Odontogenic Maxillofacial Infections in a High-level Hospital: Orofacial Pain and Related Conditions

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient 's systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

Infecção cervicofacial grave de origem odontogênica: relato de caso / Severe cervicofacial infection of odontogenic origin: case report

Introdução: as infecções odontogênicas tem como principal origem a necrose pulpar com invasão bacteriana no tecido periapical e periodontal, podendo levar à formação de quadros de celulite e posteriormente de abscesso, além disso, possuem o potencial de disseminar-se pelos espaços faciais profundos e comprometer a vida do paciente. Complicações graves, decorrentes dos quadros de infecções odontogênicas, podem ocorrer, se o tratamento instituído não for adequado, como: trombose do seio cavernoso, abscesso cerebral, mediastinite e até óbito. Objetivo: discutir o manejo das infecções odontogênicas disseminados em espaços faciais profundos, através do relato de caso clínico. Caso clínico: paciente de 52 anos, portador de diabetes mellitus tipo 2, com infecção odontogênica, no exame clínico inicial apresentava trismo, disfonia, dispneia, disfagia, hiperemia e edema em lado esquerdo da face, envolvendo os espaços canino, bucal, submandibular e cervical além de unidades dentárias com foco infeccioso. Em exame de tomográfica computadorizada, observou-se desvio da via área, presença de um grande volume de gás e de lojas de infecção. Optou-se como tratamento a remoção dos focos dentários e drenagem intraoral foi realizada pela equipe da CTBMF com anestesia local e posteriormente drenagem sob anestesia geral, intubação com uso de fibroscopia pela equipe de cirurgia cabeça e pescoço. Considerações finais: as infecções odontogênicas que envolvem espaços faciais profundos devem ser tratadas com urgência e o tratamento de escolha dessa condição deve ser remoção imediata do foco infeccioso, exploração e drenagem rápida e agressiva dos espaços faciais envolvidos e associação com antimicrobianos de amplo espectro com características bactericidas.(AU)

Introduction: the main origin of odontogenic infections is pulp necrosis with bacterial invasion in the periapical and periodontal tissue, which may lead to the formation of cellulitis and later abscess, besides having the potential to spread to the deep facial spaces and compromise the patient's life. Severe complications from dental infections may occur if the treatment is not appropriate, such as cavernous sinus thrombosis, brain abscess, mediastinitis and even death. Objective: to discuss the management of disseminated odontogenic infections in deep facial spaces through a case report. Case report: a 52-year-old patient with type 2 diabetes mellitus, with odontogenic infection, presented at the initial clinical examination trismus, dysphonia, dysphagia, dysphagia, hyperemia and edema on the left side of the face involving the canine, buccal, submandibular and cervical spaces. of dental units with infectious focus. CT scan revealed deviation of the airway, presence of a large volume of gas and infection stores. The treatment was chosen to remove dental foci and intraoral drainage was performed by the CTBMF team under local anesthesia and subsequently under general anesthesia drainage, intubation with fibroscopy by the head and neck surgery team. Final considerations: odontogenic infections involving deep facial spaces should be treated urgently and the treatment of choice for this condition should be immediate removal of the infectious focus, rapid and aggressive exploration and drainage of the involved facial spaces and association with broad-spectrum antimicrobials with bactericidal characteristics.(AU)

Knowledge and Attitudes Towards Antibiotic Prescribing Among Dentists in Sudan

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists' awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.

Diagnóstico diferencial da sinusite de origem odontológica por meio da tomografia computadorizada / Differential diagnosis of dental sinusitis with the aid of computed tomography

O objetivo do presente artigo é apresentar três casos clínicos com diagnóstico de sinusite de origem odontológica, ou síndrome endo-antral, um quadro inflamatório infeccioso de origem endodôntica que acomete dos tecidos e mucosa do seio maxilar adjacentes aos ápices radiculares.Os casos apresentados chamam a atenção para a dificuldade do diagnóstico apenas coma radiografia periapical e a importância da tomografia computadorizada como recurso auxiliar.

The aim of the current article is to report three clinical cases diagnosed as sinusitis of dental origin, or endo-antral syndrome, an inflammatory condition of endodontic infection origin that affects the tissues and mucosa of the adjacent maxillary sinus up to the root apex. The presented cases draw attention to the difficulty of diagnosis only with periapical radiography and the importance of computed tomography as an auxiliary resource.

