Efectos de la marihuana en la salud bucal / Effects of marijuana on oral health

Aun cuando las autoridades del Sector Salud en México no se han declarado respecto al uso medicinal de la marihuana, con el objetivo de conocer el estado actual internacional sobre sus riesgos y usos terapéuticos, investigamos los avances reportados en la actualidad, así como las comunidades que han despenalizado su uso. Se presenta su origen como elemento terapéutico, pueblos involucrados, diversas denominaciones, historicidad, las diversas preparaciones, farmacodinamia, sus efectos nocivos a la salud en general y particularmente en boca, sus posibles usos en odontología tomando en cuenta sus propiedades terapéuticas. ampliamente reseñadas en relación a otros lugares del organismo. Finalmente, la propuesta de investigación en odontología con especial énfasis en aquellas especialidades donde la inflamación y el dolor agudo estén presentes de manera significativa (AU)

Although health authorities in Mexico have not officially declared their stance on the medicinal use of marijuana, our research aims to explore the current international status regarding its risks and therapeutic uses. We have investigated the latest reported advancements and examined communities that have decriminalized its usage. This presentation encompasses its therapeutic origin, involved communities, various designations, historical context, diverse preparations, pharmacodynamics, its adverse effects on overall health and particularly oral health, as well as its potential applications in dentistry, considering its widely documented therapeutic properties in comparison to other areas of the body. Finally, our research proposal in dentistry places special emphasis on specialties where inflammation and acute pain are significantly present (AU)

Oral side effects of locally delivered nicotine replacement therapy: A meta-analysis of randomized controlled trials.

BACKGROUND: Nicotine replacement therapy is the first choice pharmacotherapy for smoking cessation. Oral side effects caused due to NRT lead to discontinuation of treatment. The objective of this meta-analysis was to look for the certainty of evidence on the number of patients that reported oral side effects due to the use of NRT. METHOD: Eligible studies were selected and data extraction was carried out independently into a pre-tested data extraction form. Risk of bias was assessed using Cochrane Tool. The heterogeneity between the studies was assessed using Chi-square and I2 tests. Mean difference and Odds ratio at 95% confidence interval were the effect estimates. GRADE working group approach was used to assess the quality of evidence. RESULTS: Twenty-eight studies were included with moderate to low risk of bias. The pooled estimates revealed a statistically significant number of patients developed mouth or throat irritation (2.54 [1.23, 5.25]), or oral soreness (2.22 [1.40, 3.55]) or gastric reflux or vomiting (1.97 [1.34, 2.90]) due to NRT. CONCLUSION: It is important to understand that significant implications are caused due to NRT, on oral health. All patients on NRT must adhere to their regular dentist visits and must check their oral mucosa before initiating NRT.

Oral manifestations of illicit drug use.

The use of illicit and misuse of licit drugs is a global public health problem, with illicit drug use being responsible for 1.8% of the total disease burden in Australia in 2011. Oral adverse effects associated with illicit drug use are well-established, with aggressive caries, periodontitis, bruxism, poor oral hygiene and general neglect documented. Other factors such as a high cariogenic diet and lifestyle, social and psychological factors compound the poorer oral health in illicit drug users. Literature has shown that the oral health-related quality of life among injecting drug users is poorer compared with the Australian general population and the overall quality of life of addicted people correlates with caries experience. Thus, the role of the dentist is imperative in managing the oral health of these individuals. Given their widespread recreational use, it is likely that dental practitioners will encounter patients who are regular or past users of illicit drugs. The aim of this article is to describe the prevalence and mechanism of action of commonly used illicit drugs in Australia, including cannabis, methamphetamine, cocaine and heroin and to inform dentists about the common orofacial presentations of their side effects to help with patient management.

A prospective study of pharyngeal gonorrhoea and inconsistent condom use for oral sex among female brothel-based sex workers in Singapore.

Oral sex among female sex workers in Singapore has risen sharply from 27.1% in 1992 to 81.7% in 1997. A prospective cohort study was carried out on 724 female brothel-based sex workers who practised oral sex, to determine the risk of contracting pharyngeal gonorrhoea through inconsistent condom use. The prevalence of consistent condom use for oral sex was 70.4% compared to 96.8% for vaginal sex. One hundred and twenty-nine (17.8%) were lost to follow up because they quit prostitution. The other 595 sex workers were followed up for a maximum period of 6 months. Thirty-eight (5.2%) sex workers contracted pharyngeal gonorrhoea compared to 2.5% who contracted cervical gonorrhoea. Sex workers with inconsistent condom use for oral sex were 17.1 times (95% CI: 8.0-36.5) more likely than consistent condom users to develop pharyngeal gonorrhoea, after controlling for ethnic group, class and number of clients. STD control programmes for sex workers should place stress on consistent condom use for oral sex.

