Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014. OBJECTIVES: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS: We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication. SELECTION CRITERIA: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS: There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS: The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.

Conventional vs ultrasonic irrigation - which leads to less post-operative pain?

Data sources Medline, Scopus, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov and OpenGrey databases were systematically searched to find studies comparing post-operative pain experienced following root canal treatment with ultrasonic and conventional irrigation (up to May 2021). Hand searching of selected journals was also performed.Study selection Randomised controlled trials assessing post-operative pain experienced following primary non-surgical root canal treatment using conventional versus ultrasonic irrigation were screened. Exclusion criteria included an unsuitable follow-up period, systemic disease among the participants, severe pain, acute apical abscess diagnoses and fewer than 12 patients per trial arm. English language only studies were included. Two reviewers independently screened the studies and disagreements were resolved by consulting a third reviewer.Data extraction and synthesis Data extracted included tooth type, root type, pre-operative diagnosis, pain recording, time of pain recording, number of patients requiring analgesics and study conclusions. Meta-analyses of different post-operative time periods (6h, 24h, 48h, 72h and 7 days) were performed using a fixed-effects model to obtain a mean difference (with 95% confidence intervals) for post-operative pain. Heterogeneity between studies was evaluated using the I2 statistic. Quality assessment of the included studies was performed according to the Cochrane Collaboration protocol for randomised controlled trials. Publication bias was assessed using a funnel plot and modified via the 'trim-and-fill' method.Results A total of six articles were included in the systematic review, of which four were included in the meta-analysis. Overall risk of bias was deemed to be 'low' with one study presenting an unclear risk with respect to selection bias. Meta-analysis demonstrated that ultrasonic agitation significantly reduced post-operative pain compared to conventional irrigation at 6, 24 and 48 hours (p <0.05) but no significant differences were found at later time points.Conclusions Ultrasonic irrigation may lead to less post-operative pain compared to conventional irrigation techniques; however, the evidence base is limited and further research is needed to support these findings.

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014. OBJECTIVES: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 February 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 26 February 2018), MEDLINE Ovid (1946 to 26 February 2018), Embase Ovid (1980 to 26 February 2018), and CINAHL EBSCO (1937 to 26 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. A grey literature search was conducted using OpenGrey (to 26 February 2018) and ZETOC Conference Proceedings (1993 to 26 February 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS: Two authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data. A fixed-effect model was used in the meta-analysis as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS: We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo when provided in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. The patients included in these trials had no signs of spreading infection or systemic involvement (fever, malaise). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables reported in both studies were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects, as reported in one study, were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). Neither study reported quality of life measurements.Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscessTwo studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth when provided in conjunction with a surgical intervention. Participants in one study all underwent a total pulpectomy of the affected tooth, while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality.Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscessWe found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS: There is very low-quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.

Endodontic regeneration and tooth revitalization in immature infected sheep teeth.

AIM: To examine the response of immature sheep teeth with infected root canal systems to a commonly used pulp regeneration/revitalization protocol. METHODOLOGY: Immature mandibular right first incisors in four sheep were mechanically exposed and the pulps infected. The mandibular left first incisors remained intact as controls. Five weeks later, the experimental root canals were chemo-mechanically cleaned and dressed with a triple-antibiotic paste for 4 weeks, before bleeding was induced inside the canal by mechanically irritating the periapical tissues. A collagen dressing was packed coronally onto the blood clot and the canal orifice sealed with mineral trioxide aggregate and glass ionomer cement. Six months later, the mandibles were collected and the teeth with associated periapical tissues were analysed radiographically, with CT scanning, and by histology. The changes in root length, dentine thickness in the apical third (mesially and distally), and apical diameter were analysed using Student's t-test. RESULTS: Radiographs revealed significant increases in root length, root wall thickness and narrowing of the apical diameter of the canals after treatment (P < 0.05), with no significant differences in root diameters found between the experimental and the control teeth (P > 0.05) on both radiographic and CT results. Root maturation and thickening of the walls due to hard tissue deposition was confirmed by histology in all experimental teeth. Hard tissues in the apical portion of the root were more developed than in the coronal portion. CONCLUSION: Endodontic regeneration and tooth revitalization procedures in immature infected sheep teeth showed positive outcomes with similar increases in root length and development to the control teeth.

Regeneration or replacement? A case report and review of literature.

Endodontic treatment of immature necrotic teeth is a real challenge. Recently, a biologically based treatment strategy, referred to as regeneration, has been introduced. Tissue regeneration requires the presence of stems cells, a scaffold, and growth factors. Endodontic regeneration may improve the prognosis of immature necrotic teeth by re-establishing the functional pulpal tissue and further development of the root. However, the tissue formed in the pulpal space may not be original pulp tissue, and in some cases, it may result in uncontrolled calcification of the pulp. This study reports a case of successful endodontic regeneration and compares this process with the normal development of the contralateral tooth. Finally, it discusses the nature of the tissue formed during endodontic regeneration.

