Ten-year experience with multidisciplinary diagnosis and treatment of odontogenic sinusitis.

BACKGROUND: Odontogenic sinusitis is an underdiagnosed entity and is one cause of failure of conventional treatments of sinusitis. Unfortunately, there is no consensus so far on the best management protocol. This retrospective study aimed to suggest a practical management protocol that can reduce misdiagnosis and improve treatment outcomes. METHODS: The study included 74 patients with confirmed odontogenic sinusitis who were diagnosed and treated over 10 years (2010-2019). The patient data were recorded and analysed. RESULTS: Dental pain was reported in only 31.1 per cent of patients. Fifty-six patients (75.7 per cent) had received dental treatment during the last year, but only 13 (23.1 per cent) reported it. Dental pathology was missed on initial computed tomography evaluation in 24 patients (32.4 per cent). Forty-one patients (55.4 per cent) were successfully treated by dental procedures and antibiotics. Fourteen patients needed functional endoscopic sinus surgery in addition to dental procedures. CONCLUSION: Successful management of odontogenic sinusitis requires good communication between rhinologists, radiologists and dentists. Dental treatment should be the logical first step in the treatment protocol, unless otherwise indicated.

Odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw with facial subcutaneous abscess formation: A retrospective clinical study of difficult-to-diagnose cases.

OBJECTIVE: The objective of this study was to analyze difficult-to-diagnose cases of odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw (ARONJ) with facial subcutaneous abscesses by otolaryngologists. METHODS: The study was conducted in the department of otolaryngology of a university hospital. Seven patients exhibiting odontogenic infection and ARONJ with facial subcutaneous abscesses diagnosed at the department of otolaryngology in our hospital from January 2008 to December 2018 were included in the study. We investigated the following information obtained from the patients: clinical department for initial treatment, sex, age, offending tooth, causative disease, site of the fistula, symptoms, methods of diagnoses, and therapy. RESULTS: Odontogenic infection with facial subcutaneous abscess formation can occur in individuals in a wide range of age groups; however, the pathological manifestations of ARONJ are often observed in older women, frequently at the chin and accompanied by nodules and pain in the adjacent teeth. Computed tomography and orthopantomography are useful for diagnosis and are especially indicated for patients under long-term follow-up or with frequent recurrences. Magnetic resonance imaging, cytodiagnosis, and histological analysis might be necessary to exclude the possibility of tumors. Management of such facial subcutaneous abscesses comprises dental treatment and infection control, and f surgical removal of the abscess is usually not required. Treatments such as sequestrectomy and sitafloxacin administration are useful for patients with ARONJ. CONCLUSION: Our results demonstrated that for patients with facial subcutaneous abscesses, involvement of odontogenic infection and ARONJ should be considered.

Screening of dental and sinus infections in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased risk of infections. Screening for oral (dental and/or sinus) infection could be proposed before biologic disease-modifying antirheumatic drugs (bDMARDs) initiation but is not systematically recommended. The aim of our study was to assess the prevalence of oral infection in RA patients requiring bDMARDs. MATERIALS AND METHODS: This was a monocentric retrospective study. We included patients with RA and active disease requiring bDMARDs. Dental infection and sinusitis were assessed by a stomatologist and otorhinolaryngologist after clinical, panoramic dental X-ray and sinus CT evaluation. Factors associated with oral infections were analysed in uni- and multivariate models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included 223 RA patients (79.4% women, mean disease duration 8.9 ± 8.6 years). The mean age was 54.4 ± 10.9 years and mean Disease Activity Score in 28 joints 5.5 ± 2.6. Systematic dental screening revealed infection requiring treatment before bDMARDs initiation in 46 (20.9%) patients. Sinusitis was diagnosed by the otorhinolaryngologist in 33 (14.8%) patients. Among the 223 patients, 69 (30.9%) had dental and/or sinus infection. On univariate analysis, active smoking was associated with increased probability of oral infection (OR = 2.16 [95% CI 1.02-4.57], P = .038) and methotrexate with reduced probability (OR = 0.43 [95% CI 0.23-0.81], P = .006). On multivariate analysis, no RA variables were associated with oral infection. CONCLUSION: In our study, asymptomatic oral infection was confirmed in one third of RA patients.