PIP: This study examines the risks of pharyngeal gonorrhea due to inconsistent condom use among female sex workers in Singapore. A total of 724 brothel-based female sex workers who practiced oral sex were interviewed between December 1996 and June 1998. Data collected included sociodemographic characteristics, sexual behavior, and use of condom for oral sex. The results demonstrated a 70.4% prevalence of consistent condom use for oral sex as compared to 96.8% for vaginal sex. Of the 595 sex workers that were followed up for a maximum period of 6 months, 38 (5.2%) contracted pharyngeal gonorrhea, while 2.5% contracted cervical gonorrhea. It was revealed that sex workers with inconsistent condom use for oral sex were 17.1 times more likely to develop pharyngeal gonorrhea than consistent condom users. Since the risk of acquiring pharyngeal gonorrhea was significantly higher for inconsistent condom users, sexually transmitted disease control programs for sex workers should also emphasize the need for the consistent use of condoms with oral sex.

Influence of hormonal contraceptives on microbial flora of gingival sulcus.

To determine a possible influence of two different hormonal contraceptives on bacterial microflora of gingival sulcus, subgingival plaque samples of 29 healthy women aged between 20 and 32 years were investigated bacteriologically before subjects took a contraceptive and 10 and 20 days after subjects started the medication. In 14 women, and oral contraceptive containing 0.02 mg ethinyl estradiol and 0.15 mg desogestrel (preparation A) was used, and 15 women took a contraceptive containing 0.03 mg ethinyl estradiol and 2.00 mg dienogest (preparation B) daily over 21 days. There were no changes in clinical parameters of the teeth investigated during 3 weeks of the study. The periodontopathogenic bacteria Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were never detected throughout the study. On the other hand, the periodontopathogenic species Prevotella intermedia was found in plaque samples of 22 women. The content of this microorganism showed only a little change between the pretreatment period and plaque sampling after 10 days of contraceptive treatment, but a striking increase occurred after 20 days of contraceptive treatment, especially in the preparation A group. In this respect, there was a significant difference between preparations A and B.

PIP: Several studies have suggested an association between sex hormones and chronic inflammatory periodontal disease. This study investigated the impact of two oral contraceptives (OCs) on bacterial microflora of gingival sulcus samples obtained from 29 women 20-32 years of age recruited from Jena (Germany) University Women's Hospital. Study participants were randomly assigned to receive an OC containing either 0.02 mg of ethinyl estradiol and 0.15 mg of desogestrel (n = 14) or 0.03 mg of ethinyl estradiol and 2.00 mg of dienogest (n = 15). Subgingival plaque samples were obtained before and 10 and 20 days after the initiation of OC use. No changes in clinical parameters of the upper incisors (i.e., bleeding on probing, pocket depth, plaque) occurred in either study group during 21 days of OC use. Although Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were not detected, 22 plaque samples showed evidence of the periodontopathogenic bacteria Prevotella intermedia. The mean cultivable content of this microorganism increased significantly in users of the OC containing desogestrel from 1.2% at day 10 of OC use to 10.0% at day 20, but decreased slightly in women assigned to the OC containing dienogest and a higher dose of ethinyl estradiol. Good oral hygiene is essential in pregnancy and during OC use to compensate for hormonal influences and prevent gingivitis.

Oral manifestations of HIV infection in 600 South African patients.

Oral lesions associated with HIV infection, as classified by the EC-Clearinghouse on Oral Problems related to HIV infection and the WHO Collaborating Centre on Oral manifestations of the immunodeficiency virus, were studied in 600 consecutive HIV-infected patients in Cape Town, South Africa. One or more lesions were seen in 60.4% of cases. Combined candidal lesions were evident in 37.8%, hairy leukoplakia in 19.7% and combined gingival/periodontal lesions in 8.5% of patients seen. Lesions less commonly recorded include oral ulceration (2.9%) and Kaposi's sarcoma (1.5%). The clinical range of lesions seen is similar to those reported elsewhere, but socio-cultural differences allowed no reliable comparison. More than a quarter of our patients had oral soft tissue discomfort necessitating treatment; in 3.3% these were the presenting symptom. This indicates a potential major public health concern requiring education in recognition and appropriate referral and management.

PIP: The prevalence and clinical appearance of oral manifestations of HIV were investigated in 600 consecutive HIV patients examined at health care facilities in Cape Town, South Africa, in 1993-96. At least 1 oral lesion was present in 362 patients (60.4%). 160 oral manifestations (26.7%) were symptomatic and required treatment. The majority of lesions (37.8%) were candidosis, primarily pseudomembranous and erythematous types. Oral hairy leukoplakia was present in 19.7% of patients, while HIV-related peridontal disease was noted in 8.5%. 20 HIV-positive patients (3.3%) presented with an oral manifestation of HIV infection before HIV was diagnosed. Classifications were based on guidelines developed by the EC-Clearinghouse on Oral Problems Related to HIV Infection and the World Health Organization Collaborating Center on Oral Manifestations of the Immunodeficiency Virus. These findings, which are similar to those reported in other developed and developing countries, indicate a need for education on the recognition and appropriate management and referral of oral manifestations of HIV infection.

