Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey / Indicação dos antibióticos em Endodontia por dentistas colombianos com diferentes níveis de formação: uma pesquisa por questionário

ABSTRACT Aim: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. Materials and method: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. Results: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master's and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master's and/or PhD degrees) (p < 0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. Conclusions: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics.

RESUMO Objetivo: Este estudo investigou como dentistas colombianos com diferentes níveis acadêmicos indicaram antibióticos com fins terapêuticos em Endodontia. Materiais e método: Realizou-se um levantamento transversal com 559 dentistas. Foi enviado um questionário online. Resultados: Foram respondidos 320 questionários (57,2%). Houve diferenças significativas entre os profissionais com diferentes níveis de formação. Para pulpite irreversível, 140 (43,7%) dentistas afirmaram indicar antibióticos (57,5% clínicos gerais, 20,1% especialistas e 38,9% com mestrado e/ou doutorado), enquanto para periodontite apical sintomática, 183 (57,2%) prescrevem estes medicamentos (74,1% clínicos, 28,4% especialistas e 50,0% com mestrado e doutorado) (p < 0,05). A amoxicilina foi a mais indicada entre os profissionais, e sua associação com ácido clavulânico foi a mais referida para abscesso perirradicular agudo com acometimento sistêmico. Conclusões: Os maiores equívocos na prescrição de antibióticos ocorreram com os clínicos gerais. Considerando todas as condições clínicas que não requerem antibióticos, 60% dos clínicos gerais e 34% dos especialistas, em média, indicaram estes medicamentos.

Análise de prontuários de pacientes com infecções odontogênicas atendidos no serviço hospitalar / Análisis de registros de pacientes con infecciones dentales atendidos en el servicio de hospital / Analysis of records of patients with dental infections care at the hospital service

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)

Henoch-Schönlein Purpura (Childhood Immunoglobulin A Vasculitis) caused by dental infection in one of fraternal twins: A case report

@#Henoch-Schönlein purpura (HSP) is the most common form of vasculitis in children that is clinically characterized by the classic triad of palpable purpura, joint symptoms, and abdominal pain. A 6-year-old girl, one of fraternal twins, was admitted to the Pediatric Department, Universitas Airlangga with fever, rashes on legs and arms and intermittent mild abdominal pain. She had multiple purpuric rashes on her extremities, abdomen and buttocks. Laboratory investigation revealed immunoglobulin A level of 289.6 mg/dL. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous methylprednisolone. She was discharged after three days with normal physical examination and laboratory findings. Intraoral examination showed dental infection in the upper tooth region. The paediatrician suspected a correlation between HSP and her dental infection. The dental infection and genetic susceptibility may be the stimulant factors for the autoimmune reactions that caused HSP vasculitis. Hence, it might be useful to investigate the presence of dental infection in the etiology of HSP cases.

Multiple Brain Abscesses Secondary to Odontogenic Infection: A Clinical Case Report

Introduction Cerebral abscess is a suppurative infection of the cerebral parenchyma, which may occur due to contiguity, hematogenous dissemination of distant foci, secondary to open traumatic brain injuries, or be idiopathic. Clinical Case A 63-year-old male patient sought assistance due to a severe headache in the frontal region associated with chills and lack of appetite that started four days before. Clinical examination of the patient showed no significant changes. Imaging and laboratory tests on admission showed only nonspecific changes, such as leukocytes 18,540, platelets 517,000, and c-reactive protein 2,0. In such case,magnetic resonance imaging (MRI) of the skull was performed with contrast, showing the presence of expansive lesions compatible with multiple brain abscesses in the right parietooccipital region. Discussion After excluding the main focus of hematogenous dissemination and in view of the identification of the agent Streptococcus intermedius by means of secretion culture collected through a surgical method, the hypothesis of abscess due to contiguous dental pyogenic foci was pointed out. Conclusion Dental evaluation showed multiple foci of infection with periodontitis and dental abscess, which were treated along with the use of antibiotics directed to the etiologic agent.

