Fistules cutanées d'origine dentaire

Les fistules cutanées des dents et des maxillaires sont une des complications majeures de l'infection. La localisation dépend d'éléments anatomiques comme le rapport relatif des lésions avec les tables osseuses, le tissu cellulaire et les plans musculoaponévrotiques. Les étiologies correspondantes sont nombreuses avec dans un ordre croissant d'importance les dents nécrosées ou un échec de traitement canalaire, les parodontolyses, les inclusions et les nécroses osseuses. Le diagnostic différentiel est conséquent, les erreurs sont courantes! Elles se soldent par des échecs de traitement qui peuvent être délétères pour les tissus. D'où l'intérêt de bien conduire l'examen clinique afin de poser un diagnostic précis permettant de réaliser un traitement étiologique approprié et rapide

La fístula dentoalveolar: ¿un síntoma o una enfermedad? / The dentoalveolar sinus tract, a symptom or an illness?

La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.

Dental infection simulating skin lesion / Infecção dentária simulando uma lesão de pele

Orocutaneous fistulas or cutaneous sinus, a tract of dental origin, is an uncommon but welldocumented condition that usually requires emergency treatment. Such condition may be misdiagnosed by physicians and dentists and may sometimes be confused with bone and skin tumor, osteomyelitis, congenital fistula, salivary gland fistula, pyogenic granuloma, infected cyst, deep mycotic infection, and other pathologies. A case of facial sinus tract that was initially misdiagnosed by a physician as a nonodontogenic lesion is presented. Nonsurgical endodontic therapy was the treatment of choice for this case. Facial cutaneous sinus tracts must be considered of dental origin. Early diagnosis and prompt treatment minimize patient discomfort and esthetic problems, reducing the possibility of further complications such as sepsis and osteomyelitis.

A fístula orocutânea de origem dentária é uma condição incomum, bem documentada e geralmente requer tratamento de urgência. Esta condição pode ser confundida por médicos e dentistas com lesões ósseas, de pele, nas glândulas salivares, osteomielite, granuloma piogênico, cisto infectado, infecção fúngica, entre outras. Um caso de fístula facial que foi inicialmente diagnosticado por um médico como uma lesão não-odontogênica é apresentado e discutido. O tratamento de escolha foi a endodontia do dente envolvido, sem necessidade de cirurgia. A possibilidade de infecção dentária deve ser considerada em casos de fístula cutânea na região orofacial. O diagnóstico precoce e tratamento imediato podem minimizar o desconforto do paciente e problemas estéticos, além de reduzir a possibilidade de outras complicações, como osteomielite e sepse.

Management of lateral incisor with palatal radicular groove.

Palatal radicular grooves are developmental anomalies of maxillary incisors, which contribute to localized periodontitis resulting in loss of anterior teeth. Palatal radicular grooves, when present, act as a site for plaque accumulation and periodontal infection. They are easily overlooked as etiologic factors, as these grooves are covered by periodontal tissues. The clinician has to be alert and check for variations in the anatomy of the tooth as a cause of pulp necrosis in the anterior segment of the tooth, when other causes are ruled out. Recognition of palatal radicular grooves is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. This case report describes the diagnosis and management of a maxillary lateral incisor with necrotic pulp and localized periodontal destruction, associated with a palatal radicular groove.

Floor of the nose mucosa lysis and labial abscess caused by a bee sting

Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.

