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1.
Oral Maxillofac Surg Clin North Am ; 36(3): 391-399, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38777729

RESUMO

Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.


Assuntos
Infecção Focal Dentária , Humanos , Criança , Infecção Focal Dentária/terapia , Antibacterianos/uso terapêutico , Doenças Dentárias/terapia
2.
J Oral Maxillofac Surg ; 82(7): 852-861, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38621664

RESUMO

BACKGROUND: Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. PURPOSE: The purpose of the study was to measure the association between OI location and risk for sepsis at admission. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. PREDICTOR VARIABLE: The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. MAIN OUTCOME VARIABLES: The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. COVARIATES: Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. ANALYSES: Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05. RESULTS: The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001). CONCLUSION AND RELEVANCE: The study findings suggest that the OI location is associated with the qSOFA score >0.


Assuntos
Infecção Focal Dentária , Sepse , Humanos , Sepse/etiologia , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Infecção Focal Dentária/complicações , Fatores de Risco , Escores de Disfunção Orgânica , Adulto , Idoso
3.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 137(6): e119-e124, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38155007

RESUMO

Odontogenic infections can rarely progress to necrotizing soft tissue infections. Cervical necrotizing fasciitis (CNF) is a rare but fulminant infection that spreads along the fascial planes, including connective tissue, muscle, and subcutaneous fat, and is typified by necrosis of the skin and other adjacent tissues. This article aims to present the treatment of a patient with submental skin and soft tissue necrosis due to an odontogenic infection and the subsequent management of the tissue deficit with a vacuum-assisted closure (VAC) system. The patient presented with extensive skin necrosis in the submental area and was immediately hospitalized, and management of the odontogenic infection was performed. When the patients' infection had been sufficiently controlled, a wound VAC device was placed in the deficit. The VAC device was removed after 12 days, and the patient was discharged. In conclusion, VAC can be used to manage tissue deficits with good aesthetic results.


Assuntos
Fasciite Necrosante , Tratamento de Ferimentos com Pressão Negativa , Humanos , Fasciite Necrosante/terapia , Fasciite Necrosante/cirurgia , Infecções dos Tecidos Moles/terapia , Infecções dos Tecidos Moles/cirurgia , Pescoço/cirurgia , Masculino , Feminino , Infecção Focal Dentária/complicações , Infecção Focal Dentária/terapia , Pessoa de Meia-Idade
4.
Braz. j. oral sci ; 23: e243442, 2024. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1537096

RESUMO

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length


Assuntos
Sinais e Sintomas , Prontuários Médicos , Fatores de Risco , Tempo de Permanência , Infecção Focal Dentária , Hospitalização
5.
Braz. j. oral sci ; 23: e242836, 2024. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1553439

RESUMO

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica , Bactérias/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Infecção Focal Dentária , Antibacterianos
6.
Int. j. odontostomatol. (Print) ; 17(3): 240-244, sept. 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1514375

RESUMO

La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.


Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.


Assuntos
Humanos , Masculino , Adulto , Sinusite Maxilar/cirurgia , Sinusite Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Extração Dentária/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Celulite Orbitária/cirurgia , Infecção Focal Dentária/terapia
7.
An. sist. sanit. Navar ; 46(2): e1041, May-Ago. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-227746

RESUMO

Fundamento: La elevada prevalencia de la patología oral infantil incentiva a conocer sus manifestaciones y el carácter urgente de las mismas, objetivo del presente estudio. Metodología: Estudio transversal que incluyó pacientes de edad <14 años que acudieron a un servicio de urgencias durante un año. Se analizó la relación entre las variables recogidas y la patología oral. Resultados: Se incluyeron 55 pacientes, 45,5% niñas, edad media 4,11 años (10 días a 13 años). Globalmente, predominó la patología mucosa (74,5%) frente a la dentaria, y el origen infeccioso (54,6%) frente al traumático (14,5%). La patología dentaria (50% odontalgia y 35,7% infecciones) se asoció significativamente a edad >6 años (66,7 vs 10%), dolor (40,7 vs 10,7%) y ausencia de fiebre (37,9 vs 11,5%). La patología mucosa (61% infecciones: 53,7% víricas y 31,7% por herpangina) se asoció significativamente a edad ≤6 años (60 vs 6,7%;) y fiebre (76,9 vs 17,2%). Se observaron seis lesiones traumáticas sobre la mucosa y dos en los dientes; significativamente más pacientes acudieron a urgencias antes de 24 horas (mediana =1 hora) que en caso de infección (100 vs 51,7%). La edad ≤6 años se asoció significativamente a fiebre, patología mucosa, infección de la mucosa y herpangina, y la >6 años se asoció a dolor, tratamiento antibiótico previo y al alta y pauta previa de AINE. Conclusión: La patología oral infantil atendida en el servicio de urgencias analizado fue de la mucosa y origen infeccioso, predominando la dentaria en >6 años y la mucosa en ≤6 años, sin diferencia por sexo.(AU)


