Are dental infections a cause of brain abscess? Case report and review of the literature

Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.     

口腔颌面部牙源性感染的微生物学及药物治疗

<正>在口腔颌面部感染的现代研究中,仍然延续传统的以感染途径分类的方法:即牙源性感染和非牙源性感染。其中牙源性感染是颌面外科临床中最多见的感染类型。有资料显示:牙源性感染病例占口腔颌面外科病例总数的11.3%[1]。亦有学者报道,牙源性感染占颌面颈部脓肿及蜂窝织炎病例的77.7%[2]。陈文君等[3]报道,在112例口腔颌面部间隙感染中,牙源性感染99例,占88.3%。     

Posterior Auricular Approach for Decompression and Drainage of Superficial Temporal Space Infections of Odontogenic Origin

Involvement of superficial temporal space secondary to odontogenic infections of the maxillary and mandibular teeth is not uncommon. Usually, infections of the temporal space are drained via temporal approach. Authors propose a new approach for decompression and drainage of superficial temporal space which offers an advantage of dependent drainage and hidden scar.     

Microbiology and Antibiotic Sensitivity of Head and Neck Space Infections of Odontogenic Origin

This paper aim to assess the anatomical spaces of head and neck region and causative microorganisms responsible for infections, evaluate the resistance of antibiotics used in treatment and compare the findings with previously reported microbial flora in the orofacial infection. Forty-two patients were recorded. All underwent surgical incision and drainage, received antibiotics cover, and had culture and sensitivity test performed for gram positive and gram negative aerobes. There were 33 male (78.57 %) and 9 female (21.42 %). Out of the 42 patients 28 (66.66 %) presented with single space involvement. The submandibular space was the most frequent location for single space abscess (28.12 %). Fourteen patients presented with multiple space involvement, with a total of 64 spaces being involved. Forty microorganisms were isolated. There were 28 aerobes and 10 anaerobes. Two fungi were also identified. The most common bacteria isolated were Staphylococcus aureus, Klebsiella, Escherichia coli, Peptostreptococcus. The key issue here, which needs to be remembered, is that antibiotics alone cannot resolve odontogenic infection satisfactorily. Quick recovery of patients results with proper basic management comprising of early drainage/decompression which is equally important.     

Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department

PurposeThe 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).MethodsA retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED.ResultsDuring 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.ConclusionThe data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.     

Pseudomonas Aeruginosa in Oral Infections

Twentynine strains of Pseudomonas aeruginosa were isolated from 2518 specimens from patients with oral infections and the following clinical diagnoses: periodontitis apicalis, necrosis pulpae, pulpitis and alveolitis maxillaris and mandibularis. All strains produced at least one haemolytic toxin and most of the following extracellular enzymes: lecithinase, protease, elastase, lipase and an esterase. The importance of these proteins for the development of tissue necrosis during infection is discussed. The antibiogram showed that most strains were sensitive to treatment with gentamicin, carbenicillin or streptomycin, but were resistant to several other antibiotics. The strains belonged to 9 different phage types and 15 strains were of the same serotype (Habs's group 1) which is remarkable, since Habs's group 6 is most frequently found among isolated strains from infections outside the oral cavity.     

Phenotypic and Genotypic Characterization of Streptococcus mutans Strains Isolated from Endodontic Infections

Streptococcus mutans plays an important role in caries etiology and eventually in systemic infections. However, it is often found in infected root canals, but the pathophysiological characteristics of strains residing in this site are largely unknown. Here, we characterized strains of S. mutans isolated from root canals of primary (PI) and secondary/persistent (SI) endodontic infections in relation to serotype and genotype; presence of genes coding for collagen binding proteins (CBPs); collagen binding activity and biofilm formation capacity; ability to withstand environmental stresses; systemic virulence in Galleria mellonella; and invasion of human coronary artery endothelial cells and human dental pupal fibroblasts. Samples from 10 patients with PI and 10 patients with SI were collected, and a total of 14 S. mutans isolates, belonging to 3 genotypes, were obtained. Of these, 13 were serotype c, and 1 was serotype k. When compared with the reference strains, the clinical isolates were hypersensitive to hydrogen peroxide. Remarkably, all 14 strains harbored and expressed the CBP-encoding gene cbm, showing increased binding to collagen, enhanced systemic virulence in G. mellonella, and ability to invade human coronary artery endothelial cells and human dental pupal fibroblasts when compared with CBP-negative strains. Whole genome sequence analysis of PI and SI isolates revealed that these strains are phylogenetically related but genetically distinct from each other. Our findings highlight the importance of CBPs in facilitating colonization and persistence of S. mutans in collagenous substrates such as root canals and their potential role in the pathogenesis of endodontic infections.     

Changes in admission rates for spreading odontogenic infection resulting from changes in government policy about the dental schedule and remunerations

The government changed the system of payment to general dental practitioners on 1 April 2005 from a fee/item to a banding system. The figures collected have shown that there has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections compared with the 3-year period before this date.     

Odontogenic infection and pachymeningitis of the cavernous sinus

Hypertrophic pachymeningitis is a rare inflammatory process that causes thickening of the dura mater. Most cases are idiopathic, but it can result from many inflammatory and infective conditions. We present a case of pachymeningitis of the cavernous sinus, the aetiology of which may have been dental.     

Analysis of plaque microbiota and salivary proteins adhering to dental materials

ObjectivesPlaque causes oral diseases and aspiration-pneumonia in the elderly. It is not known whether pellicle-like attached salivary proteins and microbiota on dental materials are identical to those on teeth. The purpose of this study was to determine the properties of salivary proteins and microbiota that attach to dental materials.MethodsEight subjects wore removable oral splints with pieces of pure-titanium, cobalt-chromium alloy, silver-palladium-copper-gold-alloy, denture-base-resin, and hydroxyapatite for 24 h. The bacteria that adhered to each material were analyzed using 16S rRNA sequencing simultaneously. Each material sample was then immersed in pooled saliva, and the attached proteins were collected. Salivary proteins were analyzed using MALDI-TOF/MS, and high molecular weight proteins were identified using peptide mass fingerprinting.ResultsAmong the dental materials, the α- and β-diversity of adherent flora were similar. The bacterial species that adhered easily to materials were Streptococcus sp. oral taxon 058, Neisseria mucosa, Gemella haemolysans, and Rothia dentocariosa. Regardless of material, the peaks or spots of attached salivary proteins had similar patterns, containing functioning proteins such as anchoring receptors for early colonizers.ConclusionsThere were no significant differences in microbiota and protein adherence in hydroxyapatite compared to the dental materials. Therefore, similar microbiota was determined to have formed on the similar pellicle-like proteins. In our study, the characteristics of plaque adhesion on both hydroxyapatite and dental materials were clarified. Based on this study, the creation of new methods of inhibiting plaque adhesion to prevent aspiration-pneumonia and oral infections can be undertaken.