Invasive Dental Treatment Research Articles

Dental students' knowledge of medication-related osteonecrosis of the jaw.

Objectives:The aim of this study was to evaluate and assess knowledge and attitude of dental students about medication-related osteonecrosis of the jaw (MRONJ), to optimize future training programs in this field.Materials and Methods:A cross-sectional study was administrated. Ninety-eight participants agreed to complete an anonymous questionnaire. It was divided into two sections: the first section was about general information such as interviewer's gender and date of birth; the second section included questions about bisphosphonates (BPs), others medication associated to osteonecrosis of the jaw (ONJ), risk factors, and prevention of osteonecrosis. Descriptive statistics were computed and the odds ratio was used to compare the odds for the groups.Results:Ninety-nine percent of participants declared to know BPs, but only 26.9% of 4th year and 34.8% of 6th year students knew the correct definition of MRONJ. Almost all of students identified the importance to report, in anamnesis, the use of BPs, as well as to check-up patients before the beginning of treatment; on the other hand, the knowledge about how invasive dental treatment might be carried out in patients under therapy was not adequate. In addition, half of the students did not recognize any active principle or commercial name of BPs. The situation was even worse regarding alternative drugs involved in ONJ.Conclusions:These findings are alarming and the lack of knowledge about MRONJ suggests that greater educational efforts should be performed about this pathology at undergraduate level.

Analysis of mandibular changes using panoramic-based indices in patients with chronic renal failure.

Chronic renal failure (CRF) is a progressive disease affecting many systems and causing dental and periodontal problems, in particular a decrease or loss in the amount of cortical bone that is visible on radiographs. Panoramic radiography is useful for determining these changes. The aim of this study was to evaluate cortical parts of the mandible using panoramic-based indices in patients with CRF. 70 subjects with CRF were included in the study. The measurements of panoramic indices were made according to the visibility (mandibular cortical index, MCI) and thickness (mental index, MI) of the inferior cortex of the mandible. Then, these indices, obtained from 70 healthy controls of the same age and gender, were assessed and the results were compared. The effects of dental status and hemodialysis duration on MCI and MI were also investigated. The frequency of an eroded cortex was significantly elevated in patients with CRF (p<0.05). The mean MI was lower in patients with CRF than in healthy subjects (5.53 ± 1.62 and 5.73 ± 1.31 mm, respectively), but the difference was not statistically significant (p>0.05). No correlation was found between hemodialysis duration and mandibular indices (p>0.05). Dental status was not associated with mandibular indices (p>0.05). These results suggest that MCI might be a useful radiographic parameter for evaluating changes occurring in the cortical parts of the mandible in CRF patients. Clinicians should be aware of these changes while planning invasive dental treatments in CRF patients.

Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer: A case report and literature review.

Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κβ ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86-year-old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab-related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab-related ONJ had a similar clinical presentation to BP-related ONJ. There was also a tendency for denosumab-related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab-related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab-related ONJ, non-improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab-related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.

Strategies for Oral Health Management in Patients with Acute Confusional State

&lt;p class="AbstractContent"&gt;&lt;strong&gt;Background&lt;/strong&gt;: The presence of serious illnesses, medical complication, or drug intoxication may be the pathophysiological causes of acute confusional states (ACS). The oral diseases are highly prevalent in patients with this condition, which may cause life-threatening complications. Objectives: To describe the strategies for oral health management in patients with ACS who were treated in the inpatient ward of the Cipto Mangunkusumo Hospital.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Case Report and Management:&lt;/strong&gt; This report presented two patients with the diagnosis of ACS with differential diagnosis of dementia. The first patient was 67-year-old female with a history of nausea and vomiting before admission, eating difficulty, systemic disease and drugs use were unremarkable. The second patient was a 60-year-old female with history of nausea and vomiting every food or drinking intake, diabetes mellitus and hypertension. Clinical intraoral examination of both patients revealed poor oral health and progressive oral functional loss; However, in-office and invasive dental treatment was not indicated. The treatment focus was to improve oral comfort, oral pain management, and infection control.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: An appropriate oral healthcare plan should be considered depending on the patient’s dying stage or general condition with the collaboration between related healthcare providers.&lt;/p&gt;

