Aim
(i) To discuss the possibility that dental infections in general, and endodontic infections (apical periodontitis) more specifically, may affect cardiovascular health, (ii) which preventive ...measures should be adopted during the treatment of endodontic infections for infective endocarditis (IE), and (iii) What should be the priorities for future research, in the light of the literature available.
Methodology
A literature review was performed.
Results and Conclusions
(i) Poor oral health and endodontic infections are associated with cardiovascular diseases, and endodontic infection appears to be associated with initial endothelial damage, (ii) preventive measures for IE should be adopted during endodontic treatment of patients at risk for cardiovascular events according to the American and European available official guidelines, and (iii) more research focused on apical periodontitis and systemic diseases is needed.
Aim
To evaluate the accuracy of ultrasound examination (USE) for the detection of artificial bone defects in bovine mandibles in the absence of complete erosion of the cortical bone plate and to ...determine the minimum cortical thickness that constitutes a barrier for ultrasound waves.
Methodology
Sixty bovine mandibular anatomical blocks were harvested and uniformly distributed amongst six experimental groups. The negative control consisted of blocks with no intra‐bony defects, whereas the positive control consisted of blocks with an artificial lesion of 2 mm diameter that perforated the buccal cortical bone plate. Two experimental groups comprised blocks with small (2 mm) and large (5 mm) artificial defects created under a cortical plate thinned to varying thicknesses. Two additional groups had small (2 mm) and large (5 mm) artificial defects that did not involve the cortical plate. After USE, the scans were saved and submitted to three blinded examiners. Sensitivity, specificity, predictive values and receiver‐operating characteristics (ROC) were analysed. The significance of the findings (P < 0.05) was appraised using the chi‐square statistics with the Yates correction, whilst the intra‐ and inter‐examiner agreements were evaluated through Kappa statistics.
Results
USE was associated with high sensitivity (97.3%) and negative predictive value (89%), and a perfect score for specificity and positive predictive value. The ROC curve analysis revealed an accuracy of 97.8%. The k‐values were 0.86 and 0.89 for the first and second examinations, respectively, demonstrating very high inter‐observer agreement. The intra‐observer agreement was also high (k‐value = 0.92). A significant correlation between the echographic diagnosis and the presence or absence of artificial intraosseous lesions in the anatomical blocks of bovine mandibles was observed (P < 0.0001).
Conclusions
USE was highly accurate and reliable for the detection of artificial lesions within bovine mandibles, regardless of the thickness or presence of the cortical plate.
Similarly to a series of chronic diseases, essential arterial hypertension (HTN) may be manifested during childhood as a blood pressure (BP) reading which repeatedly rises above the 95(th) percentile ...of population-specific standards. Since BP tends to track along the same percentiles throughout life, children with higher BPs are more likely to become hypertensive adults. When healthy measures aimed at reducing BP (i.e. body weight reduction, aerobic physical exercise, low sodium intake) have failed, pharmacological treatment is usually required. This paper aims to undertake a review of antihypertensive pharmacological therapy in children, examining the drugs used in chronic treatment as well as those administered to treat hypertensive crisis (i.e. a BP major than 99(th) percentile of paediatric normograms). Moreover, several important differences registered in the therapeutic approach to paediatric HTN between US and European Guidelines will be underlined.
To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections, and on the feasibility of providing dental treatment before cardiothoracic surgery, ...cardiovascular surgery or other cardiovascular invasive procedures.
A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients had never been defined. Following the systematic review several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently and then a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures.
A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions, and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered.
Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus can become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre-interventional preparation phase.
Aim
To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections and on the feasibility of providing dental treatment before cardiothoracic ...surgery, cardiovascular surgery or other cardiovascular invasive procedures.
Methodology
A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, a systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients, had never been defined. Following the systematic review, several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently, and then, a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures.
Results
A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered.
Conclusions
Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus will become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre‐interventional preparation phase.
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