Reduced susceptibility to amoxicillin of oral streptococci following amoxicillin exposure

As antibiotic pressure often triggers bacterial resistance, the use of short-duration therapies is increasingly recommended. The objective of the present study was to evaluate both the clinical efficiency and the impact on oral streptococci of a 3 day versus a 7 day amoxicillin therapy for odontogenic infection requiring tooth extraction. On day 0, patients were randomly assigned to a 3 day or 7 day amoxicillin treatment. The tooth was extracted on day 2 and the post-operative follow-up was carried out on day 9. Oral flora was collected on days 0, 9 and 30, and the susceptibility of the streptococci to amoxicillin was determined. The results showed that treatment with amoxicillin for 3 or 7 days had a similar clinical efficiency, and also induced similar selection of oral streptococci with reduced susceptibility to amoxicillin, suggesting that the selection of strains with reduced susceptibility to amoxicillin is a rapid phenomenon, appearing even with short-duration therapies.

[Dental status, access to care and precariousness]

BACKGROUND

The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions.

METHODS

A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health.

RESULTS

Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner.

CONCLUSION

This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

Reciprocal connections between the red nucleus and the trigeminal nuclei: a retrograde and anterograde tracing study

An anterograde biocytin and a retrograde WGA-colloidal gold study in the rat can provide information about reciprocal communication pathways between the red nucleus and the trigeminal sensory complex. No terminals were found within the trigeminal motor nucleus, in contrast with the facial motor nucleus. A dense terminal field was observed in the parvicellular reticular formation ventrally to the trigeminal motor nucleus. The parvicellular area may be important for the control of jaw movements by rubrotrigeminal inputs. On the other hand, the contralateral rostral parvicellular part of the red nucleus receives terminals from the same zone in the rostral part of the trigeminal sensory complex, where retrogradely labelled neurones were found after tracer injections into the red nucleus. Such relationships could be part of a control loop for somatosensory information from the orofacial area.

Potentiation of fentanyl suppression of the jaw-opening reflex by transcranial electrical stimulation

Stinus et al. [L. Stinus, M. Auriacombe, J. Tignol, A. Limoge, M. Le Moal, Transcranial electrical stimulation with high frequency intermittent current (Limoge's) potentiates opiate-induced analgesia: blind studies, Pain, 42 (1990) 351-363.] observed that transcranial electrical stimulation (TCES) with high-frequency intermittent current potentiated opiate-induced analgesia using the tail-flick test. In unanesthetized, chronic preparations, electrical stimulation (0.5 Hz) of the lower incisor pulp of rats elicits a short-(6 ms) and a long-latency (12-18 ms) jaw-opening reflex (JOR) without any evidence of aversive behavior [J. Azerad, F. Fuentes, I. Lendais, A. Limoge, B. Pollin, Methods for selective tooth pulp stimulation in acute and chronic preparations in rats, J. Physiol., 406 (1988) 3P.]. Fentanyl increases thresholds of both reflexes and transiently suppresses the long-latency JOR. We then decided to look at the influence of TCES on both drug-induced mean of maximal threshold variation (MMTV) and duration of JOR suppression period. These parameters have been investigated in 43 Wistar rats with or without TCES administered for 3 h before the drug injection and throughout the testing period. TCES alone has no effect. In contrast, it significantly increases the duration of the reflex suppression period (149 +/- 5% vs. control, P < 0.001) while fentanyl-increased reflex thresholds remain unchanged. The fentanyl-induced JOR suppression period returns to the control values 2 days later. When a second 3-h TCES session is delivered 2 or 4 days after the first TCES session, a similar increase of this suppression period is observed. Moreover, 2 days after a second TCES session, an increase of the duration of the fentanyl-induced JOR suppression period is systematically observed. In contrast, a 6-h TCES session never induces such effects. These results confirm a potentiating effect of TCES on opioid action and demonstrate the value of repeated TCES sessions.

[Electrophysiological study of the blink reflex in Wistar rats]

The electrophysiological characteristics of the blink reflex evoked by electrical stimulation of supraorbital nerve (V1) have been studied in the awake and anaesthetized rat. This reflex has two components (R1 and R2). The first one, R1, is of short latency, strictly ipsilateral to the stimulus and exhibits all features of an oligosynaptic reflex response. The second component, R2, of longer latency, is observed bilaterally in awaked but ipsilaterally in lightly anaesthetized and totally depressed in deeply anaesthetized animals. This component possesses all characteristics of a largely multi-synaptic reflex response.

