The relationship between oral hygiene and oral colonization with Candida species in healthy adult subjects*.

UNLABELLED: Poor oral hygiene has been frequently suggested as a predisposing factor for oral candidal colonization, but the convincing evidence is lacking. OBJECTIVE: To assess and compare oral candidal colonization, both quantitatively and qualitatively, in groups of healthy dentate subjects with different levels of oral hygiene as determined by the plaque index (PI) and gingival index (GI) scores. METHODS: The concentrated oral rinse technique was used to isolate Candida species from 149 healthy dentate subjects. Candida species were cultured on Sabouraud's dextrose agar plates and identified by germ-tube test and the automated Vitek(R) system biochemical yeast card. According to the PI and GI scores, subjects were divided into different groups of oral hygiene level. RESULTS: Candida species were isolated from 86 (57.7%) subjects. The prevalence of candidal carriage increased significantly as a function of age (P = 0.023), but was comparable between males and females (58.7% and 56.7% respectively; P = 0.87). Oral candidal carriage rate and density were not affected by the levels of dental plaque or gingival condition. The prevalence of oral candididal carriage was significantly higher in the subjects who were not using dental floss compared with those who were using dental floss (P = 0.032). CONCLUSION: Oral hygiene status, as determined by the PI and the GI scores per se, does not affect oral candidal colonization in healthy dentate subjects.

Prevalence of dilaceration in Jordanian adults.

AIM: The purpose of this study was to determine the prevalence of dilaceration in a sample of Jordanian dental patients. METHODOLOGY: The data were collected from examination of radiographs from a random sample of periapical films. In all, 4655 teeth from 814 dental records at the Faculty of Dentistry, Irbid, Jordan were evaluated. The films were viewed using a magnifying lens and an X-ray viewer. A tooth was recorded as having a dilaceration towards the mesial or distal direction if there was a 90 angle or greater along its long axis using a small ruler aligned along the pulp of the tooth. Dilacerated roots towards the buccal or lingual directions were determined by evaluating the appearance of a round opaque area with a dark shadow in its central region, cast by the apical foramen in which the root canal gave a 'bulls-eye' appearance. RESULTS: Dilacerations were recorded in 3.78% of the teeth examined. Mandibular third molar teeth were the most commonly affected (19.2%) followed by mandibular first molars (5.6%). The maxillary anterior teeth and mandibular incisors were least affected exhibiting dilaceration in approximately 1% of teeth. Two-thirds of the dilacerations were in the mandible and approximately 5% were in anterior teeth. CONCLUSION: Dilaceration is not common, but it is an important dental anomaly that affects all teeth. Recognizing the condition will facilitate endodontic, orthodontic and surgical treatment.

Oral Candida and nasal Aspergillus flora in a group of Saudi healthy dentate subjects.

UNLABELLED: The prevalence of oral candidal carriage is widely variable in different populations but has never been studied previously in a Saudi population. Nasal mycological flora has never been investigated previously in a healthy population. OBJECTIVES: To assess the oral and nasal candidal and Aspergillus flora in a group of Saudi healthy adult dentate subjects. DESIGN: The concentrated oral rinse technique and nasal swab technique were used to sample the oral and nasal cavity respectively. RESULTS: Candida species were isolated from the oral cavity of 52 (52%) subjects. Candida albicans constituted 80.8% of the isolates, followed by C. krusei (5.8%). Aspergillus species were isolated from the nose of 21 (21%) subjects. A. flavus constituted 42.3% of the isolates followed by A. niger (31.8%) and A. fumigatus (26.9%). Subjects who did not brush their teeth had a significantly higher rate of oral Candida and nasal Aspergillus compared with those who brushed regularly (P = 0.02). CONCLUSION: Oral mycological flora in the Saudi population is not different than reported for other populations. Lack of oral hygiene increases oral candidal colonisation. Larger scale studies are encouraged to determine the prevalence of oral candidal carriage in the population generally, and the significance of nasal Aspergillus carriage should be determined.

Isolation of Candida species from the oral cavity and fingertips of complete denture wearers.

