcus hominis is part of the normal human microbiome. Two subspecies, S. hominis hominis (Shh) and S. hominis novobiosepticus (Shn), have clinical significance. Forty-nine S. hominis isolates were analyzed by the MicroScan automated system, SDS-PAGE and MALDI-TOF methods, followed by partial sequencing of the 16S rDNA gene. The trehalose fermentation test, disk diffusion and broth microdilution tests were used to identify (novobiocin test) and access the susceptibility to oxacillin and vancomycin of isolates. The SCCmec elements and genomic diversity were evaluated by PCR and PFGE methods, respectively. Profiles of 28 (57%; 8 Shh and 20 Shn) isolates corroborated with the results found in all the applied methods of identification. The remaining 21 (43%) isolates were phenotypically identified as Shh by MicroScan; however, they were identified as Shn by SDS-PAGE and mass spectral, and confirmed by 16S rDNA sequencing. Among 41 isolates identified as Shn by the molecular and mass spectrometry methods, 19 (41%) were novobiocin-sensitive, and the trehalose test indicated 11 positive isolates, which are considered atypical phenotypic results for this subspecies. In addition, 92.7% of the isolates identified as Shn by these methods carried mecA gene, while only 12.5% of the Shh isolates were positive. Together, the results highlighted the SDS-PAGE and MALDI-TOF MS methods as promising tools for discriminating S. hominis subspecies.

Molecular Markers of Antimicrobial Resistance in Methicillin-Resistant Staphylococcus aureus SCCmec IV Presenting Different Genetic Backgrounds.

Methicillin-resistant Staphylococcus aureus (MRSA) carrying SCCmec type IV has emerged in hospitals worldwide. The aim of this study was to evaluate phenotypic and molecular characteristics of antimicrobial resistance in MRSA SCCmec IV isolates, presenting different genetic backgrounds, isolated from hospitals in Rio de Janeiro. The antimicrobial resistance of 128 S. aureus type IV isolates from 11 hospitals was characterized by the disk diffusion test and minimum inhibitory concentration (MIC) test. Mutations in parC gene, which encodes ciprofloxacin resistance, and genes associated with macrolide-lincosamide-streptogramin B (MLSb) resistance were also investigated. MRSA isolates belonging to USA400/ST1 (60 isolates), USA800/ST5 (40), USA1100/ST30 (13), and other 11 (15) lineages were mainly resistant to erythromycin (68%), ciprofloxacin (56%), and clindamycin (50%). The highest antimicrobial resistance rates were found among USA400 isolates (p < 0.05). The majority of them (90%) carried only the erm(C) gene and mainly presented two mutation types in the parC gene. The msr(A) gene was most frequently found among USA800 isolates (p < 0.05). Among MRSA type IV isolates from Rio de Janeiro hospitals, multiresistance, including mutations in parC gene, was associated to the USA400/ST1, while the msr(A) gene was associated with USA800/ST5 isolates, highlighting that these lineages could have more potential to persist in a hospital environment.

Detection of human papillomavirus in dental biofilm and the uterine cervix of a pregnant adolescent / Detecção do papilomavírus humano em biofilme dental e no colo uterino de uma adolescente grávida

CONTEXT: Adolescence and pregnancy are considered to be risk factors for human papillomavirus (HPV) infection. The relationship between this infection in the uterine cervix and oral HPV infection is controversial. CASE REPORT: This report describes a case of a pregnant 16-year-old adolescent who presented HPV infection in the uterine cervix and the mouth. Smears were collected from the cervix and the tongue/palate. Dental biofilm samples were also collected. The microarray technique was used to detect HPV. The HPV 56 subtype was observed in the cervical smear and HPV 6 in dental biofilm. CONCLUSION: In this pregnant adolescent, HPV infection was present in both the cervix and the mouth, but the HPV subtypes infecting these two areas were different.

CONTEXTO: A adolescência e a gestação são consideradas fatores de risco para a infecção pelo papilomavírus humano (HPV). A relação entre essa infecção no colo do útero e na boca num mesmo paciente é controversa. RELATO DE CASO: Descrever o caso de uma adolescente grávida de 16 anos que apresentou a infecção pelo HPV no colo do útero e na boca. Esfregaços foram realizados no colo do útero e em língua/palato. Amostras de biofilme dental também foram coletadas. Para detectar o HPV, foi utilizada a técnica do microarranjo. O HPV 56 foi o subtipo encontrado no esfregaço cervical e o tipo HPV 6 no biofilme dental. CONCLUSÕES: Observamos, nessa adolescente grávida, a presença do HPV na boca e no colo do útero, mas os subtipos virais que infectavam essas duas regiões eram distintos.

