Odontogenic infections in the antibiotic era: approach to diagnosis, management, and prevention.

PURPOSE: The prevalence of odontogenic infections remains one of the highest in the world. If untreated, odontogenic infections can break through the limitation, disseminate to other organs or spaces, and cause high mortality rates. However, it is still difficult to rapidly target limited or disseminated infections in clinical practice. The type of disseminated odontogenic infections and the responsible bacteria have not been described in detail. METHODS: Search databases (e.g., PubMed, MEDLINE, Web of Science, Embase) for reports published from 2018.1 to 2022.9. Use search strategies: ("odontogenic infections" OR "pulpitis" OR "periapical lesions" OR "periodontal diseases") AND ("disseminated infections" OR "complication"). RESULTS: Fourteen different types of disseminated odontogenic infections, most of which are polymicrobial infections, can spread through the body either direct or through hematogenous diffusion. Multiple microbial infections can be more invasive in the transmission of infection. Secondary infections are commonly associated with bacteria like Fusobacterium spp., Streptococcus spp., Peptostreptococcus spp., Prevotella spp., and Staphylococcus spp. Antibiotics with broad-spectrum activity are fundamental as first-line antimicrobial agents based on the microorganisms isolated from disseminated infections. CONCLUSION: This review elaborates on the epidemiology, microorganisms, risk factors, and dissemination routes, and provides evidence-based opinions on the diagnosis, multidisciplinary management, and prevention of odontogenic infections for dentists and clinicians.

Efficacy of Dexamethasone Injection at Different Sites on Postoperative Sequelae After Extracting Mandibular Impacted Third Molars: A Randomized Controlled Trial.

BACKGROUND: Dexamethasone, an efficacious anti-inflammatory agent, is widely used after tooth extraction. However, its optimal injection site is yet to be investigated. PURPOSE: We compare the efficacy of dexamethasone injection at different sites on postoperative sequelae after extracting mandibular impacted third molars (MITMs). STUDY DESIGN, SETTING, AND SAMPLE: A prospective randomized controlled trial was conducted. Healthy adults with fully MITMs scheduled for extraction were included. Exclusion criteria were 1) patients with the systemic alteration that prevented the surgical procedure; 2) pregnancy, breastfeeding, and premenstrual period; 3) hypersensitivity to the drug under test; and 4) those who did not return for postoperative follow-up at 1, 3, and 7 days. EXPOSURE VARIABLE: The subjects were randomized to 3 groups. An online randomization plan generator assigned each subject to a single treatment by randomly permuting blocks. Different sites for postoperative dexamethasone injections included the buccal side of the adjacent second molar and extraction sockets. Dexamethasone injection (4 mg) on the buccal side of the adjacent second molar (group 1), an injection on the buccal side of extraction sockets (group 2), and an injection of physiological saline (0.8 mL) on the buccal side of the adjacent second molar (control). MAIN OUTCOME VARIABLES: The outcome variables were postoperative facial swelling, limitation of the mouth opening, postoperative pain, and postoperative quality of life evaluation. The pain was assessed using a visual analog scale at 1, 3, and 7 days, postoperatively. The quality of life was recorded throughout the Posse scale at 7 days. COVARIATES: The covariates are age, sex, length of operation, and type of impacted teeth and surgery. ANALYSES: The statistical analysis was performed using analysis of variance, repeated measures analysis of variance, χ2 test, or Fisher's exact tests with P values < .05 considered statistically significant. RESULTS: Our study included 58 participants with a mean age of 19.48 ± 3.31 years; group 1 (n = 24), group 2 (n = 20), and control group (n = 14). On day 3 postoperative, the swelling and trismus were significantly less in group 1 than in the other 2 groups (P < .05), and group 1 had an overall postoperative quality of life compared to other groups (P < .05). Unaffected speech function was present in 73.7% of patients in group 1, while 50% of patients in group 2 had affected speech function 3 days after the operation (P < .05). The "unable to open mouth" of the "Eating subscale" and "felt tingling" had statistical significance (P < .05). CONCLUSION AND RELEVANCE: Dexamethasone injections on the buccal side of the adjacent second molar can be a viable option for treating facial swelling and limitation of mouth opening after total MITMs extraction.

