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1.
Br Dent J ; 229(12): 760-761, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33339909
2.
Rev. ADM ; 77(6): 329-336, nov.-dic. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1151749

RESUMO

La mediastinitis se define como una inflamación aguda severa de los tejidos conectivos ubicados en la cavidad torácica media, en la que 20% de los casos puede implicar una infección difusa y polimicrobiana del mediastino denominada mediastinitis necrotizante descendente (MND), secundaria a la propagación de una infección grave desde los tejidos bucofaríngeos o cervicales tales como infecciones odontogénicas (de 36 a 47%), faríngeas (de 33 a 45%), cervicales (15%) y otras infecciones de cabeza y cuello (5%). Clínicamente, los pacientes presentan aumento de volumen, temblores, trismus, odinofagia con disnea, disfagia, hipotensión, dolor de cuerpo y del ángulo de la mandíbula. Puede observarse signo de Hamman (crepitación mediastinal con el latido cardiaco) y enfisema subcutáneo. El manejo quirúrgico de las infecciones odontogénicas, sin importar su severidad, consta de dos principios: eliminar el foco etiológico y el vaciamiento quirúrgico de los espacios anatómicos comprometidos con la instalación de un drenaje adecuado. Se presenta el caso de un masculino de 60 años con diagnóstico de mediastinitis necrotizante descendente de origen dental (AU)


Mediastinitis is defined as a severe acute inflammation of the connective tissues affected in the middle thoracic cavity, in which 20% of cases may involve a diffuse and polymicrobial infection of the mediastinum, descending necrotizing mediastinitis (MND), secondary to the spread of a serious infection from the oropharyngeal or cervical tissues, stories such as odontogenic infections (36 to 47%), pharyngeal (33 to 45%), cervical (15%) and other head and neck infections (5%). Clinically, patients present with increased volume, tremors, trismus, odynophagia with dyspnea, dysphagia, hypotension, pain in the body and in the angle of the jaw. Hamman sign (mediastinal crepitus with heartbeat) and subcutaneous emphysema may be observed. The surgical management of odontogenic infections, regardless of their severity, consists of two principles: eliminate the etiological focus and the surgical emptying of the anatomical spaces compromised with the installation of adequate drainage. We present the case of a 60-year-old man diagnosed with descending necrotizing (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecção Focal Dentária/complicações , Mediastinite , Complicações Pós-Operatórias , Enfisema Subcutâneo , Extração Dentária , Cavidade Torácica , Mandíbula , México , Dente Molar/patologia
4.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 147-156, jun. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115829

RESUMO

INTRODUCCIÓN: La rinosinusitis crónica odontogénica (RSCO) es un proceso inflamatorio/infeccioso de la mucosa nasal y senos paranasales (SPN) de origen dental. Corresponde a una patología subdiagnosticada en la actualidad. El gold standard diagnóstico es la tomografia computarizada. Los tratamientos difieren, desde tratamiento médico aislado hasta médico-quirúrgico de SPN o combinados. OBJETIVO: Caracterizar los resultados clinicos e imagenológicos de pacientes con RSCO en función del tratamiento recibido, para establecer recomendaciones terapéuticas. Describir la frecuencia de subdiagnóstico de esta patología. MATERIAL Y MÉTODO: Estudio descriptivo, retrospectivo. Se incluyeron pacientes con diagnóstico clínico e imagenológico de RSCO entre los años 2013-2017 en un centro de atención médico privado, a los que se realizó una tomografía computarizada cone beam de control. Fueron excluidos aquellos con rinosinusitis crónica, cirugía endoscópica funcional (CEF) previa, cáncer, embarazadas, rechazo a tomografía computarizada cone beam, ausencia de imágenes preoperatorias y menores de 18 años. RESULTADOS: De un total de 27 pacientes, en los operados de CEF (n =24; 89%) la resolución total de los síntomas se logró en 20/24 (83%), resolución parcial 3/24 (12,5%) y persistencia de los síntomas 1/24 (4%). Discusión: De los pacientes con RSCO 22/27 (81%) no tenían reportado el foco dental en el informe radiológico a pesar de ser visible. Aquellos pacientes con sintomatologia postratamiento, hubo factores identificados como la bilateralidad, mala dentadura general, falta de combinación de tratamiento dental y CEF. CONCLUSIONES: La CEF combinada con tratamiento dental concomitante, tiene un alto grado de éxito radiológico y clínico en esta patología. No fue posible demostrar si siempre es requerida la exodoncia con cierre de fístula oro-antral o si se pueden seleccionar pacientes para un tratamiento más conservador.