STATEMENT OF PROBLEM: Candida species usually colonize in the oral cavity of denture wearers and may also colonize on their fingers because of frequent manual manipulation of the dentures. PURPOSE: This study investigated the association between oral and fingertip candidal isolation in a group of denture wearers. MATERIAL AND METHODS: Oral rinse and fingerprints obtained from 25 healthy male complete denture wearers were microbiologically investigated for candidal growth, and isolated Candida species were identified with a germ tube test and a commercially available yeast identification system. Denture cleanliness, hand washing, and denture wearing and handling habits were recorded for each subject. RESULTS: Candida species were isolated from the oral cavity of 15 (60%) and fingertips of 11 (44%) subjects. Ten (66.7%) subjects had concomitant oral and fingertip candidal isolation, whereas 5 (33.3%) subjects had only oral Candida (P=.005). CONCLUSION: The hands of denture wearers who had oral Candida were significantly more colonized with Candida species than oral Candida-free subjects. Further studies identifying Candida species to the strain level and the significance of hand Candida as a source for mouth reinfection are needed.

Experimental induction of rheumatoid arthritis in temporomandibular joint of the guinea pig: a clinical and radiographic study.

OBJECTIVE: To correlate the clinical and radiographic changes at different stages of experimentally-induced rheumatoid arthritis (RA) of the TMJ. METHODS: Forty eight adult male guinea pigs, aged 4-6 months, were divided into two groups. Arthritis was induced in the experimental animals by intraperitoneal injection of heat-inactivated group A Streptococcus pyogenes. Four animals from each group were sacrificed and examined clinically and radiographically at intervals of 48 h and 1, 2, 4, 6 and 8 weeks. RESULTS: The main clinical findings were stiffness, crepitation and reduction in mouth opening. Radiographically, the main features were condylar erosion, flattening and sclerosis subcortical cyst formation. CONCLUSION: RA passes through stages that can be correlated clinically and radiographically. Both the clinical and radiographic manifestations in this experimental model are comparable with those previously reported in the small joints of humans.

Radiographic evidence of enamel pearls in jordanian dental patients.

OBJECTIVE: An "enamel pearl" is an ectopic globule of enamel that is adherent to the tooth root surface. Such an anomaly may facilitate the progression of periodontal breakdown. Information on the prevalence of enamel pearls is sparse, and ethnic variations are thought to occur. Our objective was to assess the prevalence of enamel pearls in a group of Jordanian dental patients. STUDY DESIGN: A random sample of 819 dental records were selected, and a total of 1032 periapical radiographs were interpreted for the presence of enamel pearls. RESULTS: Enamel pearls were detected in 4.76% of the subjects and on 1.6% of the molars. No significant difference between sexes was observed. First molar teeth were the most commonly affected, whereas the third molars were the least affected with the condition. CONCLUSIONS: Enamel pearls are not uncommon among Jordanian dental patients, and their early detection could be important in prevention of periodontal disease.

Clinical problems associated with unusual cases of talon cusp.

CASE REPORT: Talon cusp is an uncommon dental anomaly manifested as an accessory cusp-like structure on the crown of anterior teeth. This report describes two unusual cases of talon cusp. Case 1 showed bilateral anomalous cusps on the palatal aspects of maxillary supernumerary teeth, causing premature contact and tooth impaction. In case 2, a double-fused talon cusp was projected from the palatal surface of a large geminated central incisor. A talon cusp is not an innocuous defect, as it may provide a substantial diagnostic, treatment planning and procedural challenge. Early diagnosis and management are important to avoid complications.

Prevalence of pulp stones in Jordanian adults.

OBJECTIVE: The purpose of this study was to describe the prevalence of pulp stones in a sample of Jordanian dental patients. The article also presents frequency distributions of this condition among different types of teeth. STUDY DESIGN: Data were collected through radiographic examinations of a random sample of periapical and bitewing films of 4573 teeth from 814 dental records from the Faculty of Dentistry's filing system. RESULTS: Pulp stones were identified in 22% of the teeth examined. First and second molars were the teeth most commonly affected. Pulp stone incidence was not significantly different among different age and gender groups.