Technical Skills to Split Teeth During Extraction of Mesiodentes in High Site.

PURPOSE: Extraction of mesiodens in high site is complicated. Here we introduce some technical skills to simply the process and achieve high success rate meanwhile. METHODS: All patients should accept radiographic examination before surgery. According to the position of mesiodens based on cone-beam computed tomography, we choose the appropriate method and tool. RESULTS: A series of cases have proved that these skills are applicable and convenient. CONCLUSIONS: Dentists should analyze the inspection results seriously and select the optimal strategy to extract mesiodens in high site.

A Seldom Seen Complication in the Inferior Alveolar Nerve Block.

PURPOSE: Introduce Kuhn anemia as a complication during the inferior alveolar nerve block (IANB). METHODS: Here, the authors reported a lesser-known complication called Kuhn anemia during the IANB. Then, the authors searched and reviewed relevant literature on the Web of Science. RESULTS: Vasospasm of the maxillary artery results in the phenomenon. Reasons, such as inaccurate injection, anatomical variation, drug diffusion, and so on, may account for the complication during the IANB. CONCLUSIONS: All in all, doctors should be prudent before and during the surgery.

A Potential Complication After Drainage in Odontogenic Descending Necrotizing Mediastinitis: Chyle Leakage.

ABSTRACT: Descending necrotizing mediastinitis is a serious complication of odontogenic infections. Incision and drainage of the maxillofacial infection with mediastinal drainage represent the principal management. However, chyle leakage after drainage in descending necrotizing mediastinitis is rare and has not been reported. Here the authors present a case of a 74-year-old man with chyle leakage after mediastinal drainage, which is successfully treated.

The association between low birth weight and dental caries among 11-to-13-year-old school age children in Ningbo, China.

BACKGROUND: The association between low birth weight (LBW) and dental caries is currently unclear. The aim of this study was to investigate the association of LBW with dental caries in permanent teeth in children of Ningbo city. METHODS: A total of 1975 children aged 11-to-13 years in Ningbo, China were enrolled in this cross-sectional study. LBW was defined as a birthweight< 2500 g. Ten dentists assessed the status of dental caries in permanent teeth in line with the World Health Organization (WHO) criteria and guidelines. Decayed, missing or filled teeth were considered to have dental caries. Parental questionnaires were used to collect child information. Non-conditional logistic regression analysis was used to estimate odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). RESULTS: Dental caries in permanent teeth was found in 610 children (30.9%), with a mean DMFS of 2.09 (SD = 1.2). The adjusted ORs for dental caries in permanent teeth was 1.46 (95% CI 1.00, 2.13) for LBW. CONCLUSIONS: LBW was not associated with dental caries in permanent teeth in the study population.

Skull Base Sphenoid Bone: A Potential Route of Brain Abscesses Induced by Odontogenic Infection.

ABSTRACT: Odontogenic foci are rarely linked with brain abscesses. The lack of an effective approach to match the causative origin with the infection can lead to late medical response of patients. Here we present a case of a 53-year-old man with brain abscesses that was probably caused by odontogenic foci. The imaging examinations clearly showed the periodontitis of mandibular left second molar and the destruction of greater sphenoid wing. Therefore, possible routes of extension through masticator space abscesses were indicated. For early infection of the maxillofacial space caused by potential odontogenic lesions, oral surgeons should eliminate the potentially odontogenic foci and use computerized tomography imaging to determine the existence of bone destruction around the oral cavity such as the skull to prevent further bone defect complications such as brain abscesses.

Use of the buccal fat pad in the immediate reconstruction of palatal defects related to cancer surgery with postoperative radiation therapy.