Análise comparativa das alterações periapicais diagnosticadas pela técnica radiográfica do paralelismo e pelo mapeamento tomográfico cintilográfico (com e sem blindador de raios gama)J / Comparison analyzes of periapical alterations diagnosed by radiograph exam by the parallel technique and through scintigraphic tomographic mapping (with and without intra-oral apparatus)

O diagnóstico precoce de focos de infecção dentários é de fundamental importância para prevenir a ocorrência de maiores injúrias locais ou sistêmicas. Dentre os diversos métodos utilizados para complementar os achados radiológicos das alterações dentoalveolares surge uma alternativa: a cintilografia tomográfica (SPECT/CT), que permite a fusão de achados morfológicos com alterações metabólicas. Com o objetivo de estabelecer o diagnóstico precoce e acurado de processos infecciosos dentários, foram estudadas 320 áreas dentárias em mandíbula e maxila em (10 pacientes de ambos os sexos selecionados por meio de exames clínicos e radiológicos convencionais, seguidos de cintilografia tomográfica com e sem aparato blindador de raios gama. Os exames cintilográficos foram realizados no Serviço de Medicina Nuclear do Hospital Israelita Albert Einstein (HIAE). Para isso, foi administrado para cada paciente o radiofármaco tecnécio 99- metilenodifosfonato (99mTc-MDP) via endovenosa com a dose de 37mBq/3Kg de peso corporal do paciente. Após o período de acúmulo de três horas, foi realizado o protocolo de aquisição de imagens. Todas as imagens foram analisadas por um médico nuclear e um endodontista, com experiência em cintilografia tomográfica. O resultado obtido por meio do exame radiográfico intrabucal pela técnica periapical digital mostraram 6 imagens positivas, em um total de 1,87% da amostra; exame do mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gâma revelou 9 imagens positivas, correspondendo a 2,81% do total de áreas estudadas, havendo diferença estatisticamente significante ao nível de 95% pelo teste qui-quadrado. Pode-se concluir que o SPECT/CT permitiu identificar as alterações periapicais em maior número quando comparadas ao exame radiográfico periapical e ao mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gama; o exame de SPCET/CT além de mostrar imagens mais detalhadas...

The early diagnosis of cases with dental infection is very important to prevent the occurrence of major local or systemic injuries. With many methods used to complement the radiological findings of the bone alterations there's the tomographic scintigraphy witch allows the fusion of morphological and metabolic findings. With the objective of the establishment of early diagnosis and accurate dental infectious processes, it was studied 320 dental areas in maxilla and mandible (10 patients) selected randomly, through conventional radiological exams, followed by tomographic scintigraphy with and without intra-oral apparatus. The scintilographic exams were done at the Nuclear Medicine Service of Hospital Israelita Albert Einstein. For that, methylenediphosphonate-technetium-99m (99mTc-MDP) was dispensed intravenous. After the period of accumulation of 3 hours, the image acquisition protocol was taken. This protocol includes images from the top of the head to the neck. After the image analyzes, statistics was done. The intrabucal radiograph exam by the digital periapical technique showed 6 positive images, in a total of 1.87% of the total sample, Intra-oral apparatus showed 9 positive images, in a total os 2,81% of the sample and SPECT/CT exam revealed 15 positive images, corresponding to 4.28% of the total studied areas, showing statistical significance by the level of 95% of qui-square. We could conclude that SPECT/CT allowed identifying the endodontic infections in a larger number when compared with the radiograph exams; and the SPECT/CT exam showed to be of great interest by allowing the union of the diagnosis precocity with the image detail, presenting exact localization of inflammatory/infectious alterations due to the presence of the CT...