Clinical Management of Orofacial Odontogenic Infection: A Four Year Retrospective Study

ABSTRACT@#Orofacial odontogenic infection, although arises from dental origin, can extend into the facial spaces and lead to debilitating complications. This study analysed the clinical pattern and management of orofacial odontogenic infection in a tertiary hospital namely Hospital Raja Permaisuri Bainun in Perak, Malaysia. We investigated any associations between socio-demographic factors, diabetic, comorbidities, smoking, pregnancy, antibiotic resistance, number and type of space infected towards prolonged hospital stay. All adult patients with orofacial odontogenic infections treated by Department of Oral and Maxillofacial Surgery from 2014 to 2018 were included. Clinical patterns were evaluated. Statistical analysis was performed to measure various variables towards prolonged hospital stay. A total of 154 patients (78 male, 76 female) were included in this study with mean age of 37.95 ± 14.9 years. Key factors of orofacial odontogenic infection requiring admissions were swelling, pain, trismus, odynophagia, reduced oral intake, raised floor of mouth and dyspnea. Among inpatients, three factors were significantly associated with prolonged hospital stay, namely antibiotic resistance, multiple space and secondary space infection. Local prevalence data was reported. Pus culture and sensitivity tests were recommended for all inpatients with multiple space and secondary space involvement, in order to rule out antibiotic resistance and to improve recovery rate.

Isolated Meningitis and Lacrimal Gland Abscess due to Odontogenic Sinusitis: Case Report / Meningitis Aislada y Absceso de la Glándula Lagrimal debido a Sinusitis Odontogénica: Reporte de un Caso

ABSTRACT: Our objective was report an extremely rare case of isolated meningitis and suppurative dacrioadenitis as consequences of odontogenic sinusitis. We describe the diagnostic tools including imaging and culture, as well as surgical treatment and follow-up. Our final diagnosis was odontogenic sinusitis caused by Streptococcus Anginosus complicated by isolated meningitis and lacrimal gland abscess. Urgent surgical treatment to restore the paranasal sinuses and drainage of the lacrimal gland was performed. Culture from purulent material collected from maxillary sinus indicated the targeted therapy. Clinical assessment and imaging obtained 20 days after surgery demonstrated successful results. This case emphasizes the importance of evaluating intracranial complications of rinosinusitis, the need to search for a dental infection when a maxillary sinusitis is encountered, the key role of a thorough diagnostic workup in order to plan a comprehensive and effective surgical treatment, as well as targeted medical therapy.

RESUMEN: En este estudio se informa un caso extremadamente raro de meningitis aislada y dacrioadenitis supurativa, como consecuencia de sinusitis odontogénica. Describimos las herramientas de diagnóstico que incluyen imágenes y cultivo, como también el tratamiento quirúrgico y el seguimiento. El diagnóstico final fue de sinusitis odontogénica causada por estreptococo anginoso complicado por una meningitis aislada y el absceso de la glándula lagrimal. Se realizó un tratamiento quirúrgico de urgencia para restaurar los senos paranasales y drenar la glándula lagrimal. Se determinó el tratamiento de acuerdo a los resultados de cultivo del seno maxilar. La evaluación clínica y las imágenes obtenidas 20 días después de la cirugía demostraron resultados exitosos. Es importante la evaluación de las complicaciones intracraneales de la rinosinusitis además de la necesidad de considerar una infección dental frente a una sinusitis maxilar. Por otra parte, es clave una evaluación exhaustiva de diagnóstico para planificar un tratamiento quirúrgico completo y efectivo, así como el tratamiento médico.

Fasceíte necrotizante cervical: relato de caso / Cervical necrotizing fasciitis: case report

Introdução: A Fasceíte Necrotizante Cervical é uma infecção rara, geralmente com evolução rápida e progressiva da fáscia superficial e do tecido adiposo subcutâneo. Pode se desenvolver a partir de uma infecção odontogênica que se dissemina para os planos faciais e profundos. O presente trabalho tem por objetivo relatar um caso clínico de uma paciente do gênero feminino, 49 anos de idade, atendida na Emergência do Hospital Getúlio Vargas-PE, com quadro clínico sugestivo de Fasceíte Necrotizante Cervical de origem Odontogênica. Relato de caso: O tratamento proposto foi antibioticoterapia parenteral de amplo espectro, desbridamento cirúrgico radical com instalação de dreno de penrose transfixante submandibular direito, múltiplas exodontias para remoção do foco primário da infecção, além de curativos orientado pela equipe de infectologia. Considerações finais: Excepcionalmente, as Fasceítes Necrotizantes Cervicais devem ter diagnóstico e manejo imediato, devido aos altos índices de destruição, rápida progressão e mortalidade. Nos casos de Fasceíte Necrotizante de origem odontogênica, a antibioticoterapia, remoção do(s) focos(s) de infecção, desbridamento cirúrgico e monitoramento intensivo constituem a terapêutica adequada... (AU)