INTRODUCTION: Chronic odontogenic rhinosinusitis (CORS) is an inflammatory/infectious process of the nasal mucosa and sinuses of dental origin. Actually, it corresponds to an underdiagnosed pathology. The gold standard diagnosis is computed tomography. The treatments differ, from isolated medical treatment to medical-surgical sinuses or combined. AIM: To characterize the clinical and imaging results of patients with CORS according to the treatment received, to establish therapeutic recommendations. In addition to describing the frequency of subdiagnosis of this pathology. MATERIAL AND METHOD: Descriptive, retrospective study. Patients with clinical and imaging diagnosis of CORS between 2013-2017 were included in a private medical care center, to whom a cone beam computed tomography control was performed. Those with chronic rhinosinusitis, previous functional endoscopic sinus surgery (FESS), cancer, pregnant women, rejection of cone beam computed tomography, absence of preoperative images and those under 18 years were excluded. RESULTS: Of all patients operated on FESS (n =24; 89%) the total resolution of the symptoms was 20/24 (83%), partial resolution 3/24 (12.5%) and persistence of the symptoms a 1/24 (4%). Discussion: 22/27 (81%) of patients with CORS had not reported the dental focus in the radiological report despite being visible. Those patients with post-treatment symptoms had identified factors such as bilaterality, general bad teeth, lack of combination of dental treatment and FESS. CONCLUSION: The FESS combined with concomitant dental treatment, has a high degree of radiological and clinical success in this pathology. It was not possible to demonstrate whether exodontia with closure of oroantral fistula is always required or if patients can be selected for a more conservative treatment.


Assuntos
Humanos , Masculino , Feminino , Sinusite/cirurgia , Rinite/cirurgia , Sinusite/diagnóstico por imagem , Rinite/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Endoscopia , Tomografia Computadorizada de Feixe Cônico , Infecção Focal Dentária/complicações
5.
Rev. ADM ; 77(3): 156-161, mayo-jun. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1128800

RESUMO

Introducción: La instalación inmediata del implante posterior a la extracción dental se está convirtiendo en un procedimiento de rutina debido a la reducción del tiempo de tratamiento y a la preservación de las estructuras anatómicas remanentes. Sin embargo, en muchos casos esta técnica involucra dientes afectados con procesos infecciosos. Hasta ahora, no se ha descrito a ciencia cierta el grado de éxito o fracaso del implante inmediato en alvéolos infectados, ni se ha establecido un protocolo para el manejo de este tipo de casos. Objetivo: Realizar una revisión bibliográfica actualizada, para determinar qué consideraciones se deben tener para instalar un implante inmediato en alvéolos con procesos infecciosos. Conclusión: Es posible obtener las ventajas de la instalación inmediata del implante en alvéolos infectados mediante la aplicación de un adecuado manejo clínico, donde se considere un adecuado tratamiento antibiótico, acompañado de un correcto curetaje alveolar, respetar la cadena de asepsia y antisepsia, posición subcrestal del implante y obtener siempre una buena estabilidad primaria del implante (AU)


Introduction: The immediate placement of the implant after dental extraction is a procedure that every time is becoming a routine procedure due to the reduction of the treatment time and the preservation of the remaining anatomical structures. However, in many cases, this technique involves affected teeth with infectious processes. Until now, the degree of success or failure of the immediate implant in infected alveoli has not been described for sure; nor has a protocol been established for the management of these types of cases. Objective: Carry out an updated bibliographic review, to determine what considerations must be taken to install an immediate implant in alveoli with infectious processes. Conclusion: Is possible obtain the advantages of the immediate installation of the implant in infected alveoli through the application of adequate clinical management, where appropriate antibiotic treatment is considered, accompanied by proper alveolar curettage, respect the aseptic and antiseptic chain, implant subcrestal position and always obtain a good primary stability of the implant (AU)