Background: The high prevalence of oral pathology in children encourages to gain further understanding on their manifestations and urgent nature, objective of the present study. Methodology: Crosssectional study that included patients aged <14 years of age who attended an emergency department over a oneyear period. The relationship between the variables collected and oral pathology was analyzed. Results: Fifty-five patients were included, 45.5% girls, mean age 4.11 years (10 days to 13 years). Overall, mucosal pathology (74.5%) prevailed over dental ones, and lesions of infectious origin (54.6%) over the traumatic ones (14.5%). Dental pathology (50% toothache and 35.7% infections) was significantly associated with being >6 years (66.7 vs 10%), pain (40.7 vs 10.7%) and absence of fever (37.9 vs 11.5%). Mucosal pathology (61% infections: 53.7% viral and 31.7% due to herpangina) was significantly associated with being ≤6 years (60 vs 6.7%) and having fever (76.9 vs 17.2%). Six traumatic lesions on the mucosa and two on the teeth were observed; significantly more patients attended the emergency room within 24 hours (median =1 hour) than in the case of infection (100 vs 51.7%). Being ≤6 years was significantly associated with fever, mucosal pathology, mucosal infection, and herpangina, and being >6 years was associated with pain, previous antibiotic treatment and at discharge, and previous NSAID regimen. Conclusions: The analyzed pediatric oral pathologies treated in the emergency department are of mucosal and infectious origin. Dental disease prevail in children >6 years of age and mucosal lesions in those ≤6 years; no sex differences are observed.


Assuntos
Humanos , Masculino , Feminino , Criança , Serviço Hospitalar de Emergência , Infecção Focal Dentária , Mucosa Bucal , Doenças Dentárias , Saúde Bucal , Assistência Odontológica , Sistemas de Saúde , Estudos Transversais , Prevalência , Saúde da Criança , Pediatria , Estudos Retrospectivos , Inquéritos e Questionários
8.
Rev. ADM ; 80(4): 197-203, jul.-ago. 2023. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1526224

RESUMO

Introducción: en todo paciente hospitalizado con absceso odontogénico cervicofacial se busca resolución pronta del absceso, pero es necesario conocer cuáles son los factores que favorecen la resolución en hospitalizaciones cortas (1-3 días). Objetivo: determinar factores clínico-epidemiológicos de pacientes con abscesos odontogénicos para identificar factores que correlacionan con hospitalización corta. Material y métodos: estudio transversal, retrospectivo, observacional y analítico de 100 pacientes con abscesos odontogénicos en un Hospital General de Zona del Instituto Mexicano del Seguro Social de los años 2012-2013. Variables de estudio: días de hospitalización, sexo, edad, comorbilidades, conteo leucocitario, trismus, diente causal, región afectada y tratamientos realizados. Tamaño de muestra obtenido con fórmula para estudios observaciones con manejo de prevalencias para poblaciones infinitas, se empleó χ2 para identificar factores que correlacionan con hospitalización corta. Resultados: mujeres 56%, rango de edad 12-89 años y de hospitalización de 1-23 días; con comorbilidades 56%, leucocitosis 39% y trismus 21%. La caries causó 64% de abscesos, molares inferiores 70% y región submandibular afectada 73%. Variables estadísticamente significativas; conteo leucocitario, diente causal y región afectada. Conclusión: factores correlacionados con hospitalización corta: conteo leucocitario menor a 10,500 leucocitos, que el molar inferior no sea el diente causal y que la región submandibular no esté afectada (AU)


