Dental care for the patient with bipolar disorder.
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Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Given the shift in treatment regimens from the traditional institutionally based approach to more community-focused alternatives, general dental practitioners can expect to see and be asked to treat patients with various forms of psychiatric disorders. One such group consists of patients with bipolar disorder (including type I bipolar disorder or manic-depressive disorder). The purpose of this paper is to acquaint the dental practitioner with the psychopathological features of bipolar disorder and to highlight the oral health findings and dental management considerations for these patients. Bipolar disorder is considered one of the most treatable forms of psychiatric illness once it has been diagnosed correctly. Through a combination of pharmacotherapy, psychotherapy and life-adjustment skills counselling, these patients are better able to understand and cope with the underlying mood swings that typify the condition and in turn to interact more positively and progressively within society as a whole. Both the disease itself and its various pharmacologic management modalities exact a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. It is hoped that after reading this article the general dental practitioner will feel more confident about providing dental care for patients with bipolar disorder and in turn to become a vital participant in the reintegration of these patients into society. (+info)
Unconventional dentistry: Part IV. Unconventional dental practices and products.
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This is the fourth in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). Several common UD and UM practices are described to familiarize practitioners with a variety of theories, practices, products and treatments that specifically apply to dentistry. This brief review is not intended as an in-depth resource. (+info)
Oral care interventions in critical care: frequency and documentation.
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BACKGROUND: No data have been collected to describe the products, methods, and frequency of oral care needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients. OBJECTIVES: To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center. METHODS: Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit's flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month. RESULTS: Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit's flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses' mean rating of oral care priority was 53.9 on a 100-point scale. CONCLUSIONS: Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care units is needed. (+info)
Indirect blastogenesis of peripheral blood leukocytes in experimental gingivitis.
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The blastogenic response of peripheral blood leukocytes to lipopolysaccharide (LPS) was followed over a short course of experimental gingivitis, developed in human volunteers who strictly avoided oral hygeine procedures for periods up to 9 days. Eleven young males initially received thorough dental prophylaxes and supervised oral hygeine until they acquired optimal gingival health. At this point, leukocytes (5 X 10(5)) incubated with 1.5 to 25 mug of LPS in serum-free media showed no response as measured by tritiated thymidine uptake. Coincubation of cells with LPS and phytohemagglutinin (PHA), however, caused synergistic enhancement of blastogenesis in every LPS-PHA dose combination tried. With progressive accumulation of dental plaque and the concomitant development of gingival inflammation, this synergistic response was lost and replaced, proportionately, by a direct response to LPS. The leukocyte response to PHA was marginally enhanced with gingivitis. (+info)
Insufficient awareness of endocarditis prophylaxis in patients at risk.
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OBJECTIVE: To determine whether patients at risk for development of infective endocarditis (IE) have adequate knowledge of IE and the need for endocarditis prophylaxis (EP), and to test the impact of reeducation on subsequent knowledge. METHODS: We assessed awareness of IE and EP in 139 patients at risk. To assess their knowledge of IE and EP, patients were asked to complete a questionnaire. 59 patients underwent education concerning IE and EP. RESULTS: On the basis of 123 analysed questionnaires, 87 patients were considered high risk and 36 moderate/low risk. Overall, 59% displayed inappropriate knowledge of IE and EP, 15% did not remember receiving IE education, nor had they been given an EP card. The term "endocarditis" was correctly defined by 45%. 63% were aware of the precautions necessary for IE and 55% remembered the need for antibiotic prophylaxis prior to invasive dental procedures. More than two thirds of the patients with prior education and an EP card could not recall having their knowledge of IE and EP "brushed up" by their primary care physicians. Only 21% had not informed their dentist of their risk for IE. CONCLUSIONS: Many patients at risk for IE have an inadequate knowledge of their heart disease, IE, and EP. Most of them are unaware of the need for good dental hygiene. Educational efforts should be intensified and regularly upgraded in adults with valvular disease. Communication between patient, physician and dentist needs to be improved in order to address these issues. (+info)
Evaluation of antibacterial activity of Mangifera indica on anaerobic dental microglora based on in vivo studies.