Introduction: Cervical Necrotizing Fasciitis is a rare infection, usually with rapid and progressive evolution of the superficial fascia and subcutaneous adipose tissue. It can develop from an odontogenic infection that spreads to the facial and deep planes. This study aims to report a clinical case of a 49-year-old female patient, seen at the Emergency Department of Hospital Getúlio Vargas-PE, with a clinical condition suggestive of Cervical Necrotizing Fasciitis of Odontogenic origin. Case report: The proposed treatment was broad-spectrum parenteral antibiotic therapy, radical surgical debridement with the installation of a right submandibular transfixing penrose drain, multiple extractions to remove the primary focus of the infection, in addition to curatives guided by the infectology team. Final considerations: Exceptionally, cervical necrotizing fasciitis must have an immediate diagnosis and management, due to the high rates of destruction, rapid progression and mortality. In cases of Necrotizing Fasciitis of odontogenic origin, antibiotic therapy, removal of the foci (s) of infection, surgical debridement and intensive monitoring constitute the appropriate therapy... (AU)

Medidas de precaução padrão adotadas em uma clínica escola de graduação em Odontologia / Standard precautionary measures adopted in a clinical school of graduation in Dentistry

Introdução: Precauções padrão(PP) são normas de prevenção que devem ser utilizadas na assistência a todos os pacientes, independente de seu diagnóstico sorológico prévio. Dentre as PP temos medidas simples como a lavagem das mãos, o uso adequado de todos os equipamentos de proteção individual (EPIs) e a imunização contra patógenos que podem ser transmitidos durante acidentes de trabalho com material biológico. Objetivo: Verificar ações de precaução padrão em biossegurança realizadas por docentes e discentes em clínica escola, para controle de infecção durante atendimento odontológico. Material e Métodos: Realizou-se pesquisa com delineamento transversal descritiva. Os dados foram coletados por meio de dois questionários, um para 21 docentes coordenadores das disciplinas clínicas do 3º ao 9º períodos da graduação em Odontologia e outro para sete discentes, líderes de turmas. A análise estatística foi realizada através do programa IBM SPSS versão 22.0. Resultados: A maioria dos entrevistados era do gênero feminino. Todos os discentes e 95,2% dos docentes fazem uso rotineiro de EPIs. Dentre os professores pesquisados, 52,4% já sofreram acidente com perfurocortantes, o que também foi observado em 14,3% dos acadêmicos. Os 21 docentes e a maioria dos discentes conheciam os procedimentos a serem realizados após acidentes com exposição sanguínea. A maioria dos entrevistados relatou conhecer o protocolo de biossegurança e as normas para controle de infecção cruzada. Conclusão: Grande parte dos pesquisados relataram conhecer as normas de biossegurança, no entanto os mesmos ainda sentem necessidade de aprimorar no que se refere ao tema investigado. É relevante estimular a revisão de protocolos para controle de infecções em Instituições de Ensino Superior em Odontologia.

Introduction: Standard precautions (SP) are prevention standards that should be used to assist all patients. SP are used regardless of previous serological diagnosis of the patients. Among the SP we have simple measures such as hand washing, proper use of all personal protective equipment (PPE) and immunization. Objective: To verify standard precautionary actions in biosafety carried out by teachers and students in clinical school. Material andMethods: Research with descriptive cross-sectional design. The data were collected through two questionnaires. The questionnaire was applied to 21 coordinating teachers of the clinical disciplines from the 3rd to the 9th graduation period in dentistry and another for 7 students, the leader of these classes. A statistical analysis was done through the IBM SPSS version 22.0 program. Results: The majority of respondents were female. All students and 95.2% of teachers routinely use all PPE. Of the teachers, 52.4% and 14.3% of the academics already suffered the accident with sharps. All the teachers and most of the students know the procedures in which they are submitted to accidents with the blood disease. Most interviewees reported on the biosafety protocol and criteria for cross-infection control. Conclusion: Most of the respondents reported knowing biosafety standards. However they still feel the need to improve on the subject investigated. It is relevant to stimulate the revision of protocols for infection control in Higher Education Institutions in Dentistry.

