Use of botulinum neurotoxin A in uncontrolled salivation in children with cerebral palsy: a pilot study.

This study investigated the safety and efficacy of botulinum neurotoxin type-A (BNT-A) injections into the salivary glands for treatment of sialorrhea in children with cerebral palsy (CP) and assessed the clinical factors that affect treatment outcome. The parotid and submandibular glands of nine CP patients were injected with BNT-A 1.4 U/kg in each parotid gland, and 0.6 U/kg in each submandibular gland. All children had neurological disorders. Gross motor function classification system levels ranged from I to V. All children had moderate to severe intellectual disability. A telephone interview with one parent determined response to treatment. Drooling intensity and frequency were measured with the drooling severity and frequency scale. After BNT-A treatment, the patients were followed up for 6 months using self-assessed rating scales for drooling intensity, discomfort and treatment effect (drooling impact scale). All parents reported an improvement in sialorrhea in the first week. Drooling was very intensive at baseline, and moderate 2 weeks after treatment. Maximum response occurred at 2-8 weeks. The use of BNT-A in uncontrolled salivation in children with CP can be considered acceptable and effective. Malocclusion and anterior salivation are closely related clinical characteristics and should be taken into account when planning treatment.

Mandibular ameloblastoma: a 28-years retrospective study of the surgical treatment results.

AIM: The aim of this study was to analyse the long-term treatment results of mandibular ameloblastomas over a 28-year period and determine the most appropriate method of management of these tumours. METHODS: Sixteen patients with a diagnosis of mandibular ameloblastoma treated in our Department between January 1977 and December 2004 were selected for this retrospective study. Data included gender, age at surgery, symptoms, tumour type, size and site of lesion, radiological findings, primary surgical methods, complications, recurrences, and follow-up period. RESULTS: There were eight male and eight female patients. Their age ranged from 15 to 74 years (average 43.4 years). The dominant symptom was facial deformity (9 cases). From analysis of ortopantomographs or radiographs, four cases were unilocular and 12 cases were multilocular, and its size ranged from 2 to 11 cm. Observation time varied from 5 to 27 years after treatment. Histologically prevalence of follicular type was observed. The treatment selected was segmental resection in three cases (18.6%), a resection with bone margin in six cases (37.5%) and conservative treatment by means of enucleation was carried out in seven patients (43.8%). Recurrences were observed in three patients. All these cases have been primarily treated through conservative surgical technique, i.e., by enucleation. CONCLUSION: In summary, conservative treatment enucleation should be used only in the treatment of unicystic ameloblastoma, while the radical approach, resection with some safe margin, should be the first choice in the treatment of solid, multicystic mandibular ameloblastoma to avoid recurrence.

Characterization of oral lactobacilli as potential probiotics for oral health.

INTRODUCTION: Intestinal lactobacilli have been successfully used as probiotics to treat gastrointestinal disorders, but only limited data are available for the probiotic properties of oral lactobacilli to combat oral diseases. We aimed to characterize oral lactobacilli for their potential probiotic properties according to the international guidelines for the evaluation of probiotics, and to select potential probiotic strains for oral health. METHODS: The study included 67 salivary and subgingival lactobacilli of 10 species, isolated from healthy humans. All strains were identified using amplified ribosomal DNA restriction analysis, tested for antimicrobial activity against oral pathogens, tolerance of low pH and bile content. Thereafter, the lysozyme tolerance and antibiotic susceptibility of 22 potential probiotic strains were assessed. RESULTS: The majority of strains suppressed the growth of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Streptococcus mutans, but none inhibited Candida albicans. The lowest pH tolerated by lactobacilli following 4 h of incubation was pH 2.5, but none of the strains grew at this pH. All strains tolerated a high concentration of lysozyme (10 mg/ml) and half of the strains tolerated a high concentration of human bile [5% volume/volume (V/V)]. Four Lactobacillus plantarum and two Lactobacillus oris strains expressed resistance to tetracycline and/or doxycycline. CONCLUSIONS: Strains of L. plantarum, Lactobacillus paracasei, Lactobacillus salivarius, and Lactobacillus rhamnosus expressed both high antimicrobial activity and high tolerance of environmental stress. The absence of transferable antibiotic-resistance genes in L. plantarum strains remains to be confirmed. These results suggest a potential for oral lactobacilli to be used as probiotics for oral health.

Oral lactobacilli in chronic periodontitis and periodontal health: species composition and antimicrobial activity.

BACKGROUND/AIMS: Lactobacilli are known to play an important role in the maintenance of health by stimulating natural immunity and contributing to the balance of microflora. However, their role in chronic periodontitis is unclear. We aimed to identify oral lactobacilli in chronic periodontitis and periodontally healthy subjects, and to determine their antimicrobial activity against putative oral pathogens. METHODS: A total of 238 Lactobacillus isolates from the saliva and subgingival sites of 20 chronic periodontitis and 15 healthy subjects were collected. In all, 115 strains were identified using rapid amplified ribosomal DNA restriction analysis. Antimicrobial activity against Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia was assessed. RESULTS: Lactobacilli belonging to 10 species were identified. The most prevalent strains in healthy persons were Lactobacillus gasseri and Lactobacillus fermentum and in chronic periodontitis patients, Lactobacillus plantarum. Obligately homofermentatives, particularly L. gasseri, were less prevalent in chronic periodontitis patients compared with healthy subjects (8% vs. 64% for L. gasseri, P < 0.01). Sixty-nine percent of tested lactobacilli inhibited S. mutans, 88% A. actinomycetemcomitans, 82% P. gingivalis and 65% P. intermedia. The strongest antimicrobial activity was associated with Lactobacillus paracasei, L. plantarum, Lactobacillus rhamnosus, and Lactobacillus salivarius. The strains from periodontally healthy patients showed a lower antimicrobial activity against S. mutans than the strains from chronic periodontitis patients. CONCLUSION: The composition of oral lactoflora in chronic periodontitis and healthy subjects differs, with a higher prevalence of homofermentative lactobacilli, particularly L. gasseri, in the latter group. Both homo- and heterofermentative oral lactobacilli suppress the growth of periodontal pathogens, but the antimicrobial properties are strain, species and origin specific.