Erratum to: Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10 years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data supported by evidence-based medicine are still sparse. However, the diagnosis and staging of ARONJ, identification of risk factors, and development of preventive and therapeutic approaches have advanced significantly over the past decade. The Position Paper 2017 is an updated version of the Position Paper 2010 of the Japanese Allied Committee on Osteonecrosis of the Jaw, which now comprises six Japanese academic societies. The Position Paper 2017 describes a new diagnostic definition for ARONJ, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), summarizes our current understanding of the pathophysiology of ARONJ based on a literature search, and suggests methods for physicians and dentists/oral surgeons to manage the disease. In addition, the appropriateness of discontinuing antiresorptive medications (drug holiday) before, during, and after invasive dental treatments is discussed extensively. More importantly, the manuscript also proposes, for the first time, the importance of interactive communication and cooperation between physicians and dentists/oral surgeons for the successful treatment of ARONJ. The Position Paper 2017 is intended to serve as a guide for improving the management of ARONJ patients in Japan.

Direct oral anticoagulants and its implications in dentistry. A review of literature.

BackgroundFour novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously.Material and MethodsA comprehensive search of the PubMed, Scopus and ISI Web of Science databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The quality of the reported information was assessed following the PRISMA statement.ResultsEleven studies that met the inclusion criteria were included in the review: 2 randomized clinical trials, 3 prospective studies, 3 retrospective studies, 2 case series and 1 case report.ConclusionsDOACs are safe drugs in terms of bleeding. The possible postoperative bleeding complications are manageable with conventional haemostasis measurements. The bridging approach with heparin does not seem to be recommended. Consensus among the professionals involved in the management of the patient is fundamental in invasive dental treatments and in complex patients. Key words:Oral anticoagulants, DOAC, NOAC, dabigatran, rivaroxaban, apixaban, edoxaban, bleeding, oral surgery.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

BackgroundAssessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children.Material and Methods151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children’s anxiety.ResultsGSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36).ConclusionsThe findings suggest that GSR is a reliable and valid measure for assessment of children’s dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions. Key words:Dental anxiety, reliability, validity, galvanic skin response.

Effectiveness of audiovisual distraction with computerized delivery of anesthesia during the placement of stainless steel crowns in children with Down syndrome.

Objective:Assessing effectiveness of audiovisual (AV) distraction with/without video eyewear and computerized delivery system-intrasulcular (CDS-IS) for local anesthesia during placement of stainless steel crowns for the management of pathological tooth grinding in children with Down syndrome.Materials and Methods:This clinical study includes 22 children (13 boys and 9 girls), with mean age being 7.1 years. The study involved three sessions 1-week apart. During Session I, dental prophylaxis to the upper jaw was done while watching a movie projected on the ceiling without video eyewear whereas prophylaxis for the lower jaw and impressions of both jaws were taken while watching another movie using eyewear projection. After 1 week, during Session II/III, children had their upper and lower second primary molars which were prepared and steel crowns inserted, respectively, while watching movies which were projected using video eyewear under the effect of CDS-IS local anesthesia. Changes in pulse oximeter and heart rate were recorded every 5 min. Independent sample t-test was used to assess significance of changes during each visit.Results:A statistically significant difference (P < 0.03) was observed in mean pulse rate between dental prophylaxis without video eyewear and during dental prophylaxis and dental impression taken while children were distracted using AV distracter with video eyewear. We observed an increase in mean pulse rate during tooth preparation use dental drills, but this does not lead to disruptive behavior as children were being distracted by AV distracter with video eyewear.Conclusion:Routine psychological (Tell-Show-Do) intervention along with visual distraction using video eyewear and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with Down syndrome during invasive dental treatment.

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data supported by evidence-based medicine are still sparse. However, the diagnosis and staging of ARONJ, identification of risk factors, and development of preventive and therapeutic approaches have advanced significantly over the past decade. The Position Paper 2017 is an updated version of the Position Paper 2010 of the Japanese Allied Committee on Osteonecrosis of the Jaw, which now comprises six Japanese academic societies. The Position Paper 2017 describes a new diagnostic definition for ARONJ, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), summarizes our current understanding of the pathophysiology of ARONJ based on a literature search, and suggests methods for physicians and dentists/oral surgeons to manage the disease. In addition, the appropriateness of discontinuing antiresorptive medications (drug holiday) before, during, and after invasive dental treatments is discussed extensively. More importantly, the manuscript also proposes, for the first time, the importance of interactive communication and cooperation between physicians and dentists/oral surgeons for the successful treatment of ARONJ. The Position Paper 2017 is intended to serve as a guide for improving the management of ARONJ patients in Japan.

