Combined surgical and conservative endodontic management of Oehler's type 3b dens invaginatus aided by guided tissue regeneration.

The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.

Increased Risk for Acute Periapical Abscesses in Multiple Sclerosis Patients and the Possible Association with Epstein-Barr Virus.

INTRODUCTION: Multiple sclerosis (MS) is a severe inflammatory neuroimmune degenerative condition affecting more than 2 million individuals worldwide. The purpose of this study was to assess the prevalence of acute periapical abscesses in patients with MS and to evaluate whether acute periapical abscesses (PAs) are more likely to affect patients who were previously infected by Epstein-Barr virus (EBV). METHODS: Integrated data of hospital patients were used. Data from the corresponding diagnosis codes for MS and acute PA were retrieved by querying the appropriate International Classification of Diseases, Tenth Revision codes in the database. RESULTS: Of the total hospital patient population, 0.18% were diagnosed with a history of MS. Females were more affected than males 3.25-fold. Whites were more affected than African Americans 6-fold. Whites were more affected than African Americans combined with other ethnicities 3.6-fold. The odds ratio (OR) for acute PAs in patients with a history of MS was 2.2 (P < .0001). After adjustment for diabetes mellitus comorbidity, the OR for acute PAs in patients with a history of MS was 2.6. After adjustment for cardiovascular disease comorbidity, the OR for acute PAs in patients with a history of MS was 1.27. Of the patients who presented with PAs, 0.2% were diagnosed with a history of EBV infection. The OR was 3.98, and the difference in prevalence was statistically significant (P < .0001). CONCLUSIONS: Under the conditions of this cross-sectional study, it appears that the prevalence of acute PAs is higher in patients with MS and that EBV may play a role.

Periapical disease in post-stroke patients.

PURPOSE: To assess the prevalence of acute periapical abscesses (PAs) in patients with history of stroke. METHODS: Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for PAs and stroke were retrieved by searching the appropriate query in the database. The odds ratio (OR) of acute PAs and its association with post-stroke conditions was calculated and analyzed statistically. RESULTS: The prevalence of acute PAs in patients with stroke history was 1.39% as compared to 0.6% in the general patient population of the hospital. The OR was 2.78 and the difference was statistically significant (P< 0.0001). The prevalence of acute PAs in patients with a history of hemorrhagic stroke was 1.19% and the OR was 2.38. The difference was statistically significant (P< 0.0001). The prevalence of acute PAs in patients with a history of cerebral infarction was 1.55% and the OR was 3.11. The difference was statistically significant (P< 0.0001). The prevalence of acute PAs in patients with a history of cerebral infarction without hypertension was 0.87% and the OR was 1.75. The difference was statistically significant (P< 0.0001). CLINICAL SIGNIFICANCE: Oral healthcare providers should be aware of the possible higher prevalence of periapical abscesses in post-stroke patients. This can include patients with a history of hemorrhagic stroke or cerebral infarction.

Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess.

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.

The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess.

BACKGROUND: Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids. OBJECTIVES: We sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72 h after discharge from the ED. RESULTS: Seventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72 h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12 h compared with the placebo group (p = 0.029). Changes in pain scores from baseline and at 24, 48, and 72 h were not statistically significant. No adverse events were reported. CONCLUSIONS: Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo.

Diagnostic difficulties in a patient with multiple sclerosis who presents with cranial nerve palsies: an unusual complication of dental work.

A woman in her 60s with multiple sclerosis (MS) presented with right-sided ptosis, right sixth nerve palsy, right facial paraesthesia and signs of sepsis. She had a recent diagnosis of a dental abscess. Investigations revealed a right submasseter abscess leading to bacterial meningitis (Streptococcus intermedius) and a cavernous sinus thrombosis. She was managed in intensive care and underwent surgical drainage of the abscess. Anticoagulation for 6 months was planned. Cavernous sinus thrombosis is a very rare complication of a dental abscess, and even less frequently associated with submasseter abscesses. The case was complicated by a history of MS, to which the patient's symptoms and signs were initially attributed to. This case highlights the diagnostic pitfalls, and aims to enhance learning around similar cases. To the best of our knowledge, this is the first case report of a masseter/submasseter abscess leading to cavernous sinus thrombosis.