High levels of salivary lactobacilli in Estonian schoolchildren.

AIM: This was to assess oral salivary lactobacilli levels compared with oral health in a group of 12-year-old schoolchildren in Tartu, Estonia. METHODS: Whole saliva samples were collected and transferred to dip-slides (Dentocult LB) and incubated at 37 degrees C for 3 days. Dental caries, dental plaque, and data concerning the general health, dental habits and eating patterns were recorded. RESULTS: Salivary lactobacilli were found in all children, with a quarter of them having high or very high lactobacilli counts. Caries prevalence of 75% and 2.6 DMFT were recorded. A positive correlation was found between the DMFS counts and the lactobacilli counts. CONCLUSION: High levels of salivary lactobacilli were found in Estonian schoolchildren. Caries indicators of these children were slightly higher than in the same age group in Nordic countries.

Immediate effects of the serotonin antagonist granisetron on temporomandibular joint pain in patients with systemic inflammatory disorders.

The aim of this study was to investigate if the 5-HT3 antagonist granisetron reduces temporomandibular joint (TMJ) pain in patients with systemic inflammatory joint disorders. Sixteen patients with systemic inflammatory joint disease with pain localized over the TMJ region and tenderness to digital palpation of the TMJ were included. The current resting pain (VASRest) and the pain during maximum mouth opening (VAS(MVM)) of the TMJs were assessed with a 100 mm visual analogue scale. An electronic pressure algometer was used to estimate the pressure pain threshold (PPT) over the lateral aspect of the TMJ. Venous blood was collected for measurement of the plasma and serum levels of 5-HT, erythrocyte sedimentation rate, rheumatoid factor and C-reactive protein. The selective 5-HT3 receptor antagonist granisetron or saline were injected into the posterior part of the upper TMJ compartment in a randomized double-blind manner. The patients in the granisetron group had lower VASRest than the patients in the saline group after 10 min. In the granisetron group, VASRest was decreased after 10 min, while VAS(MVM) was decreased and PPT increased after 20 min. In the saline group, VAS(MVM) was decreased after 20 min. In conclusion, granisetron has an immediate, short-lasting and specific pain reducing effect in TMJ inflammatory arthritis. The 5-HT3 receptor may therefore be involved in the mediation of TMJ pain in systemic inflammatory joint disorders.

Prostaglandin E2 levels in blood plasma and in crevicular fluid of advanced periodontitis patients before and after surgical therapy.

AIM: The aim of the study was to determine PGE2 levels in venous blood plasma (VBP), gingival blood plasma (GBP) and gingival crevicular fluid (GCF) in advanced periodontal patients before and after 6 months surgical treatment. PATIENTS AND METHODS: There were 12 patients aged 28-45 years and seven healthy subjects as controls included into the study. Clinical parameters such as PLI, GI, BI, PD, AL and bone height % from radiographs were recorded before and after treatment. PGE2 levels were determined by radioimmunoassay (125 I RIA Kit, NEN(R)). RESULTS: Before treatment the mean VBP, GBP and GCF PGE2 levels in periodontal patients were higher than healthy controls (P < 0.001, Student's t-test). Six months after treatment the mean levels of PGE2 in VBP, GBP and GCF were significantly reduced in patients with improvement of clinical and roentgenological parameters (P < 0.001, Student's t-test). CONCLUSIONS: It can be concluded that PGE2 is involved in the pathogenesis of periodontal disease. The inflamed periodontal tissues may produce significant amount of PGE2 and the degree of inflammation might be determined by the ratios of PGE2. The lower levels of PGE2 in blood plasma and in gingival crevicular fluid after treatment are signs of improvement of periodontal disease.

[Effect of cyclic nucleotides on the mitotic activity of dental anlage and alveolar bone cells in tissue culture]. / Vliianie tsiklicheskikh nukleotidov na mitoticheskuiu aktivnost' kletok zubnykh zachatkov i al'veoliarnoi kosti v tkanevoi kul'ture.

A study was made of the effects of cAMP, db-cGMP and db-cAMP on the mitotic activity of the cells of the tooth anlage and alveolar bone in tissue culture of mouse embryo aged 15 days. The data indicate that db-cGMP and db-cAMP at concentrations 10(-6) M and 10(-8) M do not have any essential effect on the mitotic activity of the cells of the tooth anlage whereas cAMP inhibits the mitotic activity in these cells as compared with control. A definite relationship was established between the character of differentiation of the osseous and dental tissues in tissue culture and the concentration of cyclic nucleotides. db-cAMP, db-cGMP and cAMP raise the mitotic activity of the osteogenic cells, inhibit resorption of the alveolar bone, and stimulate formation of a new osseous tissue.