PURPOSE: To evaluate the use of the buccal fat pad (BFP) in the immediate reconstruction of oncologic palate defects and the influence of postoperative radiotherapy on reconstruction. PATIENTS AND METHODS: Patients who were diagnosed with moderate- to high-grade malignancies of the palate underwent partial maxillectomy. The BFP was used as a pedicled flap to reconstruct the defects. All patients received postoperative radiotherapy 4 to 5 weeks after surgery. RESULTS: Eighteen patients (9 men and 9 women; age range, 37 to 81 yr) underwent surgery and subsequent radiotherapy. The size of all defects ranged from 7.5 to 19.2 cm2. Adequate closure of the defects was achieved during surgery and all flaps were epithelialized within 3 weeks after surgery, with no complications of dehiscence or flap failure. Furthermore, there were no complications derived from postoperative radiotherapy. CONCLUSIONS: This study suggests that BFP grafting is an effective and reliable method for the reconstruction of small to medium-size palate defects. Furthermore, postoperative radiotherapy does not influence the success of reconstruction.

Modified Leclerc blocking procedure with miniplates and temporal fascial flap for recurrent temporomandibular joint dislocation.

This study introduced the modified Leclerc blocking procedure with miniplate and temporal fascial flap for recurrent temporomandibular joint (TMJ) dislocation and evaluated its clinical effects. Seven patients were treated by the modified Leclerc blocking procedure with miniplate and temporal fascial flap. The postoperative follow-up period ranged from half a year to 2 years to access the maximal mouth opening, TMJ disorder symptoms (pain and sound), and incidence of recurrence. No recurrence was observed in all of the 7 patients postoperatively. The mean preoperative and postoperative MMOs were 49.7 mm and 40.1 mm, respectively. There were 3 patients who reported the alleviation of pain and/or sound postoperatively. Two older patients with long-term course of disease reported no improvement of the TMJ symptoms in terms of pain and sound postoperatively. Our results showed that the modified Leclerc blocking procedure with miniplates and temporal fascial flap provided a more stable support for the condylar movement with less recurrence, suggesting that this operation could be a good alternative for the treatment of recurrent TMJ dislocation.

Surgical approaches for tongue base schwannoma.

Schwannomas (neurilemmomas) are benign nerve sheath tumor originating from Schwann cells. They are well circumscribed and rarely infiltrate and metastasize. Schwannomas of the head and neck commonly occur in the tongue followed by the palate, floor of mouth, buccal mucosa, and mandible. Tongue base schwannomas could extend to the pharyngeal cavity or the floor of the mouse, and it is difficult to differentiate between tumors of the lingual, hypoglossal, and glossopharyngeal nerves.Surgical treatment of tongue base schwannomas is difficult because of limited operative exposure. Although mandibulotomy with lip splitting could obtain good exposure, surgeons might strike a balance between exposure obtaining and morbidity following because there are intricate neurovascular anatomical relationships in this region, and mandibulotomy with lip splitting would cause significant morbidity. Surgical approach options are important for tongue base schwannoma removal. From March 2008 to March 2010, 8 patients were clinically and pathologically diagnosed with tongue base schwannomas in our department, and all underwent surgical treatment. In our experience, transoral approach was used for tongue base schwannomas extending to the floor of the mouse and suprahyroid pharyngotomy approach for those extending to the pharyngeal cavity. Follow-up was made until now. One patient who experienced transoral excision still experienced numbness in the region of the lateral tongue tip, and the other 7 patients had no postoperative long-term complications.

A single-cell transcriptional atlas reveals resident progenitor cell niche functions in TMJ disc development and injury.

The biological characteristics of the temporomandibular joint disc involve complex cellular network in cell identity and extracellular matrix composition to modulate jaw function. The lack of a detailed characterization of the network severely limits the development of targeted therapies for temporomandibular joint-related diseases. Here we profiled single-cell transcriptomes of disc cells from mice at different postnatal stages, finding that the fibroblast population could be divided into chondrogenic and non-chondrogenic clusters. We also find that the resident mural cell population is the source of disc progenitors, characterized by ubiquitously active expression of the NOTCH3 and THY1 pathways. Lineage tracing reveals that Myh11+ mural cells coordinate angiogenesis during disc injury but lost their progenitor characteristics and ultimately become Sfrp2+ non-chondrogenic fibroblasts instead of Chad+ chondrogenic fibroblasts. Overall, we reveal multiple insights into the coordinated development of disc cells and are the first to describe the resident mural cell progenitor during disc injury.

