Colonisation on the tongue surface by respiratory pathogens in residents of a nursing home--a pilot study.

OBJECTIVE: The morbidity and mortality of the dependent elderly that result from aspiration pneumonia have been recognised as a major geriatric health problem. The tongue has an extremely large surface area and due to its papillary structure can retain considerable quantities of food, and thus can support and harbour a large bacterial population. The purpose of this study was to gain more information on the microflora of the tongue surface and to assess the existence of oral infectious pathogens potentially causing respiratory disease in nursing home residents. SUBJECTS AND METHODS: The tongue bacterial flora of 69 nursing home residents were examined to identify microorganisms by the culture method. RESULTS: Thirteen species of microorganisms were detected from the tongue in this study. In 41 of 69 subjects (59%), potential respiratory pathogens, had colonised the tongue surface. CONCLUSION: The results of the present study revealed that bacteria that commonly cause respiratory infection colonised the tongue of nursing home residents, suggesting that it may function as a reservoir of potential respiratory pathogens to facilitate colonisation on the oropharynx.

Colonization of denture plaque by respiratory pathogens in dependent elderly.

OBJECTIVES: Recently, there has been a resurgence of interest in the interactions between oral conditions and a number of prevalent systemic diseases. The morbidity and mortality of the dependent elderly that result from aspiration pneumonia have been recognized as a major geriatric health problem. The purpose of this study was to gain more information on the microflora of plaque on dentures and to assess the existence of oral infectious pathogens potentially causing the respiratory disease in the dependent elderly. SUBJECTS AND METHODS: The denture bacterial flora of 50 dependent elderly were examined to identify microorganisms by the culture method. RESULTS: 18 species of microorganisms were detected in denture plaque in this study. A variety of pathogens with the potential to cause respiratory infection pathogens colonized on the dentures of dependent elderly. CONCLUSION: The results of the present study revealed that bacteria that commonly cause respiratory infection colonized on the dentures of dependent elderly, suggesting that denture plaque may function as a reservoir of potential respiratory pathogens to facilitate colonization on the oropharynx.

Attitudes to oral care among caregivers in Japanese nursing homes.

OBJECTIVES: The purpose of this study is to investigate oral care practice and awareness of it among caregivers in Japanese nursing homes. METHODS: Caregivers were surveyed by means of a self-administered questionnaire designed to elicit the following information: awareness of oral care, its importance, the burden involved in oral care, and systematization of oral care. RESULTS: The results showed that most caregivers are adequately informed of the importance of oral care, but are inadequately educated in oral care and have little training in systematic oral care. CONCLUSION: The importance of providing appropriate and systematic oral care training must be stressed among caregivers along with the need to develop equipment to simplify and support oral care.

Marked enlargement of the jaws in secondary hyperparathyroidism--a case report.

A case of facial deformity and malocclusion due to secondary hyperparathyroidism is presented. Treatment consisted of parathyroidectomy, followed by recontouring of the maxilla and mandible with additional dental treatment. A 3-D reconstruction of the computed tomography (CT) scan was helpful in evaluating the facial deformities and in treatment planning.

Congenital velopharyngeal incompetence in Kabuki make-up syndrome.

The Kabuki make-up syndrome is characterized by peculiar cranio-facial abnormalities, including cleft lip and palate. A case with velopharyngeal incompetence in a 7-year-old boy is reported. The significance of a possible association of this syndrome with congenital velopharyngeal incompetence is also discussed.

Functional effects of a free jejunum flap used for reconstruction in the oropharyngeal region.

Postoperative articulatory function was assessed in 5 patients who had had radical operations for cancers of the oropharyngeal region with surgical reconstruction using free jejunum flaps. A patient with total resection of the soft palate had the lowest scores of 39.9%. 4 patients with less resection than total removal of the soft palate had good scores (86.0%), and the articulatory dysfunction was limited only in plosive sounds produced in the velar region. A comparative study with glossectomized patients revealed that those who had had resection of the oropharynx achieved excellent articulation except for sounds produced in the velar region. The importance of operative function was stressed, to evaluate indications for the surgical technique for reconstruction of large tissue defects after ablation of head and neck cancers, and to improve the quality of life of those patients.

Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap.

