Brain Abscess Potentially Resulting from Odontogenic Focus: Report of Three Cases and a Literature Review

Introduction

Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection.

Case reports

The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and F. nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases.

Conclusions

Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.

     

牙周异物致牙周牙髓联合病变1例

患者上前牙腭侧反复溢脓1年就诊,自述1年前吃饭时被鸡骨头戳伤上前牙牙龈,之后伤处反复溢脓。诊断为21牙周脓肿,经单纯牙周治疗后21无溢脓,瘘管闭合。但半年后复发,X线片检查示21近中有致密白线,龈下刮治时刮出骨片样物质。牙周治疗1周后复诊,X线片上未见21近中致密白线。第2天患者再次就诊,主诉上前牙夜间痛,诊断为逆行性牙髓炎,行牙周牙髓联合治疗。再过半年后复查,21瘘管闭合,无溢脓,X线片检查示21近中硬骨板清晰,成骨迹象明显。     

An Evaluation of Shade Differences Between Natural Anterior Teeth in Different Age Groups and Gender Using Commercially Available Shade Guides

Shade selection with the help of shade guides and color matching the restorations to the natural dentition continues to be one of the most perplexing and frustrating problems in fixed prosthodontics. The purpose of the study was to evaluate the shade differences of the natural anterior teeth in different age groups and gender, within the cross sectional Bangalore, Karnataka population, using commercially available shade guides. The shade of a cross section of the population comprising of 400 subjects of both the sexes (800 incisors; 400 maxillary central incisors; 400 mandibular central incisors) visiting the outpatient Department of Government Dental College was selected randomly and evaluated visually by a single observer using three commonly used shade guides i.e. Vita Lumin, Chromascop and the Vita 3D Master. The incidence of the most common shades in the different age groups and gender using these shade guides was obtained and this data was subjected to the χ² test (p < 0.05—significant). The most common shade for the maxillary and mandibular incisors in the younger age group is A2/2R1.5/140 and A1/1M2/120 for the males and females using Vita Lumin, Vita 3D Master and Chromascop shade guides respectively. In the advanced age group the most common shade for the maxillary and mandibular incisors is A2/2R2.5/140 using the same order of shade guides. However the results showed no statistical significance in shade variation in males and females in different age groups using different shade guides. Although the incidence of males with darker teeth as compared to females was higher; the study showed no statistical significant correlation between shade differences in both the sexes. It is also observed that there is a significant darkening of teeth as the age advances.     

Evaluation of Secondary Thermal Hyperalgesia Resulting from Pulpal Inflammation in Patients with Symptomatic Irreversible Pulpitis

IntroductionInflammation can lead to hyperalgesia and allodynia by activation or sensitization of peripheral and central nervous system neurons. This study aimed to assess the occurrence of secondary thermal hyperalgesia in patients with symptomatic irreversible pulpitis (SIP).MethodsThe cold sensitivity test (visual analog scale) was performed for the tooth with SIP, its adjacent sound tooth, the same sound tooth in the opposite jaw, and the contralateral sound tooth in the opposite quadrant of the same jaw. Next, the tooth with SIP underwent root canal treatment, and 3 weeks later, after complete elimination of pain, the teeth underwent cold sensitivity testing again.ResultsA total of 64 patients, including 41 women and 23 men 18–65 years old, were evaluated in this study. The response to the cold sensitivity test significantly decreased in the tooth with SIP (P < .001), its adjacent sound tooth (P < .001), and the same sound tooth in the opposite jaw (P = .004) but not in the contralateral sound tooth in the opposite quadrant of the same jaw (P = .45) after endodontic treatment. No significant difference was noted between men and women in the groups (P > .05).ConclusionsHypersensitivity to cold test due to pulpal inflammation can also result in exaggerated response of the adjacent sound tooth and the same tooth in the opposite jaw to cold sensitivity test; these observations can be explained by the central and peripheral sensitization mechanisms.     

Variations of L*a*b* values among Vitapan Classical Shade Guides.