Root sepsis associated with insect-dwelling Sebaldella termitidis in a lesser dwarf lemur (Cheirogaleus medius).

Sebaldella termitidis is a rare fastidious microorganism of the Leptotrichiaceae family. A variety of closely related species are associated with severe and even life-threatening disease in humans and animals, such as Streptobacillus moniliformis, the etiological organism of rat-bite fever as well as members of Leptotrichia spp. and Sneathia sanguinegens, which have been reported from cases of septicaemia. In contrast, since its description some 50 years ago, S. ermitidis has so far never been reported as a vertebrate pathogen, nor has it been found aside from its natural termite host. A lesser dwarf lemur was presented with unilateral facial inflammation originating from rotten maxillary teeth and septic root abscess. Surgical intervention and root extraction significantly improved the clinical cause in that a pus-filled cavity underneath the right eye could be drained, sampled and flushed. Bacteria displaying substantial characteristics of S. termitidis were cultured from the sampled pus. Morphological features observed included strictly anaerobic regular Gram-negative rods. Significant shared biochemical properties included negative reactions for cytochrome oxidase, catalase, urease, nitrate reduction and indole production. Furthermore, 16S rRNA gene sequencing revealed 99.9 % sequence homology to the S. termitidis type strain NCTC 11300(T), from which it, nevertheless, differed with respect to rep and rep- and RAPD-PCR profiles. An affiliation of the lemur isolate described in this study with the type strain of S. termitidis as well as a clear discrimination from other members of the Leptotrichiaceae could also be confirmed by matrix-assisted laser desorption/ionization time-of flight mass spectrometry and Fourier transform-infrared spectroscopy. This is the first evidence for clinical disease caused by S. termitidis in a vertebrate species indicating a broader host spectrum of this rarely encountered microorganism.

[A Case of Squamous Cell Carcinoma of the Anal Canal with a Perianal Abscess].

A 72-year-old female patient was referred to our department because she felt pain at the anus with pus discharge. Physical examination revealed a tumor on the left side of the anus, and a subcutaneous induration near the tumor. Abdominal CT scan revealed an irregularly shaped tumor with abscess formation. There were no enlarged lymph nodes or distant metastasis. Anal canal carcinoma (cStage Ⅱ) with a complication of perianal abscess was suspected, so we performed surgical incision and drainage. A biopsy of the tumor led to the diagnosis of squamous cell carcinoma. However, because surgical drainage alone was not effective for treatment of the abscess, colostomy of the sigmoid colon was carried out 14 days after admission. After chemoradiation therapy (5-FU 800 mg/m2/day on days 1-4 and 29-32, mitomycin C [MMC] 10 mg/m2 on days 1 and 29, and radiation with a total dose 54 Gy), the tumor disappeared completely, considered to be a complete response. Twenty months after chemoradiation, there were no signs of recurrence.

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

BACKGROUND: Dental pain can have a considerable detrimental effect on an individual's quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with symptomatic apical periodontitis or an acute apical abscess should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists continue to prescribe antibiotics for these conditions. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies both within the individual and within the community as a whole. OBJECTIVES: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis or acute apical abscess in adults. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health Group's Trials Register (to 1 October 2013); Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 1 October 2013); EMBASE via OVID (1980 to 1 October 2013) and CINAHL via EBSCO (1980 to 1 October 2013). We searched the World Health Organization (WHO) International Trials Registry Platform and the US National Institutes of Health Trials Registry (ClinicalTrials.gov) on 1 October 2013 to identify ongoing trials. We searched for grey literature using OpenGrey (to 1 October 2013) and ZETOC Conference Proceedings (1993 to 1 October 2013). We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS: Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS: We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo given in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth (no signs of spreading infection or systemic involvement (fever, malaise)). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables presented were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects as reported in one study were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). No studies reporting quality of life measurements were suitable for inclusion. Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess. Two studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth. Participants in one study all underwent a total pulpectomy of the affected tooth while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality. Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess. We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS: There is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.

Management of rapidly progressing periopical pathologies: a case report.

Dentists often treat swellings from odontogenic periapical pathologies. One management option involves immediate treatment with antibiotics, followed by surgical intervention. We report a clinical case in which an 8-year-old patient sought care for such a lesion and received pharmacological therapy alone. The lesion expanded into multiple facial spaces approximating the ocular organ and other vital cranial structures. Eventual treatment of the lesion required a CT-scan, followed by an intubated general anesthetic, incision and drainage, extraction of the involved dentition and an overnight hospital admission. This case report is meant to highlight appropriate courses of action in management of rapidly progressing periapical pathologies.

Irrigating drains for severe odontogenic infections do not improve outcome.