Oral manifestations of HIV infection by gender and transmission category in Mexico City.

A cross-sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV-associated oral lesions was based on preestablished criteria. For the statistical analysis chi-squared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV+ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV-related oral lesions by gender and the risk categories analysed, particularly blood transfusion.

PIP: A cross-sectional analysis conducted in Mexico City, Mexico, in 1989-96 investigated the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The 436 HIV-positive patients enrolled in this study were part of a larger, ongoing study conducted through the Infectious Diseases Clinic in Mexico City. The primary mode of HIV transmission was blood transfusion among female respondents (63%) and sexual activity among male respondents (90%). 71% of subjects had at least 1 (mean, 1.3) HIV-related oral lesion, including hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis, and oral ulcers. Candidosis, pseudomembranous candidosis, hairy leukoplakia, exfoliative cheilitis, and xerostomia were all significantly associated with a CD4 count under 200 cells/cu. mm and were more prevalent among those with advanced HIV disease. Oral ulcers were present only in men. Women had a higher prevalence than men of hyperpigmentation (10.5% vs. 4%) and xerostomia (7% vs. 2%), but these differences were not significant. Multivariate analysis revealed a significant association between erythematous candidosis and blood transfusion, even after controlling for gender, clinical stage, CD4 count, antiretroviral therapy, smoking history, and xerostomia.

Prevalence of Candida species in AIDS patients and HIV-free subjects in Thailand.

The purpose of this study was to examine the prevalence of Candida species among groups of HIV-infected and HIV-free subjects in Thailand and to ascertain whether particular Candida species were associated with HIV infection. Oral rinse specimens were collected from 45 AIDS patients (CDC stage IV), 74 HIV-free healthy subjects, and 42 HIV-free patients who had clinical candidiasis. Yeasts recovered in culture were identified and quantified. The mean ages of the cohorts were 30.75+/-8.19 years (AIDS group), 28.50+/-7.98 (HIV-free healthy group) and 41.83+/-12.25 years (HIV-free candidiasis group). Yeasts were isolated from 30/45 (66.66%, range 6.6x10(2)-5.7x10(6) CFU/ml) of the AIDS group, 8/74 (10.81%, range 8.0x10(1)-3.5x10(4) CFU/ml) of the HIV-free healthy group, and 24/42 (57.14%, range 1.0x10(2)-1.1x10(5) CFU/ml) of the HIV-free candidiasis group. There were statistically significant differences in the Candida colony counts between the AIDS group without oral candidiasis and the healthy group (P=0.0078) and between the AIDS group with candidiasis and the HIV-free, oral candidiasis group (P=0.0003). Candida albicans was the most common species recovered from AIDS patients (29 out of 30; 96.66%).

PIP: The association between Candida species and HIV serostatus in Thailand was compared in 45 patients hospitalized with AIDS-related conditions, 74 HIV-negative blood donors, and 42 HIV-negative individuals with clinical signs of oral candidiasis. Pseudomembranous and erythematous lesions were the most common clinical findings. After collection of oral rinse specimens by a single clinician, yeasts recovered in culture were identified and quantified. Yeasts were isolated from 30 AIDS patients (66.6%), 8 HIV-negative blood donors (10.81%), and 24 individuals in the HIV-free candidiasis group (57.14%). Both the number of subjects who yielded Candida species and the mean number of Candida colonies were significantly higher in the AIDS group than in the HIV-free candidiasis group. C. albicans was the isolated yeast in 96.66% of AIDS patients, 79.16% of HIV-free candidiasis patients, and 100% of those in the healthy carrier group. Although C. albicans is a common and harmless commensal of the mucous membranes, it can cause severe mucosal or invasive disease in immunodeficient patients. It has been postulated that Candida strains that are nonpathogenic in healthy persons become pathogenic in HIV-infected individuals due to impaired host defense mechanisms.

Association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children aged 18 months to 5 years.

The objective was to determine whether there is an association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children. A case-control study design within a cross-sectional study was used, and the outcome was carriage of oral yeasts. The exposure variables were malnutrition and HIV-1 antibody, and confounders to be adjusted for were age, sex, and breastfeeding. The study was carried out in Dar-es-Salaam, Tanzania, in two maternal and child health (MCH) clinics that offer routine medical checkups to all expectant mothers and children aged between 0 and 5 years in the catchment area. A total of 882 children aged between 18 months and 5 years participated. Smears from the tongue and buccal mucosa were examined for oral yeasts. Malnutrition was categorized according to standards on the MCH chart and World Health Organization/Centers for Disease Control (WHO/CDC) standards as weight-for-height (wasted), weight-for-age (underweight), and height-for-age (stunted). HIV-1 infection was determined by an enzyme-linked immunosorbent assay. Reactive sera were confirmed by Western Blot. About 27% of the children were slightly or severely malnourished according to standards on the MCH chart. According to WHO/CDC standards, 2.6% were wasted, 16.3% were underweight, and 29.6% were stunted. Fourteen (1.6%) were seropositive for HIV-1 antibody. Hyphal forms and blastospores were much more frequent among children infected with HIV-1 with odds ratios ranging from 3.8 (95% CI: 1.3;11.2) to 6.2 (95% CI: 2.1;18.4) depending on categorization of malnutrition. Malnutrition was a risk factor, too, albeit to a much lesser and insignificant degree. The study supports our previous findings that malnutrition may predispose to carriage of oral yeasts and subsequent infection. However, in this study population HIV infection was clearly the predominant risk factor.