Diabetes Mellitus and Periapical Abscess: A Cross-sectional Study.

INTRODUCTION: Dental morbidities associated with diabetes mellitus (DM) include an increased prevalence of periodontal diseases (PDs). However, the occurrence of periapical infections in DM has not been sufficiently documented in the literature. The purpose of this study was to investigate the occurrence of periapical abscesses (PAs) in type 1 DM (T1DM) patients, type 2 DM (T2DM) patients, and nondiabetics in a hospital-based population. METHODS: We conducted a cross-sectional study by accessing the University of Florida Health Integrated Data Repository, and diagnoses of T1DM, T2DM, and PA were obtained from queries using the International Statistical Classification of Diseases, 10th Revision. The following parameters were recorded: age, sex, and race. A logistic regression model for aggregated data was used to assess the association between the occurrence of PA and the diabetic groups (T1DM, T2DM, and nondiabetic groups) after adjusting for PDs and cardiovascular disease (CVD). RESULTS: Among 867,526 patients, we found 5260 (0.6%) with T1DM and 52,493 (6.1%) with T2DM. The prevalence of PAs in the total hospital population was 4923 (0.6%), 102 patients (1%) with T1DM and 766 (6%) with T2DM with statistically significant differences. In subjects without PDs, diabetic patients are almost 3 times likely to have PAs compared with nondiabetic subjects. Among subjects with PDs, the association is weaker (odds ratio = 1.35) but still significant at a level of 0.05. In subjects without CVD, DM subjects are greater than 3 times more likely to have PA, whereas among subjects with CVD, subjects with DM are 1.5 times more likely to have PA. CONCLUSIONS: A higher prevalence of PAs was reported in diabetic patients compared with the other hospital population. Comprehensive dental treatment should be administered to diabetic patients to maximize glycemic control.

Chronic migraine headache and multiple dental pathologies causing cranial pain for 35 years: the neurodental nexus.

We report a case that illustrates how chronic migraine headaches and multiple dental pathologies caused severe and long-standing cranial pain that affected the quality of life of a man for more than 35 years. His case was investigated at several settings including the neurology outpatient clinic of the hospital without a definitive diagnosis or resolution. After investigations, multiple oral pathologies including two occult dental abscesses were diagnosed. Once both affected teeth and associated abscesses were surgically removed, with subsequent antibiotic therapy the headaches resolved.

Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata.

Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with sinus tract can be conservatively healed with endodontic treatment alone.

Mediastinitis as complication of odontogenic infection: A case report.

Odontogenic infections are one of the most common dental problems, which affect 80%-90% of the population. Untreated odontogenic infections can cause life-threatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response syndrome. This report aims to present a mediastinitis case, in a 22-year-old healthy male patient, which originated from an odontogenic infection. The patient was hospitalized because of worsening general health status, despite the antibiotherapy. Computed tomography (CT) scan revealed that periapical abscess was spreading to the mediastinum through retropharyngeal space. The patient was successfully treated by IV antibiotherapy, transcervical drainage, and extraction of tooth.

Desafios da abordagem interdisciplinar de indivíduo cardiopata grave com abcesso odontogênico agudo / Challenges of the interdisciplinary approach in an individual with severe heart disease and acute dental abcess

Os indivíduos sistemicamente comprometidos e com múltiplas comorbidades são um desafio para a abordagem cirúrgica. Pacientes com flutter atrial fazem uso de anticoagulantes para diminuir o risco de eventos tromboembólicos, porém há maior risco de hemorragia durante procedimentos cirúrgicos. As infecções de origem odontogênica podem ter disseminação hematogênica e agravar ainda mais o quadro clínico geral do indivíduo. A abordagem cirúrgica deve sempre visar à segurança e à qualidade de vida do paciente, levando em consideração os riscos e benefícios do procedimento e o preparo do profissional frente a possíveis acidentes e complicações, haja vista o risco de mortalidade perioperatória. O presente caso relata o desafio de estabelecer plano de tratamento e conduta diante de infecção odontogênica em indivíduo cardiopata grave polimedicado ASA IV com histórico de doença renal crônica sob hemodiálise, hipertensão arterial sistêmica, diabetes mellitus, anemia, insuficiência coronariana, flutter atrial, aterosclerose e pé diabético. Para o procedimento sob anestesia geral, foi instituída a terapia de ponte prévia, utilização de medidas hemostáticas locais e antibioticoterapia pré e pós-operatória. A atuação interdisciplinar mostrou-se essencial para estabelecer critérios de segurança e decidir o melhor momento para a atuação cirúrgica

