High frequency of isolation of antibiotic-resistant oral Viridans streptococci from children in Kuwait.

Antimicrobial resistance among the Viridans group of streptococci (VGS) has emerged as a hindrance to effective antibiotic therapy. Our objective was to evaluate the prevalence of antibiotic-resistant VGS in healthy children. Plaque samples were collected from tooth and tongue surfaces of 102 healthy subjects. Serially diluted samples were inoculated onto BHI agar plates and Mitis Salivarius Agar (MSA) plates and incubated as appropriate. Representative colonies were identified to species level by standard methods. Susceptibility of the VGS was performed by determining the minimum inhibitory concentrations (MICs) of 11 antibiotics using Etest. Of the 540 VGS isolates from both sites, 58% were from the tooth surfaces and 42% from the tongue. The most prevalent were S. salivarius (21.5%) and S. sanguis (16.3%). Imipenem and vancomycin had excellent activities. Resistance rates to trimethoprim, amoxicillin, piperacillin, erythromycin, cefuroxime and cephalothin, were 60.7, 40.8, 34.7, 32.6, 27.5 and 25.3%, respectively. Resistance rates to penicillin and clindamycin were 15.9% and 15.4%, respectively. The majority of the erythromycin-resistant isolates were from the tongue; 41% versus 29%. At the species level, 26% and 23% of S. salivarius and 23% and 14% of S. mutans from the tooth and tongue, respectively were resistant to penicillin. The data show species-related and site-related variations in the susceptibility pattern and an emerging high prevalence of antibiotic-resistant VGS. The difference in the susceptibilities between the species underscores the importance of accurate-identification and the need for surveillance of antimicrobial resistance among clinical isolates in our hospitals.

Pattern of antibiotic prescription in the management of oral diseases among dentists in Kuwait.

OBJECTIVES: The use and abuse of antibiotics have been of concern to the medical and the dental profession for sometime now, due mainly to the emergence of antibiotic-resistant bacteria. The objective of this project was to determine the rationale and the pattern of antibiotic prescription for dental management in Kuwait. METHODS: A questionnaire was distributed to 200 dental practitioners working in the Ministry of Health dental centers in Kuwait. The questionnaires sought answers to the clinical and non-clinical factors; signs, clinical conditions and dental treatment modalities for which the practitioners would prescribe antibiotics. RESULTS: Of the 200 questionnaires sent out, 168 (84%) respondents returned fully completed forms. A total of 107 (63.7%) of the respondents were males. Of respondents, 90% would prescribe antibiotics for patients with elevated body temperatures and evidence of systemic involvement, gross or diffuse facial swelling and closure of the eye due to inflammatory swelling. However, over 50% would prescribe antibiotics for cases with localized fluctuant swelling without any systemic involvement, while 59.6% would prescribe for patients with difficulty in swallowing as a result of an oral infection. Many respondents would consider antibiotic prescription for routine dental extraction, and for non-clinical reasons such as uncertainty of diagnosis, convenience, expectation of the patient and lack of time to treat immediately. Amoxicillin was the most frequently prescribed antibiotic. Higher knowledge regarding adequate indications for antibiotic use was associated with longer professional experience. CONCLUSIONS: The results of this analysis suggest that there is lack of uniformity in the rationale for antibiotic use among dental practitioners in Kuwait. There is an urgent need for the formulation of evidence-based guidelines, which should take into account the peculiar behavioral characteristics of the community.

The bacteriology of the supragingival plaque of child dental patients in Kuwait.

OBJECTIVE: To investigate the bacterial flora of the gingival plaques of pediatric dental patients in order to establish baseline data for future studies on the complex microbiota of the oral cavity of this group of child dental patients. SUBJECTS AND METHODS: Forty subjects, aged 3-12 years, were enrolled and investigated after informed consent was obtained. During the patients' first visit to the dental clinic supragingival plaque samples were collected from the gingival area of buccal and lingual tooth surfaces of all primary and permanent molar teeth using sterile curettes. Serially diluted samples were inoculated onto a set of selective and nonselective media and then incubated at the appropriate atmospheric conditions and temperatures. Representative colonies of isolates were identified by standard methods, including hemolytic characteristics on blood agar and profiling on API 20S and API 20A as appropriate. RESULTS: A total of 183 isolates (123 aerobes and 60 anaerobes) were recovered from the 40 patients with a mean count of 3 per sample of aerobes compared to 1.5 per sample for the anaerobes. Streptococcus sanguis was the predominant aerobic species (23.6%) isolated from 29 (72.5%) of the 40 patients, followed by Streptococcus mitis, 19.5 and 60%, Streptococcus salivarius, 17.1 and 52.5% and Streptococcus mutans, 17.1 and 52.5%. The frequency of isolation of anaerobic bacteria was Prevotella spp. 50% from 30 (75%) of the 40 patients, Fusobacterium spp., 18.3 and 27.5%, Bacteroides spp., Porphyromonas spp. and Peptostreptococcus spp., 6.7 and 10%, 6.7 and 10%, and 5 and 7.5%, respectively. Prevotella intermedia was the single most common species. CONCLUSION: The results show that there were more aerobic/facultative anaerobic bacteria than the obligate anaerobes in the dental plaque of the pediatric dental patients in Kuwait. The high prevalence of the pioneering streptococci as well as black-pigmented Prevotella spp. and Fusobacterium spp. indicates that the dental plaques of the children were in the developing stage, a precursor to the development of periodontal diseases.