Adhesion and Biofilm Formation Abilities of Bacteria Isolated from Dental Unit Waterlines / 치위생과학회지

The purpose of our study is to compare the adhesion and biofilm formation abilities of isolates from water discharged from dental unit waterlines (DUWLs). Bacteria were isolated from a total of 15 DUWLs. Twelve isolates were selected for the experiment. To confirm the adhesion ability of the isolates, each isolate was attached to a glass coverslip using a 12-well plate. Plates were incubated at 26℃ for 7 days, and the degree of adhesion of each isolate was scored. To verify the biofilm formation ability of each isolate, biofilms were allowed to form on a 96-well polystyrene flat-bottom microtiter plate. The biofilm accumulations of all isolates formed at 26℃ for 7 days were identified and compared. A total of 56 strains were isolated from 15 water samples including 12 genera and 31 species. Of the 56 isolates, 12 isolates were selected according to the genus and used in the experiment. Sphingomonas echinoides, Methylobacterium aquaticum, and Cupriavidus pauculus had the highest adhesion ability scores of +3 among 12 isolates. Among these three isolates, the biofilm accumulation of C. pauculus was the highest and that of S. echinoides was the third-most abundant. The lowest biofilm accumulations were identified in Microbacterium testaceum and M. aquaticum. Most isolates with high adhesion ability also exhibited high biofilm formation ability. Analysis of adhesion and biofilm formation of the isolates from DUWLs can provide useful information to understand the mechanism of DUWL biofilm formation and development.

Establishment of a Dental Unit Biofilm Model Using Well-Plate / 치위생과학회지

The water discharged from dental unit waterlines (DUWLs) is heavily contaminated with bacteria. The development of efficient disinfectants is required to maintain good quality DUWL water. The purpose of this study was to establish a DUWL biofilm model using well-plates to confirm the effectiveness of disinfectants in the laboratory. Bacteria were obtained from the water discharged from DUWLs and incubated in R2A liquid medium for 10 days. The bacterial solution cultured for 10 days was made into stock and these stocks were incubated in R2A broth and batch mode for 5 days. Batch-cultured bacterial culture solution and polyurethane tubing sections were incubated in 12-well plates for 4 days. Biofilm accumulation was confirmed through plating on R2A solid medium. In addition, the thickness of the biofilm and the shape and distribution of the constituent bacteria were confirmed using confocal laser microscopy and scanning electron microscopy. The average accumulation of the cultured biofilm over 4 days amounted to 1.15×10⁷ CFU/cm². The biofilm was widely distributed on the inner surface of the polyurethane tubing and consisted of cocci, short-length rods and medium-length rods. The biofilm thickness ranged from 2 µm to 7 µm. The DUWL biofilm model produced in this study can be used to develop disinfectants and study DUWL biofilm-forming bacteria.

A Case of Endoscopic Transethmoidal Drainage of Subdural Abscess Originated from Dental Infection / 대한이비인후과학회지

Subdural empyema is fulminating purulent infection that develops between the dura and the arachnoid membranes. It is rare but one of the most immediate of neurosurgical emergencies, hence the importance of proper diagnosis and early intervention. Most subdural empyema complicated in the ENT field originate from sinonasal or otologic infections rather than dental infections. In our case of 64-years-old male, who was admitted with headache and fever, the diagnosed subdural empyema originated from odontogenic parapharyngeal abscess. We report that the case was successfully managed after urgent surgical drainage by endoscopic transethmoidal approach with long term intravenous antibiotics.