Systemically compromised individuals with multiple comorbidities represent a challenge in terms of the surgical approach. Patients with atrial flutter take anticoagulants to reduce the risk of thromboembolic events, but there is a greater risk of hemorrhaging during surgical procedures. Infections of odontogenic origin may involve hematogenous dissemination and further aggravate the patient's overall clinical condition. The surgical approach should always target the patient's safety and quality of life, considering the risks and benefits of the procedure and the professional's preparedness to cope with possible accidents and complications, given the risk of perioperative mortality. This is a case report of the challenge of establishing a treatment plan and course of action for dental infection in an ASA IV polymedicated patient with a history of chronic kidney disease undergoing hemodialysis, systemic arterial hypertension, diabetes mellitus, anemia, coronary insufficiency, atrial flutter, atherosclerosis and diabetic foot. Prior bridge therapy, use of local hemostatic measures, and pre- and postoperative antibiotic therapy were instituted for the procedure to be carried out under general anesthesia. Interdisciplinary action has proved to be essential for establishing safety criteria and deciding on the best time for surgical intervention

Ludwig Angina after First Aid Treatment: Possible Etiologies and Prevention-Case Report.

Ludwig angina is a life-threatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Prevention, early recognition, and treatment of Ludwig angina are critical because this is a clinical diagnosis with unpredictable progression. This article describes a rare case of Ludwig angina that evolved from an odontogenic infection and the specific microbiology and clinical course and discusses possible etiologies and prevention.

Impact of odontogenic chronic rhinosinusitis on general health-related quality of life.

Chronic rhinosinusitis (CRS) may arise due to odontogenic etiologies. However, it is unknown whether odontogenic CRS has a differential impact on patients' quality of life (QOL) compared to standard, inflammatory (but non-odontogenic) CRS. The objective of this study was to determine whether there is a difference in the impact of sinonasal symptomatology on general health-related QOL in odontogenic CRS compared to non-odontogenic CRS. This was a retrospective review of 21 odontogenic CRS patients who visited our tertiary care center. The severity of sinonasal symptomatology and CRS-specific QOL detriment was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was measured using the health utility index from the 5-item EuroQol survey (EQ-5D HUV). Compared to non-odontogenic CRS, odontogenic CRS was not associated with a difference in SNOT-22 score [linear regression coefficient (ß) = - 1.57, 95% CI - 12.47 to 9.32, p = 0.777] but was significantly associated with decreased EQ-5D HUV (ß = - 0.10, 95% CI - 0.17 to - 0.03, p = 0.008). We also found that the magnitude of association (ß) between SNOT-22 and EQ5D-HUV was greater for odontogenic CRS patients compared to non-odontogenic CRS patients (p = 0.045). Our findings suggest sinonasal symptoms may have a greater impact on general QOL in odontogenic CRS compared to non-odontogenic CRS. The reason for this remains unknown, but deserves further study.

Painful jaw lesion.

A 48-year-old Chinese woman was referred to our center with a 7-month history of a painful lesion on her left jaw that had been gradually increasing in size. The patient noted occasional purulent and bloody discharge from the lesion. She denied having a toothache. An examination revealed an erythematous nodule with perilesional puckering superior to the left body of the mandible, measuring 7 × 8 mm, with no discharge or surrounding inflammation. There was no cervical lymphadenopathy. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?

Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).

Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series.

BACKGROUND: The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS: A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS: A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS: The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.

Cutaneous Sinus Tract from Mandibular Second Molar with C-shaped Canal System and Improper Former Root Canal Treatment: A Case Report.

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.