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The present study was carried out to compare the subgingival plaque microflora in mango leaf users. Fifty subjects of both sexes, 25 of them used tooth brush and 25 used mango leaf as their home care hygiene device were included in the study. The microbiological evaluation for specific bacterial counts of Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium nucleatum and Peptostreptococcus micros were carried out for all subject. Specific microbial evaluation revealed significant decrease in the proportion of P. intermedia and P. gingivalis in mango leaf users compared to tooth brush users. It shows that mangiferin possesses antibacterial activity in vivo against specific periodontal pathogens such as P. intermedia and P. gingivalis. Use of mango leaf in conjunction with a tooth brush will be a good home care device for maintenance of oral hygiene. (+info)
A survey of the oral status of children undergoing liver transplantation.
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BACKGROUND: The purposes of this study were to examine the oral tissues and caries prevalence of children undergoing liver transplantation, and to evaluate the relationship between tooth staining and serum bilirubin level. METHODS: Thirty-four children (22 boys and 12 girls) under the age of 6 years with end-stage liver disease were referred from the Liver Transplantation Center at Kaohsiung Chang Gung Children's Hospital, Taiwan. Oral tissues were examined, and photographs taken to determine the green staining of the teeth and gingiva. A questionnaire was completed by their parents. Serum bilirubin levels were collected preoperatively in these children. Student's t-test was used to compare the mean decayed, missing, and filled tooth (dmft) difference between night-fed and non-night-fed groups, and to test the relationships between tooth staining and serum bilirubin levels. RESULTS: The caries prevalence of the 34 children undergoing liver transplantation was 61.8%. The mean dmft score of children 2 to 6 years old who were night-fed was significantly higher than that of children who were not (10.1 +/- 1.2 vs. 6.3 +/- 1.2; p = 0.038). Green staining of the teeth and gingiva was found in 61.3% of cases in children with biliary atresia. Total serum bilirubin levels were significantly higher in the green-stained group than in the non-stained group (17.87 +/- 2.50 vs. 2.20 0.65; p < 0.01). CONCLUSIONS: Oral findings of children undergoing liver transplant presented significant green staining of the teeth and gingiva related to high serum bilirubin levels. Children who were night-fed showed an increased risk of developing caries suggesting that oral hygiene instructions should begin as early as possible before liver transplantation. (+info)
Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis.
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OBJECTIVES: Recent decades have seen a trend to treat juvenile idiopathic arthritis (JIA) with increasing immunosuppression to improve the long-term outcome. Poor oral hygiene and dental decay cause significant morbidity, and patients with chronic disease (who may be further immunocompromised by treatment) are at greater risk. This study investigated patients with JIA using standard measures of oral health. METHODS: One hundred and forty-nine patients with JIA were included. The children were attending a regional paediatric rheumatology service and the adults were attending an adult rheumatology clinic. Random age- and sex-matched healthy controls were recruited from a dental teaching hospital. The structured dental examination included standard epidemiological indices of oral hygiene (gingival index, plaque index, oral cleanliness index) and dental decay [DMFT (decayed, missing or filled teeth) index]. RESULTS: JIA patients, at all ages, had increased levels of dental decay and poor oral hygiene. This increased level of decay was statistically significant in the patients aged 0-11 yr. Significant levels of untreated caries and increased levels of missing teeth were found in JIA, suggesting that patients with JIA had less restorative dental treatment, with tooth extraction often the chosen option for the treatment of dental decay. CONCLUSIONS: This is the largest study of oral health in JIA and is cross-sectional with non-diseased controls. It shows significantly increased levels of poor oral hygiene and dental decay in patients with JIA. The high levels of untreated dental decay suggest barriers to dental care. These results emphasize the role of regular dental care in the multidisciplinary management of JIA. (+info)