Postoperative articulation in 18 glossectomized patients was investigated. The subjects were: 5 cases of tongue tumour, 7 cases of tumour of the anterior part of the floor of the mouth and 6 cases of tumour of the lateral part. A new modification of the Freiburger test for speech audiometry was used as test material. Then the articulatory function was assessed according to an overall score based on 180 monosyllables, the manner of production of 171 initial consonants and the place of production of 85 glossal sounds. The cases of tumour of the tongue and the lateral part of the floor of the mouth had excellent scores in all classes of sounds, which were compatible with the normative data. The subjects of tumour of the anterior part of the floor of the mouth had low overall scores, low scores for plosive and affricative sounds, and very low scores for sounds produced with the rear of the tongue. The relation between the site or amount of resection and subsequent articulation was significantly poor in all categories of sounds for the cases of anterior tumour, particularly in the movement of the posterior portion of the tongue even though it was not involved in the operation. In all groups there was a weak negative relation between the amount of resection and postoperative articulation. In reviewing the literature, reconstruction with a free jejunum flap was considered to lead to better articulation than reconstruction by other techniques. The need to assess postoperative function objectively was stressed, to compare the postoperative functions and to determine the indications for the reconstructive technique.

Factors contributing to skeletal relapse after surgical correlation of mandibular prognathism.

Postoperative follow-up and multiple regression analysis of skeletal relapse following mandibular setback were carried out to clarify the timing and causes of the relapse. The subjects were 24 mandibular prognathism patients. All patients underwent intraoral oblique sagittal splitting osteotomy with circumferential wiring and intermaxillary fixation for 8 weeks. Occlusal splints were not used. Postoperative positional changes of segments were evaluated by lateral cephalograms taken at appropriate intervals. Horizontal relapse was most evident within six months after surgery; vertical relapse seldom occurred. Multiple regression analysis revealed little association between preoperative morphological patterns and postoperative relapse. Although spatial changes of the proximal segment at operation and age of the patient were the best predictors for postoperative horizontal relapse, analysis indicated unsatisfactory prediction of vertical relapse because of its rare occurrence. Based on these results, the aetiology of relapse is discussed and two proposals are suggested for its prevention.

Functional effects of intraoral reconstruction with a free radial forearm flap.

Postoperative articulation was investigated in patients who underwent glossectomy and reconstruction with free radial forearm flaps. The methods of evaluation consisted of scores for intelligibility of 100 Japanese syllables and 3 groups of glossal sounds. The glossal sounds, based on palato-lingual contact (lingogram), were useful to evaluate function of the respective parts of the tongue. One patient who had had a partial glossectomy and resection of the floor of the mouth achieved an overall score of 80.5% one year postsurgery, and his glossal sounds were also excellent. Three patients who underwent removal of the floor of the mouth and hemiglossectomy, excluding the root of the tongue, had overall scores ranging from 45.6% to 82.1%. Two of these had particularly low scores for the glossal sounds produced with the rear part of the tongue, and this suggested the necessity for suspension slings to prevent depression of the reconstructed tongue and the floor of the mouth. The hemiglossectomy with partial mandibulectomy had an acceptable score of 68.7%. Chronologically, the glossal sounds produced with the rear part and the blade of the tongue often tended to improve postsurgery.

[Fundamental and clinical studies of long acting amoxicillin granules in oral and maxillofacial surgery infections].

Long acting amoxicillin granules (L-AMPC), a newly developed presentation of amoxicillin (AMPC), maintains an effective blood level for an extended period. The following results were obtained from fundamental and clinical studies of L-AMPC. Serum and gingiva levels of AMPC were measured in 5 patients at 2 (Patient 1), 3 (Patient 2), 4 (Patient 3), 5 (Patient 4) and 6 (Patient 5) hours. Serum levels were 4.1, 5.2, 3.0, 1.7 micrograms/ml and 1.2 micrograms/ml respectively, and gingiva levels were 1.3, 2.6, 2.1, 1.1 micrograms/g and 1.1 micrograms/g respectively. Twenty-five patients with oral and maxillofacial infections containing maxillary or mandibular osteitis were treated with L-AMPC. Clinical efficacy was assessed according to the criteria of numerical judgement established by the Japanese Society of Oral Surgery (1973) and also by the global evaluation of the clinician. In numerical judgement there were 1 excellent case, 19 good cases and 5 poor cases (efficacy ratio; 80%). The clinician's assessment was 4 excellent cases, 17 good cases, 3 fair cases and 1 poor case (84%). Although 2 slight side effects, diarrhea and black hairy tongue were observed, both treatments were completed without problem. L-AMPC therapy (b.i.d.) showed good prolonged tissue levels and satisfactory clinical results.