Developing a Dental Unit Waterline Model Using General Laboratory Equipments / 치위생과학회지

Water supplied through dental unit waterlines (DUWLs) has been shown to contain high number of bacteria. To reduce the contamination of DUWLs, it is essential to develop effective disinfectants. It is, however, difficulty to obtain proper DUWL samples for studies. The purpose of this study was to establish a simple laboratory model for reproducing DUWL biofilms. The bacteria obtained from DUWLs were cultured in R2A liquid medium for 10 days, and then stored at −70℃. This stock was inoculated into R2A liquid medium and incubated in batch mode. After 5 days of culturing, it was inoculated into the biofilm formation model developed in this study. Our biofilm formation model comprised of a beaker containing R2A liquid medium and five glass rods attached to DUWL polyurethane tubing. Biofilm was allowed to form on the stir plate and the medium was replaced every 2 days. After 4 days of biofilm formation in the laboratory model, biofilm thickness, morphological characteristics and distribution of the composing bacteria were examined by confocal laser microscopy and scanning electron microscopy. The mean of biofilm accumulation was 4.68×10⁴ colony forming unit/cm² and its thickness was 10~14 µm. In our laboratory model, thick bacterial lumps were observed in some parts of the tubing. To test the suitability of this biofilm model system, the effectiveness of disinfectants such as sodium hypochlorite, hydrogen peroxide, and chlorhexidine, was examined by their application to the biofilm formed in our model. Lower concentrations of disinfectants were less effective in reducing the count of bacteria constituting the biofilm. These results showed that our DUWL biofilm laboratory model was appropriate for comparison of disinfectant effects. Our laboratory model is expected to be useful for various other purposes in further studies.

Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients

OBJECTIVES: This study was performed to evaluate the impact of glycosylated hemoglobin (HbA1c) level on characteristics and prognosis of maxillofacial fascial infection in diabetic patients. MATERIALS AND METHODS: We reviewed the medical records of 72 patients (35 patients with HbA1c lower than 7.0% and 37 patients with HbA1c higher than 7.0%) diagnosed with maxillofacial fascial space infection and hospitalized for treatment at the Department of Oral and Maxillofacial Surgery in Dankook University Hospital (Cheonan, Korea) from January 2005 to February 2014. We compared demographics, parameters of glucoregulation (HbA1c), laboratory parameters of inflammation (white blood cell [WBC], C-reactive protein [CRP] count), type and number of involved spaces, type and number of antibiotics, period of hospitalization, number of surgical operations, need for tracheostomy, complications, computed tomography (CT), and microorganisms between the two groups. RESULTS: Compared with the well-controlled diabetes mellitus (DM) group (HbA1c or =7.0%) DM group had the following characteristics: longer hospitalization periods, higher values of laboratory parameters of inflammation (WBC, CRP count) at the time of admission, higher number of antibiotics prescribed, more frequent complications, frequent deep neck space involvement, and distinctive main causative microorganisms. As the HbA1c level increases, hospitalization periods and incidence of complications increase gradually. CONCLUSION: This retrospective study suggests that regulation of DM significantly impacts maxillofacial fascial infection. Poorly controlled DM with high HbA1c level negatively influences the prognosis of infection.

Oral cavity infection: an adverse effect after the treatment of oral cancer in aged individuals

Objective: The immune compromised patients after treatment of oral cancer may have a chance of infection by drug-resistant opportunistic microbes. We investigated the occurrence of opportunistic microorganisms in aged individuals receiving follow-up examinations after treatment of oral cancer in China. Material and Methods: These patients were used as test group and the respective age grouped healthy individuals as control group. In this study, the oral cavity microorganisms such as bacteria and yeast were taken for the analysis. After the screening of representative microorganisms, their aptitude of pervasiveness against drugs was studied. Here, we used antimicrobial agents which are common in clinical practice. We also performed studies to investigate the presence of toxin genes in methicillin-resistant S. aureus (MRSA). Results: The results indicate that the prevalence of drug-resistant microbes was more pronounced in oral cancer patients after initial treatment above 70 years old. The oxacillin resistance of S. aureus isolate confirms that the prevalence of MRSA is increasing in accordance to age-factor and immune compromise in elderly patients. Conclusions: This study reveals the occurrence of drug-resistant opportunistic microorganisms in oral cavity after treatment for oral cancer in aged individuals. Special attention should be directed to MRSA during the treatment of oral cancer, and to realize the fact of immune compromise in elderly patients. .