Análise comparativa das alterações periapicais diagnosticadas pela técnica radiográfica do paralelismo e pelo mapeamento tomográfico cintilográfico (com e sem blindador de raios gama)J / Comparison analyzes of periapical alterations diagnosed by radiograph exam by the parallel technique and through scintigraphic tomographic mapping (with and without intra-oral apparatus)

O diagnóstico precoce de focos de infecção dentários é de fundamental importância para prevenir a ocorrência de maiores injúrias locais ou sistêmicas. Dentre os diversos métodos utilizados para complementar os achados radiológicos das alterações dentoalveolares surge uma alternativa: a cintilografia tomográfica (SPECT/CT), que permite a fusão de achados morfológicos com alterações metabólicas. Com o objetivo de estabelecer o diagnóstico precoce e acurado de processos infecciosos dentários, foram estudadas 320 áreas dentárias em mandíbula e maxila em (10 pacientes de ambos os sexos selecionados por meio de exames clínicos e radiológicos convencionais, seguidos de cintilografia tomográfica com e sem aparato blindador de raios gama. Os exames cintilográficos foram realizados no Serviço de Medicina Nuclear do Hospital Israelita Albert Einstein (HIAE). Para isso, foi administrado para cada paciente o radiofármaco tecnécio 99- metilenodifosfonato (99mTc-MDP) via endovenosa com a dose de 37mBq/3Kg de peso corporal do paciente. Após o período de acúmulo de três horas, foi realizado o protocolo de aquisição de imagens. Todas as imagens foram analisadas por um médico nuclear e um endodontista, com experiência em cintilografia tomográfica. O resultado obtido por meio do exame radiográfico intrabucal pela técnica periapical digital mostraram 6 imagens positivas, em um total de 1,87% da amostra; exame do mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gâma revelou 9 imagens positivas, correspondendo a 2,81% do total de áreas estudadas, havendo diferença estatisticamente significante ao nível de 95% pelo teste qui-quadrado. Pode-se concluir que o SPECT/CT permitiu identificar as alterações periapicais em maior número quando comparadas ao exame radiográfico periapical e ao mapeamento cintilográfico dos ossos da face com a utilização do blindador de raios gama; o exame de SPCET/CT além de mostrar imagens mais detalhadas...

The early diagnosis of cases with dental infection is very important to prevent the occurrence of major local or systemic injuries. With many methods used to complement the radiological findings of the bone alterations there's the tomographic scintigraphy witch allows the fusion of morphological and metabolic findings. With the objective of the establishment of early diagnosis and accurate dental infectious processes, it was studied 320 dental areas in maxilla and mandible (10 patients) selected randomly, through conventional radiological exams, followed by tomographic scintigraphy with and without intra-oral apparatus. The scintilographic exams were done at the Nuclear Medicine Service of Hospital Israelita Albert Einstein. For that, methylenediphosphonate-technetium-99m (99mTc-MDP) was dispensed intravenous. After the period of accumulation of 3 hours, the image acquisition protocol was taken. This protocol includes images from the top of the head to the neck. After the image analyzes, statistics was done. The intrabucal radiograph exam by the digital periapical technique showed 6 positive images, in a total of 1.87% of the total sample, Intra-oral apparatus showed 9 positive images, in a total os 2,81% of the sample and SPECT/CT exam revealed 15 positive images, corresponding to 4.28% of the total studied areas, showing statistical significance by the level of 95% of qui-square. We could conclude that SPECT/CT allowed identifying the endodontic infections in a larger number when compared with the radiograph exams; and the SPECT/CT exam showed to be of great interest by allowing the union of the diagnosis precocity with the image detail, presenting exact localization of inflammatory/infectious alterations due to the presence of the CT.

Choque séptico por infecção odontogênica em paciente com diabetes melito tipo I / Odontogenic septic shock in patient with type 1 diabetes mellitus

O objetivo deste estudo é apresentar um caso de paciente com diabetes melito tipo I descompensado e infecção odontogênica severa que, apesar do tratamento, progrediu para choque séptico e óbito. Os achados clínicos e laboratoriais, diagnóstico e tratamento são apresentados e discutidos. A sepse é uma condição potencialmente fatal que ocorre quando mediadores químicos da inflamação são liberados na corrente sanguínea para combater a infecção e iniciam respostas inflamatórias sistêmicas. A sepse pode progredir para sepse severa e, finalmente, choque séptico, uma condição com altas taxas de mortalidade e pode estar associada às infecções dentárias. Infecções odontogênicas podem se disseminar para os espaços profundos do pescoço, resultando em complicações graves, especialmente em pacientes com doenças crônicas imunodepressoras. Cirurgiões-Dentistas e médicos devem ter conhecimento dos sinais e sintomas associados à condição e devem considerar o diagnóstico de sepse em pacientes com infecções odontogênicas, uma vez que o reconhecimento precoce e tratamento efetivo podem prevenir a morte.