PIP: The association between carriage of oral yeasts, malnutrition, and HIV-1 infection was investigated in a case-control study involving 403 girls and 479 boys 18 months-5 years of age attending 2 maternal-child health clinics in Dar-es-Salaam, Tanzania, in a 4-month period in 1994. The children designated as cases had Candida-like microorganisms on smears from the tongue and buccal mucosa. 14 children (1.6%) were HIV-positive; 11 of these children were under 3 years of age. 241 (27%) were moderately or severely malnourished. 20.0% had hyphal forms and 17.5% had blastospores. Presence of HIV infection was the most significant risk factor for hyphal forms or blastospores consistent with Candida-like microorganisms (unadjusted odds ratios, 5.5 and 3.8, respectively). Although malnutrition was also a risk factor for oral yeasts, the association was not significant. The study findings suggest that malnutrition may predispose to carriage of oral yeasts and subsequent infection. The rates of oral yeasts detected among these children were lower than expected and may reflect a reduced secretion of stimulated whole saliva associated with malnutrition and HIV infection.

Dentists and cross-infection.

A structured questionnaire was administered to a random sample of general dental practitioners in Natal, South Africa in 1994, to ascertain the precautions they use against cross-infection and to gauge the attitudes and behaviour towards the treatment of HIV-infected individuals. An interview was conducted covering 5 broad topics: demographic details, personal barrier protection, instrument sterilization and disinfection, sharps disposal and incidence of needlestick injuries and the extent of the knowledge, attitude and behaviour of the practitioners toward the treatment of HIV-infected individuals. The key findings were: routine glove wearing, for all patients, was practised by 87 per cent. The most common heat sterilization method was by autoclave (68 per cent), although a dry heat sterilizer and water boiler were used by 22 per cent of the respondents. Of the 18 respondents reporting a needlestick injury in the past 6 months only one sought after-care. 42 per cent of the respondents would continue to treat carriers of HIV in their practices. This survey shows that a significant number of dentists are using unacceptable cross-infection control procedures. Educational efforts should be made to improve their knowledge and to alleviate anxiety of health workers to treat HIV-infected patients.

PIP: The precautions against occupational HIV transmission employed by general dental practitioners in Natal, South Africa, were investigated in 1994 in a survey of 100 dentists (33% random sample) drawn from the South African Medical and Dental Council registry. The interviews addressed personal barrier protection; instrument sterilization and disinfection; sharps disposal and needle-stick injury incidence; and knowledge, attitudes, and behavior related to the treatment of HIV-infected patients. In response primarily to seminars and scientific journal articles, 73% of dentists had made some modifications in their clinical practices to prevent HIV cross-infection. 87% of dentists routinely wore gloves and 65% wore masks. 68% used an autoclave for heat sterilization, but only 4% decontaminated impressions or appliances before sending them to the laboratory. 25% discarded used sharps in the normal rubbish bin. 18 respondents had experienced a needle-stick injury in the 6 months preceding the interview; however, only 1 had sought post-exposure care or testing. 42% expressed a willingness to treat patients known to be HIV-positive. It is recommended that these findings be used as a basis for formulation of specific guidelines for treating HIV-infected dental patients in South Africa. Also urged are educational interventions to increase the willingness of South African dentists to treat HIV-infected individuals.

Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria.

Herpesviruses have been implicated in the pathogenesis of human periodontitis. The present study investigated whether herpesviruses are present in the lesions of acute necrotizing ulcerative gingivitis. Sixty-two Nigerian children, aged 3-14 years, were studied. Twenty-two children had acute necrotizing ulcerative gingivitis and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished and 20 were free of acute necrotizing ulcerative gingivitis and in a good nutritional state. Polymerase chain reaction methods were used to determine the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 and type 2 (EBV-1, EBV-2), herpes simplex virus (HSV), human herpes virus 6 (HHV-6), human papilloma virus and human immunodeficiency virus type 1 in crevicular fluid specimens collected by paper points. Of the 22 acute necrotizing ulcerative gingivitis patients, 15 (68%) revealed viral infection and 8 (36%) viral coinfection. Thirteen (59%) acute necrotizing ulcerative gingivitis patients demonstrated HCMV, 6 (27%) EBV-1, 5 (23%) HSV and 1 (5%) HHV-6. Only 2 (10%) subjects from each group not affected by acute necrotizing ulcerative gingivitis showed viral presence, and no control subject revealed viral coinfection. These findings suggest that HCMV and possibly other herpesviruses contribute to the onset and/or progression of acute necrotizing ulcerative gingivitis in malnourished Nigerian children.

