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Purpose: The purpose of this study was to: (1) evaluate the prevalence of mutans streptococci (MS) and dental caries in sickle cell anemia (SCA) patients receiving long-term prophylactic penicillin therapy; and (2) determine changes in MS colonization and dental caries upon discontinuing the antibiotic. Methods: Sixty subjects with SCA and 60 age- and race-matched control subjects participated in this study. The SCA subjects were divided into 2 separate age groups: (1) group 1 subjects were under 6 years of age and received penicillin twice a day; and (2) group 2 subjects were 6 to 12 years old and received no daily prophylactic antibiotics, although up to age 6 they had received daily penicillin before it was discontinued. DMFS/dmfs scores for all subjects were obtained through a comprehensive dental examination including bitewing radiographs. Stimulated salivary samples to assess MS levels were obtained on all subjects. Data on medical, dental, fluoride, and dietary history were obtained on all patients through a written parental questionnaire. Results: No group 1 patients had positive cultures for MS. In contrast, 70% of matched controls cultured positively for MS (P<.01). The DMFS/dmfs score for group 1 was 0.21 vs 5.1 for the control group (P<.01). Differences in surfaces affected were also noted, with no group 1 patients having interproximal lesions compared to 47% of control subjects having these lesions (P<.01). Group 2 also had significantly lower levels of MS than matched controls (47% vs 97%, P<.01), although there was no statistically significant difference in caries prevalence or surfaces involved. Conclusions: These findings demonstrate that long-term penicillin prophylaxis in SCA patients likely prevents the acquisition of MS, resulting in significantly lower caries rates in these patients. This benefit occurs only during active administration of the drug, however, and only delays the acquisition of MS. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a previously published article about the evidence based title in manuscripts.

Purpose: The purposes of this study were to investigate prescribing patterns of antibiotics for the management of common pediatric oral infections, and to and identify the independent predictors of antibiotic preference across different groups of dental practitioners in Massachusetts, USA. Methods: A cross-sectional survey assessed antibiotic prescribing practices of general dentists, pediatric dentists, endodontists, and oral surgeons based on a series of clinical scenarios where antibiotic coverage may be warranted. Results: The appropriate therapeutic management of patients with facial cellulitis occurred across all clinical groups. Endodontists were least likely to prescribe antibiotics for patients with irreversible pulpitis, and those with palpal necrosis with associated paruiis. Seventy-four percent of respondents prescribed antibiotics for patients suffering from pericoronitis and trismus. Conclusion: With the exception of the management of facial cellulitis, adherence to published guidelines for the prescription of antibiotics is low. Specifically, antibiotics are being prescribed too often for patients with tooth pain or localized abscesses and infreguently when the systemic spread of infection is less obvious, such as with trismus but no fever. Universally promulgated guidelines formulated by professional bodies may lead to improved adherence and a reduction in negative outcomes resulting from the overprescription of antibiotics. [ABSTRACT FROM AUTHOR]

White-spot lesions (WSL) associated with orthodontic appliances are a cosmetic problem and increase risk for cavities. We characterized the microbiota of WSL, accounting for confounding due to gingivitis. Participants were 60 children with fixed appliances, aged between 10 and 19 yrs, half with WSL. Plaque samples were assayed by a 16S rRNA-based microarray (HOMIM) and by PCR. Mean gingival index was positively associated with WSL (p = 0.018). Taxa associated with WSL by microarray included Granulicatella elegans (p = 0.01), Veillonellaceae sp. HOT 155 (p < 0.01), and Bifidobacterium Cluster 1 (p = 0.11), and by qPCR, Streptococcus mutans (p = 0.008) and Scardovia wiggsiae (p = 0.04) Taxa associated with gingivitis by microarray included: Gemella sanguinis (p = 0.002), Actinomyces sp. HOT 448 (p = 0.003), Prevotella cluster IV (p = 0.021), and Streptococcus sp. HOT 071/070 (p = 0.023); and levels of S. mutans (p = 0.02) and Bifidobacteriaceae (p = 0.012) by qPCR. Species' associations with WSL were minimally changed with adjustment for gingivitis level. Partial least-squares discriminant analysis yielded good discrimination between children with and those without WSL. Granulicatella, Veillonellaceae and Bifidobacteriaceae, in addition to S. mutans and S. wiggsiae, were associated with the presence of WSL in adolescents undergoing orthodontic treatment. Many taxa showed a stronger association with gingivitis than with WSL.

Sixty-eight children who were diagnosed with acute lymphoblastic leukaemia (ALL) prior to age 5 years and treated with chemotherapy alone, chemotherapy plus 1800 cGy cranial irradiation (RT), or chemotherapy plus 2400 cGy RT were assessed clinically for overall dental health. All patients were at least 60 months in continuous remission. Dental caries were assessed by NIDR diagnostic criteria, oral hygiene was assessed by the modified Oral Hygiene Index, and gingival health was assessed by the modified gingival index of Loe and Silness. There was no significant difference in caries experience between the three groups nor with the normal population. Those patients that received 2400 cGy RT had significantly higher plaque and periodontal index scores than patients in the other treatment groups. The results of this study suggest that: (1) children with ALL treated with any of the described modalities are at no greater risk of developing dental caries than the normal population; and (2) patients receiving 2400 cGy prior to age 5 years are at greater risk of developing periodontal disease than patients treated with other central nervous system prophylaxis regimens examined in this study.