PURPOSE: To measure the variations in L*a*b* values of a group of 25 guides and to assess whether shade guides are indeed interchangeable. MATERIALS AND METHODS: The L*a*b* values of individual shade tabs were measured with a LabScan(tm) XE scanning spectrocolorimeter (SSC) with a special attachment for reproducibly positioning shade tabs. Each shade guide (Vitapan Classical, Vident) contained 16 shade tabs. Absolute calibration of the SSC was performed with color tiles traceable to NIST. One shade guide was used to determine the reproducibility of the experimental method by measuring and then removing each shade tab of the standard 10 times. This assessed the variations in observed values induced by the measurement method and the geometry of the specimens. The entire sample consisted of 25 shade guides. The tabs of each of the 25 shade guides were read five times in the SSC, without moving the specimen. Measurements and calculations of E, L*, a*, and b* were performed using Universal Software V4.10 (Hunter Associates Laboratory). The mean, standard deviation, and range were determined of the E, L*, a*, and b* values for each one of the 16 shades in the shade guides. Differences in color are expressed as DeltaE in color science. The standard deviation of E (E(sd)) and the range of E (E(r)) for each of the shades were used as a DeltaE value to assess color differences. RESULTS: For the reproducibility measurements, the shades had values for E(r) varying from 0.08 to 0.69, and E(sd) between 0.02 and 0.22. This established the detection limit for our method for each of the shades. For the group of 25 shade guides, E(r) varied from 0.75 to 3.05, and E(sd) from 0.22 to 0.54. The difference in value of E(r) obtained from the reproducibility test and the E(r) of the group of 25 guides is significant at p < 0.05. The same was found for E(sd). The largest reproducible E(r) observed was 3.05 for shade C1. CONCLUSIONS: The differences observed between shade guides are larger than the variations induced by the experimental method. The difference in E values for the shades C1 and C2 is 2.19; hence the observed E(r) of 3.05 between shade tabs of the same shade (C1) is larger than the changes in color between shades. This large a variation in what are claimed as identical shade tabs is deemed of clinical importance, and therefore, the shade guides should not be considered interchangeable.     

模拟上颌前牵引对大鼠上颌骨周围骨缝影响的实验观察

目的:观测模拟前牵引作用下,SD大鼠上颌骨骨缝的改建情况。方法:采用直接前牵引大鼠上颌骨的方式模拟上颌前牵引,建立前牵引大鼠上颌动物模型。选用90只5周龄的Sprague-Daw ley健康雌性大鼠作实验动物,随机分到实验加力组、手术对照组、自然生长组。分别在第3、7、14、21、28天时间点每组处死大鼠6只。将大鼠上颌骨的额颌缝,腭颌缝的组织标本制作切片,采用常规HE染色进行组织学观察和组织学测量。结果:实验加力组骨缝内成骨活动明显活跃,并且持续进行。结论:本动物模型较好地模拟了上颌前牵引后在上颌骨周围骨缝改建的情况,发现在直接牵引大鼠上颌向前的外力作用下,上颌骨周围骨缝内发生了显著的改建。     

Comparison of the color of natural teeth measured by a colorimeter and Shade Vision System.

OBJECTIVES: The objectives were to measure the difference in the color and color parameters of natural teeth measured by a tristimulus colorimeter (CM, used as a reference) and Shade Vision System (SV), and to determine the influence of color parameters on the color difference between the values measured by two instruments. METHOD: Color of 12 maxillary and mandibular anterior teeth was measured by CM and SV for 47 volunteers (number of teeth=564). Color parameters such as CIE L*, a* and b* values, chroma and hue angle measured by two instruments were compared. Chroma was calculated as C*ab=(a*2 = b*2)1/2, and hue angle was calculated as h degrees =arctan(b*/a*). The influence of color parameters measured by CM on the color difference (DeltaE*(ab)) between the values measured by two instruments was analyzed with multiple regression analysis (alpha=0.01). RESULTS: Mean DeltaE*(ab) value between the values measured by two instruments was 21.7 (+/-3.7), and the mean difference in lightness (CIE L*) and chroma was 16.2 (+/-3.9) and 13.2 (+/-3.0), respectively. Difference in hue angle was high as 132.7 (+/-53.3) degrees . Except for the hue angle, all the color parameters showed significant correlations and the coefficient of determination (r(2)) was in the range of 0.089-0.478. Based on multiple regression analysis, the standardized partial correlation coefficient (beta) of the included predictors for the color difference was -0.710 for CIE L* and -0.300 for C*(ab) (p<0.01). CONCLUSION: All the color parameters showed significant but weak correlations except for hue angle. When lightness and chroma of teeth were high, color difference between the values measured by two instruments was small. Clinical accuracy of two instruments should be investigated further.     

氯胺酮治疗颌面部撞击致颅脑损伤的动物实验研究

探索临床应用氯胺酮对颌面部撞击致颅脑损伤早期治疗的可能性。方法采用落体撞击大鼠颌面部发生中等程度的创伤性损伤动物模型,给予氯胺酮进行早期药物治疗,观察大鼠神经功能的恢复时间。     

Use of a reflectance spectrophotometer in evaluating shade change resulting from tooth-whitening products

Historically, shade change assessment associated with vital bleaching treatment regimens has been visually evaluated through the use of shade guide tabs. Innovations in the industry of dentistry have brought forth new technologies capable of measuring such changes via the capture and analysis of reflected wavelengths of light. CLINICAL SIGNIFICANCE: This article introduces the use of a 45/0 reflectance spectrophotometer and identifies the advantages and limitations associated with such a technology in the assessment of shade change owing to vital bleaching.