A ordem das himenópteras inclui abelhas, que possuem um ferrão na cauda capaz de de injetar veneno nos tecidos afetados. Fasciite necrosante, infecção fatal e assimetria hemifacial são algumas das reações incomuns relatadas após picada de himenópteras. Este estudo relata um caso de picada de abelha no assoalho da narina direita que simulou uma infecção odontogênica atingindo o lábio superior, o espaço canino e a cavidade nasal, como observado nos casos de infecção secundária após patologia pulpar ou periodontal dos dentes anteriores. Após completo exame clínico e radiográfico, foi descartada a hipótese de infecção odontogênica e foi estabelecido o diagnóstico de lise da mucosa do assoalho da narina e abscesso do lábio, após picada de abelha. Este caso foi tratado com sucesso com adequada incisão, drenagem e administração de antibióticos, sem outras complicações. Há vários relatos de reações incomuns resultantes de picada de himenópteras, porém poucos são relativos a infecções locais e nenhum se refere à localização anatômica afetada no paciente do caso aqui relatado. Diagnóstico e tratamento precoces preveniram a disseminação da infecção e a possibilidade de necrose tecidual, como já relatado em casos de fasciite necrosante.

Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial.

BACKGROUND: Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion. OBJECTIVES : The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth. SETTINGS AND DESIGN: This was a prospective, randomized clinical trial. MATERIALS AND METHODS: In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth) or electrosurgical technique (35 teeth). Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency. STATISTICAL ANALYSIS: The data were assessed with Fishers' Exact test. RESULTS: After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05). CONCLUSIONS: Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.

Diagnosis and treatment of mandibular extraoral sinus of periodontal origin in a 9-year-old boy: a case report.

Cutaneous sinus tract of dental origin is the commonest of the many types of sinus tracts that are formed on the face and neck. Cutaneous sinus tracts may originate from local chronic osteomyelitis (Garre's osteomyelitis). Although the etiological factor is usually periapical infection, they are seldom of periodontal origin. Conventional periapical and panoramic roentgenograms are generally insufficient for diagnosis and treatment planning of cutaneous sinus tracts of periodontal origin. In the present case, computed tomography was used for diagnosis, and osteomyelitis was managed by periodontal treatment.

Reabsorción dentinaria interna: reporte de un caso / Internal dentin resorption: report of a case

La reabsorción dentinaria interna es una patología pulpar ocasionada por un proceso inflamatorio del complejo pulpo-dentinario de etiología diversa, la cual por lo general cursa en un estadio asintomático y sólo se detecta por hallazgos radiográficos, que se manifiestan como un aumento de diámetro de la cámara pulpar o conducto radicular. Sin embargo, en ocasiones esta patología presenta comunicación al periodonto, en donde se pueden encontrar manifestaciones clínicas, como inflamación de la encía, tracto fistuloso y en ocasiones coloración rosada en la corona del diente. Debido a la naturaleza y evolución de esta patología, el procedimiento endodóntico de limpieza, conformación y sellado tridimensional se puede tornar complicado. En este trabajo se presenta el manejo no quirúrgico de un caso clínico de reabsorción dentinaria interna con comunicación al periodonto

Reabsorción radicular cervical: reporte de dos casos clínicos / Cervical root resorption: report of two cases

Las reabsorciones cervicales son entidades patológicas de etiología no pulpar, ocasionadas por procesos inflamatorios tardíos a nivel cervical del cemento radicular, lo que hace complicado su diagnóstico. En el presente trabajo se presenta el manejo de dos casos clínicos de reabsorciones radiculares cervicales

Unusual presentation of mandibular extraoral sinus in a fourteen year old girl: a case report.

A case of fourteen year old healthy girl with complaint of a discharging sinus on the lower right side of face is reported. All teeth were vital and there was no evidence of periodontitis. There was no history of extraction of a tooth. Total leucocyte count, differential leucocyte count, fasting blood sugar, chest x-ray and routine urine examination were within normal limits. Actinomycosis and scrofuloderma which simulate such a condition were ruled out by culture study. The intraoral periapical x-ray of mandibular molar showed questionable periapical changes at the time of presentation. But definite osteolysis was observed in the repeat radiograph after three months. It was decided to extract the second molar and curette the sinus tract. The extraction proved to be difficult. On examination of the extracted tooth, it was found that the mandibular second molar and second premolar were fused together. The radiograph of the tooth taken after extraction showed confluence of the premolar pulp with the periodontal membrane. On follow up, the lesion was found to heal satisfactorily.