Introduction: prompt resolution of the abscess is sought in all patients hospitalized with cervicofacial odontogenic abscess, but which factors favor this resolution in short hospitalizations (1-3 days). Objective: determine clinical-epidemiological factors of patients with odontogenic abscesses to identify factors that correlate with short hospitalization. Material and methods: crosssectional, retrospective, observational and analytical study of 100 patients with odontogenic abscesses in a General Hospital of the Zone of the Mexican Social Security Institute from 2012-2013. Study variables; days of hospitalization, sex, age, comorbidities, leukocyte count, trismus, causative tooth, affected region and treatments performed. Sample size obtained with the formula for observational studies with prevalence management for infinite populations, χ2 was used to identify factors that correlate with short hospitalization. Results: women 56%, age range 12-89 years and hospitalization of 1-23 days, with comorbidities 56%, leukocytosis 39% and trismus 21%. Caries caused 64% of abscesses, lower molars 70% and affected submandibular region 73%. Statistically significant variables; leukocyte count, causative tooth and affected region. Conclusion: factors correlated with short hospitalization; leukocyte count less than 10,500 leukocytes, that the lower molar is not the causal tooth and that the submandibular region is not affected.


Assuntos
Humanos , Masculino , Feminino , Actinomicose Cervicofacial , Comorbidade , Infecção Focal Dentária/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Distribuição por Idade e Sexo , Hospitalização , Hospitais Gerais/estatística & dados numéricos
9.
Rev. Asoc. Odontol. Argent ; 111(2): 1110801, mayo-ago. 2023.
Artigo em Espanhol | LILACS | ID: biblio-1532251

RESUMO

Frente a la difusión en medios de comunicación de medias verdades con enunciados alarmantes y anticientíficos, este editorial busca revisar las bases científicas para determinar el comportamiento clínico. Así, el texto discurre por el concepto de infección focal desde su origen, yendo al encuentro de sus transformaciones conceptuales a través de los descubrimien- tos científicos, teniendo en cuenta las características emocio- nales propias de cada paciente como un todo y los peligros a los que se puede estar expuestos frente a las medias verdades (AU)


Facing the diffusion of alarming and anti-scientific state- ments in the media, this editorial seeks the scientific bases to determine the clinical behavior. Thus, the text runs through the concept of focal infection from its origin and across its conceptual transformations through scientific discoveries, by considering the emotional characteristics of each patient as a whole and the dangers to which they may be exposed in the face of half-truths (AU)


Assuntos
Tratamento do Canal Radicular/métodos , Infecção Focal Dentária/complicações , Infecção Focal Dentária/terapia , Resultado do Tratamento , Cavidade Pulpar/microbiologia
10.
Otolaryngol Pol ; 77(2): 1-5, 2023 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-36718574

RESUMO

INTRODUCTION: Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections with odontogenic sources. MATERIAL AND METHOD: This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections with an odontogenic source who had been operated on in Shahid Rajaee hospital from March 2014 to December 2019. RESULTS: 123 (53.7%) patients were female and there were106 (46.3%) males. The mean age ± SD was 33.01±13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (p=0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared with 57.6% in patients without failure of treatment (p=0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender and history of chemotherapy, hypertension, smoking, pregnancy, alcohol usage, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, and surgical approach. CONCLUSION: Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.


Assuntos
Infecção Focal Dentária , Masculino , Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Infecção Focal Dentária/tratamento farmacológico , Infecção Focal Dentária/complicações , Infecção Focal Dentária/microbiologia , Hospitalização , Pescoço , Antibacterianos/uso terapêutico
11.
Minerva Dent Oral Sci ; 72(1): 1-7, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36197276

RESUMO

BACKGROUND: Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. METHODS: Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). RESULTS: The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. CONCLUSIONS: Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.