The aim of this study is to present a case of a patient with poorly controlled type I diabetes mellitus and severe odontogenic infection that progressed to septic shock and succumbed despite therapy. Clinical and laboratory findings, diagnosis and treatment are presented and discussed. Sepsis is a potentially life-threatening condition that occurs when chemicals mediators of inflammation are released into the bloodstream to combat the infection and trigger inflammatory multi-system responses. Sepsis can progress to severe sepsis and finally septic shock, a condition with high mortality rates and may be associated with dental infections. Odontogenic infections can spread to deep neck spaces leading to severe complications, especially in patients with chronic systemic immunocompromised diseases. Dentists and physicians must be aware of the signals and symptoms associated with the disease and should consider the diagnosis of sepsis in patients with odontogenic infection once early recognition and effective management could prevent death.

Detección de microorganismos anaerobios en pacientes con pericoronaritis y sensibilidad a los antimicrobianos / Anaerobic microorganisms detection in patients with pericoronaritis and antimicrobial susceptibility

El propósito de este estudio fue la identificación de microorganismos anaerobios más frecuentemente encontrados en pericoronaritis y realizar pruebas de sensibilidad a los antimicrobianos. Se estudiaron los sacos pericoronarios del tercer molar en 20 pacientes. De las muestras recogidas en los 20 pacientes que presentaron pericoronaritis, solo en 7 (35%) hubo crecimiento de microorganismos anaerobios estrictos mientras que en los 13 restantes (65%) no se detectaron estos. En cuanto a las 12 cepas aisladas del saco pericoronario de los 7 pacientes, el microorganismo más frecuentemente encontrado fue Bifidobacterium spp en 5 casos (42%), Bifidobacterium adolescentis en 2 casos (17%), Veillonella spp en dos casos también (17%), Prevotella melaninogenica en 1 caso (8%), 1 caso Prevotella loescheii (8%) y en 1 caso a Prevotella oralis (8%). De los resultados obtenidos las bacterias anaerobias estrictas detectadas a partir de muestras de sacos pericoronarios fueron: Bifidobacterium spp., B. adolescentis, Veillonella spp, P. loeschii, P. melaninogenica y P. oralis.

Epidemiologia das infecções maxilofaciaistratadas num hospital público da cidadede São Paulo / Epidemiology of maxillofacial infections treated in a public hospital in the city of Sao Paulo

As infecções maxilofaciais são condições clínicas graves, de ocorrência relativamente comum,caracterizadas pela rápida disseminação do processo infeccioso aos tecidos adjacentes eespaços faciais da região de cabeça e pescoço. Sua causa é geralmente odontogênica. O objetivodeste estudo foi avaliar dados referentes às causas, características clínicas, manifestaçõesclínicas e eficácia do tratamento realizado em 42 pacientes admitidos com infecção maxilofacialno Departamento de Cirurgia Bucomaxilofacial do Hospital Tatuapé, São Paulo, no períodode março de 2005 a fevereiro de 2006. As infecções odontogênicas (83,30/0). com predomíniodas infecções periapicais, foram as principais causas das infecções maxilofaciais. As manifestaçõesclínicas mais comuns encontradas nos registros foram o edema acentuado (97,60f0), trismo(52,40f0) e prostração (47,60f0). Os pacientes diabéticos não compensados apresentaram tempode internação maior quando comparados ao dos pacientes não diabéticos (P = 0,001). Em 76,2%dos casos, o tratamento instituído foi a drenagem cirúrgica complementada por antibioticoterapiaendovenosa e remoção da causa. De acordo com o estudo realizado, pudemos concluirque houve predomínio de infecções maxilofaciais em adultos jovens, sendo as infecções odontogênicasas principais causas. O tratamento empregado foi efetivo na grande maioria dos casos.