Odontogenic Maxillofacial Infections in a High-level Hospital: Orofacial Pain and Related Conditions

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient 's systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

Infecção cervicofacial grave de origem odontogênica: relato de caso / Severe cervicofacial infection of odontogenic origin: case report

Introdução: as infecções odontogênicas tem como principal origem a necrose pulpar com invasão bacteriana no tecido periapical e periodontal, podendo levar à formação de quadros de celulite e posteriormente de abscesso, além disso, possuem o potencial de disseminar-se pelos espaços faciais profundos e comprometer a vida do paciente. Complicações graves, decorrentes dos quadros de infecções odontogênicas, podem ocorrer, se o tratamento instituído não for adequado, como: trombose do seio cavernoso, abscesso cerebral, mediastinite e até óbito. Objetivo: discutir o manejo das infecções odontogênicas disseminados em espaços faciais profundos, através do relato de caso clínico. Caso clínico: paciente de 52 anos, portador de diabetes mellitus tipo 2, com infecção odontogênica, no exame clínico inicial apresentava trismo, disfonia, dispneia, disfagia, hiperemia e edema em lado esquerdo da face, envolvendo os espaços canino, bucal, submandibular e cervical além de unidades dentárias com foco infeccioso. Em exame de tomográfica computadorizada, observou-se desvio da via área, presença de um grande volume de gás e de lojas de infecção. Optou-se como tratamento a remoção dos focos dentários e drenagem intraoral foi realizada pela equipe da CTBMF com anestesia local e posteriormente drenagem sob anestesia geral, intubação com uso de fibroscopia pela equipe de cirurgia cabeça e pescoço. Considerações finais: as infecções odontogênicas que envolvem espaços faciais profundos devem ser tratadas com urgência e o tratamento de escolha dessa condição deve ser remoção imediata do foco infeccioso, exploração e drenagem rápida e agressiva dos espaços faciais envolvidos e associação com antimicrobianos de amplo espectro com características bactericidas.(AU)

Introduction: the main origin of odontogenic infections is pulp necrosis with bacterial invasion in the periapical and periodontal tissue, which may lead to the formation of cellulitis and later abscess, besides having the potential to spread to the deep facial spaces and compromise the patient's life. Severe complications from dental infections may occur if the treatment is not appropriate, such as cavernous sinus thrombosis, brain abscess, mediastinitis and even death. Objective: to discuss the management of disseminated odontogenic infections in deep facial spaces through a case report. Case report: a 52-year-old patient with type 2 diabetes mellitus, with odontogenic infection, presented at the initial clinical examination trismus, dysphonia, dysphagia, dysphagia, hyperemia and edema on the left side of the face involving the canine, buccal, submandibular and cervical spaces. of dental units with infectious focus. CT scan revealed deviation of the airway, presence of a large volume of gas and infection stores. The treatment was chosen to remove dental foci and intraoral drainage was performed by the CTBMF team under local anesthesia and subsequently under general anesthesia drainage, intubation with fibroscopy by the head and neck surgery team. Final considerations: odontogenic infections involving deep facial spaces should be treated urgently and the treatment of choice for this condition should be immediate removal of the infectious focus, rapid and aggressive exploration and drainage of the involved facial spaces and association with broad-spectrum antimicrobials with bactericidal characteristics.(AU)

Knowledge and Attitudes Towards Antibiotic Prescribing Among Dentists in Sudan

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists' awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.

Are Emergency Medicine Physicians Able to Determine the Need for Computed Tomography and Specialist Consultation in Odontogenic Maxillofacial Infections?

PURPOSE: Pain and swelling from a necrotic tooth is a common complaint in emergency departments. These patients impose substantial burdens on hospital budgets and provider time. The initial triage of odontogenic infections can be difficult without advanced knowledge and training in head and neck anatomy and odontogenic disease pathogenesis. The purpose of this study was to determine the frequency with which emergency medicine physicians correctly determine the need for computed tomography (CT) and specialist consultation in patients with odontogenic infections. MATERIALS AND METHODS: A retrospective case series was designed. Patients older than 18 years with an odontogenic infection presenting to the emergency department from August 1, 2012 to April 30, 2015 were eligible for inclusion in the study. Demographic, clinical, laboratory, and treatment data were recorded, with special attention paid to the hospital service consulted and imaging ordered. The location of the abscess and the clinical presentation of the patient were used to determine the necessity for the imaging and consultation. Descriptive statistics were used to analyze the data. RESULTS: Seventy-two patients met the inclusion criteria (52.9% women; mean age, 40.0 yr). The decision to order CT was made by emergency medicine physicians for 61.7% of patients with infections that did not require CT. Likewise, oral and maxillofacial surgery was consulted for 77.8% of patients with infections that did not require a specialist consultation. CONCLUSION: In this study, emergency medicine physicians misinterpreted the clinical needs of a large percentage of patients with odontogenic infections. Better education, interdepartmental collaboration, and conducting and disseminating peer-reviewed research are several ways to increase efficiency of care in patients with odontogenic infections.

