Compendium-Continuing Education for Veterinarians最新文献

As one of the major autoimmune conditions involving the oral, head, and neck regions, Sjögren's syndrome has a significant level of dentally related pathology. As a result of salivary dysfunction, the teeth and mucosa may develop a wide array of changes. If these changes are not managed properly, major oral dysfunction can occur. An evaluation of salivary function, the management of xerostomia and its effects, dietary counseling, and an overall appreciation of the extraoral components of Sjögren's syndrome are presented. The dental component of comprehensive patient management is one of the most important aspects of this condition, with the dental practitioner being an essential part of the health-care team.

Smoking and smokeless tobacco can cause significant damage to the oral cavity, including life-threatening cancers. Consequently, dentists and their office staffs should and can play an influential role in advising their patients to quit using tobacco. The National Cancer Institute has developed the "Four A's" approach to tobacco-cessation counseling: (1) ask about tobacco use; (2) advise to quit; (3) assist with quitting; and (4) arrange for follow-up. With minimal expenditures of treatment time, the dentist and office staff can encourage patients to quit using tobacco through nonconfrontational messages that point out the clinical damage caused by smoking and smokeless tobacco. Besides behavior modification, dentists can prescribe several Food and Drug Administration-approved pharmaceutical agents as adjuncts to a tobacco-cessation program. Nicotine polacrilex (gum) and nicotine transdermal systems have proven very useful in helping tobacco users quit their habit.

Antimicrobial mouthrinses can play an important role in maintaining oral health by killing cariogenic organisms and preventing plaque and gingivitis. The active ingredients are adsorbed by oral tissues and then gradually released into the saliva. In this article, the effectiveness of a substantive chlorhexidine and a nonsubstantive phenolic antimicrobial mouthrinse were tested. When compared, the results indicated that the two types of mouthrinses are equally effective at killing salivary microbes for up to 30 minutes after rinsing. The prescriptive substantive rinse, however, continued its microbicidal effect for a longer duration (up to 5 hours) than the over-the-counter nonsubstantive rinse. The substantive rinse showed pronounced and measurable zones of inhibition around each well in the agar diffusion assay where the nonsubstantive rinse showed no zone around any well at any time. The substantive rinse also showed a superior ability to inhibit the growth of 28 oral microbes, including some putative periodontopathogens, which were assayed.

Many individuals with cardiovascular disease appear from epidemiologic studies to have either periodontal disease or to be edentulous. A Finnish group has provided evidence that after conventional risk factors for stroke and heart attacks have been accounted for, there still remains a significant relationship between dental disease and cardiovascular disease. A preliminary analysis of our own investigation of the interrelationship of medical and dental health shows that individuals with a high dental morbidity (ie, edentulous or with many missing teeth) have a high prevalence of coronary heart disease and stroke. A model based on how smoking can predispose to periodontal disease is used to explain how periodontal disease could be a potential risk factor for heart disease.

Cigarette smoking is a risk factor for many diseases, and recent evidence indicates that it adversely affects periodontal health. A number of epidemiologic studies have shown strong associations between smoking and the prevalence and severity of periodontitis, as well as interproximal bone loss. Although the pathogenesis of periodontitis in smokers is poorly understood, there are data suggesting that smoking causes defects in neutrophil function, impaired serum antibody responses to periodontal pathogens, and potentially diminished gingival fibroblast function. The prevalence and severity of periodontitis in former smokers is decreased compared to current smokers, providing evidence that smoking cessation is beneficial. Smoking markedly influences response to treatment, and a subset of smokers predominates among refractory periodontitis patients who are resistant to conventional treatment. A patient's smoking history is a useful clinical predictor of future disease activity. Current estimates suggest that smoking is associated with a large proportion of periodontitis cases and constitutes a major public dental health problem.