Maxillofacial infections are severe clinical processes of relative occurrence characterizedbya rapid spreading of the infection into the neighboring tissues and to the fascial spaces ofthe head and neck region. Its cause is predominantly odontogenic. This study aimed to assess,retrospectively, data concern to the causes, clinical characteristics, clinical manifestations andtreatment efficacy in 42 in-patients with maxillofacial infection at the Department of Oraland Maxillofacial Surgery of Hospital Tatuapé, São Paulo, from March 2005 to February 2006.The odontogenic infections (mainly the periapical infections) accounted for 83.30f0 of the maxillofacialinfections. The most common clinical manifestations were exuberant edema (97.6%),trismus (52.40f0) and prostration (47.60f0). Uncontrolled diabetic patients showed a lonqer-recoveringperiod at the hospital when compared with that of nondiabetic patients (P = 0.001). In76.20f0 of the cases, the treatment proceeding was surgical drainage coupled with antibiotic intravenoustherapy and cause resolution. Summarizing the main findings, this study showed thatmaxillofacial infections occurred mostly in young-adults, with the odontogenic infections beingtheir principal cause. The providing treatment was effective in the great majority of the cases.

Angina de Ludwig: considerações sobre conduta e relato de caso / Ludwig's angina: procedures approach and case report

A angina de Ludwig é uma celulite frequentemente originada de uma infecção odontogênica classicamente localizada no segundo e terceiro molares inferiores, que envolve os espaços submandibular, sublingual e submentoniano. A sintomatologia típica inclui dor, aumento de volume em região cervical, disfagia, odinofagia, trismo, edema do assoalho bucal, protrusão lingual, febre, linfadenopatia e calafrios. Métodos de imagem são utilizados para determinar a severidade da infecção. Radiografias planas convencionais são úteis na abordagem inicial. Os exames por tomografia computadorizada e ressonância magnética indicam a extensão da lesão, o comprometimento das vias aéreas e a presença de gases entremeados nos tecidos musculares. O tratamento concentra-se em manutenção das vias aéreas, incisão e drenagem, antibioticoterapia e eliminação do fator causal. Um caso é apresentado, contendo características clínicas e imaginológicas. O diagnóstico baseado em exames clínicos e imaginológicos aliados a medicação efetiva e intervenção cirúrgica precoces são primordiais para a manutenção da vida do paciente.

Ludwig's angina is a cellulitis often caused by an odontogenic infection classically located in the lower second and third molars, which involves the submandibular, sublingual and submentonian spaces. The typical symptoms include pain, increase in cervical volume, dysphagia, odinophagia, trismus, mouth floor edemas, tongue protrusion, fever, chills and lymphadenopathy. Image methods are used to determine the severity of infection. Plan conventional radiographies are usefull for initial evaluation. Examinations by computed tomography and magnetic resonance images indicate the extension of the lesion, commitment of the air space and gases interlocking muscular tissues. Treatment concentrated in maintenance air space, incision and drainage, antibiotic therapy and disposal of causal factor. A case is presented, containing clinical and imaginological characteristics. The diagnosis based on clinical examination and imaginological allies to effective medication and early surgery are crucial for maintaining the life of the patient.

Incidencia de celulitis facial odontógena en el territorio de Matanzas / Odontogenic Facial Cellulites incidence in the territory of Matanzas

La Celulitis Facial Odontógena es relativamente frecuente, puede convertirse en un grave riesgo vital cuando el tratamiento no es adecuado. Se realizó un estudio observacional, analítico, transversal desde enero 2006 a diciembre 2008. La muestra incluyó 49 pacientes que acudieron o fueron remitidos a los servicios de urgencias con el diagnóstico de CFO. Los niños y jóvenes resultaron los más afectados, así como el sexo masculino. Los dientes incurables y los restos radiculares constituyeron las causas más frecuentes, la región anatómica prevaleciente fue la cavidad bucal. El 51 por ciento de los casos tuvieron diagnóstico de celulitis leves, siendo necesario el ingreso hospitalario para 25 pacientes, los demás tuvieron tratamiento ambulatorio. Se recomienda diseñar una estrategia de intervención para disminuir la incidencia de CFO en el territorio de Matanzas.

The Odontogenic Facial Cellulites is relatively frequent; when the treatment is not right, it can become a serious risk for life. We carried up an observational, analytic, transversal study from January 2006 to December 2008. The sample included 49 patients assisting or remitted to the Urgent Care Services with a diagnosis of Odontogenic Facial Cellulites. The most affected were children and young people, and the female sex. The most frequent causes were teeth that can not be healed and roots remaining; the prevailing anatomic region was the oral cavity. 51 percent of the cases were diagnosed as mild cellulites, being necessary the hospital staying for 25 patients; the rest received home treatment. It is recommended to design an intervention strategy to diminish the incidence of the Odontogenic Facial Cellulite in the territory of Matanzas.