[Clinical characteristics of oral and maxillofacial space infection in patients with different ages].

PURPOSE: To analyze the general information,clinical symptoms, etiology of infection, and complications of oral and maxillofacial space infection in patients with different ages, in order to provide references for prevention of complications. METHODS: Three hundred and forty-eight patients with oral and maxillofacial space infection treated in the Oncology Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed from March 2007 to Feburary 2017. Statistical analysis was performed with SPSS 20.0 software package. RESULTS: All patients were divided into 2 groups. 152(43.68%) patients were senior and 196(56.32% ) patients were younger. In the two groups, male patients accounted for 59.69% in the younger group, 59.87% in the senior group. There was no significant difference. We also have found that label test and interval times of symptoms appeared to visit. There was no significant difference. 51.53% of the younger patients had negative bacterial culture results, which was significantly more than those of the senior groups. CONCLUSIONS: In patients with oral and maxillofacial space infection, senior patients had many similar clinical characteristics to younger patients, but senior patients suffered from more and severe complications.

A Fatal Aortic Arch Rupture Due to Descending Necrotizing Mediastinitis in a 24-year-old Woman.

Descending necrotizing mediastinitis (DNM) is a life-threatening disease which often develops from a purulent infection of the oral cavity and is associated with high rates of mortality. Here we report the case of a young patient who died from an aortic arch rupture in context of DNM developed from an odontogenic infection caused by Prevotella buccae. Based on the current knowledge on this very rare vascular complication, we discuss factors that may have contributed to this fatal issue and future issues to optimize care provided to patients.

Can progression of odontogenic infections to cervical necrotizing soft tissue infections be predicted?

The progression of odontogenic infections to necrotizing soft tissue infections (NSTIs) is unknown. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to predict risk of NSTI. This study aimed to (1) estimate the frequency at which odontogenic infections progress to NSTIs, (2) measure the value of LRINEC in predicting progression to NSTI, and (3) estimate the charges associated with managing NSTIs. This retrospective cohort study enrolled all subjects admitted for the management of odontogenic infections from 2001 to 2013. The primary predictor was the LRINEC score. The primary outcome was NSTI. The secondary outcome was billing charges. Descriptive and bivariate statistical analyses were performed, with significance set at a P-value of <0.05. Of 479 odontogenic infections, (1.0%) progressed to NSTI. The mean LRINEC for NSTI was 5.8 and for odontogenic infection was 3.4 (P=0.043). LRINEC parameters for the prediction of NSTIs had 60% sensitivity, 68.4% specificity, 20% positive predictive value, and 92.9% negative predictive value. The mean charge for NSTI was $319,337 and for odontogenic infections was $19,291 (P=0.051). One percent of odontogenic infections progressed to NSTIs. The LRINEC score was not able to identify all NSTIs. NSTIs are 16 times more costly.

New admission scoring criteria for patients with odontogenic infections: a pilot study.

Odontogenic infections are often referred to the oral and maxillofacial surgical department, which can cause a dilemma for junior clinicians who have to decide whether such patients require admission. We have devised a score to be used on admission to our unit to help junior on-call staff, and designed a prospective pilot study to assess it.

Diagnóstico diferencial da sinusite de origem odontológica por meio da tomografia computadorizada / Differential diagnosis of dental sinusitis with the aid of computed tomography

O objetivo do presente artigo é apresentar três casos clínicos com diagnóstico de sinusite de origem odontológica, ou síndrome endo-antral, um quadro inflamatório infeccioso de origem endodôntica que acomete dos tecidos e mucosa do seio maxilar adjacentes aos ápices radiculares.Os casos apresentados chamam a atenção para a dificuldade do diagnóstico apenas coma radiografia periapical e a importância da tomografia computadorizada como recurso auxiliar.