Assuntos
Transtornos de Deglutição , Infecção Focal Dentária , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Prognóstico , Irritantes/uso terapêutico , Infecção Focal Dentária/tratamento farmacológico , Índia , Dispneia
12.
Belo Horizonte; s.n; 2023. 80 p. ilus.
Tese em Português | BBO - Odontologia | ID: biblio-1525094

RESUMO

Introdução: A Infecção Odontogênica (IO) possui a sua origem no tecido dental e de suporte, que que em uma eventual situação, pode evoluir para os espaços fasciais subjacentes. O processo infeccioso pode evoluir de uma infecção odontogênica localizada simples para uma infecção maxilofacial grave, levando a sérias complicações. A epidemiologia das IO é importante para o desenvolvimento de estratégias de prevenção, evitando assim a progressão para complicações graves e hospitalização. As implicações resultantes de IO continuam a ser uma preocupação significativa para a saúde pública e isso não se deve apenas ao seu potencial prejudicial para a saúde, mas também à considerável carga financeira hospitalar ligada ao tratamento dessas situações. Objetivos: Analisar casos de infecção de origem odontogênica em pacientes internados pelo Setor de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Metropolitano Odilon Behrens (HMOB), em Belo Horizonte, Minas Gerais, Brasil. Materiais e métodos: Estudo transversal, analítico, realizado por meio da coleta de dados secundários. Foram analisados 530 prontuários de pacientes internados devido a infecção odontogênica no HMOB, entre janeiro de 2018 e dezembro de 2022. As variáveis independentes foram idade, sexo, presença de comorbidade, município de residência, ano, lado da face, etiologia da infecção, dente acometido e arcada dentária. A variável dependente foi constituída por um escore de gravidade construído a partir das variáveis de conduta clínica e de complicações na internação. Além disso, foram coletadas informações sobre o número de dias de internação e custo das internações. Foram realizadas análises estáticas descritivas. Testes bivariados foram realizados e aqueles que tiveram um p<0.05 foram incluídos na análise de regressão de Poisson com variância robusta. Resultados: Pode-se observar que aproximadamente, 60.6% dos pacientes fizeram uso de pelo menos uma das opções de dreno intraoral ou extraoral. A angina de Ludwig foi identificada em 7.4% da amostra. O ano com maior número de internações foi o ano de 2022 (24.2%), no qual aconteceram, em sua maioria, no primeiro trimestre (28.9%), causadas por infecções que acometiam o lado direito (42.3%), a etiologia da maioria dos casos foi a cárie (56.4%), o dente mais acometido o molar inferior permanente (55.3%) e na mandíbula (88.7%). O tempo médio de internação foi de 6,9 dias e foi possível verificar aumento no tempo médio das internações ao longo dos anos. O número médio de antibióticos administrados aos pacientes foi de 2,2 e o custo médio total das internações no período de janeiro de 2018 a dezembro de 2022 foi de R$991,65. Pessoas com mais de 60 anos apresentaram gravidade 19% maior que aquelas de 1 a 19 anos. Em relação ao ano de internação, as que foram internadas em 2022, tiveram quadro 13% mais grave que os pacientes internados em 2018 e foi possível observar indícios de gradiente dose-resposta quando ano e gravidade foram relacionados. Os casos em que o acometimento foi bilateral foram 38% mais graves que quando o acometimento foi em um lado da face; e os casos que acometeram a mandíbula foram 17% mais graves que quando o acometimento se deu na maxila. Foi realizado georreferenciamento de Belo Horizonte, a partir do endereço de domicílio dos pacientes do município. A distribuição de casos decorrentes de infecção de origem odontogênica foi homogênea no município. Ao analisar a renda mensal per capita dos domicílios com 2 salários-mínimos, observou-se a formação de aglomerados de alta densidade nos bairros Aparecida e Santa Mônica. Conclusão: Conclui-se que a maioria dos casos de internação por infecção odontogênica foram de pacientes que residem no município de Belo Horizonte, a principal causa foi a cárie, os dentes mais acometidos os molares inferiores permanentes e acometimento da mandíbula. A adoção de estratégias preventivas e a intervenção precoce emergem como abordagens de destaque.