Temporomandibular disorders among school children.

A large volume of literature is available on the Temporomandibular Disorders (TMD) in adults. However, relatively little information is available on this condition in children. The present study is aimed at providing a comprehensive survey on Temporomandibular Joint Status in Saudi Arabian Children in the Western Region of the Kingdom. This is a report on the prevalence of TMDs in children. Five hundred and two children aged 3-7 years old were examined for signs and symptoms of TMDs in a classroom setting. Eighty-three (16.53%) presented with TMDs, with 34 (14.46%) males 49 (18.35%) female (This difference between sexes is significant P < 0.001); 39 (7.8%) of the children had TMJ sounds; 34 (6.77%) had associated muscle tenderness; 13 (2.59%) had pain during TMJ movement; 17 (3.39%) had deviation of the mandible during movement; and 9 (1.7%) had a restricted mouth opening. There is a general tendency for these signs and symptoms to be more significantly prevalent in females. None of the children had sought dental treatment for these conditions. The importance of TMJ examinations in the overall clinical assessment of the pediatric patient should not be overlooked. Identifying this subject early in life would allow us to follow up the patient and intervene in the appropriate time to avoid future problem in the TMJ apparatus.

Prevalence of the Carabelli trait in Saudi Arabian children.

This study was carried out to evaluate the prevalence of trait of Carabelli in Saudi Arabian children. 250 children, aged 7 to 10 years were examined. The criterion of inclusion was caries free maxillary second deciduous and first permanent molars. The prevalence of the trait was 58.7% with almost similar distribution between males and females. The tubercular variety was the commonest type, which was significantly more in males than females. The frequency of the trait was similar to that of Malaysians but less than for other population groups.

Caries experience of children aged 6-9 years in Jeddah, Saudi Arabia.

This study was conducted to examine the caries experience of children aged 6-9 years in Jeddah, Saudi Arabia. Overall, 1522 children were examined from six primary schools located in different areas of the city. Results showed that the mean dmft and DFT were 4.23 and 1.85, respectively. The mean dmft and DFT values excluding caries-free children, however, were 5.71 and 2.95, respectively. Only 26.1% of the children were caries free. There was a high proportion of untreated dental caries and most of the carious teeth were treated by extraction. The need for effective preventive measures was stressed.

A retrospective study of oral cysts in Nigerian children.

A retrospective analysis of oral cysts that were seen over an 11-year period in children at a dental institution in Nigeria was carried out. In general, oral cysts accounted for only 2.6% of the total biopsied lesions during the period under review. The most common oral cysts were the mucous retention cysts, the gingival cysts of infants and the dentigerous cyst. The commonest sites were the maxilla, the mandible and the floor of the mouth respectively and there was no significant difference in sex preference. Most of the cases were seen in the age group 11-16 years while the least was in the group aged 6-10 years.

Oral findings in a child with Prader-Labhart-Willi syndrome.

This case report highlights the dental implications of some features of Prader-Labhart-Willi syndrome. A 5-year-old child with this syndrome presented with a severe form of dental caries. The need for early dental consultation and preventive dental procedures is stressed.

The effect of different extraction methods on the antiglycolytic and antiureolytic properties of Sorindeia warneckei--a Nigerian chewing stick.

Experiments were carried out to determine the best partition reagents for extracting the active biological agents in Sorindeia warneckei--chewing stick. Results show the Soxhlet extraction method to be the most effective.

Effect of aqueous extract of miswak on the in vitro growth of Candida albicans.

Chewing sticks (miswak) which are the roots of Salvadora persica plant have been used for centuries as oral hygiene tools in many parts of the world particularly in Saudi Arabia. Many studies have demonstrated the antiplaque, antiperiopathic, anticaries and antibacterial effect of these sticks. This study was designed to investigate the antimycotic effect, if any, of the aqueous extract of the plant roots. Various concentrations of aqueous extract of miswak prepared with Sabouraud medium were inoculated with Candida albicans (oral isolate). These were incubated at 37 degrees C and the turbidity was determined by OD at 600 nm wavelength measured at specific intervals over a period of 48 h. Data show that the extract at a concentration of 15% and above, has a fungistatic effect for up to 48 h. This antimycotic effect was probably due to one or more of the root contents which included chlorine, trimethylamine, and alkaloid resin, and sulphur compounds.