Oral health evaluation of cardiac patients admitted to cardiovascular pre-surgery intervention

ABSTRACT Objective: To assess the oral health status of patients admitted to pre-intervention heart surgery, observing the need index concerning invasive treatment. Methods: hospitalized volunteers in number of 75 were evaluated in order to be investigated concerning which systemic changes were occurring, the patients' oral health conditions as well as the need for invasive dental procedures. Results: Volunteers analyzed in the study were: 69.3% male and 30.7% female. As for the reason for hospitalization were: valvuloplasty (41.3%), coronary artery bypass surgery (24%), pacemaker implantation (16%), cardiac catheterization (8%), placement of stent (6.6%), congenital heart disease (4%). The associated systemic changes were: hypertension (54.6%), diabetes mellitus (20.0%), hypertension and diabetes mellitus (13.3%). Most patients presented the need to undergo invasive dental treatment procedures such as: Periodontal (58.6%), Restorative Dentistry (26.6%), surgical (18.6%), endodontic (12%), dental pain source (2, 6%), abscess presence (1.3%). Conclusion: The oral health status of the patients was considered poor, a significant number of patients at the time of the oral examination, needed some type of invasive dental treatment and the oral environment adequacy indicated dental condition which may cause the formation of infectious sites which in turn can trigger complications both in the oral cavity and general health, as well.

Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty.

OBJECTIVES We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear. DESIGN Retrospective cohort study. PARTICIPANTS All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened. METHODS The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs. RESULTS PJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics. CONCLUSIONS The risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis. Infect Control Hosp Epidemiol. 2017;38:154-161.

Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy.

Objective:Assessing the effectiveness of behavioral modification techniques in combination with visual distraction with/without video eyewear using computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in hearing-impaired pediatric patients undergoing pulp therapy of primary molars.Materials and Methods:This randomized, crossover clinical study includes 15 children (7 boys and 8 girls), mean age was 6.1 years. Children were randomly distributed into two groups (Group A, n = 7; Group B, n = 8). The study involved three sessions, 1-week apart. During Session I, employing Tell-Show-Do technique, prophylactic dental cleaning was done while participants were watching a movie with sign-language interpretation with/without visual eyewear. At the end of Session I, score on Smiley Faces Program was used for anxiety assessment. During Session II and III, respectively, both groups underwent pulp treatment of equivalent teeth in the opposite sides of the mouth with/without video eyewear vice versa. After the procedure, children were instructed to rate their pain during treatment on the Wong-Bakers' (WBs') Faces Pain Scale. Changes in pulse oximeter and heart rate were recorded every 5 min. Paired sample t-test and independent sample t-test were used to assess the significance of changes during each visit.Results:There was a significant (P > 0.04) change in the heart rate observed for Group A underwent pulp treatment while watching video using video eyewear. Self-reported mean pain score also increases during treatment sessions' with video eyewear, for both groups.Conclusion:Routine psychological (Tell-Show-Do) intervention along with visual distraction with full visibility of the surrounding and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with hearing impairment undergoing invasive dental treatment.

Longevity of restorations in direct composite resin: literature review

ABSTRACT Composite resin restorations have increased considerably in popularity and predictability, enabling the realization of a minimally invasive dental treatment. However, to obtain the success of composite resin restorations, knowledge of adhesives and the use of the technique are required, otherwise failure may appear quickly. The objective of the present work was to conduct a literature review on the clinical performance of different types of composite resins and adhesive systems with regard to longevity. For this evaluation, some characteristics of the restorations were immediately verified after they were completed and after a determined time. Characteristics such as postoperative sensitivity, color, marginal integrity, secondary caries, texture, marginal adaptation, retention, displacement, marginal discoloration and anatomical shape had their performances compared. The influence of different adhesive systems on the longevity of the restorations was also observed as a function of its fundamental importance in the union between the tooth and the restorative material. It was concluded that most restorations performed clinically acceptable when hybrid, nanoparticle or microhybrid composite resins and conventional adhesive systems were used.