Introduction: Odontogenic Infection (IO) has its origin in the dental and supporting tissue, which in an eventual situation, can evolve into the underlying fascial spaces. The infectious process can evolve from a simple localized odontogenic infection to a severe maxillofacial infection, leading to serious complications. The epidemiology of OI is important for the development of prevention strategies, thus avoiding progression to serious complications and hospitalization. The resulting implications of OI continue to be a significant public health concern and this is not only due to its harmful potential for health, but also the considerable hospital financial burden linked to the treatment of these situations. Objectives: To analyze cases of infection of odontogenic origin in patients admitted to the Oral and Maxillofacial Surgery and Traumatology Sector of the Hospital Metropolitano Odilon Behrens (HMOB), in Belo Horizonte, Minas Gerais, Brazil. Materials and methods: Cross-sectional, analytical study, carried out through the collection of secondary data. A total of 530 medical records of patients hospitalized due to odontogenic infection at the HMOB between January 2018 and December 2022 were analyzed. The independent variables were age, gender, presence of comorbidity, municipality of residence, year, side of the face, etiology of infection, tooth affected and dental arch. The dependent variables consisted of a severity score constructed from the clinical management and hospitalization complications variables. In addition, information was collected on the number of days of hospitalization and the cost of hospitalizations. Descriptive static analyzes were performed and those that had a p<0.05 were included in the Poisson regression analysis with robust variance. Results: It can be seen that approximately 60.6% of the patients used at least one of the options for intraoral or extraoral drain. Ludwig's Angina was identified in 7.4% of the sample. The year with the highest number of hospitalizations was 2022 (24.2%), in which they mostly occurred in the first quarter (28.9%), caused by infections that affected the right side (42.3%), the etiology of the majority of cases was caries (56.4%), the most affected tooth was the lower permanent molar (55.3%) and the mandible (88.7%). The mean length of stay was 6.9 days, and it was possible to see an increase in the mean length of stay over the years. The average number of antibiotics administered to patients was 2.2 and the total average cost of hospitalizations in the period between January 2018 and December 2022 was R$991.65. People aged over 60 years had a 19% greater severity than those aged 1 to 19 years. Regarding the year of hospitalization, those who were hospitalized in 2022 had a 13% more severe condition than patients hospitalized in 2018 and it was possible to observe evidence of a dose-response gradient When year and severity were related. Cases in which the involvement was bilateral were 38% more severe than when the involvement was on one side of the face; and the cases that affected the mandible were 17% more severe than when the maxilla was affected. Belo Horizonte was georeferenced based on the home addresses of patients in the city. The distribution of cases resulting from infection of odontogenic origin was homogeneous in the municipality. When analyzing the per capita Monthly income of households earning 2 minimum wages, the formation of highdensity clusters was observed in the Aparecida and Santa Mônica neighborhoods. Conclusion: It is concluded that most cases of hospitalization due to odontogenic infection were patients residing in the city of Belo Horizonte, the main cause was caries, the most affected teeth were permanent lower molars and involvement of the mandible. The adoption of preventive strategies and early intervention emerge as prominent approaches.


Assuntos
Atenção Terciária à Saúde , Odontologia , Infecção Focal Dentária , Estudos Transversais
13.
Rev. Fac. Odontol. (B.Aires) ; 38(90): 45-50, 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1554019

RESUMO

Objetivo: se presenta el caso clínico de sinusitis de origen endodóntico, conocida como síndrome en-doantral, haciendo énfasis en la dificultad de diag-nóstico con radiografía periapical y la importancia de la tomografía computarizada. Caso clínico: una mujer de 32 años, con antecedentes de apretamiento dental nocturno y sinusitis recurrente, fue remitida para evaluación endodóntica. El examen clínico reve-ló sensibilidad a la percusión y palpación en la unidad dental. La radiografía periapical no indicó lesión en el diente 16 y la prueba de sensibilidad pulpar fue ne-gativa, además, la tomografía computarizada reveló una extensa lesión periapical y comunicación entre la raíz del diente 16 y el seno maxilar, confirmada por la pérdida de la continuidad de la imagen hiperdensa en el suelo del seno, lo que llevó al tratamiento endo-dóntico. El control de la infección dental resolvió la sinusitis, resaltando la importancia del diagnóstico preciso y el tratamiento en casos de sinusitis odon-togénica. Conclusión: este caso destaca el valor de la tomografía computarizada como herramienta diag-nóstica crucial en contextos clínicos complejos (AU)