PIP: Recent laboratory studies have implicated herpesviruses in the pathogenesis of human periodontitis. This present study examines whether herpesviruses are present in the lesions of acute necrotizing ulcerative gingivitis. A total of 62 Nigerian children, aged 3-14 years were studied: 22 had acute necrotizing ulcerative gingivitis and were also malnourished, 20 showed no acute necrotizing ulcerative gingivitis but were malnourished, and 20 were free of acute necrotizing ulcerative gingivitis and in a good nutritional state. A polymerase chain reaction assay was used to determine the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 and type 2 (EBV-1, EBV-2), herpes simplex virus (HSV), human herpes virus 6 (HHV-6), human papilloma virus, and HIV-1 in crevicular fluid samples obtained by paper points. Of the 22 patients with acute necrotizing ulcerative gingivitis, 15 (68%) showed viral infection and 8 (36%) showed a viral coinfection. In addition, 13 (59%) of these patients demonstrated HCMV, 6 (27%) EBV-1, 5 (23%) HSV, and 1 (5%) HHV-6. Only 2 (10%) subjects from each group not affected by acute necrotizing ulcerative gingivitis revealed viral presence, and none of the control group demonstrated viral coinfection. The findings suggest that HCMV and possibly other herpesviruses contribute to the onset and/or progression of acute necrotizing ulcerative gingivitis in malnourished children in Nigeria.

Clinical profile and risk factors for oral candidosis in sick newborns.

OBJECTIVES: To provide the clinical profile and assess the significance of various risk factors contributing to the occurrence of oral candidosis in newborns. DESIGN: Case-control study. SETTING: Neonatal Intensive Care Unit (NICU). SUBJECTS: Twenty newborns with oral candidosis and an equal number of age and weight matched controls. INTERVENTIONS: All cases of oral candidosis were treated with local application of 1% Clotrimazole. RESULTS: Oral candidosis was documented in 3.2% (20/650) cases in the NICU. Acute pseudomembranous candidosis was the most common presentation. The mean age of onset was 10.5 days. Candida albicans was isolated in 50% cases in addition to C. tropicalis, C. paratropicalis, C. krusei, C. glabrata and C. parapsilosis. On univariate analysis, male sex, birth asphyxia and prolonged antibiotic therapy had a significant correlation with occurence of oral candidosis in neonates. Out of these, birth asphyxia was the only factor significantly associated with oral candidosis (OR 8.09, 95% CI 1.34-48.8, p = 0.0226) on multivariate analysis. CONCLUSIONS: C. albicans was the predominant isolate in this series of oral candidosis. Clinical manifestations were evident in the second week of life and birth asphyxia was the most important associated perinatal event.

PIP: During February-September 1992, all 650 infants admitted to the neonatal intensive care unit of the University College of Medical Sciences and G.T.B. Hospital were screened for oral thrush. A case control study was conducted to determine risk factors for oral candidiasis in newborns. The rate of oral candidiasis in this population was 3.2% (20 cases). The most common pathogen was Candida albicans (50%). All but 1 oral thrush case had acute pseudomembranous candidiasis. 75% of oral thrush cases were asymptomatic. Mean age of onset was 10.4 days (median, 9.5 days). Clotrimazole solution was applied to oral lesions of all oral thrush cases. The multiple logistic regression revealed that birth asphyxia was the only significant factor responsible for oral thrush in newborns (odds ratio = 8.09; p = 0.0226). These findings show that the most important perinatal event associated with oral thrush in newborns was birth asphyxia.

Preventing measles deaths.

PIP: Each year, measles kills more than 1 million children in developing countries, especially malnourished children and children with complications. Prompt hospital admission is required to prevent measles-associated deaths if children with measles exhibit a general danger sign (lethargy or unconsciousness, convulsions, inability to eat or drink, or vomiting), signs of xerophthalmia, deep or extensive mouth ulcers, severe pneumonia, severe dehydration, or severe malnutrition. No drug can treat this viral infection; measles management consists of treating complications. Health workers must insert a nasogastric tube to administer liquid foods and fluids in children with severe measles who cannot eat. They should clean both eyes with a clean cloth and water 3 times a day. They should apply tetracycline eye ointment 3 times a day for 7 days. They should give a child with signs of xerophthalmia a treatment dose of vitamin A and another dose 3 weeks later. Health workers need to clean the mouth with clean water and a pinch of salt at least 4 times a day and put 1% gentian violet on mouth sores after cleaning. They should treat an anaerobic mouth infection, indicated by a foul smelling discharge, with metronidazole. Measles patients with an acute ear infection should receive paracetamol for pain and fever and an antibiotic for the infection. In the case of ear discharge, the health worker must clean the ears at least twice a day with cotton wool or a clean cloth. They should encourage mothers of measles patients with diarrhea to continue breast feeding. Health workers must administer more fluids than usual. They need to monitor hospitalized children to detect any additional complications. They need to look for danger signs; record the child's temperature, pulse, and respiratory rate twice a day; and weigh the child daily. Children with measles must be isolated for 4 days after onset of the rash. Any child in contact with the ill child should receive a dose of measles vaccine if he/she has not already been vaccinated or had measles. A vaccine coverage rate of at least 90% is the best way to prevent measles and measles-associated deaths.^ieng

Noma: a neglected scourge of children in sub-Saharan Africa.

