The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds.

Wound microbiology and associated approaches to wound management.

/pdf/white-paper-walking-speed-the-sixth-vital-sign-gtycujhxm3.pdf

White paper: "walking speed: the sixth vital sign".

The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Clinical complications with implants and implant prostheses.

Massive evidence has now accumulated which indicates that the pituitary-adrenal cortical system responds sensitively to psychological influences. This evidence represents converging and reinforcing findings from diverse studies of many species, including man. It involved the use of many methods of e

A review of psychoendocrine research on the pituitary-adrenal cortical system.

Background:Grafting the floor of the maxillary sinus has become the most common surgical intervention for increasing alveolar bone height prior to the placement of endosseous dental implants in the posterior maxilla. Outcomes of this procedure may be affected by specific surgical techniques, simultaneous versus delayed implant placement, use of barrier membranes over the lateral window, selection of graft material, and the surface characteristics and the length and width of the implants. Rationale:The primary objective of this systematic review was to determine the efficacy of the sinus augmentation procedure and compare the results achieved with various surgical techniques, grafting materials, and implants. Focused Question: In patients requiring dental implant placement, what is the effect on implant survival of maxillary sinus augmentation versus implant placement in the non-grafted posterior maxilla? Search Protocol: MEDLINE, the Cochrane Oral Health Group Specialized Trials Register, and the Database...

/pdf/effect-of-maxillary-sinus-augmentation-on-the-survival-of-4uoigk3y04.pdf

Effect of Maxillary Sinus Augmentation on the Survival of Endosseous Dental Implants. A Systematic Review

A clinical report. Water-free stannous-fluoride gel and post-irradiation caries.

: Directions are given for the fabrication, cleaning, and sterilizing of a modified CarlsonCrittenden parotid fluid collecting device that has been use-tested by the authors in the collection of over 40,000 specimens. It has served particularly well in prolonged collections made with exogenous stimulants. The size of the device is such that it is easily adapted for use in making collections from dogs and other large experimental animals. (Author)

Modified Carlson-Crittenden device for the collection of parotid fluid.

Saliva: Composition and Secretion

: Parotid fluid, which can be easily collected in continuous fashion, was previously shown to possess free 17-hydroxycorticosteroid (17-OH-CS) levels which paralleled those in serum and reached a maximum two hours after corticotropin or cortisol administration to normal men. The present study demonstrated that intravenously administered cortisol rapidly appeared in the parotid fluid, and that, thus, parotid fluid 17-OH-CS levels would serve as reliable indicators of adrenal function. This was borne out by studies in a patient with Cushing's syndrome as well as in those showing adrenal hyporesponsiveness. Despite the large rise in plasma 17-OH-CS in the third trimester of pregnancy there was only a small, though significant, rise in parotid fluid 17-OH-CS. These data are compatible with the hypothesis that only nonprotein-bound free 17-OH-CS reach the parotid fluid. Conjugated 17-OHCS were not found in appreciable quantity in parotid fluid. Chemical and radioisotopic technics indicated cortisol and cortisone to be the major human parotid fluid 17-OH-CS. (Author)

Identification and significance of parotid fluid corticosteroids.

Parotid fluid corticosteroids, substantially comprised of cortisol and cortisone, were previously demonstrated to rise to far greater levels 4 hr after administration of ACTH than they did in the third trimester of pregnancy, although the plasma total corticosteroid concentrations were similar in these two states. It was therefore suggested that only nonproteinbound corticosteroid gains access to parotid fluid. In the present study parotid fluid cortisol and cortisone and plasma dialyzable cortisol concentrations have been measured in normal men before and 2 hr after 40 U ACTH, and, in another group, before and after 10 days of diethystilbestrol (5 mg daily). Total plasma cortisol rose from a mean of 6.3 to 17.9 μg/100 ml after ACTH and from 14.6 to 39.4 mg/100 ml after the estrogen. However parotid fluid cortisol plus cortisone rose from 0.8 to 2.6 μg/100 ml after ACTH and to only 2.2 after estrogen. This rise resembled that of the plasma dialyzable cortisol (control 0.4, ACTH 1.8, estrogen 1.2 μg/100 ml) rather than the increase in total plasma cortisol which was over twice as high after estrogen as after ACTH. Thus parotid fluid corticosteroids seem to be a good measure of nonprotein-bound corticosteroid, the cortisol available to the cell. The total amount of cortisol plus cortisone excreted is approximately constant, independent of parotid fluid flow rate. Cortisone exceeds cortisol in parotid fluid in the basal state, but after ACTH the situation is reversed.

/pdf/parotid-fluid-cortisol-and-cortisone-4aifpno16y.pdf

Ira L. Shannon

Papers

A clinical report. Water-free stannous-fluoride gel and post-irradiation caries.

Modified Carlson-Crittenden device for the collection of parotid fluid.

Saliva: Composition and Secretion

Identification and significance of parotid fluid corticosteroids.

Parotid fluid cortisol and cortisone