Objective: the clinical case of sinusitis of endodontic origin, known as endoantral syndrome, is presented, emphasizing the difficulty of diagnosis with periapical radiography and the importance of computed tomography. Clinical case: a 32-year-old woman, with a history of tooth clenching and recurrent sinusitis, was referred for endodontic evaluation. The clinical examination revealed sensitivity to percussion and palpation in the dental unit. The periapical radiograph did not indicate a lesion in tooth 16 and the pulp sensitivity test was negative, in addition, the computed tomography revealed an extensive periapical lesion and communication between the root of tooth 16 and the maxillary sinus, confirmed by the loss of continuity of the hyperdense image in the sine floor, which led to endodontic treatment. Dental infection control resolved sinusitis, highlighting the importance of accurate diagnosis and treatment in cases of odontogenic sinusitis. Conclusion: this case highlights the value of computerized tomography as a crucial diagnostic tool in complex clinical contexts (AU)


Assuntos
Humanos , Feminino , Adulto , Sinusite Maxilar/etiologia , Sinusite Maxilar/diagnóstico por imagem , Necrose da Polpa Dentária/complicações , Tomografia Computadorizada de Feixe Cônico/métodos , Infecção Focal Dentária/complicações , Periodontite Periapical/complicações , Tratamento do Canal Radicular/métodos
14.
Rev. Asoc. Odontol. Argent ; 110(3): 1101251, sept.-dic. 2022. ilus
Artigo em Espanhol | LILACS | ID: biblio-1426046

RESUMO

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)


The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)


Assuntos
Humanos , Doenças Periapicais/etiologia , Doenças da Polpa Dentária/etiologia , Infecção Focal Dentária/complicações , Infecção Persistente/complicações , Doenças Periapicais/cirurgia , Actinomicose/patologia , Cisto Radicular/complicações , Colesterol/efeitos adversos , Reação a Corpo Estranho/patologia , Retratamento/métodos , Bactérias Anaeróbias Gram-Negativas/patogenicidade
15.
J Ayub Med Coll Abbottabad ; 34(3): 511-514, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36377166

RESUMO

BACKGROUND: Orofacial space infections are commonly odontogenic in origin and the anatomical locations along with mode of spread to critical areas (e.g., orbit, brain, mediastinum) can result in morbidly and mortality if not diagnosed and treated well in time. This study was aimed to analyzing the incidence and pattern of oro-facial infections. METHODS: This Descriptive case series was carried out at Oral Surgery unit (Ayub Medical College) Abbottabad from January 2016 - May 2017. The sample was collected using purposive, consecutive non-probability sampling. The demographic data, infection site and clinical features were recorded. The data was analyzed by using SPSS version 21. All the descriptive variables were analyzed for percentages & frequencies. RESULTS: Thirty-six patients were included in the study. The male (23) to female (13) ratio was (1.7:1). Right Submandibular space was most common site. In one case each, there was involvement of retropharyngeal and retromandibular space. Majority of the patients presented with swelling (88.89%). Diabetes mellitus was the most commonly found systemic disorder in the patients affecting aggressiveness of infection. Conclusion: The most common source of odontogenic facial space infections is mandibular molars resulting spread to submandibular space. Diabetes Mellitus was the most common systemic disorder affecting host immunity. The proximity of oro-facial spaces with the critical areas makes it crucial for clinicians to identify the condition promptly and provide pertinent treatment in order to avoid the fatal complications as the rate of spread of facial space infection is very rapid.


