Abscesso dentoalveolar crônico em paciente pediátrico com drenagem rara / Absceso dentoalveolar crónico en paciente pediátrico con drenaje raro / Chronic dentoalveolar abscess in a pediatric patient with rare drainage

RESUMO Introdução: As infecções do complexo maxillomandibular são corriqueiras na odontologia, podendo ser um quadro facilmente revertido, a depender da habilidade do profissional de diagnosticar e tratar precocemente, bem como da imunocompetência do paciente. Seu fator etiológico na grande maioria das vezes é de origem dentária, possuindo microbiota mista com presença de Streptococos e Peptostreptococos. Estas bactérias estão associadas ao processo de necrose pulpar e formação de abscesso dentoalveolar. Quando este quadro se desenvolve a partir dos molares inferiores, a disseminação ocorre normalmente pelo espaço vestíbulo bucal. No entanto, há casos que evadem o padrão, podendo um molar disseminar através dos espaços mastigador, mandibular, submandibular, sublingual e submentoniano. Objetivo: Relatar um caso de infecção odontogênica do dente 36, com disseminação atípica para o espaço submandibular em paciente pediátrico. Relato de caso clínico: Paciente do sexo feminino, 8 anos de idade, constou em seu histórico odonto-médico, junto a sua genitora, episódio de internamento para diagnóstico e tratamento da infecção em face. O diagnóstico de celulite foi determinado e a origem dentária descartada. Iniciou antibióticoterapia e após regressão teve alta. Após 9 meses apresentou reagudização do processo com disseminação para região submandibular. Através da história da doença atual, exame físico e radiográfico foi definido o diagnóstico de abscesso dentoalveolar crônico com disseminação e drenagem para o espaço submandibular, optando-se pela exodontia e antibióticoterapia. Conclusões: Faz-se importante o diagnóstico e tratamento precoce, afim de evitar a progressão para complicações mais severas, como a mediastinite e fasciíte necrosante(AU)

RESUMEN Introducción: Las infecciones del complejo maxilo-mandibular son comunes en la odontología, pudiendo ser un cuadro fácilmente revertido, que depende de la habilidad del profesional de diagnosticar y tratar precozmente, así como de la inmunocompetencia del paciente. Su factor etiológico en la gran mayoría de las veces es de origen dental, con microbiota mixta y presencia de Streptococos y Peptostreptococos. Estas bacterias están asociadas al proceso de necrosis pulpar y formación de absceso dentoalveolar. Cuando este cuadro se desarrolla a partir de los molares inferiores, la diseminación ocurre normalmente por el espacio vestíbulo bucal. Sin embargo, hay casos que evaden el estándar, pudiendo un molar diseminar a través de los espacios masticador, mandibular, submandibular, sublingual y submentoniano. Objetivo: Describir un caso de infección odontogénica proveniente de necrosis pulpar del diente 36, con diseminación atípica para el espacio submandibular en paciente pediátrico. Caso clínico: Paciente de sexo femenino, de 8 años, constó en su historia médica-dental, episodio de internamiento para diagnóstico y tratamiento de la infección en el rostro. Se determinó el diagnóstico de celulitis y tuvo el origen dental descartado. Se inició antibioticoterapia y se dio alta hospitalaria. Después de 9 meses presentó exacerbación del proceso con diseminación para región submandibular. A través de la historia de la enfermedad actual, examen físico y radiográfico se definió el diagnóstico de absceso dentoalveolar crónico con diseminación y drenaje para el espacio submandibular, y entonces fue posible optar por la exodoncia y antibioticoterapia. Conclusiones: Se hace importante el diagnóstico y tratamiento precoz, a fin de evitar la progresión para complicaciones más severas, como la mediastinitis y fasciitis necrosante(AU)

ABSTRACT Introduction: Infections of the maxillomandibular complex are common in dentistry and may be easily reversed, depending on the professional's ability to diagnose and treat promptly, as well as the patient's immunocompetence. In most cases their etiology is dental, i.e. a mixed microbiota with presence of Streptococci and Peptostreptococci. These bacteria are associated to the process of pulp necrosis and dentoalveolar abscess formation. When this condition develops from the lower molars, dissemination usually occurs through the buccal vestibular space. However, there are cases that do not follow this pattern, allowing a molar to spread through the buccal, mandibular, submandibular, sublingual and submental spaces. Objective: Report a case of odontogenic infection from pulp necrosis of the lower first molar (36) ​​with atypical dissemination to the submandibular space in a pediatric patient. Clinical case: Female 8-year-old patient with an episode of hospitalization for diagnosis and treatment of a facial infection, according to her medical / dental record. The infection was diagnosed as cellulitis and dental origin was discarded. Antibiotic therapy was started and the patient was discharged. After 9 months, the infection underwent a process of exacerbation with dissemination to the submandibular region. Analysis of the antecedents of the current condition, alongside physical and radiographic examination, led to the diagnosis of chronic dentoalveolar abscess with dissemination and drainage to the submandibular space, and the consequent indication of dental extraction and antibiotic therapy. Conclusions: Early diagnosis and treatment are vital to avoid progression to severer complications such as mediastinitis and necrotizing fasciitis(AU)