The aim of the current article is to report three clinical cases diagnosed as sinusitis of dental origin, or endo-antral syndrome, an inflammatory condition of endodontic infection origin that affects the tissues and mucosa of the adjacent maxillary sinus up to the root apex. The presented cases draw attention to the difficulty of diagnosis only with periapical radiography and the importance of computed tomography as an auxiliary resource.

Odontogenic infections: a national survey to assess confidence of the OMFS "first on-call".

Odontogenic infections can range from simple toothache to life-threatening swellings in the neck. We conducted a national survey to assess the confidence of the "first on-call" in oral and maxillofacial surgery (OMFS) to admit or discharge these patients, and to see if local protocols or guidelines were in place to aid decision-making. We designed a questionnaire and emailed it to all OMFS units across the UK over a 3-week period in June 2015. We also contacted first on-call OMFS juniors by phone. A total of 54 respondents were confident and 24 were very confident to admit patients with odontogenic infections without a senior review, but only 45 were confident and 9 very confident to discharge patients from the emergency department without a senior review. Twenty-one were fairly confident to admit patients, and 37 were fairly confident to discharge them. One respondent was not confident to admit patients at all, and 9 did not feel confident to discharge patients without a senior review. Seventy-eight reported that no local protocols or structured guidance on odontogenic infections were used in their unit. This survey highlights the need for admission criteria to help junior clinicians decide whether to admit or discharge these patients.

Clinical management of acute orofacial infections.

Management of acute dental infections requires an understanding of microbiology, anatomy, pharmacology, wound healing, and oral surgery. Recognizing early signs of inflammation and differentiating them from characteristics of an infection facilitates timely intervention and avoids further complications. This article addresses various aspects of the diagnosis and treatment of acute oral infections. Suggestions are made to help differentiate between swelling associated with an infection and edema related to inflammation of nonpathogenic origin. In addition, discussion focuses on how to distinguish between an abscess and cellulitis, when to culture, and which antibiotics to select to resolve an infection. Protocols for managing an infection with and without fluctuance are reviewed. Finally, the consequences of spreading cellulitis are discussed, and signs indicating the need for referral of a patient are delineated.

Choque séptico por infecção odontogênica em paciente com diabetes melito tipo I / Odontogenic septic shock in patient with type 1 diabetes mellitus

O objetivo deste estudo é apresentar um caso de paciente com diabetes melito tipo I descompensado e infecção odontogênica severa que, apesar do tratamento, progrediu para choque séptico e óbito. Os achados clínicos e laboratoriais, diagnóstico e tratamento são apresentados e discutidos. A sepse é uma condição potencialmente fatal que ocorre quando mediadores químicos da inflamação são liberados na corrente sanguínea para combater a infecção e iniciam respostas inflamatórias sistêmicas. A sepse pode progredir para sepse severa e, finalmente, choque séptico, uma condição com altas taxas de mortalidade e pode estar associada às infecções dentárias. Infecções odontogênicas podem se disseminar para os espaços profundos do pescoço, resultando em complicações graves, especialmente em pacientes com doenças crônicas imunodepressoras. Cirurgiões-Dentistas e médicos devem ter conhecimento dos sinais e sintomas associados à condição e devem considerar o diagnóstico de sepse em pacientes com infecções odontogênicas, uma vez que o reconhecimento precoce e tratamento efetivo podem prevenir a morte.

The aim of this study is to present a case of a patient with poorly controlled type I diabetes mellitus and severe odontogenic infection that progressed to septic shock and succumbed despite therapy. Clinical and laboratory findings, diagnosis and treatment are presented and discussed. Sepsis is a potentially life-threatening condition that occurs when chemicals mediators of inflammation are released into the bloodstream to combat the infection and trigger inflammatory multi-system responses. Sepsis can progress to severe sepsis and finally septic shock, a condition with high mortality rates and may be associated with dental infections. Odontogenic infections can spread to deep neck spaces leading to severe complications, especially in patients with chronic systemic immunocompromised diseases. Dentists and physicians must be aware of the signals and symptoms associated with the disease and should consider the diagnosis of sepsis in patients with odontogenic infection once early recognition and effective management could prevent death.

