Dentoalveolar infections

Dentoalveolar infections represent a wide spectrum of conditions, from simple localized abscesses to deep neck space infections. The initial assessment of the patient with a dentoalveolar infection requires considerable clinical skill and experience, and determines the need for further airway management or emergent surgical therapy. Knowledge of head and neck fascial space anatomy is essential in diagnosing, understanding spread, and surgically managing these infections. Oral and maxillofacial surgeons must make use of their wide spectrum of clinical skill and knowledge to effectively evaluate and treat patients with dentoalveolar infections.     

西北地区颌面部间隙感染65例临床总结

目的:回顾性研究颌面部间隙感染(MSI)的临床特征和诊治要点,以及MSI的危险因素。方法:收集2004-06—2011-12在甘肃省兰州大学第二医院口腔颌面外科就诊的65例MSI患者的临床资料,要求有详细的病历记录。分析其病因、手术方式、术后效果及并发症的发生情况。结果:65例患者年龄2～86岁(平均年龄44.4岁),男34例,女31例;牙源性颌面部间隙感染是主要原因;下颌下间隙是最容易发生感染的颌面部间隙;6例患者出现严重的并发症,其中3例死亡(病死率4.6%);糖尿病患者有14例(21.53%)。结论:早期的牙病治疗、脓肿切开引流协同使用抗生素是治疗MSI的有效措施。尤其对西北地区农牧民患者,需要重视口腔卫生宣教;针对糖尿病患者,控制血糖非常重要。     

Microbiological monitoring and results of treatment of extraradicular endodontic infection

Abstract This report describes a case where aggressive treatment of a tooth with Asymptomatic apical periodontitis was at first unsuccessful. The reason for the failure of the treatment was an established infection extraradicularly in the periapical lesion that only partly could be influenced by local and systemic antimicrobial treatment. The effectiveness of this treatment was monitored by microbiological sampling from the root canal, a fistulous tract, and, in the end, directly from the periapical lesion. The results of the monitoring were meaningful. They showed that the bacterial flora could be influenced, but not eliminated, and were strongly suggestive of an established infection outside the root. Scanning electron microscopy confirmed the presence of a bacterial plaque on the surface of the root tip removed during the final surgical-endodontic treatment of the tooth. Following apicoectomy and removal of the periapical lesion, repair was uneventful with the formation of new bone in the surgical cavity after 6 months.     

Opportunistic infections associated with HIV infection in Africa

HIV-associated infections in sub-Saharan Africa differ markedly in their incidence from those in industrialized countries. Tuberculosis is the commonest cause of morbidity and mortality. Enteric pathogens such as microsporidiosis commonly cause disease as access to safe water is limited. Pneumocystis carinii pneumonia, which is the commonest opportunistic infection in industrialized countries, is uncommon in adults with HIV infection. This remains unexplained because P. carinii pneumonia is common in Black African HIV-infected children. Cytomegalovirus and Mycobacterium avium complex, which only occur in severely immune-suppressed individuals, are seldom found. One reason may be that survival after conversion to AIDS is relatively short in Africa. Patients often die before they develop severe immune suppression. Recently, prophylactic cotrimoxazole treatment was shown to be effective in symptomatic HIV-infected adults in Africa. Tuberculosis preventive therapy is also effective in Africa, at least in the medium term. It is hoped that these two affordable interventions will become available to large numbers of patients identified in voluntary counselling and testing centres.     

Deep neck infection in patients with and without human immunodeficiency virus: a comparison of clinical features,complications, and outcomes

We retrospectively studied the clinical features, complications, and outcomes of deep neck infections in 31 adult patients with the human immunodeficiency virus (HIV) (HIV group) and 192 patients without (non-HIV group). In the HIV group, the cause was more likely to be odontogenic (21 (68%) compared with 90 (47%); odds ratio (OR) 2.38; 95% CI 1.06 to 5.32). In both groups, the parapharyngeal, submandibular, and masticator spaces, were those most often involved. However, in the HIV group, Ludwig’s angina was common, and was the main cause of airway obstruction. Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were most often isolated in the HIV group. Upper airway obstruction tended to be more common in the HIV group (5/31 compared with 13/192). These patients also had a higher risk of other complications (sepsis, mediastinitis, jugular vein thrombosis, and pneumonia) (6/31 compared with 12/192; OR 3.60; 95% CI 1.24 to 10.45), a higher mortality rate (3/31 compared with 2/192), and longer hospital stay (19 days compared with 16 days). Factors associated with an increased risk of complications in this group were an age of 55 years or over and a CD4 count of less than 350 cells/mm³. Deep neck infections in these patients are more severe. Dental health care, appropriate empirical antibiotics, early detection, and management of the airway and complications, may improve outcomes.     