PURPOSE: The need to irrigate surgical drains in the postoperative period in patients with odontogenic infections is controversial. The purpose of this study was to evaluate the efficacy of irrigating surgical drains postoperatively in patients with severe odontogenic infections. MATERIALS AND METHODS: Consecutive patients presenting with severe odontogenic infections who required incision and drainage were randomized to irrigating drains (red rubber catheters) or nonirrigating drains (Penrose drains). The primary predictor variable was the type of drain and the use of postoperative irrigation. The primary outcome variable was length of stay. Secondary outcomes included postoperative temperature, need for additional procedures, and complications. The t test was used for the primary outcome, and a P value lower than .05 was considered statistically significant. RESULTS: Forty-six patients completed the study. There was no statistically significant difference in overall length of stay, length of stay after surgery, temperature, or need for additional procedures between the 2 treatment groups. CONCLUSIONS: The use of nonirrigating drains appears to be equally efficacious as irrigating drains in the management of severe odontogenic infection.

Orbital cellulitis as a complication of mandibular odontogenic infection.

A 30-year-old man presented with an acute left eye proptosis, pain, and decreased vision. He had been having a dental infection since 3 days. Orbital CT scan showed abscess in the left orbit. On dental X-ray a periapical radiolucency of the mandibular left-second molar was observed, and no obvious sinus involvement was noted. Intravenous antibiotic therapy did not lead to any significant improvement. Therefore, the patient underwent combined dental and orbital surgery to drain the abscess. Following the surgery, the patient's clinical signs and symptoms resolved completely.

[Dental care during pregnancy]. / Enquête sur la prise en charge de la femme enceinte au cabinet dentaire.

AIM: to understand and analyze knowledge and practices of dentists regarding dental care during pregnancy using a questionnaire which focuses on the knowledge of the relationship between oral infections and complications of pregnancy, the attitude of practitioners on the implementation of dental care during pregnancy and the training of practitioners. RESULTS: 53.9% of pregnant women are not referred by an obstetrician. Only 59.8% of practitioners believe that dental anesthesia is not contraindicated, and most practitioners believe that the best time for care is the second trimester or after pregnancy. During pregnancy, practitioners realize the motivation for hygiene (90.7%), drainage of an abscess (82.2%), scaling (76.1%), the placement of a splint (74.1%), the treatment of caries (70%), and the removable prosthesis (67.2%). CONCLUSION: these results indicate the existence of a gap between the care of pregnant women and the state of the art in dental science, despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second and third trimester. Moreover, the results highlight the need to reinforce the initial training of dental students, but also to develop the training for practitioners in this field.

Pattern of tooth extraction in children attending tertiary health care centers in Nigeria: a prospective study.

BACKGROUND: To identify the causes of tooth extraction in a tertiary pediatric center in an urban centre in Nigeria. METHOD: Data was collected prospectively from 400 children attending one of the four tertiary dental clinics. The demographic profile, the indications for tooth extraction, and the tooth extracted were noted. Data was compared with result of study conducted 21 years back in the same center, and data from two other tertiary health centers in the region. RESULTS: The prevalence of tooth extraction was 58.8% in the study population. This occurred in significantly more male patients. Tooth loss was commonest amongst the 7-10 age group. Dental caries was the main cause of tooth loss for all age groups. Most patients (66.0%) lost a single tooth. The lower molars were the most frequently lost teeth (47%). Indications for tooth extraction were similar in the region. CONCLUSION: Dental caries remains the most common cause of tooth extraction. The indications for tooth extraction remain the same but the prevalence of tooth loss per cause of tooth loss had not changed over the last 21 years, and across institutions in Southwestern Nigeria.

Cutaneous facial sinus tract of dental origin.

Cutaneous sinus tract on the head and neck area in a child may originate from dental disease. A high degree of clinical suspicion and complementary tests are often needed, as the diagnosis is usually not straight forward. Anatomical correlation is also useful in tracing the affected tooth or teeth. We present the case of a boy with a facial sinus tract that originated from periapical abscesses of maxillary molars.

Apical actinomycosis: case report.

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontic therapy. After conventional root canal therapy of the lower left first and second molars, a 24-year-old woman presented with a persistent periapical lesion associated with one of the sinus tracts. The lesion was surgically removed, and actinomycosis was diagnosed on the basis of biopsy results. The clinical and histologic features of this rare condition are discussed.

Short-term treatment of periapical lesion of anterior tooth affected by microleakage using Nd:YAG laser. Case report.

Tooth-colored restorations are the first choice for anterior restorations. However, microleakage is a significant problem at the margins of anterior cavities restored with resin composites. Microleakage can cause pulpal irritation and periapical inflammation. Today, laser irradiation is used frequently for dental treatments. Nd:YAG laser has been used successfully in endodontic treatments. A 17-year-old male presented to our clinic with a maxillary right lateral incisor that resulted in microleakage of an old composite resin restoration. Clinical examination revealed swelling and abcess formation on the palatal mucosa. The radiographic examination was performed and an inflammation around the apex was diagnosed. Root canal preparation, canal sterilization by Nd:YAG laser and root canal filling were performed at the same visit. The patient was observed for two months. In the case presented here, short-term treatment of a periapical lesion of an anterior tooth affected by microleakage using the Nd:YAG laser is discussed.

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.