Niños con hemofilia y su atención odontológica por estomatología pediátrica. Revisión de la literatura / Children with Hemophilia and their Dental Care by Pediatric Stomatology. Review of Literature

&lt;strong&gt;ABSTRACT. &lt;/strong&gt;&lt;strong&gt;&lt;em&gt;Purpose&lt;/em&gt;&lt;/strong&gt;: To carry out systematic review of literature about diagnostics, severity, and dental treatment considerations of children with Hemophilia A. &lt;strong&gt;&lt;em&gt;Methods&lt;/em&gt;&lt;/strong&gt;: The search for articles and other document was conducted through the databases available at the National Library System of the National University of Colombia. The English and Spanish terms used in the search were “pediatric dentistry,” “hemophilia A,” dental care,” “coagulation factors,” and/or “coagulation disorders.” &lt;strong&gt;&lt;em&gt;Results&lt;/em&gt;&lt;/strong&gt;: The sample consisted of 29 articles that met the inclusion criteria. Hemophilia A is a congenital disorder caused by a deficiency of coagulation factor VIII. Treatment of hemophilia depends on its severity and focuses on avoiding risking life of children due to preventable bleeding by timely applying local therapies such as tranexamic acid or factor VIII, depending on dental needs. Dental treatment of hemophilia A should be interdisciplinary and must emphasize primary health care, health promotion, and prevention in order to avoid invasive dental treatments that could cause bleeding. In addition, treatments seek to maintain oral health and to provide quality of life to children living with hemophilia A.

Moderate sedation helps improve future behavior in pediatric dental patients – a prospective study

There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Can Impression Procedures Affect Certain Vital Functions of Edentulous Patients? A Clinical Study.

The most suitable treatment conditions and timing for medically unstable patients with severe systemic diseases about to undergo invasive dental treatment are well documented in the literature; however, no medical guides or recommendations identify these conditions for noninvasive dental treatments in such patients. The aim of this clinical study was to determine the effect of impression procedures on arterial oxygen saturation (AOS) and pulse rates (PRs) of edentulous subjects. A total of 28 Caucasian edentulous participants (15 females, 13 males) were included in the study. Pulse oximetry recordings (150 seconds) were performed for each participant at three stages; recording at rest (CON), during mandibular impressions (MANIs), and maxillary impressions (MAXIs). The mean values of PR, AOS, and event scores (ESs) indicating desaturation were obtained from the records. The comparisons of mean PR and AOS values were performed with the Bonferroni-corrected Wilcoxon-signed ranks test. The ESs were analyzed with the McNemar Test. The mean AOS values of MANI and MAXI did not display significant changes when compared with CON; however, the ESs obtained in both MANI and MAXI were significantly higher than those of CON (p = 0.008, p = 0.004). In addition, mean PR values obtained in MAXI were significantly higher than CON (p = 0.009). According to the results of this clinical study, the impression procedures may affect the PR values and lead to desaturation events in edentulous patients; however, further studies evaluating blood gas levels, which indicate precise AOS values, are necessary to support the results of this study.

Balancing the risks and benefits associated with cosmetic dentistry - a joint statement by UK specialist dental societies.

Cosmetic dentistry has become increasingly popular, largely as a result of social trends and increased media coverage. This understandable desire for the alleged 'perfect smile' needs to be tempered with an appropriate awareness of the significant risks associated with invasive cosmetic procedures such as veneers and crowns. Patients need to be properly informed that elective removal of healthy enamel and dentine can result in pulpal injury and poorer periodontal health in the longer term, particularly if they are young. The duty of candour means that they ought to be informed that aggressive reduction of sound tooth tissue is not biologically neutral and results in structural weakening of their teeth. Less invasive procedures such as bleaching on its own or for example, combined with direct resin composite bonding, can satisfy many patient's demands, while still being kinder to teeth and having much better fall-back positions for their future requirements. It is the opinion of the British Endodontic Society, British Society for Restorative Dentistry, Restorative Dentistry UK, Dental Trauma UK, British Society of Prosthodontics and the British Society of Paediatric Dentistry that elective invasive cosmetic dental treatments can result in great benefit to patients, but that some aggressive treatments used to achieve them can produce significant morbidities in teeth which were previously healthy. This is a worrying and growing problem with many ethical, legal and biologic aspects, but many adverse outcomes for patients who request cosmetic dental improvements are preventable by using biologically safer initial approaches to treatment planning and its provision.