Infección del seno maxilar por desplazamiento accidental de un implante dental: cirugía de Caldwell Luc / Sinus infection by accidental displacement of a dental implant: Caldwell Luc surgery

El desplazamiento accidental de los implantes dentales hacia el seno maxilar es una complicación poco frecuente, pero potencial en los procedimientos de implantología, debido a las características de la morfología y densidad del sector posterior del maxilar superior desdentado. Ante esta complicación, es imperativa la remoción inmediata o temprana del implante, ya sea por vía endoscópica o mediante el abordaje de Caldwell Luc, conservando la membrana sinusal, ya que una vez infectado el seno y producida una sinusitis crónica maxilar, con cambios irreversibles en la morfología de la membrana, obligará a realizar una cirugía radical de seno. En el presente trabajo se realiza una revisión bibliográfica sobre el tema, así como la presentación de un caso clínico con su resolución quirúrgica

Infection from an exfoliating primary tooth in a child with severe neutropenia: a case report.

In patients with deficient immune defenses, a localized oral infection can progress to a systemic infection. The purpose of this paper was to describe the case of a child with acute lymphoblastic leukemia who presented with fever, trismus, and submandibular swelling in the absence of the typical dental causes of infection such as deep dental caries or clinically significant periodontal disease. Treatment included an aggressive intravenous antibiotic regimen and extraction of the offending tooth after the recovery from bone marrow suppression.

Multiple brain abscess from dental origin: case report and literature review.

BACKGROUND: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. CASE REPORT: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. DISCUSSION: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance.

Occurrence of odontogenic infections in patients treated in a postgraduation program on maxillofacial surgery and traumatology.

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Araçatuba Dental School, São Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. Of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.

[Planning dental care and orthodontic treatment for children afflicted with malignant hematological diseases]. / Planification des soins bucco-dentaires et des traitements ODF chez les enfants atteints d'une hémopathie maligne.

THE PROBLEM: In France, cancer affects 1 to 3% of all children and represents the second most frequent cause of mortality among children younger than fifteen. Malignant blood diseases are the most frequently occurring childhood cancers. Although their mortality rate has been tending to decrease, they often seem to develop after "opportunistic" latent infections persist, undetected, in un-eradicated sites that may be of dental origin. This infectious risk, frequently undiagnosed in hospitals, should be of concern to both general dentists and orthodontists. OBJECTIVES: General dentists and orthodontists each have specific roles to play in teaching children about oral health at an early age and in detecting and eradicating infection as well as in seeing at risk children in regular follow-up visits. DISCUSSION: Dentists should examine children on regularly scheduled preventive appointments and treat dental caries when they discover it. Orthodontists, who see the children they are treating on frequently scheduled appointments, should always be on the alert for incipient caries in their patients and be careful to make the appliances they wear as well fitting and non-irritating as possible to minimize the risk of inflammation and development of sore spots. Both dentists and orthodontists should teach their patients how to maintain healthy diets and good oral hygiene. They may be called upon to provide local relief for acute lesions that chemotherapy sometimes causes in the soft tissues of patients with hematological cancers and to modify irritating appliances.

Partially erupted third molars as a potential source of infection in patients receiving peripheral stem cell transplantation for malignant diseases: a retrospective study.

Forty-four patients with malignant diseases for which they received peripheral stem cell transplant therapy (PSCT) were retrospectively studied regarding local and systemic infection originating from around partially erupted third molars (PEMs). Twenty-two patients had one or more PEMs, while 22 patients had none. Data were retrieved from medical and dental records. Systemic and local signs of infection and treatment were assessed. We recorded the number of transplanted CD34(+) blood stem cells, days with white blood cell counts < 0.5 x 10(9) l(-1), days until engraftment, maximum level of C-reactive protein (CRP), days with fever, positive blood cultures, days taking antibiotics, days drinking < 0.5 l, days of total parenteral nutrition, days receiving intravenously administered analgesics, and number of admission days. No statistically significant difference was detected between patients with PEMs and those without PEMs regarding any of the studied parameters. Of patients with PEMs, 36% (8 of 22) developed local infections around PEMs during the PSCT period. The study indicates that PEMs pose no significant risk of causing systemic infection in patients receiving PSCT for malignant diseases but increase the risk of developing a local infection, justifying close supervision and early treatment in cases of local infection during PSCT treatment.