Divergent chondro/osteogenic transduction laws of fibrocartilage stem cell drive temporomandibular joint osteoarthritis in growing mice.

The anterior disc displacement (ADD) leads to temporomandibular joint osteoarthritis (TMJOA) and mandibular growth retardation in adolescents. To investigate the potential functional role of fibrocartilage stem cells (FCSCs) during the process, a surgical ADD-TMJOA mouse model was established. From 1 week after model generation, ADD mice exhibited aggravated mandibular growth retardation with osteoarthritis (OA)-like joint cartilage degeneration, manifesting with impaired chondrogenic differentiation and loss of subchondral bone homeostasis. Lineage tracing using Gli1-CreER+; Tmfl/-mice and Sox9-CreER+;Tmfl/-mice showed that ADD interfered with the chondrogenic capacity of Gli1+ FCSCs as well as osteogenic differentiation of Sox9+ lineage, mainly in the middle zone of TMJ cartilage. Then, a surgically induced disc reposition (DR) mouse model was generated. The inhibited FCSCs capacity was significantly alleviated by DR treatment in ADD mice. And both the ADD mice and adolescent ADD patients had significantly relieved OA phenotype and improved condylar growth after DR treatment. In conclusion, ADD-TMJOA leads to impaired chondrogenic progenitor capacity and osteogenesis differentiation of FCSCs lineage, resulting in cartilage degeneration and loss of subchondral bone homeostasis, finally causing TMJ growth retardation. DR at an early stage could significantly alleviate cartilage degeneration and restore TMJ cartilage growth potential.

Buccal reconstruction with the mouth floor mucosal flap.

A mouth floor mucosal flap was developed to reconstruct medium-sized intraoral buccal defects, too large for primary closure if major functional and aesthetic impairment is to be avoided. Although free flaps, perforator flaps, or even skin grafts can be designed for buccal reconstruction, they may not provide good mucosal sensitivity, motility, volume, and texture to replace lost structures with similar tissue. Moreover, secondary morbidity can be avoided with this adjacent flap.In our study, 8 flap reconstruction procedures were performed from March 2009 to July 2011: 4 cases of leukoderma, 2 cases of buccal cancer (T1 N0 M0), and 2 cases of papillary epithelioma. The largest size amount to 5.3 × 3.8 cm (length × width), with a mean of 4.3 × 3.4 cm. Compared with free flaps (forearm arm flap for example) for buccal reconstruction, application of the mouth floor flap has its indications. First, to secure the motility of tongue and function of mouth opening, the upper bound of the defects was below the occlusion line. Generally, the width between top and bottom was less than 4 cm. Second, at least a partial buccinator muscle can be preserved after lesion resection and then facial collapse can be avoided. Third, patients had molar absence or relevant teeth had to be extracted during surgery.All patients recovered from intraoral surgeries with good objective and subjective speech and swallowing and aesthetics and without injury to the lingual nerve, the submandibular gland duct, and the sublingual gland. Results indicate that the mouth floor mucosal flap is reliable and technically easy for reconstructing medium-sized intraoral buccal defects, with good function and aesthetics with little secondary morbidity.

Intraoral multistage mandibular angle ostectomy: 10 years' experience in mandibular contouring in Asians.

In Asia, a round face rather is more acceptable than a square face. Intraoral mandibular angle ostectomy is a common aesthetic procedure for correcting a prominent mandibular angle. However, an operation of sheer straight-lined prominent mandibular angle resection would sometimes create extramandibular angles or palpable bone steps in the margin of mandibular body and produce unnatural lower one-third facial appearance, especially for a square and disproportional mandibular angle even extending to the middle mandibular body. This article describes the method of multistage mandibular angle ostectomy to produce a natural lower one-third facial contour. This method mainly focused on the posterior area of mandibular ostectomy by intraoral approach, although it has modifications. Mandibular contouring is realized first through bone cutting from antegonial notch posteriorly upperward, reaching to the middle ramus of the mandible near the earlobe; second ostectomy followed along mandible lower part is to get rid of extramandibular angle according to the preoperative design; sometimes necessarily, third ostectomy creates a smooth mandibular contour. From January 2000 to January 2010, 379 patients were operated on, and satisfactory results were achieved. Thus, this procedure could avoid excessive bone cutting, extramandibular angles, unnatural appearance, and palpable bone steps.