Synbiotic supplementation promotes improvement of chronic diarrhea of unknown etiology in patient with chronic kidney disease and provides better outcomes in dialysis / La suplementación con simbióticos promueve la mejora de la diarrea crónica de etiología desconocida en pacientes con enfermedad renal crónica y ofrece mejores resultados en diálisis

Background: Chronic kidney disease (CKD) patients often have gastrointestinal symptoms which may result in malnutrition and a negative impact on their quality of life. Modulation of the gut microbiota can be a strategy to promote host health and homeostasis. Case report: The authors present a case of chronic diarrhea in a hemodialysis (HD) patient with an unknown etiology. After about one year and several failed interventions, synbiotic therapy was performed. The diarrhea episodes ceased after three months of daily supplementation and both biochemical and nutritional parameters improved. Synbyotic therapy promoted clinical benefits in this patient. Discussion: Therefore, this simple therapy may be a promising alternative in CKD and it should be tested in larger studies (AU)

Introducción: los pacientes con enfermedad renal crónica (ERC) a menudo tienen síntomas gastrointestinales que pueden provocar desnutrición y un impacto negativo en su calidad de vida. La modulación de la microbiota intestinal puede ser una estrategia para promover la salud del huésped y la homeostasis. Caso clínico: los autores presentan un caso de diarrea crónica de etiología desconocida en un paciente en hemodiálisis (HD). Después de varias intervenciones fallidas durante un año, se realizó el tratamiento simbiótico. Los episodios de diarrea cesaron después de tres meses de la suplementación diaria y ambos parámetros bioquímicos y nutricionales mejoraron. La terapia con simbióticos promovió beneficios clínicos para este paciente. Discusión: por lo tanto, esta sencilla terapia puede ser una alternativa prometedora en la ERC y debe ser probada en estudios más amplios (AU)

Detection of human papillomavirus in dental biofilm and the uterine cervix of a pregnant adolescent.

CONTEXT: Adolescence and pregnancy are considered to be risk factors for human papillomavirus (HPV) infection. The relationship between this infection in the uterine cervix and oral HPV infection is controversial. CASE REPORT: This report describes a case of a pregnant 16-year-old adolescent who presented HPV infection in the uterine cervix and the mouth. Smears were collected from the cervix and the tongue/palate. Dental biofilm samples were also collected. The microarray technique was used to detect HPV. The HPV 56 subtype was observed in the cervical smear and HPV 6 in dental biofilm. CONCLUSION: In this pregnant adolescent, HPV infection was present in both the cervix and the mouth, but the HPV subtypes infecting these two areas were different.

Human papillomavirus coinfection in the oral cavity of HIV-infected children.

AIM: To identify the early presence of human papillomavirus (HPV) DNA in the oral cavity of HIV-infected children. METHODS: The study group comprised 50 HIV-infected children and 50 healthy aged paired controls. Oral mucosa samples were collected by swab, and a 450 bp HPV DNA fragment was amplified by PCR, using degenerate consensus primers directed to the L1 gene. HPV typing was performed using specifics primers for types 6/16 and 11/18. RESULTS: All HPV co-infected children had vertical transmission of HIV. HPV DNA was detected in 6/50 (12.0%) of HIV children and three control group individuals 3/50 (6.0%) (p>0.01). In the HIV group, one had type 11, in the control group one had co-infection of types 11/16, and the others had type 16 and 18. CONCLUSIONS: Based upon the results, it is concluded that HPV DNA may be present in HIV disease, but no association with immunosuppression, delivery, or medical records (CD4 cell count, viral load and use of highly active antiretroviral therapy) was observed, and no differences could be observed between the groups either.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment.

Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment / Herpes simplex recorrente: laser terapia como método alternativo para tratamento a longo prazo

Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Os vírus do herpes simplex tipos 1 e 2 são os principais agentes infecciosos associados às ulcerações orais e vaginais. Estas infecções são amplamente reconhecidas como doenças sexualmente transmissíveis. Entre as opções de tratamento, o laser de baixa intensidade (LBI) mostrou resultados promissores como terapia de supressão de longa duração. Descrevemos dois casos clínicos com herpes labial recorrentes nos quais o LBI foi utilizado que permaneceram assintomáticos durante 17 meses de controle clínico.

Oral squamous papilloma and condyloma acuminatum as manifestations of buccal-genital infection by human papillomavirus.

Genital infection by human papillomavirus (HPV), a sexually transmitted disease (STD), has increased considerably due to the changes in sexual behaviour and an increase in the practice of oral sex. HPV, in a parallel manner, has been closely studied due to its oncogenic potential. We present the case of a 27-year-old patient, with a multi-partner sexual history and frequent practice of oral sex, who suffered from warts lesions on the genitalia and tongue. Squamous papilloma was diagnosed from a tongue biopsy. The treatment of the oral lesion was by way of surgery, without relapse in the first two years. Our discussion in this report is regarding the HPV infection in the oral cavity.