Incidencia de celulitis facial odontógena en el territorio de Matanzas / Odontogenic Facial Cellulites incidence in the territory of Matanzas

La Celulitis Facial Odontógena es relativamente frecuente, puede convertirse en un grave riesgo vital cuando el tratamiento no es adecuado. Se realizó un estudio observacional, analítico, transversal desde enero 2006 a diciembre 2008. La muestra incluyó 49 pacientes que acudieron o fueron remitidos a los servicios de urgencias con el diagnóstico de CFO. Los niños y jóvenes resultaron los más afectados, así como el sexo masculino. Los dientes incurables y los restos radiculares constituyeron las causas más frecuentes, la región anatómica prevaleciente fue la cavidad bucal. El 51 por ciento de los casos tuvieron diagnóstico de celulitis leves, siendo necesario el ingreso hospitalario para 25 pacientes, los demás tuvieron tratamiento ambulatorio. Se recomienda diseñar una estrategia de intervención para disminuir la incidencia de CFO en el territorio de Matanzas.

The Odontogenic Facial Cellulites is relatively frequent; when the treatment is not right, it can become a serious risk for life. We carried up an observational, analytic, transversal study from January 2006 to December 2008. The sample included 49 patients assisting or remitted to the Urgent Care Services with a diagnosis of Odontogenic Facial Cellulites. The most affected were children and young people, and the female sex. The most frequent causes were teeth that can not be healed and roots remaining; the prevailing anatomic region was the oral cavity. 51 percent of the cases were diagnosed as mild cellulites, being necessary the hospital staying for 25 patients; the rest received home treatment. It is recommended to design an intervention strategy to diminish the incidence of the Odontogenic Facial Cellulite in the territory of Matanzas.

Absceso subperióstico y síndrome del vértice orbitario: complicación posterior a la extracción del tercer molar mandibular / Subperiostial orbital abscess and apex syndrome as a complication after a mandibular molar extraction

Introducción: La diseminación de las infecciones que se extienden de dientes mandibulares y estructuras adyacentes hacia la órbita y tejido periorbitario son infrecuentes, pero graves ya que tienen el potencial de causar la pérdida de la visión. Objetivos: El propósito de este artículo es publicar un caso clínico muy interesante por lo infrecuente, y explicar a juicio de los autores las vías de diseminación de la infección, a su vez alertar a los diferentes especialistas involucrados sobre las severas consecuencias que pueden resultar tras la extracción de piezas dentales, como es la pérdida definitiva de la visión. Reporte del caso: Se trata de un paciente masculino de 43 años, sin antecedentes mórbidos relevantes, que fue enviado al Servicio Médico Legal para examen clínico forense con pérdida total de la visión del ojo derecho por atrofia óptica como complicación de un síndrome del vértice orbitario, luego de la exodoncia del tercer molar mandibular derecho. Conclusiones: Es fundamental el tratamiento oportuno y agresivo para detener la diseminación de una infección desde las estructuras adyacentes hacia la órbita. La comunicación efectiva interdisciplinaria entre los profesionales involucrados evita complicaciones de tipo médico-legales y secuelas definitivas al paciente.

Introduction: Infection dissemination from mandibular teeth to the orbit and adjacent structures is infrequent, but nevertheless serious, as they may cause severe problems, including vision loss. Aim: The purpose of this study is to present a rare and interesting case of such a dissemination, to discuss the possible routes of infection propagation, and to alert the different specialists involved on the possible complications after dental extractions, such as visual loss. Report of the case: The case of a 43-year-old previously healthy male is presented. The patient was sent to the Medical Legal Service for clinical forensic examination after total vision loss of the right eye, caused by optic atrophy as a complication of orbital apex syndrome, after the extraction of the third right mandibular molar. Conclusions: Opportune and aggressive treatment is crucial to stop infection spread from adjacent structures to the orbit. Effective communication among the professionals involved avoids medical - legal complications and precludes permanent sequels to the patient.

[Oral jewelry: a review]. / Schmuck im Mundbereich: eine Ubersicht.