Distractor with supporting computer program for the reconstruction of arc defects in mandible by distraction osteogenesis.

Distraction osteogenesis as a technique seems to be a promising method in craniofacial bone lengthening and reconstruction through the process of bone and soft-tissue regeneration under stimulation of gradual tensile stress. Distractor plays a very important role especially in the reconstruction of large, irregular bone defects. We designed a new-type distractor and supporting computer program for the reconstruction of arc defects in the mandible by distraction osteogenesis. This distractor was applied for the reconstruction of the monkeys' artificial mandibular median defects. Owing to computer program, perfect distracting plan was made to finish this task. X-ray files showed that the mandibular defects in all animals were repaired successfully, and the anterior mandibular contours were similar to the normal ones. The success of distraction osteogenesis for repair of mandibular median defects in monkeys suggests that this distractor and supporting computer program met the needs of the reconstruction of arc defects in the mandible by distraction osteogenesis.

NanoPADs and nanoFACEs: an optically transparent nanopaper-based device for biomedical applications.

Paper has been a popular material of choice for biomedical applications including for bioanalysis and cell biology studies. Regular cellulose paper-based devices, however, have several key limitations including slow fluid flow; large sample retention in the paper matrix for microfluidic paper-based analytical device (µPAD) application; serious solvent evaporation issues, and contamination and poor control of experimental conditions for cell culture. Here, we describe the development of two novel platforms, nanopaper-based analytical devices (nanoPADs) and nanofibrillated adherent cell-culture platforms (nanoFACEs), that use nanofibrillated cellulose (NFC) paper, simply called nanopaper, as the substrate material to create transparent, pump-free and hollow-channel paper-based microfluidic devices. Due to the natural hydrophilicity and nanoscale pore size of nanopaper, the hollow-channel microfluidic devices can realize a totally pump-free flow without any complicated surface chemical functionalization on the nanopaper. Experimental results showed that within a certain range, larger hollow channel size leads to faster pump-free flows. Different from previous designs of paper-based hollow-channel microfluidic devices, the high transparency of the nanopaper substrate enabled the integration of various optical sensing and imaging technologies together with the nanoPADs and nanoFACEs. As proof-of-concept demonstrations, we demonstrated the use of nanoPADs for colorimetric sensing of glucose and surface-enhanced Raman spectroscopy (SERS)-based detection of environmental pollutants and applied the nanoFACEs to the culture of human umbilical vein endothelial cells (HUVECs). These demonstrations show the great promise of nanoPADs and nanoFACEs for biomedical applications such as chemical/bioanalysis and cell biology studies.

Effect of different doses of transforming growth factor-ß1 on cartilage and subchondral bone in osteoarthritic temporomandibular joints.

Transforming growth factor-beta (TGF-ß) plays an important part in the repair of cartilage in osteoarthritis. It has been hypothesised that intra-articular injection of TGF-ß1 promotes repair of cartilage and protects the subchondral bone from damage in osteoarthritic temporomandibular joints (TMJs). We made bilateral partial perforations of the disc to induce osteoarthritic joints in 36 rabbits. TGF-ß1 20, 40, or 80 ng were injected into the right joint, and vehicle alone was injected into the left joint. Four additional animals were used as normal controls. Microcomputed tomography was used to quantify the three-dimensional microarchitecture of subchondral bone, followed by assessment of the proteoglycan content. All joints treated with TGF-ß1 were covered by a layer of well-organised fibrocartilage, and had increased proteoglycan content and normal microarchitectural properties, whereas the joint treated by vehicle alone had typical osteoarthritis-related degradation of cartilage and sclerosis of subchondral bone. These results suggested that TGF-ß1 is an effective way of treating osteoarthritis of the TMJ.