Assuntos
Humanos , Extração Dentária , Alvéolo Dental , Carga Imediata em Implante Dentário , Infecção Focal Dentária/terapia , Clorexidina/uso terapêutico , Regeneração Tecidual Guiada , Lasers , Antibacterianos/uso terapêutico
7.
Cient. dent. (Ed. impr.) ; 16(3): 191-196, sept.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185993

RESUMO

La celulitis crónica circunscrita es resulta-do de la persistencia de una lesión dentaria, bacterias de baja virulencia o una antibioterapia mal planteada. Se caracteriza por la presencia de un cordón fibroso, signo patognomónico, que debe ser elimina-do junto al foco causal. La clínica es poco llamativa y puede pasar desapercibida al paciente. Sin embargo, no está exenta de un posible proceso de agudización que dificulten su posterior tratamiento o que actúen como un foco infeccioso a distancia. Se presenta un caso de un paciente de 51 años que acude a consulta exudado de contenido purulento a través de una fistula extra-oral de un año de evolución. Se realizó la extracción de los dientes involucrados y se eliminó el cordón fibroso asociado. Se plantea junto al abordaje quirúrgico una pauta antibiótica de corta duración para prevenir la aparición de resistencias basado en la evidencia científica actual


Circumscribed chronic cellulitis is the result of the persistence of a dental lesion, bacteria of low virulence or poorly raised antibiotic therapy. It has been defined by the presence of a fibrous cord, a pathognomonic sign, which must be eliminated together with the causal focus.The clinic is inconspicuous and can go unnoticed to the patient. However, it is not exempt from a possible process of exacerbation that hinders its subsequent treatment or that acts as an infectious focus at a distance. We present a case of a 51-year-old patient who included an exudate consultation of purulent content through an extra oral fistula that had been one year old. The extraction of the involved teeth was performed and the associated fibrous cord was removed. It is presented with the surgical approach, a short-term medical practice to prevent the emergence of resistance based on current scientific evidence


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Celulite/complicações , Celulite/terapia , Doença Crônica , Fístula Bucal/cirurgia , Fístula Bucal/diagnóstico por imagem , Hipertensão , Diabetes Mellitus Tipo 1 , Radiografia Panorâmica , Antibacterianos/administração & dosagem , Fístula Bucal/tratamento farmacológico , Infecção Focal Dentária/complicações , Infecção Focal Dentária/cirurgia
8.
Rev. cuba. estomatol ; 56(4): e2043, oct.-dez. 2019. graf
Artigo em Português | LILACS | ID: biblio-1093258

RESUMO

RESUMO Introdução: As infecções do complexo maxillomandibular são corriqueiras na odontologia, podendo ser um quadro facilmente revertido, a depender da habilidade do profissional de diagnosticar e tratar precocemente, bem como da imunocompetência do paciente. Seu fator etiológico na grande maioria das vezes é de origem dentária, possuindo microbiota mista com presença de Streptococos e Peptostreptococos. Estas bactérias estão associadas ao processo de necrose pulpar e formação de abscesso dentoalveolar. Quando este quadro se desenvolve a partir dos molares inferiores, a disseminação ocorre normalmente pelo espaço vestíbulo bucal. No entanto, há casos que evadem o padrão, podendo um molar disseminar através dos espaços mastigador, mandibular, submandibular, sublingual e submentoniano. Objetivo: Relatar um caso de infecção odontogênica do dente 36, com disseminação atípica para o espaço submandibular em paciente pediátrico. Relato de caso clínico: Paciente do sexo feminino, 8 anos de idade, constou em seu histórico odonto-médico, junto a sua genitora, episódio de internamento para diagnóstico e tratamento da infecção em face. O diagnóstico de celulite foi determinado e a origem dentária descartada. Iniciou antibióticoterapia e após regressão teve alta. Após 9 meses apresentou reagudização do processo com disseminação para região submandibular. Através da história da doença atual, exame físico e radiográfico foi definido o diagnóstico de abscesso dentoalveolar crônico com disseminação e drenagem para o espaço submandibular, optando-se pela exodontia e antibióticoterapia. Conclusões: Faz-se importante o diagnóstico e tratamento precoce, afim de evitar a progressão para complicações mais severas, como a mediastinite e fasciíte necrosante(AU)