Oral jewelry is popular. One of the most widely spread types are so-called tooth diamonds made of composite materials which are applied to the teeth with an adhesive. Note that parents are required to sign a release form for under-aged patients in Switzerland. Tooth cap grills and gold teeth are considered status symbols within the Hip-Hop fashion scene. However, tooth ornaments favour the accumulation of plaque and can diminish the ability to articulate. With respect to jewelry in oral soft tissue especially tongue and lip piercings are of significance to dentists. Besides the systemic complications, which are mostly caused by a lack of hygiene or the failure of noting medical contraindications by the piercer, local complications occur frequently. After surgery, pain, swelling, infections as well as hemorrhages or hematomas can be observed. Long-term effects can be problematic: gingival recession can be discernes mainly in the case of lip piercings the loss of hard tooth substance in the case of tongue piercings. Because of that, conservation therapies can become indespensable. Patients wearing dental jewelry have to be aware of risks of tooth damage, and they regularly have to undergo dental check-ups. Information campaigns--for dentists as well as patients--are necessary.

Diabetes mellitus and odontogenic infections--an exaggerated risk?

INTRODUCTION: The diabetic host is considered to be at an increased risk for the development of odontogenic infections due to his medically compromised state. This perceived risk of higher infections often results in dentists delaying much-needed surgical treatment in this patient population. DISCUSSION: A critical examination of literature does not seem to support the role of diabetes mellitus as a definitive risk factor for odontogenic infections. A simplistic extrapolation of infection rates observed in other sites may not be justified in the orofacial region.

An open-label study to evaluate the transition of patients with chronic plaque psoriasis from cyclosporine to alefacept.

Eleven patients with well-controlled psoriasis on cyclosporine (Physician's Global Assessment [PGA] of "mild" or better) participated in an open-label study that evaluated a strategy for transition to alefacept. Using this transition strategy, 7 of 11 patients (64%) maintained PGA scores. Quality of life improved or was maintained in all patients. Adverse events and reductions in CD4+ T cell counts were consistent with those seen during alefacept monotherapy.

Large erupting complex odontoma: a case report.

Odontomas are the most common odontogenic tumours. They are usually asymptomatic and are often discovered during routine radiography. We report a case of a large erupting complex odontoma that caused pain, infection and facial asymmetry. This case is significant as there are few reports of complex odontoma erupting in the oral cavity.

Orbital abscess: visual loss following extraction of a tooth--case report.

OBJECTIVE: It is the purpose of this article to alert the general practitioner to the severe consequences that may result from a tooth extraction, including the loss of vision, despite the use of antibiotics. CONCLUSIONS: Early and aggressive treatment is critical in obstructing the spread of infection toward the orbits, the eyes, and eventually the brain.

[Dental care of patients with leukemia]. / Zahnärztliche Betreuung von Leukämiepatienten.

Leukemias include a variety of acute and chronic malignant hematological diseases that require antineoplastic chemotherapy. Hematological stem cell transplantation allows an aggressive chemotherapy during which patients suffer from severe immunosuppression. Oral infections may cause serious complications during this immunosuppression. Therefore, professional diagnosis and elimination of oral infection foci must be carried out as early as possible before such treatment. Aggressive chemotherapy causes hyposalivation and as a consequence an increased risk for oral hard and soft tissue diseases. Adequate oral care before, during and after chemotherapy combined with a stem cell transplantation is necessary to prevent oral diseases and systemic complications of oral origin.

The medical oncology patient.

Chemotherapy may be either an effective alternative to surgery or a valuable adjunct to surgery and/or radiotherapy in the treatment of cancer. The care of medical oncology patients is a multidisciplinary effort. Oral health care providers can expect to be called on to care for patients with cancer undergoing chemotherapy. Early, active participation in developing preventive and therapeutic strategies, in implementing the plan, and in the education and rehabilitation of patients is paramount in addressing quality of life issues. To provide timely and competent care, oral health care providers must understand the disease, its treatment, and the impact the disease and/or its treatment may have on these patients. Oral health care providers should develop and implement preventive and therapeutic strategies with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.