Poverty is the single most important risk indicator for noma (cancrum oris), a severe gangrene of the soft and hard tissues of the mouth, face, and neighbouring areas. The risk factors associated with an increased probability of noma developing include the following: malnutrition, poor oral hygiene, and a state of debilitation resulting from human immunodeficiency virus (HIV) infection, measles, and other childhood diseases prevalent in the tropics. There are many similarities between noma and necrobacillosis of the body surface of wallabies (Macropus reforgriseus), and it is proposed that noma results from oral contamination by a heavy load of Bacteroidaceae (particularly Fusobacterium necrophorum) and a consortium of other microorganisms. These opportunistic pathogens invade oral tissues whose defences are weakened by malnutrition, acute necrotizing gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers. The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region, which has adversely affected the health and well-being of children through deteriorating sanitation, declining nutritional status and the associated immunosuppression, and increased exposure to infectious diseases. Prevention of noma in Africa will require measures that address these problems, and most importantly, eliminate faecal contamination of foods and water supplies.

PIP: Noma (cancrum oris) is a severe gangrene of the soft and hard tissues of the mouth, face, and neighboring areas observed especially in children. Without the timely intervention of appropriate antibiotics, noma is almost always quickly fatal. Survivors of the disease may exhibit facial mutilation, impaired growth of the facial skeleton, nasal regurgitation of food, leakage of saliva, defective speech, and chewing difficulties. Noma is frequently seen in developing countries, especially in sub-Saharan Africa, where it occurs almost exclusively among poor children usually aged 3-10 years. It may be that noma results from oral contamination by a heavy load of Bacteroidaceae and a consortium of other microorganisms. The opportunistic pathogens invade oral tissues when an individual's immune response is compromised by malnutrition, acute necrotizing, gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers. Accordingly, malnutrition, poor oral hygiene, and debilitation resulting from HIV infection, measles, and other childhood diseases prevalent in the tropics are factors associated with an increased probability of developing noma. Poverty, however, is the most important risk indicator for the condition. The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region. The prevention of noma in Africa will require measures which address these problems and, most importantly, eliminate the fecal contamination of food and water supplies.

Biotypes of oral Candida albicans isolates in human immunodeficiency virus-infected patients from diverse geographic locations.

Oral Candida albicans isolates from HIV-infected individuals in Hong Kong, Australia, Germany and England were characterised using a biotyping system based on enzyme profiles, carbohydrate assimilation patterns and boric acid resistance of the yeasts. A total of 44 biotypes were found amongst the 117 oral C. albicans isolates examined. The major biotype A1R accounted for 17.9% of all isolates while the second commonest biotype was A1S (11.1% of isolates). Whereas these two biotypes were isolated from all the regions studied, there were a number of other biotypes unique to individual countries. The data indicate that there are many different sub-strains of oral C. albicans in HIV-infected patients, some of which are globally prevalent. However, further work is required to ascertain the diversity of oral C. albicans biotypes, if any, in health and disease.

PIP: 11-96% of patients with HIV infection develop oral candidosis at some point during the progression of HIV infection to AIDS. In the early stages of HIV infection, the development of oral candidosis is highly predictive of worsening immunodeficiency. Despite its importance as a sentinel opportunistic infection in HIV disease, however, little is known about the epidemiology of the major etiological agent, Candida albicans, associated with the disease. The authors conducted a study to identify the different biotypes of C. albicans isolated from oral samples of HIV-infected patients from Hong Kong, Australia, Germany, and England, and to gain insight into their geographic distribution. 33 isolates from Hong Kong, 37 from Australia, 30 from Germany, and 17 from England were characterized using a biotyping system based upon enzyme profiles, carbohydrate assimilation patterns, and boric acid resistance of the yeasts. 44 biotypes were identified. A1R and A1S were the two major biotypes, accounting for 17.9% and 11.1% of all isolates, respectively, isolated from all the regions studied. Some other biotypes were unique to individual countries. This study therefore found that there are many different sub-strains of oral Candida albicans in HIV-infected patients, some of which are globally prevalent.

AIDS and the gateway of the body.