Análise comparativa das alterações periapicais diagnosticadas pela técnica radiográfica do paralelismo e pelo mapeamento tomográfico cintilográfico (com e sem blindador de raios gama)J / Comparison analyzes of periapical alterations diagnosed by radiograph exam by the parallel technique and through scintigraphic tomographic mapping (with and without intra-oral apparatus)

O diagnóstico precoce de focos de infecção dentários é de fundamental importância para prevenir a ocorrência de maiores injúrias locais ou sistêmicas. Dentre os diversos métodos utilizados para complementar os achados radiológicos das alterações dentoalveolares surge uma alternativa: a cintilografia tomográfica (SPECT/CT), que permite a fusão de achados morfológicos com alterações metabólicas. Com o objetivo de estabelecer o diagnóstico precoce e acurado de processos infecciosos dentários, foram estudadas 320 áreas dentárias em mandíbula e maxila em (10 pacientes de ambos os sexos selecionados por meio de exames clínicos e radiológicos convencionais, seguidos de cintilografia tomográfica com e sem aparato blindador de raios gama. Os exames cintilográficos foram realizados no Serviço de Medicina Nuclear do Hospital Israelita Albert Einstein (HIAE). Para isso, foi administrado para cada paciente o radiofármaco tecnécio 99- metilenodifosfonato (99mTc-MDP) via endovenosa com a dose de 37mBq/3Kg de peso corporal do paciente. Após o período de acúmulo de três horas, foi realizado o protocolo de aquisição de imagens. Todas as imagens foram analisadas por um médico nuclear e um endodontista, com experiência em cintilografia tomográfica. O resultado obtido por meio do exame radiográfico intrabucal pela técnica periapical digital mostraram 6 imagens positivas, em um total de 1,87% da amostra; exame do mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gâma revelou 9 imagens positivas, correspondendo a 2,81% do total de áreas estudadas, havendo diferença estatisticamente significante ao nível de 95% pelo teste qui-quadrado. Pode-se concluir que o SPECT/CT permitiu identificar as alterações periapicais em maior número quando comparadas ao exame radiográfico periapical e ao mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gama; o exame de SPCET/CT além de mostrar imagens mais detalhadas...

The early diagnosis of cases with dental infection is very important to prevent the occurrence of major local or systemic injuries. With many methods used to complement the radiological findings of the bone alterations there's the tomographic scintigraphy witch allows the fusion of morphological and metabolic findings. With the objective of the establishment of early diagnosis and accurate dental infectious processes, it was studied 320 dental areas in maxilla and mandible (10 patients) selected randomly, through conventional radiological exams, followed by tomographic scintigraphy with and without intra-oral apparatus. The scintilographic exams were done at the Nuclear Medicine Service of Hospital Israelita Albert Einstein. For that, methylenediphosphonate-technetium-99m (99mTc-MDP) was dispensed intravenous. After the period of accumulation of 3 hours, the image acquisition protocol was taken. This protocol includes images from the top of the head to the neck. After the image analyzes, statistics was done. The intrabucal radiograph exam by the digital periapical technique showed 6 positive images, in a total of 1.87% of the total sample, Intra-oral apparatus showed 9 positive images, in a total os 2,81% of the sample and SPECT/CT exam revealed 15 positive images, corresponding to 4.28% of the total studied areas, showing statistical significance by the level of 95% of qui-square. We could conclude that SPECT/CT allowed identifying the endodontic infections in a larger number when compared with the radiograph exams; and the SPECT/CT exam showed to be of great interest by allowing the union of the diagnosis precocity with the image detail, presenting exact localization of inflammatory/infectious alterations due to the presence of the CT.

Análise comparativa das alterações periapicais diagnosticadas pela técnica radiográfica do paralelismo e pelo mapeamento tomográfico cintilográfico (com e sem blindador de raios gama)J / Comparison analyzes of periapical alterations diagnosed by radiograph exam by the parallel technique and through scintigraphic tomographic mapping (with and without intra-oral apparatus)