RESUMEN Introducción: Las infecciones del complejo maxilo-mandibular son comunes en la odontología, pudiendo ser un cuadro fácilmente revertido, que depende de la habilidad del profesional de diagnosticar y tratar precozmente, así como de la inmunocompetencia del paciente. Su factor etiológico en la gran mayoría de las veces es de origen dental, con microbiota mixta y presencia de Streptococos y Peptostreptococos. Estas bacterias están asociadas al proceso de necrosis pulpar y formación de absceso dentoalveolar. Cuando este cuadro se desarrolla a partir de los molares inferiores, la diseminación ocurre normalmente por el espacio vestíbulo bucal. Sin embargo, hay casos que evaden el estándar, pudiendo un molar diseminar a través de los espacios masticador, mandibular, submandibular, sublingual y submentoniano. Objetivo: Describir un caso de infección odontogénica proveniente de necrosis pulpar del diente 36, con diseminación atípica para el espacio submandibular en paciente pediátrico. Caso clínico: Paciente de sexo femenino, de 8 años, constó en su historia médica-dental, episodio de internamiento para diagnóstico y tratamiento de la infección en el rostro. Se determinó el diagnóstico de celulitis y tuvo el origen dental descartado. Se inició antibioticoterapia y se dio alta hospitalaria. Después de 9 meses presentó exacerbación del proceso con diseminación para región submandibular. A través de la historia de la enfermedad actual, examen físico y radiográfico se definió el diagnóstico de absceso dentoalveolar crónico con diseminación y drenaje para el espacio submandibular, y entonces fue posible optar por la exodoncia y antibioticoterapia. Conclusiones: Se hace importante el diagnóstico y tratamiento precoz, a fin de evitar la progresión para complicaciones más severas, como la mediastinitis y fasciitis necrosante(AU)


ABSTRACT Introduction: Infections of the maxillomandibular complex are common in dentistry and may be easily reversed, depending on the professional's ability to diagnose and treat promptly, as well as the patient's immunocompetence. In most cases their etiology is dental, i.e. a mixed microbiota with presence of Streptococci and Peptostreptococci. These bacteria are associated to the process of pulp necrosis and dentoalveolar abscess formation. When this condition develops from the lower molars, dissemination usually occurs through the buccal vestibular space. However, there are cases that do not follow this pattern, allowing a molar to spread through the buccal, mandibular, submandibular, sublingual and submental spaces. Objective: Report a case of odontogenic infection from pulp necrosis of the lower first molar (36) ​​with atypical dissemination to the submandibular space in a pediatric patient. Clinical case: Female 8-year-old patient with an episode of hospitalization for diagnosis and treatment of a facial infection, according to her medical / dental record. The infection was diagnosed as cellulitis and dental origin was discarded. Antibiotic therapy was started and the patient was discharged. After 9 months, the infection underwent a process of exacerbation with dissemination to the submandibular region. Analysis of the antecedents of the current condition, alongside physical and radiographic examination, led to the diagnosis of chronic dentoalveolar abscess with dissemination and drainage to the submandibular space, and the consequent indication of dental extraction and antibiotic therapy. Conclusions: Early diagnosis and treatment are vital to avoid progression to severer complications such as mediastinitis and necrotizing fasciitis(AU)


Assuntos
Humanos , Feminino , Criança , Abscesso Periapical/diagnóstico por imagem , Cirurgia Bucal/métodos , Infecção Focal Dentária/etiologia , Antibacterianos/uso terapêutico
9.
Georgian Med News ; (294): 57-61, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687950

RESUMO

Objective of the investigation - to increase the effectiveness of treatment of phlegmon of the maxillo-facial area and neck with the influence onto the pathogenic factors, complementing the main treatment plan with the injection of a second antibiotic in a regionary lymphatic way. 100 patients with acute inflammatory odontogenic diseases of the maxillofacial area were examined. Patients received both traditional medical treatment and regional lymphotropic antibiotic therapy added to the main method of treatment as well. Regionarnl lymphotropic antibiotic injection in the treatment of phlegmon of the maxillofacial area and neck leads to an accelerated onset of the second phase of the development of the wound process, more rapid detoxification of the body. Key words: acute inflammatory odontogenic diseases, maxillofacial area, lymphatic system.


Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Pescoço , Doença Aguda , Adolescente , Adulto , Idoso , Celulite (Flegmão)/sangue , Celulite (Flegmão)/diagnóstico , Face , Dermatoses Faciais/diagnóstico , Feminino , Infecção Focal Dentária/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
BMC Oral Health ; 19(1): 173, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375095

RESUMO

BACKGROUND: More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. METHODS: All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. RESULTS: Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. CONCLUSION: Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.


Assuntos
Antibacterianos , Infecção Focal Dentária , Sepse , Abscesso , Feminino , Infecção Focal Dentária/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Rev. odontol. Univ. Cid. São Paulo (Online) ; 31(1): 95-105, jan.2019. il.
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1009855

RESUMO

O cisto periapical tem origem associada à proliferação dos restos epiteliais de Malassez, após um processo inflamatório crônico decorrente de uma extensa lesão cariosa com acometimento pulpar. Quando um cisto periapical passa por um processo de reagudização infecciosa o quadro clínico é denominado de abscesso Fênix. O objetivo deste trabalho é relatar um caso de abscesso Fênix associado à raiz residual do dente 44. Paciente M.R.G, 19 anos, apresentou queixa principal de "espinha no meu queixo". Ao exame clínico, foi observada uma fístula cutânea na região mentual, com drenagem purulenta. Ao exame intraoral, foi observada a raiz residual do dente 44. Ao exame imaginológico, observou-se um cisto periapical associado ao dente 44 que se estendia anteriormente até a região anterior de mandíbula, fenestrando a cortical vestibular (mais espessa) e drenando para a região de mento. O paciente foi então tratado com a enucleção da lesão, seguida de plastia da fístula cutânea. Após exame histopatológico foi confirmado o diagnóstico de cisto periapical com processo de inflamação aguda. O paciente evoluiu bem após o tratamento, sem queixas álgicas. Portanto, é fundamental que o Cirurgião-Dentista conheça a etiopatogenia das lesões odontogênicas para o correto diagnóstico e tratamento em casos atípicos como o relatado


The periapical cyst origin is associated to the proliferation of epithelial cell rests of Malassez after a chronic inflammatory process due to an extensive carious lesion with pulp involvement. When a periapical cyst goes through a process of infectious exudation, clinically, it gets denominated phoenix abscess. The purpose of this study is to report a case of phoenix abscess associated to the residual root of the tooth 44. Patient M.R.G., 19 years old, presenting as main complaint a "pimple on my chin". After the clinical exam it was observed an exudating cutaneous fistula on the mentual region. After the intra-oral exam it was observed a residual root of the tooth 44. Radiographically, it was observed a periapical cyst associated to the tooth 44 wich reaches the anterior region of the jaw penetrating the vestibular cortical and draining on the mentual region. The patient has been treated with an enucleation procedure followed by a fistuloplasty. After hystological exam it was confirmed the diagnostic of periapical cyst with an acute inflammatory process. Patient has evolved well after treatment without any pain complaints. Therefore, it is fundamental that the dentists know the etiopathology of the odontogenics lesions to have a correct diagnostic and treatment of unusual cases as same as the reported.


Assuntos
Humanos , Feminino , Adulto , Cisto Radicular , Fístula Cutânea , Infecção Focal Dentária , Abscesso
12.
J Craniomaxillofac Surg ; 47(8): 1292-1299, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331847

RESUMO

PURPOSE: The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). METHODS: A retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. RESULTS: During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. CONCLUSION: The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.