PIP: In the early phases of HIV infection, the oral cavity may develop erythematous and pseudomembranous candidiasis, oral hairy leukoplakia (OHL), necrotizing ulcerative periodontal disease, Kaposi's sarcoma, and infections with Herpes simplex viruses, cytomegalovirus, Epstein-Barr virus, and Varicella zoster virus. The leading oral infections are candidiasis and OHL. The most common oral form of candidiasis is pseudomembranous, which appears white and milky and can be easily removed from the mucosal surface. After removal, this surface will bleed and be raw. OHL forms a white, corrugated (hairy) 1 m to 2 cm patch, generally on the lateral borders of the tongue. OHL rarely occurs in persons not infected with HIV. HIV-positive people often experience considerable periodontal destruction, causing much pain. They may also have atypical gingivitis. Painful, indolent oral ulcers are often on the tongue, lip, gingiva, and esophagus. Almost everyone with advanced HIV infection is seropositive for cytomegalovirus. Molluscum contagiosum lesions in HIV-infected persons are larger and more numerous than those in children. Various cutaneous or noncutaneous noninfective conditions (e.g., psoriasis and vasculitis) are also more common in HIV-infected persons. Possible agents to control candidiasis are fluconazole and chlorhexidine oral rinse. Topical or systemic corticosteroids may control aphthous-like ulcers. The drug acyclovir may control herpes virus and other viral infections. If acyclovir is ineffective, desciclovir, ganciclovir, or foscarnet are possible alternatives. Papilloma virus lesions can be treated with cryosurgery, laser therapy, or surgical excision. Radiotherapy, chemotherapy, and interferon are treatments for Kaposi's sarcoma. Aspirin and other nonsteroidal anti-inflammatory drugs may be contraindicated in patients with thrombocytopenia or who are on corticosteroid therapy.^ieng

[HIV infection: a new concern in dental public health]. / L'infection à VIH: nouvelle préoccupation en santé publique dentaire.

The authors report the results of a seroepidemiological study, conducted in Senegal on dental personnel. This study allows them to confirm that professional dental practice is a factor of risk for the HIV infection. This study recommends work methods to the dental profession.

PIP: During January-March 1990, at 26 of 38 dental facilities throughout Senegal, health workers took blood samples from 10 dental surgeons, 60 nurse specialists in dentistry, and 21 dental health agents so researchers could determine the prevalence of HIV infection among dental public health providers. There were 2.67 men for every woman. Women were more likely to be dental surgeons than men. Most subjects were 26-35 years old and worked in the Dakar region. Five persons (3.81%) were infected with HIV. Three had HIV-1 infection (2.29%), one had HIV-2 infection (0.76%), and one had dual infection (HIV-1 and HIV-2) (0.76%). All three HIV-1 infection cases were women as well as dental surgeons. The remaining cases were men as well as nurse specialists in dentistry. The age of all HIV infected persons but one fell between 25 and 35. The age of the other case fell within the 36-45 age group. Four of the HIV infected persons were married and monogamous. The remaining case was single. All HIV positive persons had been practicing their profession for at least four years. The sole HIV-2 positive person had been practicing his profession for 10 years. Since there is the case of an HIV positive dentist in Florida (USA) who had transmitted HIV to five patients, one should not rule out the possibility of HIV transmission from dental professionals to patients. Thus, dental professionals should use bleaching solution diluted to 10% for 10 minutes. This solution should be available for all dental services. Dental providers should wear gloves, masks, and goggles with all patients. They should use single-use sterile material for each patient. Adequate emergency measures to prevent nosocomial transmission of HIV must be established in Senegal.

A longitudinal study of dental caries in the primary teeth of children who suffered from infant malnutrition.

A prospective, four-year longitudinal study of 209 Peruvian children was conducted to evaluate the effect of a single malnutrition episode occurring at infancy (i.e., < 1 year of age) on dental caries in the primary teeth. Children were recruited into the study at age 6-11 months after they had suffered from a malnutrition episode and were thus classified by anthropometry as either: (1) Normal; (2) Wasted (low weight for height); (3) Stunted (low height for age); or (4) Stunted and Wasted (S and W). Eruption of the primary teeth was significantly delayed in all malnourished children; however, the effect of stunting--that is, retarded linear growth--was more pronounced and lasted longer than that of wasting or acute malnutrition (i.e., 2.5 vs. 1.5 years, respectively). By age 4 years, children from group 4 (S and W) showed a significantly higher caries experience in the primary teeth than did those in any of the other three groups. In summary, this longitudinal study has confirmed previous studies in animals and indirect epidemiological evidence which had suggested a cause-effect relationship between early malnutrition and increased dental caries.

