Prosthetic joint infections are difficult to diagnose and treat due to biofilm formation by the causative pathogens. Pathogen identification relies on microbial culture that requires days to weeks, and in the case of chronic biofilm infections, lacks sensitivity. Diagnosis of infection is often delayed past the point of effective treatment such that only the removal of the implant is curative. Early diagnosis of an infection based on antibody detection might lead to less invasive, early interventions. Our study examined antibody-based assays against the Staphylococcus aureus biofilm-upregulated antigens SAOCOL0486 (a lipoprotein), glucosaminidase (a domain of SACOL1062), and SACOL0688 (the manganese transporter MntC) for detection of chronic S. aureus infection. We evaluated these antigens by enzyme-linked immunosorbent assay (ELISA) using sera from naive rabbits and rabbits with S. aureus-mediated osteomyelitis, and then we validated a proof of concept for the lateral flow assay (LFA). The SACOL0688 LFA demonstrated 100% specificity and 100% sensitivity. We demonstrated the clinical diagnostic utility of the SACOL0688 antigen using synovial fluid (SF) from humans with orthopedic implant infections. Elevated antibody levels to SACOL0688 in clinical SF specimens correlated with 91% sensitivity and 100% specificity for the diagnosis of S. aureus infection by ELISA. We found measuring antibodies levels to SACOL0688 in SF using ELISA or LFA provides a tool for the sensitive and specific diagnosis of S. aureus prosthetic joint infection. Development of the LFA diagnostic modality is a desirable, cost-effective option, potentially providing rapid readout in minutes for chronic biofilm infections.
Temporomandibular joint disorders (TMD) are oro-facial pain conditions that originate from either intraarticular or extraarticular related pathology. Following an accurate diagnosis, there are a variety of non-surgical and surgical management options available. The aim of this article is to review the available pharmacologic agents for the management of extraarticular and intraarticular TMD. These medical options are often first line and are combined with other non-surgical modalities. There are multiple pharmacologic options utilized to treat TMD, from non-steroidal anti-inflammatory drugs (NSAIDs) to muscle relaxants and steroids. Many of these medications are used synergistically to provide symptom improvement and prevention of persistent disease. This paper will discuss the use of the following classes of medications used to manage TMD: NSAIDs, corticosteroids, narcotics, muscle relaxants, anticonvulsants, anxiolytics, and topical therapy. Despite their extensive clinical use, there remains insufficient evidence to recommend one therapy over another. This is due to the lack of systematic reviews and meta-analyses in the current literature.For this reason, there remains a need for a randomized control trial with clear pre-pharmacotherapy diagnoses, blinding, and research objectives. NSAIDs have been recommended as first line therapy for intraarticular disorders with the addition of muscle relaxants if there is a muscle component. Several of the other medications discussed are often patient specific or given secondarily when previous therapy has failed.It is critical to recognize systemic patient factors when prescribing any of these medications to avoid side effects and drug-drug interactions.
Background: Orthognathic surgery is an underutilized resource in the treatment of congenital, developmental, and post-traumatic skeletal abnormalities in addition to obstructive sleep apnea. Despite the documented volume of patients who would benefit from orthognathic surgery, most fail to receive appropriate treatment. Purpose: The purpose of this study was to evaluate knowledge and attitudes within the dental community regarding orthognathic surgery via an anonymous electronic survey, and to explore whether misconceptions about orthognathic surgery represent potential barriers to care. Methods: This preliminary 5-question cross-sectional study was conducted via a “quick poll” distributed by the National Dental Practice-Based Research Network (PBRN). Results: The final sample size was 280 general dentists and dental specialists. The majority of respondents agreed that orthognathic surgery could correct malocclusions affecting a patient’s speech, function, and long-term dental health. However, few respondents agreed that orthognathic surgery is an evidence-based treatment for obstructive sleep apnea or positively affects upper airway size. Conclusions: Our survey demonstrates that while most dental providers consider orthognathic surgery as an effective treatment for the surgical correction of dentofacial deformities, many fail to recognize its potential role in the treatment algorithm for obstructive sleep apnea.
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