Assuntos
Infecção Focal Dentária , Humanos , Masculino , Feminino , Infecção Focal Dentária/epidemiologia , Infecção Focal Dentária/terapia , Infecção Focal Dentária/complicações , Incidência , Dente Molar , Face
16.
Orv Hetil ; 163(37): 1455-1463, 2022 Sep 11.
Artigo em Húngaro | MEDLINE | ID: mdl-36088622

RESUMO

A wide scale of medical professionals including general practitioners, dentists, maxillofacial surgeons, otolaryngologists or even emergency physicians frequently encounter patients suffering from abscesses of odontogenic origin. These dental infections spreading along the fascial planes into the adjacent anatomical spaces or by the lymphatic vessels and veins may result in life-threatening situations. It is essential to prevent and - in the case of an evolved disease pattern - to treat them properly, since improper or delayed treatment may entail avoidable burdens on the healthcare system. Our aim was to review the current literature regarding the development, diagnostics and treatment of odontogenic infections. A review of the English and Hungarian literature was performed. Considerations regarding the surgical management of dental abscesses have well-tried, traditional routes. Prompt intervention is considered mandatory with surgical decompression of the swelling by performing incision and drainage. A rapid improvement of radiology has provided the possibility to realize and avoid fatal consequences of this disorder. The administration route, necessity and duration of empiric antibiotic therapy are still debated, protocols vary across studies. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, future research should evaluate evidence-based and effective management of dental abscesses.


Assuntos
Infecção Focal Dentária , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Drenagem/métodos , Infecção Focal Dentária/tratamento farmacológico , Humanos , Estudos Prospectivos
17.
Braz J Otorhinolaryngol ; 88 Suppl 4: S170-S176, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35659711

RESUMO

OBJECTIVES: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. METHODS: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. RESULTS: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. CONCLUSION: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. LEVEL OF EVIDENCE: Level 2b.


Assuntos
Infecção Focal Dentária , Humanos , Tempo de Internação , Infecção Focal Dentária/complicações , Unidades de Terapia Intensiva , Pescoço , Tomografia Computadorizada por Raios X , Estudos Retrospectivos
18.
Rev. cir. traumatol. buco-maxilo-fac ; 22(1): 13-16, jan.-mar. 2022. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1391391

RESUMO

Objetivo: O seguinte estudo é uma análise de prontuários para traçar um perfil epidemiológico de pacientes acometidos por infecções odontogênicas e/ou angina de Ludwig em um serviço hospitalar público. Metodologia: Foi realizado um estudo observacional de 37 prontuários com diagnóstico de infecção odontogênica e/ou Angina de Ludwig no Hospital da Restauração, na cidade do Recife, Pernambuco, entre os meses de julho a novembro de 2021. Resultados: Dos 37 prontuários, a maioria foi do sexo masculino (55%; n=20), a faixa etária mais acometida foi dos 18 aos 40 (45%; n=17); abaixo dos 10 anos foram acometidos 27% (n = 10). 21% (n = 8) foram internados e dos 37 prontuários, 13% (n = 5) evoluíram para Angina de Ludwig. Conclusão: O perfil mais acometido por infecções odontogênicas no período proposto foram pacientes do sexo masculino adultos e a internação não prevaleceu na maioria dos casos. O alto acometimento de crianças é um sinal de alerta, sugerindo uma atenção maior dos responsáveis. A angina de Ludwig acometeu menos da metade dos pacientes e a Ceftriaxona e o Metronidazol foram os antibióticos de escolha para a maioria dos casos... (AU)


Objetivo: El siguiente estudio es un análisis de historias clínicas para trazar un perfil epidemiológico de los pacientes afectados por infecciones odontogénicas y/o angina de Ludwig en un servicio hospitalario público. Metodología: Se realizó un estudio observacional en 37 historias clínicas con diagnóstico de infección odontogénica y/o Angina de Ludwig en el Hospital da Restauração, en la ciudad de Recife, Pernambuco, entre julio y noviembre de 2021. Resultados: De las 37 historias clínicas, la mayoría eran hombres (55%; n=20), el grupo de edad más afectado fue el de 18 a 40 años (45%; n=17); menores de 10 años, el 27% (n = 10) estaban afectados. El 21% (n = 8) fueron hospitalizados y de las 37 historias clínicas, el 13% (n = 5) progresó a Angina de Ludwig. Conclusión: El perfil más afectado por infecciones odontogénicas en el periodo propuesto fueron pacientes adultos del sexo masculino y no predominó la hospitalización en la mayoría de los casos. La alta participación de los niños es una señal de advertencia, lo que sugiere una mayor atención por parte de los responsables. La angina de Ludwig afectó a menos de la mitad de los pacientes y la ceftriaxona y el metronidazol fueron los antibióticos de elección en la mayoría de los casos... (AU)