Effect of a multi-layer infection control barrier on the micro-hardness of a composite resin

OBJECTIVE: The aim of this study was to evaluate the effect of multiple layers of an infection control barrier on the micro-hardness of a composite resin. MATERIAL AND METHODS: One, two, four, and eight layers of an infection control barrier were used to cover the light guides of a high-power light emitting diode (LeD) light curing unit (LCU) and a low-power halogen LCU. The composite specimens were photopolymerized with the LCUs and the barriers, and the micro-hardness of the upper and lower surfaces was measured (n=10). The hardness ratio was calculated by dividing the bottom surface hardness of the experimental groups by the irradiated surface hardness of the control groups. The data was analyzed by two-way ANOVA and Tukey's HSD test. RESULTS: The micro-hardness of the composite specimens photopolymerized with the LED LCU decreased significantly in the four- and eight-layer groups of the upper surface and in the two-, four-, and eight-layer groups of the lower surface. The hardness ratio of the composite specimens was <80% in the eight-layer group. The micro-hardness of the composite specimens photopolymerized with the halogen LCU decreased significantly in the eight-layer group of the upper surface and in the two-, four-, and eight-layer groups of the lower surface. However, the hardness ratios of all the composite specimens photopolymerized with barriers were <80%. CONCLUSIONS: The two-layer infection control barrier could be used on high-power LCUs without decreasing the surface hardness of the composite resin. However, when using an infection control barrier on the low-power LCUs, attention should be paid so as not to sacrifice the polymerization efficiency.

Assessment of microbiological contamination of radiographic devices in School of Dentistry / Avaliação da contaminação microbiológica em equipamentos radiográficos de uma Faculdade de Odontologia

Although dental radiology is not directly involved in either invasive procedures or in the use of piercing-cutting material, the high-touch areas of dental x-ray device, including radiographic films, are a potential source of infection. The purpose of this study was to assess the amount of cross infection present in the dental x-ray devices of the School of Dentistry of the Federal University of Maranhão by investigating the presence of pathogenic microorganisms in high-touch areas of dental x-ray devices (tube head, timer button, portable processing box and lead apron). Twenty surfaces of 4 dental radiology clinics were cultured in different media. The results showed that 70 percent of the surfaces had contamination. All thedental x-ray devices assessed were contaminated (tube head, timers or both) as well as all the lead aprons. The portable processing boxes showed 75 percent of contamination. The groups found no statistical significance between the different surfaces assessed and the microorganisms. The highest frequent microorganisms found were from Staphylococcus genus. The authors concluded that because of the high incidence of contamination found, the x-ray devices used in the dental clinics could be at potential risk of cross infection, demonstrating the necessity for applying biosecurity practices whentaking radiographic and during radiographic processing.

Embora a Radiologia odontológica não envolva a realização de procedimentos invasivos e o uso de instrumentos perfurocortantes, os equipamentos, acessórios e filmes utilizados durante os procedimentos radiográficos podem transmitir doenças infecciosas. O objetivo deste estudo foi avaliar a contaminação microbiológica em equipamentos radiográficos do Curso de Odontologia da Universidade Federal do Maranhão, investigando a presença de microrganismos patogênicos em áreas de contato frequente com o operador (cabeçote e disparador do aparelho de raios X; manga de acesso e tampa da câmara escura portátil e borda superior do avental de chumbo). Vinte superfícies de quatro salas de exame radiográfico foram avaliadas com a utilização de diferentes meios de cultura. Os resultados revelaram um percentual de contaminação de 70%. Todos os aparelhos de raios X avaliados apresentaram contaminação (no cabeçote, no disparador, ou em ambos), assim como todos os aventais de chumbo. Em relação às câmaras escuras, 75% mostraram contaminação. Não houve diferença estatisticamente significante entre a contaminação nas diferentes superfícies analisadas, e os microrganismos encontrados com maior frequência (55%) pertencem ao gênero Staphylococcus. Diante do alto índice de contaminação encontrado, conclui-se que as superfícies dos equipamentos utilizados na Radiologia odontológica podem servir como vetores de infecção cruzada, demonstrando a necessidade do emprego rotineiro de medidas de biossegurança durante a realização das incidências e processamento radiográficos.