Isolation of amoxicillin-resistant oral streptococci from children and their mothers

Background and objectiveInfective endocarditis has been reported to be induced by invasive dental treatments in individuals with certain underlying heart disorders. Although oral amoxicillin (AMPC) is widely used for prophylaxis in the dental field, scant information is available regarding transmission of AMPC-resistant strains. In the present study, AMPC-resistant strains harbored in the oral cavities of children and their mothers were examined to consider the possibility of transmission between them. DesignAMPC-resistant strains were isolated from 320 saliva specimens taken from 150 healthy Japanese mother–child pairs using selective medium for streptococci containing AMPC. The minimum inhibitory concentrations of these strains were evaluated using a macrodilution broth method. Randomly amplified polymorphic DNA analysis was performed to compare the fingerprinting patterns of the strains. ResultsAMPC-resistant streptococcal strains were isolated from 11 children and seven mothers, which included four mother–child pairs, although the fingerprinting patterns were consistent in only three. The proportion of children harboring AMPC-resistant strains with mothers who also harbored them was significantly higher than that of children whose mothers did not. ConclusionOur results suggest that AMPC-resistant strains can be transmitted between mothers and their children.

薬剤関連性顎骨壊死（MRONJ）の1例

For patients undergoing treatment for bone metastases by the administration of drugs such as bisphosphonates (BP), osteonecrosis of the jaw is a serious side effect. In recent years, it has been reported that some drugs other than BP also cause osteonecrosis of the jaw. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has designated such osteonecrosis as MRONJ (medication-related osteonecrosis of the jaw), and has published its position paper. We herein report a case of osteonecrosis of the jaw in a patient being treated with three drugs (denosumab, bevacizumab, and zoledronate).A 68-year-old patient who was being treated with the administration of the three drugs for lung cancer and bone metastases was referred to our department with pain and exposed bone in the posterior mandible. Under a clinical diagnosis of osteonecrosis of the jaw, routine observation with antibiotic administration and irrigation of the exposed bone were performed after stopping administration of the drugs. However, the patient's general symptoms worsened, and six months after the first visit he died of multiple organ failure.The present case indicates that the use of denosumab may be associated with osteonecrosis of the jaw because denosumab was used more frequently than BP. Reports on necrosis of the jaw caused by denosumab or angiogenesis inhibitors may increase in the future, therefore it is necessary to understand the condition of underlying diseases and to diagnose the adaptation of invasive dental treatment for patients treated with those drugs as well as BP.

Current Practices of the 2012 Antibiotic Prophylaxis Recommendations for Orthopaedic Implants in a Mid-West City

Background: This investigation examines practices with the 2012 recommendations by the American Dental Association (ADA) and American Academy of Orthopaedic Surgeons (AAOS) for antibiotic prophylaxis in patients with orthopaedic implants. Quantifying practices allow enforcement efforts to be focused, so the medical community can gain credibility by having united practices on this topic. Methods: A survey regarding the recommendations was mailed to randomly selected clinicians from the ADA and the AAOS membership lists. Participants were sixty orthopaedic surgeons, twenty-five oral surgeons, twenty-four endodontists, twenty-five general dentists, and twenty-one periodontists, all practicing within 100 miles of Omaha, Nebraska. Results: 81.3% of clinicians surveyed were aware of the recommendations, with no significant difference between orthopaedic surgeons and dentists (p=0.074). Of these clinicians, 74.5% indicated that they would recommend prophylactic antibiotics for patients with prosthetic implants prior to invasive dental treatment. Orthopaedic surgeons were significantly more likely to recommend prophylactic antibiotics for these patients (p<0.001). Conclusions: The primary hypothesis that clinicians who are aware of the recommendations would not routinely prescribe prophylactic antibiotics was rejected. The secondary hypothesis that there is no difference in practices between orthopaedic surgeons and dentists was rejected. Further studies should investigate the reason for this difference.