Objective: The following study is an analysis of medical records to trace an epidemiological profile of patients affected by odontogenic infections and/or Ludwig's angina in a public hospital service. Methodology: An observational study was carried out on 37 medical records with a diagnosis of odontogenic infection and/or Ludwig's Angina at Hospital da Restauração, in the city of Recife, Pernambuco, between July and November 2021. Results: Of the 37 medical records, the most were male (55%; n=20), the age group most affected was from 18 to 40 (45%; n=17); under 10 years of age, 27% (n = 10) were affected. 21% (n = 8) were hospitalized and of the 37 medical records, 13% (n = 5) progressed to Ludwig's Angina. Conclusion: The profile most affected by odontogenic infections in the proposed period were adult male patients and hospitalization did not prevail in most cases. The high involvement of children is a warning sign, suggesting greater attention from those responsible. Ludwig's angina affected less than half of the patients and Ceftriaxone and Metronidazole were the antibiotics of choice for most cases... (AU)


Assuntos
Humanos , Masculino , Feminino , Prontuários Médicos , Infecção Focal Dentária , Angina de Ludwig , Antibacterianos , Bactérias , Hospitais Públicos , Infecções
19.
Spec Care Dentist ; 42(2): 187-193, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34697819

RESUMO

Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of São Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus spp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.


Assuntos
Abscesso Encefálico , Infecção Focal Dentária , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Drenagem , Infecção Focal Dentária/complicações , Infecção Focal Dentária/tratamento farmacológico , Humanos
20.
Rev. Fac. Odontol. (B.Aires) ; 37(85): 67-76, 2022. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1411632

RESUMO

Se realizó una revisión sistemática de la literatura científica en relación con las variantes de tratamien-to que recibieron las piezas dentarias permanentes asociadas a la presencia de una fístula cutánea. Se incluyeron reportes de casos clínicos en inglés, pu-blicados en los últimos diez años. Se obtuvieron 481 artículos, 359 excluidos por escasez de datos en títu-lo e incumplimiento de criterios de selección. Se ex-cluyeron 89 por carecer de tratamiento. Se incluye-ron 33 artículos. Se analizaron fístulas de 45 piezas dentarias, superiores e inferiores, anteriores y pos-teriores. En base a los resultados obtenidos se llegó a la conclusión de que las fístulas cutáneas faciales de origen odontogénico se diagnostican de manera errónea; esto conduce a un tratamiento inadecuado y secuela estéticas. Realizar un correcto diagnóstico y adecuado plan de tratamiento permite una curación rápida y predecible. Los hallazgos obtenidos estable-cen que realizar un correcto tratamiento endodóntico en la pieza afectada, es la terapéutica adecuada para lograr el cierre definitivo de la fístula, sin necesidad de tratar quirúrgicamente la misma (AU)


A systematic review of the scientific literature was carried out in relation to the variants of treatment received by permanent teeth associated with the presence of a cutaneous sinus tract. Clinical case reports in English, published in the last ten years, were included. A total of 481 articles were obtained, 359 were excluded due to lack of title data and non-compliance with selection criteria. 89 were excluded due to lack of treatment. 33 articles were included Cutaneous sinus tracts of 45 teeth, upper and lower, anterior and posterior, were analyzed. Based on the results obtained, it was concluded that facial cutaneous sinus tracts of odontogenic origin are misdiagnosed, leading to inadequate treatment and aesthetic sequelae. Carrying out a correct diagnosis and adequate treatment plan allows a quick and predictable healing. The findings obtained establish that performing a correct endodontic treatment in the affected piece is the appropriate therapy to achieve the definitive closure of the cutaneous sinus tract, without the need to surgically treatment (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fístula Cutânea/diagnóstico , Fístula Cutânea/terapia , Infecção Focal Dentária/complicações , Tratamento do Canal Radicular/métodos , Diagnóstico Diferencial , Distribuição por Idade e Sexo , Mandíbula , Maxila
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