Skin surface lipids inhibit adherence of Candida albicans to stratum corneum.

BACKGROUND: Candida albicans (CA) infections represent a significant threat to the health of immunocompromised individuals. The initial step in the establishment of a CA infection is adherence of the organism to an epithelial surface. METHODS: An in vitro model for studies on adherence of CA to keratinized surfaces has been developed and used to test the hypothesis that specific lipids can modulate adherence of this organism. Porcine stratum corneum (SC) disks were incubated with candidal suspensions, after which unattached cells were washed away. Adherent cells were stained and counted using light microscopy. RESULTS: Attachment of three pathogenic CA isolates was significantly greater than attachment of commensal strains of either CA or Candida parapsilosis. Removal of lipid from the SC lead to a doubling of the number of adherent organisms, whereas additional skin lipid inhibited adherence. Squalene, wax esters, cholesterol esters and triglycerides had no effect on adherence, but fatty acids, sterols and ceramides inhibited adherence significantly. CONCLUSIONS: Specific epithelial lipids can modulate adherence of CA to keratinized epithelial surfaces.

Sjögren's syndrome: diagnosis and management of oral complications.

Sjogren's syndrome, a common autoimmune disease process, is characterized by destruction of exocrine (including the lacrimal and salivary) glands. Patients with this disorder may initially complain of a dry mouth or have rapid onset of new carious lesions. Here, a case of Sjogren's syndrome is presented that was initially diagnosed because of dental complaints, and long-term treatment of Sjogren's patients is discussed.

Clinical management of oral and perioral candidosis.

Oral candidosis is a diagnosable and treatable mucosal disease that may be complicated by various other local or systemic disease conditions. Dependable diagnosis always should include a combination of clinical signs and symptoms suggestive of candidal disease as well as positive cytologic or direct culture results. The management of candidal infections should be individualized for each patient, with concern for interactions with current medications, immune status, other concurrent mucosal diseases, and exogenous infectious sources. In selecting the appropriate therapeutic agent(s) the clinician should consider patient health factors, location and severity of infection, and the probability of chronicity.

Benign mucous membrane pemphigoid with advanced periodontal involvement: diagnosis and therapy.

This paper describes a case of benign mucous membrane pemphigoid which affected the periodontal tissues and complicated ocular prosthesis placement. The clinical findings, diagnostic criteria, and therapeutic management of this disorder are reviewed.

A three-dimensional finite-element stress analysis of an endodontically prepared maxillary central incisor.

This study is an application of a three-dimensional Finite-Element Method to investigate the changes in stress characteristics of a prepared maxillary central incisor. The purpose of this study was to analyze stress distributions in this tooth after simulated canal preparation and static loading. A maxillary central incisor was embedded in acrylic, sectioned, photographed, and digitized. A three-dimensional finite-element model was generated by a computer and appropriately modified to simulate canal preparation. Data identified the highest stress magnitudes to be located between the middle and coronal thirds of the root; an area clinically observed to be prone to fracture during treatment. In addition, the magnitude of generated stresses was directly correlated with the simulated prepared canal diameter. The development of a validated three-dimensional finite-element method could identify areas that may predispose a tooth to structural failure during condensation loads.

The management of odontogenic infections. A rationale for appropriate chemotherapy.

Odontogenic infections are one of the most frequently occurring infectious processes known to health practice. Significant changes have occurred in the use of antibiotics and antimicrobials since the use of chemotherapeutic agents became widespread. This article provides some important considerations for selecting appropriate chemotherapeutic agents during the management of odontogenic infections.

Disinfectant storage media and composite/metal bond strength.

PURPOSE: To evaluate the effect of three disinfection procedures on the tensile bond strength of Panavia resin composite cement. MATERIALS AND METHODS: Alloy cylinders were bonded and stored in: (1) 0.2% chlorhexidine; (2) 2% activated glutaraldehyde; (3) distilled water and sterilized with ethylene oxide; and (4) distilled water. Solutions were monitored for bacterial cultures and pH changes regularly for 90 days after which all samples were tested to tensile failure. RESULTS: ANOVA showed no significant difference between mean group bond strengths. A direct positive correlation was demonstrated between solution pH and bond strengths (r = 0.98). All groups were found to represent effective methods for preventing bacterial growth in storage solutions during long term cement bonding studies.