Assuntos
Infecção Focal Dentária , Serviço Hospitalar de Emergência , Feminino , Grécia , Humanos , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos
13.
Br J Oral Maxillofac Surg ; 57(6): 594-596, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31155399

RESUMO

Streptococcus constellatus is part of the Str milleri subgroup. It is a commensal organism that is often present in the oral flora, and has been implicated in pyogenic infections of the central nervous system, abdomen, and deep neck spaces. We present three patients within our unit who developed bony destruction in the facial bones and base of the skull after odontogenic infections. Str constellatus, a known oral and gut commensal that may cause atypical presentations in odontogenic abscesses, was cultured in all cases.


Assuntos
Infecção Focal Dentária , Infecções Estreptocócicas , Streptococcus constellatus , Abscesso , Infecção Focal Dentária/complicações , Humanos , Pescoço/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus constellatus/patogenicidade
14.
Rev. clín. med. fam ; 12(2): 82-86, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186260

RESUMO

Las infecciones odontogénicas son muy frecuentes y representan el 10 % de las prescripciones antibióticas en España. Para el médico de familia es importante conocer los distintos cuadros clínicos para elegir adecuadamente el tratamiento, así como hacer hincapié en la prevención de los mismos. Para ello es necesario identificar la microflora oral y cómo se comporta. No debemos preguntarnos qué antibiótico dar. La cuestión es si necesitamos prescribirlos o no cuando nos enfrentamos a las infecciones odontogénicas vistas en nuestra práctica diaria. Además, debemos conocer los más indicados, tanto para el tratamiento como para la profilaxis


Odontogenic infections are very frequent and account for 10% of all antibiotic prescriptions in Spain. It is important for the family doctor to know their different clinical pictures in order to choose the treatment properly, as well as to emphasize prevention. Hence it is necessary to know the oral microflora and how it behaves. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics to deal with the most common odontogenic infections seen in our practice. In addition, we must know the most suitable ones, both for the treatment and for the prophylaxis


Assuntos
Humanos , Antibacterianos/uso terapêutico , Infecção Focal Dentária/tratamento farmacológico , Antibioticoprofilaxia/métodos , Abscesso Periapical/tratamento farmacológico , Doenças Dentárias/tratamento farmacológico , Atenção Primária à Saúde/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Gengivite/tratamento farmacológico , Fatores de Risco , Desbridamento Periodontal/métodos
15.
Drug Metab Rev ; 51(3): 340-355, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30999773

RESUMO

Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.


Assuntos
Infecção Focal Dentária/tratamento farmacológico , Infecção Focal Dentária/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , Fáscia/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos
16.
Pesqui. bras. odontopediatria clín. integr ; 19(1): 4430, 01 Fevereiro 2019. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-997963

RESUMO

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists' awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.


Assuntos
Humanos , Masculino , Feminino , Prescrições de Medicamentos , Sudão , Conhecimentos, Atitudes e Prática em Saúde , Odontólogos , Infecção Focal Dentária/diagnóstico , Antibacterianos/administração & dosagem , Distribuição de Qui-Quadrado , Educação em Saúde , Inquéritos e Questionários
17.
J Craniomaxillofac Surg ; 47(2): 334-340, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30600196

RESUMO

PURPOSE: Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants. MATERIALS AND METHODS: A 5-year retrospective study investigated records of 303 in-hospital patients with abscess of odontogenic origin. Time-to-event models were used to analyse data where the outcome variable is the time to the occurrence of a specific event. Here, the focus is on a statistical model for the prediction of LOS of patients. RESULTS: The group of all patients (n = 303) was analysed by considering seven characteristics of the patients (age, gender, spreading of infection, localization of infection focus, type of administered antibiotics, diagnosed diabetes mellitus, and existence of a remaining infection focus). Age (p = 0.049; rc = -0.007) and spreading of infection (p < 0.001; rc = -0.965) showed a significant impact on the LOS. Subjects were divided into two groups. Group A (n = 185) consisted of patients who presented with a severe odontogenic infection and not yet removed infection focus; group B were patients having undergone outpatient operative tooth removal (n = 118). To group A patients' data, two new risk factors ("days between abscess incision and removal of infection focus" = dbir and "removal of infection focus during the same stay as abscess incision" = riss) replaced the risk factors "remaining infection focus." A significant impact on the LOS was detected for dbir (p < 0.001; rc = -0.15) and riss (p < 0.001; rc = -1.76). Our statistical model explicitly describes how the probability for discharge depends on the time and how specific characteristics affect the LOS. We observed a significantly higher LOS in older patients and subjects with infection spreading. In group A patients, dbir and riss had a highly significant impact on the LOS. CONCLUSION: Predicting the LOS may promote transparency to costs and management of patients under inpatient treatment. Our statistical model describes the probability of a discharge at time t compared to a discharge later than t (a LOS longer than t). Furthermore, the model enables a prediction of the LOS of each patient for practitioners in an easy way.