Clindamicina para el tratamiento de infecciones dentales / Clindamycin for the treatment of dental infections

La clindamicina es un antibiótico de amplio espectro con actividad contra los aerobios grampositivos y una extensa gama de bacterias anaerobias, entre ellas los patógenos productores de betalactamasa. Los estudios in vitro e in vivo han demostrado que este fármaco alcanza una concentración elevada en el punto de infección, reduce la virulencia de las bacterias y refuerza las actividades fagocíticas de los linfocitos inmunitarios del huésped. La clindamicina por vía oral se absorbe con rapidez y eficacia, y su concentración permanece por encima de la concentración inhibidora mínima de la mayoría de los organismos por lo menos durante 6 horas. En este análisis, presentaremos pruebas de la eficacia e inocuidad de la clindamicina en el tratamiento de las infecciones odontogénicas con datos de estudios preclínicos y clínicos, los cuales avalan la aplicación general de este antibiótico como antiinfeccioso en el campo de la odontología.

Clindamycin is an antibiotic of wide range of action with a great activity against aerobic gram-positive germs and a broad spectrum of anaerobic bacteria, among which we can find the pathogenic agents that produce Beta-lactamase. The in vitro and in vivo have shown that this medicine reaches a high concentration at the infection point, reduces the bacteria virulence, and strengthens the phagocytic activity of the immunizing lymphocyte of the host. Clindamycin through oral ingestion is absorbed very quickly and effectively, and its concentration remains the same above the minimum inhibitory concentration of most of the organisms at least for six hours. In this analysis, we will introduce some proofs about the effectiveness and innocuousness of clindamycin in the treatment of odontogenic infections. This data is based upon clinical and pre-clinical studies that support the general use of this mentioned antibiotic as an anti-infectious agent in the field of odontology.

Contribución del diagnóstico microbiológico a la clínica odontológica / Contribution of the microbiological diagnosis to clinical dentistry

El propósito de esta publicación es el de divulgar la importancia diagnóstica que tiene el estudio micro-epidemiológico de las infecciones bucomaxilofaciales que competen tanto al odontólogo generalista como al especializado. Por este motivo hemos hecho hincapié en las recomendaciones generales para la optimización de la toma de muestras y el transporte de las presentaciones clínicas odontogénicas más frecuentes. Hemos dispuesto un algoritmo respecto a la toma de decisión y planteado la necesidad de establecer una comunicación óptima y fluida con el laboratorio microbiológico de derivación. Se encuentran planteadas las distintas posibilidades de microorganismos a investigar, sus requerimientos nutricionales para el transporte y cuáles son aquellos que pueden predecir con certeza la susceptibilidad a antimicrobianos específicos. Esperamos que este trabajo facilite y colabore con la capacitación del profesional odontólogo en el momento de decidir cómo, cuándo y con qué debe realizar una toma de muestra para su posterior investigación microbiológica. De esta manera, odontólogos y microbiólogos contribuiremos a la formulación del diagnóstico de certeza y el restablecimiento del estado de salud del paciente.

Mediastinitis after cervical suppuration

The objective of this study is to decode the etiopathogenesis, the clinical feature, the diagnosis and the prognosis of the acute mediastinitis resulting of infectious processes of the cephalic segment. Three out of five patients studied presented focus of dental origin and two patients presented focus in the face area. One of them presented Ludwig's Angina before the suppurative process would spread over the mediastinum. In the others, there was fast expansion through the fascial spaces of the neck and, in two of them, besides the mediastinum, there was pleuropericardial involvement. Three patients died due to respiratory insufficiency and two survived with complications. The mediastinitis after cervical suppuration is a special and extremely serious kind of endothoracic infection. The pus reaches that area through the fascial spaces of the neck, taking the organism to an alarming toxemic feature. The rarity of the disease, the little is known about its physiopathology and the initial care of the patient in non-specialized services, which are not familiarized with this type of feature, are factors that can delay the diagnosis and worsen the prognosis