Buccinator window anomaly.

Four patients, three women and one man, with a mean age of 32 years, presented with a history of recurrent parotid swelling. In the women the swelling was unilateral. All had previously undergone sialography using a hand injection technique and no structural abnormality was demonstrated. Sialography was repeated using a continuous-infusion pressure-monitored system. In all cases an initial very high filling pressure (>200 mmHg) was recorded followed by a rapid reduction in pressure and a more normal filling pressure pattern. The duct system and glands all appeared morphologically normal. Treatment with acrylic appliance therapy and an intraductal catheter was attempted with some success.

Oral lesions in a Jordanian population.

Since there is little information available on the prevalence of oral lesions in the Middle East population generally, and no data on the Jordanian population, this study was undertaken to correct this deficiency in our knowledge. During this investigation 2175 consecutive asymptomatic dental patients attending the Initial Treatment Unit in the Faculty of Dentistry, Jordan University of Science and Technology were examined for the presence of oral lesions. A total of 30 different oral lesions and conditions were diagnosed. Fordyce's granules and tori were the most common conditions diagnosed in 49 per cent and 15.7 per cent of the subjects respectively. Larger scale studies are required on an unselected group of the Jordanian population to assess the overall significance of the findings.

Prevalence of taurodontism in Jordanian dental patients.

OBJECTIVES: To assess the prevalence of taurodontism in a group of Jordanian adult dental patients. METHODS: Posterior periapical radiographs of 875 unselected dental patients were examined for the presence of taurodontism defined as the presence of an apically displaced pulp chamber without the usual constriction at the cemento-enamel junction. RESULTS: Taurodontism was detected in 8% of subjects and 4.4% of the teeth examined. The maxillary second molar was the most commonly affected tooth. It was equally distributed between males and females (7.9% compared with 8.1% respectively, P > 0.05). 26.7% of the taurodont teeth also had pulp stones or calcifications. CONCLUSION: Taurodontism is not uncommon in Jordan but further larger scale studies are required to assess its prevalence in the general population to compare it with other ethnic groups.

Oral white sponge naevus: response to antibiotic therapy.

White sponge naevus is a rare benign inherited disorder of the mucous membranes, principally the oral mucosa. Although the condition is painless, patients are often symptomatic, complaining of an altered texture of the mucosa or that the lesions are unaesthetic. No standard treatment for the condition exists although numerous treatments have been tried. We now report on six patients who were prescribed systemic antibiotic therapy; three were adult men aged 24 years, 32 years, and 52 years, one an 11-year-old woman, one a 6-year-old woman (daughter of the 32-year-old man) and an 18-month-old boy (son of the 24-year-old man). Four responded as judged by clinical examination, although not the 6-year-old female or the 18-month-old male; the discontinuation of therapy then resulted in clinical recurrence in those who had responded, but long-term low dose treatment maintained the remission.

The in vitro adhesion of Candida albicans to buccal epithelial cells (BEC) from diabetic and non-diabetic individuals after in vivo and in vitro application of nystatin.

Buccal epithelial cells (BEC) from 12 patients with diabetes mellitus and 12 age- and sex-matched non-diabetic subjects were tested in vitro for adhesion of Candida albicans following exposure to nystatin both in vitro and in vivo. Adhesion was significantly reduced (P < 0.002) to cells from both the diabetic and non-diabetic subjects after in vitro exposure to nystatin, but the reduction in adhesion was variable (5.0-50.7% in control subjects and 0.5-48.4% in diabetic subjects) and equivalent between the two groups. In vivo exposure to nystatin produced no overall significant reduction in candidal adhesion to cells from either diabetic or control subjects.

Oral candidal flora in healthy infants.