PIP: The study was conducted from 1986 through 1990 among 209 children residing in Canto Grande, a poor community located north of Lima, Peru. The children were recruited as infants, aged 6-11 months, from the outpatient population of the Canto Grande Health Center, or from two other hospitals. All children were of full-term gestation and normal birth weight ( 2500 g). Each child was assigned to 1 of 4 study groups ascertained by weight and height measurements, with the National Center for Health Statistics standards used as the reference: 1) normal; 2) wasted, indicating current acute malnutrition; 3) stunted, indicating past or chronic malnutrition; and 4) stunted and wasted, indicating malnutrition soon after birth. The data, composed of 2700 examinations, were analyzed by the Statistical Analysis System (SAS) General Linear Models (GLM) program for computation of ANOVA tables. The mean numbers of teeth at ages 1 and 1.5 years for normal children were significantly higher than those of the children who were either wasted, stunted, or stunted and wasted as infants. At age 2, normal children had significantly more teeth in the mouth than did stunted children and stunted and wasted children. At age 2.5, the number of teeth in the normal children was still significantly higher than in stunted children. At age 4, all 4 groups had their full 20 teeth. At age 4, children who were stunted and wasted during infancy showed a significantly higher number of decayed, extracted, and filled teeth (def) compared with that of the other 3 groups. When grouped into 4 def categories of low, moderate, high, and very high caries experience, the distribution of the 4th group was distinctly different from that of the other 3 groups. 17.2% of stunted and wasted children had a very high caries experience (i.e., def 13) at age 4, significantly higher than that in any of the other 3 groups (i.e., normal 9.8%, wasted 4.4%, and stunted 3.6%, respectively; p 0.001).

Patterns of breast and bottle feeding and their association with dental caries in 1- to 4-year-old South African children. 1. Dental caries prevalence and experience.

In order to study associations between breast and bottle feeding and dental caries a questionnaire on feeding habits was completed by trained interviewers for 1,263 children aged 1 to 4 years from five South African communities. Of these, 73 to 94 per cent had been breast fed for mean periods of 9 to 16 months. The types of infant feeding practised (breast, bottle or mixed) varied little within the groups although each group differed significantly from the others for the preferred feeding practice. Using responses to a dietary interview the children were subdivided into those breast fed for 12 months or longer (n = 546), those who had mixed breast and bottle feeding (n = 527) and those who were bottle fed only (n = 190). Caries prevalence increased with the age of the child, more in bottle fed than other groups. Within all feeding groups caries prevalence was lowest among white children and in social class I. The dmfs and dmft scores showed irregular patterns and were significantly influenced by feeding group and the interaction between race and social class.

PIP: The importance of breast feeding in industrialized societies is increasing. As such, it is important to establish whether or not breast feeding on demand for a prolonged period is associated with nursing caries so that the necessary prevention measures may be implemented in both developing and developed countries. The authors present findings from an investigation of breast and bottle-feeding practices and their relationships to dental caries in infants and pre-school children in the Transvaal. The relationship between feeding groups, age, race, social class, and dental decay was explored. Mothers or child carers of 1263 children aged 1-4 years from 5 South African communities were interviewed. 73-94% of the children had been breast fed for mean periods of 9-16 months. Although types of infant feeding varied little within groups, preferred feeding practice differed significantly between groups. 546 children were breast fed for 12 months or longer, 527 had mixed breast and bottle feeding, and 190 were bottle fed only. The prevalence of caries increased with the age of the child and more among the bottle fed than others. The prevalence of caries was lowest among white children and in social class I within all feeding groups.

Use of health care services in two rural communities in Tanzania.

This study was undertaken to investigate the pattern of utilization of medical and dental health care services in rural Tanzania. Two hundred adults, 91 men and 109 women aged 20 or over, were interviewed. Nearly all subjects reported using modern dental and medical health care services. Home remedy was the only indigenous method of treatment used for dental problems while for medical problems a traditional healer was the most commonly used indigenous alternative. The use of both indigenous and modern health care services was significantly lower for dental than for medical problems (P < 0.05). It seems that the pattern of utilization of health care services differs for medical and dental problems. This should be taken into account when planning comprehensive health care services for rural African societies.

PIP: In September 1988 a dentist interviewed 91 men and 109 women aged 20 years and older living in 2 villages in Ilala, Tanzania, to study their pattern of utilization of dental and medical care services. Most adults had used modern dental and medical care services. Most adults had used modern dental and medical care services (96% and 98%, respectively). 84% of adults who used modern dental care services used a dentist, 23% a medical practitioner, and 1% a pharmacy. The only traditional method of treating dental problems was home remedy, which was used by men more often than women (30% vs. 18%; p .05). Use of analgesics likely was included among the home remedies. Adults probably did not use traditional healers for dental problems because they cannot alleviate the acute episodic dental pain. Dentists at hospitals using local anesthesia tend to do tooth extraction, the most common dental treatment in Tanzania. Adults were more likely to use both modern and traditional medical care services for medical problems than dental problems (p .05). They tended to use a traditional healer more often for medical problems than home remedies (61% vs. 34%; p .05). The farther people lived from the nearest modern medical health care unit, the greater the likelihood that they used traditional medical care services (92% for those living = or 5 km away vs. 61% for 5 km; p .05). Older adults were more likely to use both traditional dental and medical services (odds ratio [OR] = 3.85 and 2.65, respectively). Men tended to use traditional dental services more often than did women (OR = 3.93). These findings show that village-level modern dental health care has not been accorded a high priority. Existing medical staff at village-level health dispensaries should take on the responsibility for dental health.