Non-tuberculous Mycobacterium infection after transfer of autologous fat to the face: a rare case

Autologous fat has long been used as a filler in the face, and has recently gained popularity in plastic surgery with a wound infection rate of 1% ? 5%. The incidence of mycobacterial infections has increased over recent decades, which is attributed in part to the increased popularity of these procedures.² Infections by non-tuberculosis mycobacteria often cause chronic inflammation and progressive infection that may eventually manifest themselves as severe scars, fistulas, and hollows, and irregular facial contours. However, few cases of mycobacterial infection have been reported to have been caused by plastic surgery. We present a rare case of non-tuberculosis mycobacterial infection after transfer of autologous fat to the face.     

Microbial flora of sinus tracts and root canals of non-vital teeth

Abstract The occurrence of bacteria in 12 endodontically induced periodontal lesions associated with sinus tracts was examined. The microbial flora encountered in the sinus tract was compared with that of the root canal of the involved teeth which had not experienced any prior endodontic therapy. All microbiological samples taken from the sinus tract and from the root canal system contained bacteria. Seventy-one strains were detected in the extraradicular lesions. Of the anaerobic species, Fusobacterium nucleatum (7 strains), Prevotella intermedia (4 strains) and P. oralis (4 strains) were most frequently found. In the group of the facultative anaerobes Streptococcus spp. were predominant. Ninety-four strains were isolated from the root canal system of the 12 teeth. P. intermedia (6 strains), P. buccae (5 strains), F. nucleatum (5 strains) and Lactobacillus plantarum (5 strains) were most common. In 9 cases, species present in the root canal could be revealed in the extraradicular lesions. It was concluded that a variety of microorganisms were capable of colonizing endodontically induced, extraradicular lesions clinically characterized by sinus tracts.     

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??Oral outpatient treatment is mostly pour-in operation. The operation not only directly contacts the patient's saliva and blood??but also can cause indirect contact through the equipment??instruments??materials and microorganism’s aerosols generated by the treatment??resulting between doctors and patients??patients and patients cross infection. In this article??through the theoretical research on the hospital infection control management laws and regulations??with reference to the dental infection control guidelines in developed countries??combined with the oral clinic clinical practice??summarize the infection prevention of oral outpatient diagnosis and treatment operations??for reference in the work.     

Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM

Abstract The aim of this study was to observe the root canal flora and possible penetration of microorganisms into dentinal tubules in teeth with necrotic pulps. Ten infected maxillary and mandibular molars with periapical lesions were extracted and fixed in 2.5% phosphate-buffered glutaraldehyde solution for nine days. After separation from the crowns, longitudinal grooves were cut in the roots, and they were split into two halves. The specimens were prepared for SEM. The root canals and the dentinal tubules of the fractured dentin were scanned systematically from the cervical to the apical area of the root. Cocci and rods were seen in 6 specimens. Penetration of bacteria into the dentinal tubules ranged from 10 to 150 μm. In 4 specimens, the root canals were heavily invaded by yeasts. The antimicrobial effect of routinely used endodontic disinfectants also on yeasts may be considered in persistent root canal infections.     

HIV and hepatitis B infection in an international cohort of dental hygienists

Abstract – The risk for dental hygienists to contract HIV and hepatitis B infection at work was studied in an international cohort of 167 dental hygienists from 13 countries. A significant proportion of the hygienists had taken care of HIV-positive patients or patients known to be at risk for contracting HIV infection. None of the hygienists had antibodies to HIV. Five hygienists who came from or worked in high-endemic areas for hepatitis B infection had antibodies to hepatitis B core antigen, consistent with previous infection with hepatitis B virus. The study is in agreement with previous reports on blood-borne infections among health care workers, concluding that the risk for dental hygienists of contracting HIV and hepatitis B infection is minimal.     

Clostridial deep neck infection developed after extraction of a tooth: a case report and review of the literature in Japan

A rare case of severe deep neck infection caused by clostridia after extraction of the left lower canine is presented. The patient was a 63-year-old Japanese woman who had a history of diabetes. The pertinent literature in Japan is reviewed and discussed.     

An unusual case of a brain abscess arising from an odontogenic infection

A brain abscess that originates from an odontogenic infection, although rare, can at times be difficult to diagnose, especially in the context of pain and trismus. We report a rare case of odontogenic infection as a result of an infected maxillary third molar, causing an infratemporal and temporalis collection, resulting in a brain abscess with concurrent cerebritis. This is a clinical case review documenting an uncommon but potentially fatal complication.     

59例口腔颌面部多间隙感染继发下行坏死性纵隔炎的回顾性分析

目的通过分析口腔颌面部多间隙感染继发下行坏死性纵隔炎(descending necrotizing mediastinitis,DNM)患者的临床特点,为该病的防治提供依据。方法收集2010年3月~2020年3月新疆医科大学附属口腔医院颌面肿瘤外科收治的59例诊断为DNM患者的病例资料进行回顾性分析,所有患者通过胸部增强CT确诊,并转入重症监护病房(intensive care unit,ICU)治疗。对患者临床数据进行统计分析。结果DNMⅠ型患者21例(35.6%),DNMⅡA型患者19例(32.2%),DNMⅡB型患者19例(32.2%)。所有DNM患者均行急诊手术,Ⅰ型及ⅡA型患者经前纵隔剑突下切开引流配合胸腔引流;ⅡB型患者开胸纵隔彻底清创,术后引流;59例DNM患者的脓液全部送细菌培养,其中19例培养为阳性;全身抗炎治疗。死亡患者5例(8.5%),生存患者54例(91.5%)。与生存组相比,死亡组中年龄≥65岁、有糖尿病患者、入院到转入ICU时间间隔≥6 d、APACHEⅡ评分≥20、ICU治疗时间≥10 d、感染性休克患者占比高,差异有统计学意义(P<0.05)。结论及时转入ICU、配合早期手术、积极治疗全身系统性疾病和全身抗菌治疗是降低DNM死亡率的关键。     

