Efeitos da clindamicina e gentamicina sobre amostras isoladas de infecções odontogênicas graves: estudo piloto / Effects of clindamycin and gentamicin on strains isolated from severe dental infections: a pilot study

As infecções odontogênicas graves constituem um desafio de tratamento por parte dos Cirurgiões Bucomaxilofaciais, geralmente necessitando de intervenções cirúrgicas e administração de antibióticos endovenosos. A associação entre a clindamicina e a gentamicina vem apresentando resultados clínicos satisfatórios ao longo dos anos. Este estudo analisou, in vitro, o tipo de efeito promovido pela gentamicina e pela clindamicina sobre amostras isoladas de infecções odontogênicas graves. Foram utilizadas 20 amostras bacterianas, sendo 13 de Streptococcus do grupo Viridans e 7 de anaeróbios obrigatórios. Estas amostras foram inoculadas em meios de cultura contendo clindamicina e gentamicina, isoladamente e em associação. Utilizou-se a clindamicina em diferentes concentrações e manteve-se a gentamicina a 3 µg/mL em todo o estudo. As amostras de Streptococcus do grupo Viridans mostraram resistência a ambas as drogas e à associação das mesmas, exceto por uma amostra, que se mostrou sensível à gentamicina. Os anaeróbios apresentaram resultados diversos, variando entre sensibilidade ou resistência extremas. Pode-se concluir que não existe um efeito de sinergismo por potenciação entre a gentamicina e a clindamicina e que, de acordo com o espectro de ação de cada droga, esta combinação pode favorecer o tratamento hospitalar das infecções odontogênicas graves. Novos estudos, entretanto, são necessários, para verificar se os efeitos variáveis observados na pesquisa podem interferir nos resultados clínicos

Severe dental infections are a challenge to treatment by oral and maxillofacial surgeons, usually requiring surgical intervention and administration of intravenous antibiotics. The combination of clindamycin and gentamicin, has shown satisfactory results over the years. This study analyzed in vitro the type of effect caused by gentamicin and clindamycin on the strains isolated from severe dental infections. Twenty bacterial samples were used, 13 Streptococcus from Viridans group and 7 obligate anaerobes. These samples were inoculated in culture media containing clindamycin and gentamicin, singly and in combination. Utilizing the clindamycin in different concentrations and kept gentamicin 3 µg/mL throughout the study. Streptococcus from Viridans group were kept for 24 hours in microaerophilic and anaerobic were kept in anaerobic jar for 48 hours both under a 37 ° C temperature. After the incubation period, the reading of the results was performed. Samples of Streptococcus Viridans group showed resistance to both drugs and combination there of, except for one, which was sensitive to gentamicin. Anaerobes showed mixed results, ranging from sensitivity or extreme resistance to variable effects and synergism by adding between drugs. It can be concluded that there is no synergistic effect of potentiation between gentamicin and clindamycin and, according to the spectrum of action of each drug, this combination can enhance hospital treatment of severe dental infections. New studies, however, are required to check whether the variable effects observed in this study may interfere with clinical outcomes

[Dental focal infection. Literature review]. / A fogeredetú góc. (Irodalami áttekintés)

The author gives an account of the history of the dental foci from the ancient times up to the present day, together with the change of the concept of dental foci and their modern interpretation. The article points out the shift in the assessment of the importance of focal infection. It gives a detailed account of the focal infection of dental origin, as well as the consequence of such inflammation. Mentions the phenomenon of tropism and its role in the development of secondary diseases. The article is based upon an excessive literature.

Odontogenic infection pathway to the submandibular space: imaging assessment.

The aims of this study were to determine the pathways of odontogenic infection spread into the submandibular space and their relationship to the clinical symptoms. Computerized tomography (CT) and magnetic resonance (MR) images of 33 patients with submandibular involvement were analyzed. The spread of infection was evaluated by lateral asymmetry of the shape and density of the fascial spaces and tissues, and by obliteration of the interfascial fat spaces. Imaging findings were classified into three types: in 19 patients (57.6%), infection spread through the mylohyoid muscle or sublingual space (type I). In five patients (15.2%), infection spread through the bony structures of the mandible with periosteal reaction or perforation of the cortical plate (type II) and was associated with relatively mild symptoms. In four patients (12.1%), infection spread from the masticatory space (type III). Seven of 11 patients with dysphagia or fever showed submandibular involvement spreading into the parapharyngeal space. CT and MR imaging clearly demonstrated different pathways of the spread of odontogenic infection into the submandibular space, which influenced the manifestation of clinical symptoms.

Surgical management of orofacial infections.

This overview of the surgical management of orofacial odontogenic infections is designed as a practical guide for the oral and maxillofacial surgeon. Fortunately, the incidence of serious odontogenic infections is decreasing. This decreased frequency, however, necessitates diligent study and mental preparation in advance of the emergent situations in which such cases present.