O diagnóstico precoce de focos de infecção dentários é de fundamental importância para prevenir a ocorrência de maiores injúrias locais ou sistêmicas. Dentre os diversos métodos utilizados para complementar os achados radiológicos das alterações dentoalveolares surge uma alternativa: a cintilografia tomográfica (SPECT/CT), que permite a fusão de achados morfológicos com alterações metabólicas. Com o objetivo de estabelecer o diagnóstico precoce e acurado de processos infecciosos dentários, foram estudadas 320 áreas dentárias em mandíbula e maxila em (10 pacientes de ambos os sexos selecionados por meio de exames clínicos e radiológicos convencionais, seguidos de cintilografia tomográfica com e sem aparato blindador de raios gama. Os exames cintilográficos foram realizados no Serviço de Medicina Nuclear do Hospital Israelita Albert Einstein (HIAE). Para isso, foi administrado para cada paciente o radiofármaco tecnécio 99- metilenodifosfonato (99mTc-MDP) via endovenosa com a dose de 37mBq/3Kg de peso corporal do paciente. Após o período de acúmulo de três horas, foi realizado o protocolo de aquisição de imagens. Todas as imagens foram analisadas por um médico nuclear e um endodontista, com experiência em cintilografia tomográfica. O resultado obtido por meio do exame radiográfico intrabucal pela técnica periapical digital mostraram 6 imagens positivas, em um total de 1,87% da amostra; exame do mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gâma revelou 9 imagens positivas, correspondendo a 2,81% do total de áreas estudadas, havendo diferença estatisticamente significante ao nível de 95% pelo teste qui-quadrado. Pode-se concluir que o SPECT/CT permitiu identificar as alterações periapicais em maior número quando comparadas ao exame radiográfico periapical e ao mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gama; o exame de SPCET/CT além de mostrar imagens mais detalhadas...

The early diagnosis of cases with dental infection is very important to prevent the occurrence of major local or systemic injuries. With many methods used to complement the radiological findings of the bone alterations there's the tomographic scintigraphy witch allows the fusion of morphological and metabolic findings. With the objective of the establishment of early diagnosis and accurate dental infectious processes, it was studied 320 dental areas in maxilla and mandible (10 patients) selected randomly, through conventional radiological exams, followed by tomographic scintigraphy with and without intra-oral apparatus. The scintilographic exams were done at the Nuclear Medicine Service of Hospital Israelita Albert Einstein. For that, methylenediphosphonate-technetium-99m (99mTc-MDP) was dispensed intravenous. After the period of accumulation of 3 hours, the image acquisition protocol was taken. This protocol includes images from the top of the head to the neck. After the image analyzes, statistics was done. The intrabucal radiograph exam by the digital periapical technique showed 6 positive images, in a total of 1.87% of the total sample, Intra-oral apparatus showed 9 positive images, in a total os 2,81% of the sample and SPECT/CT exam revealed 15 positive images, corresponding to 4.28% of the total studied areas, showing statistical significance by the level of 95% of qui-square. We could conclude that SPECT/CT allowed identifying the endodontic infections in a larger number when compared with the radiograph exams; and the SPECT/CT exam showed to be of great interest by allowing the union of the diagnosis precocity with the image detail, presenting exact localization of inflammatory/infectious alterations due to the presence of the CT...

Cervical lymphadenopathy in young children: case report of nontuberculous mycobacterial infection.

A four-year-old male presented with right-sided facial swelling near the angle of the mandible. Despite the presence of multiple dental carious lesions, the cervical lymphadenopathy did not appear to be of dental origin. Otolaryngology referral with subsequent excision of the affected lymph nodes confirmed the cervical lymphadenopathy to be due to a Mycobacterium avium intracellulare infection. A two-year follow-up showed successful resolution of the condition. The purpose of the present report was to describe a case with multiple dental carious lesions and cervical lymphadenopathy, with the latter attributed to a nondental etiology. A differential diagnosis of nondental etiologies of cervical lymphadenopathy in young children is described.

Brain abscess potentially secondary to odontogenic infection: case report.

Odontogenic infections are rarely implicated in the causes of brain abscess formation. As such, there are very few reports of brain abscesses secondary to odontogenic infections in the literature. This is due partly to the relative rarity of brain abscesses but also to the difficulty in matching the causative organisms of a brain abscess to an odontogenic source. The authors report a case of a 50-year-old woman whose brain abscess may potentially have been secondary to an odontogenic infection. The patient's early diagnosis, supported by imaging and microbiologic assessment, along with early minicraniotomy and extraction of infected dentition followed by a course of cephalosporins and metronidazole, contributed to a successful outcome.