What is the current evidence for antibiotic prophylaxis in orthopaedic surgery?

Surgical site infections (SSI) continue to represent a significant postoperative burden. SSI is associated with an increased risk of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) is used to reduce the risk of SSI. Several factors must be considered for appropriate antibiotic use: antibiotic selection, timing, and duration. The evidence and use of antibiotics differs between closed fractures, open fractures, arthroplasty and percutaneous fixation. The use of SAP is a balance between reducing the incidence of SSI whilst maintaining proper antibiotic stewardship to limit adverse effects and the emergence of antibiotic resistance. This paper will discuss the evidence for the use of SAP in orthopaedic surgery and the potential adverse effects of the injudicious use of antibiotics.     

Radiological signs indicating infection of dental origin in elderly Finns

Abstract

Objective. The aim was to assess the prevalence and background factors of signs of infection of dental origin in elderly Finns. Materials and methods. Every third birth cohort between 60–78 years of age (n = 1733) in a southern and a northern region in Finland were invited. Altogether, 1069 subjects attended radiographic examination. Of those, 660 were dentate and formed the study sample. In the analysis an index as a sum of points (scale per lesion 0–3, range 0–420) indicating the severity of infection from periapical lesions, furcal lesions, vertical bone pockets, horizontal bone loss and severe dental caries was used. Results. The index ranged individually from 0–91. Horizontal bone loss was found in 94%, vertical bone loss in 19%, periapical lesions in 46%, furcal lesions in 19% and carious lesions in 39% of the subjects. Only 3% of the subjects were free of dental infections, while 2% had mild, 17% moderate and 78% severe risk of dentogenic infection. Statistically significant background factors were region, level of education, number of regular drugs in use, drugs reducing salivation, alcohol consumption, cardiovascular disease, asthma and rheumatoid arthritis. Conclusions. Elderly Finns have high a prevalence of signs of infections of dental origin, which is associated with several socio-demographic and health-related factors.     

Extraradicular endodontic infections

Abstract Eight asymptomatic periapical inflammatory lesions which were refractory to conventional endodontic therapy were examined for the presence of bacteria. Access to the periapical lesions was gained using an aseptic surgical technique. Sterile currettes were used to take microbiological samples from the soft tissue lesions and scrapings from the surface of the root tips. Möller's VMGA III transport medium was utilized and the bacteriological samples were processed using a continuous anaerobic technique. Bacterial growth was evident in the samples from all 8 lesions. Two lesions exclusively yielded anaerobic bacteria and 5 lesions were heavily dominated by anaerobes. Black-pigmented Bacteroides species as well as anaerobic gram–positive rods and cocci were isolated. Staphylococcus epidermidis was recovered from 3 lesions and 2 Actinomyces species were isolated from 1 lesion. Facultative Streptococcus species were rare periapical isolates. Our study clearly showed that anaerobic bacteria are able to survive and maintain an infectious disease process in periapical tissues.     

口腔颌面部多间隙合并颈部及胸腔纵隔感染的回顾性分析

目的探讨口腔颌面部多间隙感染合并颈部及胸腔纵隔感染的诊断、治疗及预后。方法回顾性分析5例口腔颌面部多间隙感染合并颈部及胸腔纵隔感染患者的临床资料,分析其感染来源、临床特点、并发症及处理。结果 5例患者均为牙源性感染,临床表现为颌下、口底、颈部广泛肿胀,脓液形成。影像学显示2例纵隔及胸腔内有脓液形成。经过及时广泛切开引流及多学科综合治疗,4例痊愈,1例死亡。结论对于临床上颌面多间隙感染合并颈部广泛肿胀的病例应予高度重视,影像学检查在早期诊断中有很高价值,应尽早行多部位的切开引流及多学科综合治疗。     

口腔门诊诊疗操作感染控制管理

口腔门诊治疗多为倾入性操作,操作不仅直接接触患者唾液与血液,而且还可通过治疗时所用的设备、器械、材料以及产生的微生物气溶胶,引起间接接触,导致医患、患患间的交叉感染。为避免交叉感染在口腔门诊诊疗操作中发生,通过对国家颁布的医院感染控制管理相关法律法规的理论研究,参照发达国家的牙科感染控制指南,结合口腔门诊临床实践,文章总结了口腔门诊诊疗操作的感染防控措施,供口腔同行在工作中参考。