Comportamiento clínico de la celulitis facial odontógena: Hospital Universitario General Calixto García / Clinical behavior of odontogenic facial cellulitis: General Calixto García University Hospital

Las infecciones dentarias afectan a un gran número de personas a nivel mundial, a pesar de ser prevenibles, por lo que nos sentimos motivados a realizar un estudio observacional, descriptivo, transversal para caracterizar el comportamiento de la celulitis facial odontogénica en los pacientes hospitalizados en el Hospital General Calixto García. La muestra estuvo constituida por 75 pacientes que presentaron síntomas y signos de celulitis para lo cual se les realizó un minucioso examen físico general y regional, tanto extraoral como intraoral. El sexo masculino resultó ser el màs afectado con 42 pacientes y el grupo de edades màs dañado fue el de 35 a 59 años. La región anatómica superficial externa mentoniana estuvo involucrada en 36 casos. La misma región mentoniana pero en su porción vestibular inferior se destacó con 51 pacientes. De las regiones anatómicas profundas, la submandibular predominó en 51 individuos para un 68,0 por ciento. Predominó la pulpa dental necrótica y los restos radiculares como mecanismos patogénicos fundamentales. El diagnóstico clínico de celulitis facial odontógena moderada resaltó en 40 pacientes (53,3 por ciento)(AU)

Dental infections involved many persons at worldwide level, being in many occasions avoidable, thus, a cross-sectional, descriptive and observational study was conducted to characterize the odontogenic facial cellulitis course in patients admitted in General Calixto García University Hospital. Sample included 75 patients with symptoms and signs of cellulitis underwent a meticulous intraoral and extraoral regional and general physical examination, where male sex was the more involved with 42 patients and the age group of 35-39 years with 35 patients. The menton external superficial anatomical region includes 36 cases, and of this kind but the internal one, the inferior vestibular sulcus had 51 cases. From the deep anatomical regions, the submandibular one had 51 cases for a 68,0 percent with predominance of necrotizing dental pulp and the radicular debris as main pathogenic mechanisms. Clinical diagnosis of moderate odontogenic facial cellulitis was significant with 40 patients (53.3 percent). Data were showed in statistical tables and charts and as abstract measure we used the percentage of qualitative variables(AU)

Evaluation of glutaraldehyde as antimicrobial agent used in intraoral x-ray film holder bite block / Avaliação do glutaraldeído como agente microbiano usado em blocos de mordida de posicionadores para filmes radiográficos

The aim of the present study was to evaluate sterilizationof intraoral X-ray film holder bite blocks by immersionin 2% glutaraldehyde solution for 10 hours. Seventeen intraoral X-ray film holder bite blocks were inoculated in Tryptic Soy Broth media containing one of the tested microorganisms(S. aureus and B. subtilis) and were incubated at 37 °C for 48 hours. One bite block was used as a positive control. The other blocks were immersed in 2% glutaraldehydefor 10 hours and one block was used as a negative control. Fifteen bite blocks were removed and five of them were washed with 70% alcohol, five blocks were washed with distilled water and the others were washed in running water. Bacterial growth was observed after incubation. No bacterial growth was found on any block, however, on the blocks that were washed with running water and distilled water, various colonies of fungi were observed, while no growth was found on the blocks which underwent a final wash with 70% alcohol. The 2% glutaraldehyde solution was effective for the sterilization of intraoral X-ray film holder bite blocks when they were immersed for 10 hours using 70% alcohol during the last wash.

Cutaneous Fistula of Dental Origin, Case Report

Most common etiologic factor of supprative cutaneous fistula is the extension of chronic infection of dental origin. Skin opening is commonly located on chin and jaw, occasionally neck and chest. Because the skin opening may be remote from the infection origin, the physicians often incorrectly diagnose and also treat ineffectively. Rarely large necrotic defect is caused by ineffective treatment of cutaneous fistula. Recognition and treatment of the underlying dental infection is required to allow the resolution of the associated skin lesion. In the presence of a cutaneous fistula around the face and neck, it is always useful to perform routine dental examination and radiologic evaluation to exclude an odontogenic background. From March 2001 to April 2002, we were experienced 5 cases cutaneous fistula of dental orgin. We report the 3 patients, two are simple fistula and one is a complicated case which is developed necrotizing fascitis on chin and neck.