Comparison of the effects of galactose and glucose on the pH responses of human dental plaque, salivary sediment and pure cultures of oral bacteria.

Comparisons made in dental plaque in vivo demonstrated that galactose produces a significantly smaller decrease in pH than does glucose. In vitro studies with plaque, salivary sediment and pure cultures of oral bacteria done in the absence of intraoral factors such as flowing saliva confirmed this lesser acidogenicity of galactose. Pure culture showed that most of the bacteria tested produce a moderate to large decrease with glucose but only a few do so with galactose; most produced a moderate to little or no pH response with this sugar. This suggested that the smaller decreases in pH seen in plaque in vivo with galactose were largely due to bacterial differences, basically that resident micro-organisms individually have less galactolytic than glucolytic capability. Variance in capability was attributed to differences in membrane transport processes and metabolic pathways normally available to bacteria for galactose and glucose catabolism. In the in vitro experiments, because plaque and sediment can produce base as readily as they can produce acid, the nitrogenous substrates identified earlier as major stimulants of base formation, urea and arginine, were concurrently examined for their attenuating effects on the galactose and glucose pH responses. These showed, consistent with its lesser acidogenicity, that galactose could be countered more readily in its ability to reduce the pH by either of these two base-forming substrates than could glucose. The effects were different with urea and with arginine, urea attenuation occurred sooner and arginine attenuation later in both plaque and sediment. The corresponding acid-base pH profiles for pure cultures were different.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of oral tumors in Nigerian children based on biopsy materials examined over an 11-year period.

A survey of biopsied lesions of patients aged 0-16 yr who presented with oral swellings at the Lagos University Teaching Hospital over a period of 11 yr was conducted to determine the pattern of presentation of these lesions in 203 Nigerian children, 123 boys and 80 girls. 21% of the lesions were fibro-osseous lesions. There were more non-odontogenic than odontogenic tumors and very few salivary gland tumors.

Incidence of selected ureolytic bacteria in human dental plaque from sites with differing salivary access.

Saliva is the main source of urea in the human mouth and may be responsible for the predilection of ureolytic bacteria for certain tooth sites. As a test of this hypothesis, the ureolytic bacteria, Haemophilus parainfluenzae, Actinomyces naeslundii, Actinomyces viscosus and coagulase-negative oral staphylococci, were enumerated in supragingival plaque from various sites in each of 10 subjects. The sites sampled included the maxillary and mandibular incisors (chosen because the lower incisors are more exposed to the submandibular-sublingual secretion than the upper) and the maxillary and mandibular molars (the upper molars being closer to the source of parotid saliva). After dispersion of the plaque samples in saline, subsamples of each suspension were plated on appropriate selective media and other subsamples were taken for nitrogen analysis to measure the amount of plaque sampled. H. parainfluenzae that used urea was present in the largest numbers, A. viscosus was next and A. naeslundii and coagulase-negative staphylococci were least. The staphylococci and H. parainfluenzae were more numerous from mandibular than from maxillary incisors and from maxillary than mandibular molars, a pattern which suggests that salivary access favours their selection. The numbers of A. viscosus and A. naeslundii were not related to salivary access: A. viscosus was most numerous from the maxillary incisors, possibly because this site is normally the most acidic of the four studied and A. viscosus is strongly acidogenic and aciduric; the incidence of A. naeslundii had no relationship with site.(ABSTRACT TRUNCATED AT 250 WORDS)

Infant feeding profile and dental caries status of urban Nigerian children

El perfil de alimentación y la experiencia de caries de 560 niños nigerianos de 3-7 años de edad de diferentes grupos socioeconómicos fueron investigados con cuestionarios y exámenes clínicos. Aún cuando el hábito de amamentamiento prolongado tuvo gran prevalencia en los diferentes grupos socioeconómicos fue más común en las clases media y baja. 238 (42.5%) de los niños tuvo un co medio de 1.2 + ou - 0.3 (caries activa) mientas que 322 (57.5%) tuvo un co medio de 6.8 + ou - 2.3 (sin caries). En general, el 50% de los niños de cada clase social tenía caries activa. Los niños con caries activa tendían a ser alimentados con biberon o seno por períodos más largos y permitírseles utilizar más el bilerón a la hora de acostarse (p < 0.001) que los niños sin caries. Las madres encuestadas no tenían ningún conocimiento de cómo alimentar a sus niños. El papel del pediatra y otros trabajadores de la salud en la educación odontológica de las madres es enfatizado