Asymptomatic oral candidal carriage has been extensively studied in adults, but only rarely in infants. The present investigation aimed to determine the asymptomatic oral carriage of candidal species in healthy infants and its relationship to age, sex, feeding pattern and use of a pacifier. The swab technique was used for oral candidal isolation. Candidal species were isolated from 48% of the infants without a significant relationship to age, gender or between breast-fed or bottle-fed infants. Similarly, a history of maternal vaginal candidosis, or presence of nappy rash, had no significant relationship to oral candidal carriage. Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.

The effect of exposure to chlorhexidine gluconate in vitro and in vivo on in vitro adhesion of Candida albicans to buccal epithelial cells from diabetic and non-diabetic subjects.

The effect of 0.2% chlorhexidine gluconate on in vitro adhesion of Candida albicans to buccal epithelial cells (BEC) was studied in 12 healthy subjects and 12 patients with diabetes mellitus. Exposure of BEC for one minute with 0.2% chlorhexidine gluconate in vitro, or by rinsing the mouth in vivo, resulted in a significant reduction in candidal adhesion to BEC in both diabetic and non-diabetic subjects and between both groups. In addition to the known fungicidal effect of chlorhexidine, it also reduces Candida albicans adhesion to oral mucosal cells, a factor of importance in the establishment of candidal infection.

Prevalence of tongue lesions in 1013 Jordanian dental outpatients.

Over a period of 10 months, 1013 consecutive dental outpatients attending the Screening Clinic in Faculty of Dentistry, Jordan University of Science and Technology, in the city of Irbid were investigated for the presence of tongue lesions. All subjects were seeking treatment for caries and periodontal diseases and none was complaining of oral mucosal disorder. The results showed that 240 subjects (23.7%) had one or more tongue lesions. Geographic tongue and fissured tongue were detected in 6.8% and 11.4% of the examined population respectively, and an association of the two conditions was observed in 2.9% of the subjects. Hairy tongue was diagnosed in 3.4% of the subjects with significantly higher prevalence in males (P < 0.0005). A strong correlation was found between hairy tongue and smoking.

Oral disorders associated with diabetes mellitus.

The protean manifestations of diabetes include various associated oral disorders such as sialosis, xerostomia, impairment of taste, and localized infections of which oral candidosis is the most commonly observed. The association of specific oral diseases and diabetes is of importance both in the detection of undiagnosed diabetes and in the elucidation of the pathogenesis of various oro-facial diseases. The clinical features and possible causes of oral disorders recognized to be associated with diabetes are reviewed with emphasis on good oral hygiene in the diabetic patient.

Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus.

The glucose concentration in unstimulated mixed saliva and serum was assayed and correlated with oral candidal colonization in 41 diabetics and 34 healthy control subjects. In diabetic patients, salivary glucose concentration was significantly higher than in the controls and was directly related to blood glucose concentration. Although the difference in the frequency and quantity of oral candidal isolation failed to reach significance between the two groups, diabetic patients who carried Candida intraorally had significantly higher salivary glucose concentrations than those in whom Candida could not be isolated.

Chronic hyperplastic candidosis and secretor status.

A prospective study was undertaken of 22 patients with chronic hyperplastic candidosis and 50 age and sex matched individuals with no evidence of oral mucosal disease. Specifically the relationship between the inherited ability to secrete blood group antigens in saliva and chronic hyperplastic candidosis was investigated. The proportion of non-secretors of blood group antigens was significantly higher in patients with chronic hyperplastic candidosis (68%) compared to the control subjects (38%). The inability to secrete blood group antigens in saliva may therefore be a risk factor in the development of, or persistence of chronic hyperplastic candidosis.

Systemic fluconazole therapy and in vitro adhesion of Candida albicans to human buccal epithelial cells.

The adhesion of Candida albicans to buccal epithelial cells (BEC) from four healthy dentate men was studied in vitro 1 wk before, during and after a course of systemic fluconazole (50 mg once daily for 1 wk). After 1 wk of fluconazole intake candidal adhesion to BEC was significantly reduced and this reduction persisted for a week following completion of therapy. Fluconazole, therefore, in addition to being an effective antifungal agent may also have a sustained action on reducing adherence of candidal species to the oral mucosa.