Oral and perioral candidosis.

The following article has been assembled from the current literature and our clinical experience to provide a comprehensive review of oral and perioral candidal infections. A brief review of the epidemiology and pathogenesis is followed by a description of the various clinical signs and symptoms associated with oral candidosis. Methods useful in arriving at a diagnosis of candidal infection as well as a number of effective therapeutic modalities are discussed. In addition, special considerations relating to the treatment of patients with other concurrent mucosal diseases and long-term antifungal maintenance regimes are addressed.

Differentiation of sugar assimilation characteristics and colony phenotypes in pathogenic and commensal oral candidal isolates.

A comparison of sugar assimilation patterns has been made using 72 oral candidal isolates recovered from diseased and non-diseased patients. Significant differences were demonstrated between isolates recovered from diseased versus healthy mouths. In addition, significant changes in colony phenotype (switch frequency and morphologic predominance) were found to relate to predictive data generated from carbon source utilization data. These results suggest that biochemical properties and colony phenotypic characteristics may hold promise in predicting the behavior of oral candidal isolates in disease.

Candida and candidosis. Epidemiology, diagnosis and therapeutic management.

Infections caused by Candida species comprise one of the most common oral disease conditions encountered in the practice of dentistry. Gradual changes in population demographics have been accompanied by an increased incidence in candidal and related opportunistic infection rates. Candida albicans and other candidal species traditionally have been recognized as opportunistic pathogens. Recent advances in both the scientific basis for and the clinical significance of candidal organisms, however, have demonstrated these fungi to be distributed widely and to be important contributors to a broad range of mucosal and systemic disease conditions. These factors have allowed for a better understanding of fungal pathogenesis as it affects human oral disease through improvements in clinical and laboratory diagnosis and the therapeutic management of candidosis.

Oral candidosis. Clinical, historical, and therapeutic features of 100 cases.

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.

Evaluation of intra-alveolar chlorhexidine dressings after removal of impacted mandibular third molars.

Chlorhexidine gluconate (CHX) has been investigated for its possible benefit in the prevention of alveolar osteitis complicating third molar removal. In a double-blind, placebo-controlled clinical study, 70 randomly selected healthy patients were subjected to uncomplicated mandibular third molar removal followed by CHX-gelatin sponge and saline solution-gelatin sponge intra-alveolar dressings. Each patient was followed for 6 days for postoperative discomfort and complications, and scored accordingly. The results demonstrated that patients receiving 0.2% CHX intra-alveolar dressings exhibited a significant reduction in postoperative discomfort and complications when compared with saline solution-treated control sites (p less than 0.005). Further, this phenomenon was not found to be related to patient factors including age, sex, and race, nor did any correlation exist between treated or control sites, and surgical factors including performing surgeon, surgeon's dominant hand, time of surgery, surgical site, and difficulty of the removal. These findings warrant further studies concerning the apparent clinical benefit of postextraction intra-alveolar CHX dressings for the reduction of postoperative alveolar osteitis.

Migration and chemiluminescence of polymorphonuclear cells and monocytes to Bacteroides sonicates.

Recent investigations have demonstrated that various preparations obtained from representatives of the genus Bacteroides are poorly phagocytized by polymorphonuclear cells (PMN) and macrophages. Crude cell sonicates derived from Bacteroides have been examined for their ability to inhibit migration of PMN and monocytes using a modified migration under agarose in vitro assay. B. gingivalis and B. intermedius were found to be inhibitors of such migration while B. asaccharolyticus did not share this property (P less than 0.005). In addition, B. intermedius sonicates were found to inhibit PMN chemiluminescence to known stimulants (P less than 0.001). These data were not found to result from direct sonicate cytotoxicity and therefore lend additional support to the etiologic importance of specific Bacteroides strains in the pathogenesis of acute and chronic dentoalveolar infections.