[An update on focal infection of oral origin]. / Point actuel sur l'infection focale d'origine buccodentaire.

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

[Upper aerodigestive tract erythroplakia]. / Les érythroplasies des voies aérodigestives supérieures.

Erythroplakia is a red mucosal macule with a chronic evolution. It is diagnosed after excluding traumatic, vascular, or inflammatory etiologies. Erythroplakia is rare in the upper aerodigestive tract. It affects middle-aged adults. The main predisposing factors are those of in situ carcinoma. Lesions are mainly located on lips or mucosa. Erythroleukoplakia may also occur. Ninety-one percent of erythroplakia are severe dysplasia, in situ carcinoma, or invasive carcinoma. Excision and histopathological examination are mandatory.

[Gingivoperiosteoplasty associated to bone graft: radiological evaluation]. / Gingivopériostoplasties associées à une greffe osseuse : évaluation radiologique.

INTRODUCTION: Gingivoperiosteoplasty associated to bone graft is part of a therapeutic strategy applied to the first 20 years of a patient's life. Management is pluridisciplinary. Most authors recommend a bone graft in mixed dentition at the end of premaxillary growth. Retroalveolar and panoramic radiography are the most often used to assess the bone height of the grafted site. We retrospectively studied the radiographies of 57 alveolar grafts in 44 patients. MATERIAL AND METHODS: Between 1999 and 2005, 44 patients underwent gingivoperiosteoplasty associated to bone graft. Thirteen underwent bilateral reconstruction. The surgical interventions were performed by the same surgeon. One year after surgery, the panoramic radiographies were analyzed by a single expert. The bone height compared to roots of adjacent teeth was classified in four grades. Grades 1 and 2 were considered as satisfactory or good and grades 3 and 4 not satisfactory and an indication for a new bone graft. In case of bilateral cleft, each side was analyzed independently. RESULTS: Grades 1 and 2 accounted for 84.2% of grafts. There was no statistical difference in alveolar bone height between patients presenting with agenesis of the lateral incisive. Eighty-one percent of patients grafted with mixed dentition (66% of the cases) had satisfactory results (35% of grade 1 and 46% of grade 2). Patients operated on after 15 years (n=15) had good results in 75% of the cases, 33% were bilateral cleft patients. There was no statistical difference between patients operated on early and those with delayed surgery. DISCUSSION: Radiological results for gingivoperiosteoplasty associated to bone graft are satisfactory. The procedure is easy, cheap, and reproducible. Evaluation with panoramic radiography is not as accurate as with the Denta Scan. CT scan is not used systematically to follow up alveolar cleft palate in children so as to limit irradiation. Volumetric tomography (cone beam) may be the best assessment.

[Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis]. / Ostéoarthrite temporomandibulaire secondaire à une cellulite temporale d'origine dentaire.

INTRODUCTION: Temporal cellulitis complicated by temporomandibular osteoarthritis and mandibular osteomyelitis is rare with the availability of antibiotics and the prevention of dental infections. CASE REPORT: A 56 year-old woman developed a jaw abscess during hospitalization in an intensive care unit following medical drug overdose. Repeatedly surgical drainage was performed guided by CT scans and multiple antibiotherapies. CT scan follow-up revealed temporomandibular arthritis with decrease of the joint space, synovitis, and subchondral cysts. Slow improvement was noted but limited mouth opening was persistent. DISCUSSION: This case illustrates the insidious evolution of an uncommon infection. It requires both expert clinical evaluation and an early MRI or CT scan investigation to determine the extension of the infection. Treatment is urgent because of the prognosis and is achieved by surgical drainage and adequate long-term antibiotherapy.

[Tooth extraction and anticoagulants]. / Avulsions dentaires et anticoagulants.

INTRODUCTION: The purpose of this study was to show the possibility of extracting teeth without modifying the anticoagulant treatment (anti-platelet and anti-vitamin K agents). MATERIAL AND METHOD: Two hundred patients underwent dental extraction from May 2003 to July 2006 without modifying their anticoagulant treatment; only 137 of them were hospitalized. Most of the teeth were extracted under local anesthesia, and hemostatic pad were inserted in the sockets without suture. RESULTS: One thousand (and) sixteen extractions were performed with bleeding disorders in 4%, successfully resolved by using local hemostatics. DISCUSSION: Modifying an anticoagulant treatment is a thrombo-embolic complication risk factor. Performing tooth extraction according to our protocol decreases this risk and bleeding complications, thus proving the validity of our technique.