Growth of the mandible after condylar reconstruction using transport distraction osteogenesis: an experimental investigation in goats.

BACKGROUND: Mandibular condyle damage during childhood disturbs mandibular growth and facial skeletal development. Transport distraction osteogenesis provides a new treatment for condyle reconstruction, but there are no data available on mandibular growth in growing individuals following surgery. The authors investigated the effect of condylar reconstruction by transport distraction osteogenesis on mandibular growth in goats. METHODS: A condylar defect was created unilaterally in 44 growing goats. The animals were divided randomly into group A (n = 22) and group B (n = 22). Transport distraction was used to reconstruct the condyles in group A, whereas group B served as sham controls. Three-dimensional computed tomographic imaging was performed at different intervals. Ten animals from each group were used for mandibular growth measurements at 48 weeks after the end of distraction. Four animals from each group were euthanized at 12, 24, and 48 weeks after surgery. Their transport disks were harvested and processed for histologic evaluation. RESULTS: In group A, the hemimandible of the distracted side exhibited similarities to the contralateral side except for the larger neocondyles. In group B, ramus height and width were significantly shorter on the undistracted side than on the contralateral side; concomitantly, there was mandibular deviation to the operated side. Well-organized fibrocartilage was seen at the neocondylar surface over time in group A but not in group B. CONCLUSIONS: This study suggests that a neocondyle reconstructed by means of transport distraction has the potential to grow under functional stimuli of the temporomandibular joint. Therefore, this technique may serve as an alternative method for condylar reconstruction in growing individuals.

[Study of reconstruction of mandibular condyle by transport distraction osteogenesis in monkeys].

OBJECTIVE: To evaluate the applicability and effectiveness of reconstruction of mandibular condyle by transport distraction osteogenesis in an animal model of rhesus monkeys. METHODS: Six adult rhesus monkeys were used in this study. Bilateral condyles and articular discs were extirpated, and the technique of transport distraction osteogenesis was performed to reconstruct the condyle. X-ray and CT scanning films were taken at various intervals. Two monkeys selected at random were sacrificed respectively at 4, 12 and 24 weeks after completion of distraction, and the newly formed condyles resulted from bony transport disc were harvested and processed for histologic examination. The removed condyles at surgery were used as normal control and prepared in the same manner. RESULTS: Open bite was seen in all animals postoperatively, and disappeared at the end of distraction. The shape and appearance of the bony transport disc was similar to original condyles at sacrifice. The articular cavity was filled with fibrous connective tissue and considerable cartilage cells were observed in the surface of the condyle stump. Bone regeneration was perfect in the distraction gap. CONCLUSION: A neocondyle with functional shape can be created by transport distraction osteogenesis, which suggested that this technique might be an alternative method in reconstruction of the condyle.

Reconstruction of mandibular condyle by transport distraction osteogenesis: Experimental study in rhesus monkey.

PURPOSE: This study investigated histomorphologic changes in the newly formed condyle reconstructed by transport distraction osteogenesis through a nonhuman primate model. MATERIALS AND METHODS: Six adult rhesus monkeys were used in this study. Bilateral condyles and articular discs were extirpated, and the technique of transport distraction osteogenesis was carried out to reconstruct the condyles. X-ray and 3-dimensional (3D) computed tomography (CT) scanning films were taken at various intervals. Two monkeys were killed respectively at 4, 12, and 24 weeks after completion of distraction; the transport segments and the distracted calluses were harvested and processed for histologic examination. The original condyles removed at surgery served as normal control. RESULTS: Open bite was seen in all animals postoperatively and diminished at the end of distraction. Bone regeneration was perfect in the distraction gap between the transport disc and the pre-existing mandible. The bony transport disc gradually remodeled to a neocondyle that was similar to the original condyle in the appearances and structures. The head of neocondyle was covered with a fibrous cap, which might play the role of an articular disc. CONCLUSION: A neocondyle with functional shape can be created by transport distraction osteogenesis. This suggests that this technique is an alternative method for reconstruction of the mandibular condyle.