Assuntos
Infecção Focal Dentária/terapia , Tempo de Internação/estatística & dados numéricos , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Probabilidade , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
18.
Ir J Med Sci ; 188(1): 327-331, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29700733

RESUMO

Dentofacial infections (DFI) lead to morbidity and rarely, mortality. We hypothesised that certain clinical and laboratory parameter factors may be associated with a more severe course and an increased length of stay. We designed a prospective study that included all patients admitted with a DFI to the Oral and Maxillofacial Department between July 2014 and July 2015. A total of 125 were enrolled. We found that serum concentration of CRP on admission and increasing number of fascial spaces involved by the infection were significant predictors of hospital stay (p = 0.02 and p = 0.01, respectively). The average length of stay for a dentofacial infection requiring admission was 4.5 days. Most patients require surgical intervention in combination with intravenous antibiotics for successful resolution. Improved and timely access to primary dental care is likely to reduce the burden for patients their families and the acute hospital service as a consequence of advanced DFI.


Assuntos
Infecção Focal Dentária/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Proteína C-Reativa/metabolismo , Feminino , Infecção Focal Dentária/sangue , Infecção Focal Dentária/microbiologia , Hospitalização , Humanos , Tempo de Internação , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Prospectivos , Adulto Jovem
19.
Am J Emerg Med ; 37(2): 231-236, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29898830

RESUMO

OBJECTIVE: Oral and maxillofacial infections are generally treated by primary dental or medical caregivers. Nevertheless, because these infections are known to have life-threatening complications, there is a need of clear indicators for emergency services medical staff, particularly in determining when morbidity can be expected and when in-hospital treatment is required. This retrospective study aimed to identify variables that were observable at admission, which could indicate high complication rates, long hospital stays, and/or a need for tracheostomy. MATERIALS AND METHODS: We examined data from all cases of severe oral and maxillofacial infections that were treated at the University Hospital of Leuven, between January 2013 and June 2017. 64 cases were identified after applying exclusion criteria. Uni- and multivariate analyses were performed. RESULTS: A univariate analysis showed that body temperature, C-reactive protein (CRP) levels, white blood cell counts, and positive bacterial cultures were significantly associated with longer hospital stays, which indicated potential future morbidity. A multivariate analysis showed that dyspnoea, age, and CRP comprised the most significant combination for predicting the length of hospital stay. CONCLUSION: Based on the statistical analysis of this population, the research group concludes that a thorough anamnesis and clinical examination should be accompanied by a blood analysis of CRP and white blood cell counts. Only then can a well-founded decision be reached on the severity of the case and the need for hospital admission. In an acute setting, radiological imaging is not required for assessing future morbidity, but it should be performed when accessible.


Assuntos
Serviço Hospitalar de Emergência , Infecção Focal Dentária/complicações , Infecção Focal Dentária/terapia , Tempo de Internação , Fatores Etários , Infecções Bacterianas/complicações , Infecções Bacterianas/terapia , Temperatura Corporal , Proteína C-Reativa/metabolismo , Dispneia/etiologia , Feminino , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/microbiologia , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traqueostomia
20.
Emerg Med Clin North Am ; 37(1): 81-93, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454782

RESUMO

Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures.


Assuntos
Doenças Estomatognáticas/diagnóstico , Emergências , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/terapia , Humanos , Boca/lesões , Hemorragia Bucal/etiologia , Dor/etiologia , Doenças Estomatognáticas/patologia , Doenças Estomatognáticas/terapia , Avulsão Dentária/diagnóstico , Avulsão Dentária/terapia , Traumatismos Dentários/diagnóstico , Traumatismos Dentários/terapia
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