Transcranial electrical stimulation with Limoge's currents decreases halothane requirements in rats. Evidence for the involvement of endogenous opioids

Transcutaneous cranial electrical stimulation with Limoge's currents has been shown to facilitate anesthesia/analgesia in surgical patients. However, the neurobiologic substrate of this effect remains unknown. The present study was designed to analyze the influence of transcranial electrical stimulation (TCES) on halothane requirements in rats and the contribution of the central endogenous opioid, alpha 2-adrenergic and 5-hydroxytryptamine (5-HT1 and 5-HT2) serotonergic systems to this effect. The influence of TCES on the MAC of halothane (MACH) and its reversibility by a subcutaneous 2 mg/kg naloxone injection were first determined in 20 rats using a randomized blinded protocol. MACH was decreased markedly in stimulated animals (TCES, n = 10) in comparison with sham-operated nonstimulated rats (controls, n = 10): MACH = 0.60 +/- 0.15, mean +/- SD, versus 1.07 +/- 0.05 vol%, P less than 0.001. In TCES animals, naloxone administration restored MACH values to the levels of controls but failed to affect MACH in controls. The influence of the duration of TCES applied prior to MACH determination was further investigated in 30 animals. The magnitude of MACH reduction was significantly increased with the cumulative duration of stimulation. For each duration of stimulation tested, administration of a 5-micrograms intracerebroventricular (icv) dose of the enkephalinase inhibitor thiorphan significantly enhanced TCES effects (P less than 0.05). Finally, the icv administration of a 15-micrograms naloxone dose appeared to reverse completely the MACH reduction elicited by TCES (n = 8, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Localization of 28 kDa calbindin in human odontoblasts

The presence of 28 kDa calbindin in human odontoblasts was studied by use of specific antibodies raised against chick duodenal 28 kDa calbindin, in immunofluorescence, immuno-peroxidase, and electron-microscopic labelling experiments. The calbindin-like protein was detected mainly in the cytoplasm of odontoblast cell bodies, in their processes and occasionally in their nuclei. Correspondingly, at the ultrastructural level, immunoreactive material was associated with the cytosol, microfilaments and cilia. These findings suggest that human odontoblasts express a 28 kDa vitamin D-dependent calcium-binding protein, unlike those of rats and mice in which ameloblasts are the only cells immunoreactive for the protein.

Afferent fibres in cat ventral roots: electrophysiological and histological evidence

Electrophysiological experiments using averaging techniques, as well as anatomical experiments using horseradish peroxidase staining, have provided further evidence of afferent axons in lumbosacral ventral roots of cats. Recording from dorsal root filaments in L7, S1 or S2, following stimulation of the companion ventral root close to the dura, often shows action potentials of slow conduction velocity belonging to the A delta or C group. Stimulation applied to the proximal part of the ventral root failed to evoke such responses. Recording from multiple sites along a centrally cut ventral root filament shows responses of two types: action potentials of long latency to peripheral nerve stimulation which are seen at all recording locations and which are not seen following dorsal root stimulation. These appear to be afferent fibres which enter the cord via the ventral root; action potentials which follow dorsal root stimulation and which are usually seen only at the most distal ventral root recording site. Some of these were also activated by stimulation of some skin or muscle nerves. At appropriate intervals collision of impulses from dorsal root or peripheral nerve can be demonstrated. Such axons appear to have a recurrent course in the ventral root. Section of the spinal nerve at points progressively closer to the dorsal root ganglion abolishes the dorsal to ventral root continuity of most recurrent type axons at 2 mm distal to the ganglion. Following application of horseradish peroxidase to crushed ends of distal stumps of cut dorsal roots, thin fibres marked by the enzyme are observed in the distal part of companion ventral roots. U-turns of axons have been observed in the distal part of ventral roots and in the spinal nerve near the pole of the ganglion.

The properties of cells in the cat trigeminal main sensory and spinal subnuclei activated by mechanical stimulation of the periodontium

Neurophysiological exploration of the trigeminal sensory complex was done on 42 cats under ketamine anaesthesia, paying special attention to units receiving a periodontal input. Among 492 cells recorded in the trigeminal sensory complex, 73 responded to mechanical stimulation of the periodontium and were precisely localized histologically. Thalamic stimulation was also delivered to the ipsi and contralateral ventro-posterior nucleus to test for antidromic responses. Results of this systematic study were plotted on reference drawings of the full extent of the trigeminal sensory complex.

