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)

Chondroblastic osteosarcoma mimicking periapical abscess

Abstract Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion. Case report The present report describes a case of chondroblastic osteosarcoma in the periapical region of teeth #29, #30, and #31 of an 18-year-old male. Clinical history showed self-reported discomfort in the right posterior gingiva for over a month. Physical examination showed a small expansion and redness of the right mandibular buccal and lingual cortical plates, but no signs of pain or inflammation were observed. All the teeth responded positively to pulp sensibility. Periapical and panoramic radiographs showed slight periapical radiolucency in the roots of teeth #29 and #30, clear periodontal ligament space widening, and evident loss of lamina dura. Incisional biopsy was performed, and based on microscopic findings the diagnosis of chondroblastic osteosarcoma was confirmed. Conclusions Non-endodontic diseases associated with tooth root apex, such as chondroblastic osteosarcoma, should be included in differential diagnosis of jaw lesions that resemble periapical abscess.

Cone beam computed tomography: A tool for the diagnosis of confusing periapical lesions in conventional radiographs.

We report two cases in which cone beam computed tomography (CBCT) was essential for the establishment of the diagnosis of periapical lesions. CBCT allows a three-dimensional assessment of a specific region with no superimposition of structures. Therefore, its use is recommended when radiographic images are not sufficient for the diagnosis.

Ultrasound imaging versus conventional histopathology in diagnosis of periapical lesions of endodontic origin: A comparative evaluation.

Context: Accurate assessment of periapical status is critical in diagnosis, treatment planning, and evaluation of healing. Novel imaging modalities like sonography offer promising results with reduced radiation risks. Aims: To evaluate the potential of ultrasound imaging technique together with the application of color Doppler to differentiate between periapical lesions of endodontic origin. Materials and Methods: Twenty patients with periapical lesions of endodontic origin who were already scheduled for undergoing endodontic surgery were examined further using sonography. Color Doppler was performed to assess blood flow. Information on the size of the lesion, its content, and vascular supply was gained and recorded by means of ultrasound images. The sonographic images were analyzed and discussed with an expert sonologist, and a tentative diagnosis between a periapical cyst and periapical granuloma was made. Endodontic surgery and histopathological examination was done for each case and the results were compared. Results: The sonograms revealed the lesions within the bone in three dimensions and their contents, that is, fluids or tissues or blood vessels. Measurements of the periapical lesions in three dimensions were also obtained. Of the twenty cases studied, ultrasound could detect periapical granulomas in all 9 cases and radicular cysts in all 11 cases. Conclusion: Ultrasound imaging had the potential to be used for the evaluation of periapical lesions of endodontic origin. However, further studies are required to establish a definite correlation.

A comparative evaluation of healing with a computed tomography scan of bilateral periapical lesions treated with and without the use of platelet-rich plasma.

Periradicular surgery aims to achieve complete wound healing and regeneration of the periodontal unit. Platelet-rich plasma (PRP) is a platelet concentrate that is widely used to promote tissue healing, and bone induction through its various growth factors has been used in this study. This case report describes the use of PRP unilaterally in a bilateral periapical lesion in the same patient. The site treated with PRP showed better healing than the untreated site. This was confirmed with computed tomography (CT) scan readings. It was hypothesized that PRP could promote tissue regeneration and alveolar bone repair.

Estimation of salivary amylase and total proteins in leukemia patients and its correlation with clinical feature and radiographic finding.

Background: Leukemia is a fatal disease. The oral manifestations of the leukemias occur early in the course of the disease and these oral features can at times act as a diagnostic indicator. Saliva has been used as a diagnostic aid in a number of systemic diseases. Materials and Methods: In our study, samples of unstimulated saliva of 30 leukemia patients who were not on chemotherapy were collected and analyzed for salivary amylase and total protein. The oral manifestations and radiographic changes (OPG) were recorded. The correlation between the oral manifestations and the salivary components (salivary amylase and total protein) was assessed for prognostic significance. Results: In the present study when the mean values of salivary amylase (1280±754 U/ml) and total protein (647.2±320.7 mg%) were compared with that in control subjects. There was a statistically significant difference for amylase levels (P<.05). On intraoral examination the study subjects showed pallor, gingivitis, gingival enlargement, petechiae, and ecchymosis. On the OPG, the radiographic features included generalized rarefaction of bone (20%), thinning of lamina dura (3.4%), generalized alveolar crest bone resorption (30%), thinning of walls of alveolar crypts (6.7%), besides others, e.g., periapical abscess (10%). Conclusions: The saliva of leukemic patients demonstrated obvious changes in composition. A rise in salivary amylase and total protein levels was evident, with the increase in amylase levels being statistically significant.