Angina de Ludwig associada à presença de corpo estranho em região sublingual / Ludwig´angina associated to the presence of foreing body in the floor of the mouth

A angina de Ludwig, apesar de incomum, ainda é considerada uma condição de emergência em razão do risco de obstrução das vias aéreas superiores. O tratamento é baseado no diagnóstico precoce, administração parenteral de antibióticos apropriados, proteção às vias aéreas e denagem cirúrgica. É apresentado um caso clínico de angina de Ludwig causada pela remoção cirúrgica de um terceiro molar inferior e associada à presença de corpo estranho na região sublingual

Doença periodontal em pacientes cirróticos / Periodontal disease in cirrhotic patients

Cada vez mais, a associação entre doença periodontal e doenças sistêmicas tem sido evidenciada. A inter-relação entre a doença periodontal e o hospedeiro assume novo papel na etiopatologia da mesma, sugerindo que nem todos os indivíduos são igualmente suscetíveis. Um desequilíbrio nessa relação, como redução de defesas do hospedeiro por uma doença debilitante, pode interferir na incidência, extensão ou gravidade das doenças periodontais. As repercussões sistêmicas de alterações que se originam na cavidade oral têm sido estudadas com grande em pacientes com doenças crônicas e imunodeprimidos, pelo potencial de associar comorbidades de gravidades diversas. Com o objetivo de analisar o impacto da doença periodontal em pacientes com cirrose hepática, foram revisados diversos aspectos dessas duas doenças, incluindo uma visão atual sobre a etiopatogenia das mesmas, suas manifestações clínicas e complicações. Foram avaliados também, estudos que investigam associação entre doença periodontal e cirrose e os que enfatizam o papel da imunodeficiência adquirida dos cirróticos. Esses estudos permitem concluir que a prevenção e controle da doença periodontal poderá reduzir a morbi-mortalidade associada a infecções em pacientes cirróticos

Infección odontogénica grave. Posibles factores predictores / Severe odontogenic infection. Possible predictive factors

Se analizaron factores que pudieran predisponer a una infección odontogénica grave que requiera cuidados intensivos. Se realizó un estudio observacional descriptivo a 100 pacientes ingresados consecutivamente con infección odontogénica severa en el Hospital Manuel Ascunce Domenech de Camagüey desde 1999 al 2001. A partir de las historias clínicas se estudiaron diferentes variables que incluyeron parámetros médicos, sociales y procedimientos dentales previos. Se prestó particular atención al resultado de los cultivos bacterianos. La edad media de los 59 pacientes masculinos y 41 femeninos fue de 41 ± 15,8 años; 18 pacientes requirieron cuidados intensivos. El 41 por ciento de los pacientes era de bajo nivel de escolaridad; 11 pacientes graves (61,1 por ciento) y 42 no graves (51,2 por ciento) eran fumadores. Dos pacientes (11,1 por ciento) de los graves y 8 (9,8 por ciento) de los no graves referían consumo excesivo de bebidas alcohólicas. La prevalencia de enfermedades crónicas fue mayor entre los no graves (31,7 por ciento). La afección subyacente más común fue la osteítis periapical 70 por ciento de los episodios infecciosos), seguido por la extracción dental en el 27,5 por ciento de los graves y 10,9 por ciento de los no graves. Ninguno de estos factores predijo la necesidad de cuidados intensivos. No existieron diferencias significativas en cuanto a síntomas, demora en solicitar atención médica, procedimientos dentales previos o terapéutica antimicrobiana. Predominaron los estreptococos aerobios (grupo S. milleri) asociados con bacterias anaerobias variadas. No se encontraron variables sociales o clínicas predictoras de un curso grave en infecciones odontogénicas. Todos los pacientes deben ser cuidadosamente monitoreados para evitar complicaciones severas(AU)

Those factors that may predispose to a severe odontogenic infection requiring intensive care were analyzed. An observational descriptive study was conducted among 100 patients that were consecutively admitted with severe odontogenic infection at "Manuel Ascunce Domenech" Hospital, in Camagüey, from 1999 to 2001. Different variables, including medical and social parameters and previous dental procedures were studied based on the medical histories. Special emphasis was made on the results of the bacterial cultures. The mean age of the 59 male patients and 41 female patients was of 41 ± 15.8. 18 patients needed intesive care. 41 percent of the patients had a low educational level. 11 severe patients (61.1 percent) and 42 non-severe (51.2 percent) were smokers. 2 patients (11.1 percent) of the severe and 8 (9.8 percent) of the non-severe drank alcoholic beverage excessively. The prevalence of chronic diseases was higher among the non-severe (31.7 percent). The most common underlying affection was periapical osteitis (70 percent of the infectious episodes ) followed by tooth extraction in 27.5 percent of the severe and 10.9 percent of the non-severe. None of these factors predicted the need of intensivce care. There were no significant differences concerning symptoms , delay to request medical attention, previous dental procedures or antimicrobial therapeutics. The aerobial streptococcus (S. Milleri group) associated with varied anaerobial bacteria predominated. No social or clinical variables prediciting a severe course in odontogenic infections were found. All the patients should be carefully monitored to prevent severe complications(AU)