Physiological Properties of neurons in different parts of the cat trigeminal sensory complex

The following points emerge from a systematic investigation of the 4 divisions of the cat trigeminal sensory complex. (1) The subnucleus oralis receives a large representation from the oral cavity, a region also represented in the 3 other divisions of the trigeminal sensory complex. (2) Nucleus principalis cells project heavily to the contralateral and to the ipsilateral ventroposterior thalamus. Ipsilateral projections are only from the oral cavity representation. (3) Units responding to noxious mechanical stimulation have been found at two different loci: the subnucleus caudalis for the entire trigeminal area, and subnucleus oralis for the oral cavity alone. (4) The dental pulp projects to the 4 divisions of the trigeminal sensory complex, but the heaviest projection was found in the rostral part (nucleus principalis and subnucleus oralis). (5) Three distinct types of post-synaptic responses were found to be evoked by dental pulp stimulation: (a) short latency, consistent and synaptically secure, (b) strongly variable latency, inconstant and easily fatigued and (c) a class showing progressive enhancement by progressive increase in stimulus intensity and repetition.

Sensation evoked by bipolar intrapulpal stimulation in man

Bipolar intrapulpal stimulation was applied to human teeth using the same procedure as in animal experiments. The effects of variation of stimulus parameters on the quality of sensation were studied. A prepain sensation exists which cannot be explained by diffusion of the stimulus to periodontal tissues. When the intensity of stimulation is increased, the prepain sensation is gradually replaced by a pinprick sensation. With long, high intensity stimulation, an acute long lasting very painful sensation appears. To evoke a pinprick sensation the best stimulation seems to be a 50 msec train (0.5 msec, 300 Hz, 0.5 mA). Longer train duration and a higher intensity of current are necessary to evoke a long lasting, acute very painful sensation. Since the exclusively Adelta and C nerve fiber content of the dental pulp is well documented and since it is possible to avoid current diffusion outside the dental pulp cavity, the tooth pulp implantation seems to be a good technic for studying pain, as long as the investigator uses adequate stimulation.

[Identification using glass microelectrodes of the activities recorded in the neighborhood of axons and cell bodies of the trigeminal sensory complex]

Using glass micropipettes unitary activities were recorded at the level of the trigeminal sensory complex. Iontophoresis of pontamine blue allowed us to localise the recording loci. Two types of spikes were observed, they were distinguished on the basis of their shape: one corresponds to an axon spike, the other to a cell body spike.

Mapping of the trigeminal sensory complex of the cat. Characterization of its neurons by stimulations of peripheral field, dental pulp afferents and thalamic projections

From a new systematic investigation of the 4 divisions of the trigeminal sensory complex, the following points are emphasized: 1. The subnucleus oralis receives a large representation from the oral cavity, a region also represented in the three other divisions of the trigeminal sensory complex. 2. Units responding to noxious mechanical stimulation have been found in two different loci: the subnucleus caudalis for the whole trigeminal area, and the subnucleus oralis for the oral cavity. 3. The dental pulp projects to the four divisions of the trigeminal sensory complex, but the heaviest projection is found in its rostral part (the main nucleus and subnucleus oralis). 4. Three distinct types of responses were found following dental pulp stimulation: primary, non primary and responses strongly enhanced by an increase in stimulus parameters.

Tooth pulp projection to the trigeminal complex and jaw opening reflex in the cat

The J.O.R. elecitied by pulpal, palatal or periodontal stimulations was recorded on the cat digastric nerve. As shown by the frontal sections of the brain stem the caudal subnucleus is not directly involved in this reflex. However after exclusion of the more rostral part of the interpolar subnucleus the pulpal induced J.O.R. is abolished although the palatal or periodontal induced J.O.R. is only partially suppressed.

[A microphysiologic study of thalamic projection of the cat's dental pulp (author's transl)]

(1) A similar proportion of cells in the VPM (24.7%), MGmc (24%), CM (26.8%) and CL (28.6%) is activated by electrical stimulation of the cat's dental pulp. However the thresholds are very different, cells belonging to the first group of the VPM being often activated by stimulation below 0.1 V. (2) Pain seems to be the unique sensation evoked by pulpal stimulation. A first group of cells somatotopically localized in the VPM displays a primary type of response. These cells can also be activated from an oral or perioral field. This fact is reminiscent of referred pain phenomenon often encountered in the clinic. (3) A second group of cells scattered in the VPM and activated by pulpal stimulation displays a non-primary type of response. (4) Strong pinching of the skin activates some MGmc cells tonically. Response characteristics of the MGmc cells after pulpal stimulation are heterogeneojs. (5) CM cells activated by pulpal stimulation display long latency responses whose properties are similar to those obtained after somatic stimulation. However, the latency of responses are shorter after limb stimulation than after pulpal stimulation.