Salvaging a Periodontally Compromised and Endodontically Involved Three-Rooted Mandibular First Molar With Cervical Enamel Projection.

This case report describes the management of a mandibular first molar with an additional distolingual root (radix entomolaris) and grade III cervical enamel projection through a multidisciplinary approach. Diagnosis for the case was endodontic-periodontal lesion due to non-vitality and associated advanced periodontal destruction. The patient was treated with drainage of the periodontal abscess with adjunct antibiotics, phase I periodontal therapy, endodontic therapy, radiculoplasty, regenerative periodontal therapy, replacement of the missing right mandibular second molar, and long-term maintenance. Follow-up of the patient up to 9 months has been uneventful. Cases of advanced periodontal destruction typically show some degree of tooth mobility, which was absent in this case. The article discusses the tripod effect as well as the increased surface area for periodontal attachment provided by the additional root contributing to the non-mobility of the involved tooth.

Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections.

OBJECTIVE: To develop a new radiography-based score to assess the potential of bacteria to cause odontogenic infections derived from the occurrence of bacteria at small or large radiographical lesions. MATERIALS AND METHODS: The patients analyzed were a sub-population from a large randomized clinical trial comparing moxifloxacin and clindamycin in the treatment of inflammatory infiltrates and odontogenic abscesses. Routine radiographs were used to analyze the area of the periapical radiolucent lesions. Lesions were stratified by their radiographically measured area as large (>9 mm(2)) or small (≤9 mm(2)). A risk ratio was calculated for each species from the frequency of their occurrence in large vs in small lesions. RESULTS: Fifty-one patients, 19 with abscesses and 32 with infiltrates, were evaluated. Overall, the radiographical lesion areas ranged from 0.4-46.2 mm(2) (median = 9 mm(2)). An increased risk (risk ratio >1) to occur at large abscess lesions was observed for Prevotella (P.) oralis, P. buccae, P. oris, P. intermedia, Fusobacterium nucleatum and Streptococcus (Strep.) anginosus group. An increased risk to occur at large infiltrate lesions was found for Strep. salivarius, Strep. parasanguis, Strep. anginosus group, Capnocytophaga spp., Neisseria (N.) sicca, Neisseria spp., Staphylococcus (Staph.) aureus, P. intermedia, P. buccae, Prevotella spp. and P. melaninogenica. CONCLUSIONS: The radiography-based score suggests that certain Prevotella spp., F. nucleatum and Strep. anginosus groups play a crucial role in the pathogenesis of odontogenic abscesses, and that various streptococci, Neisseria spp., Capnocytophaga spp., Staph. aureus and Prevotella spp. are involved in the pathogenesis of odontogenic infiltrates.

[Application of ultrasonography in diagnosis and treatment of acute inflammation of soft tissues in maxillofacial region and neck].

We investigated the value of ultrasonography (USG) and ultrasound-guided aspirations in diagnosis and treatment of acute inflammation of soft tissues in maxillofacial region and neck. We performed 174 USG in 136 patients (73 with abscesses and phlegmons, 27 with acute lymphadenitis, 16 with inflamed cysts, 12 with parotitis, 3 with sialolithiasis and 5 with diseases, simulated acute inflammation). Ultrasound-guided aspirations performed in 35 patients. We considered USG to be useful diagnostic tool in acute inflammation of soft tissues in maxillofacial region and neck. USG allowed to determine localization and stage of inflammation, discriminate it from non-inflammatory diseases and improve assessment of its dynamics. Ultrasound-guided aspirations was a valuable tool for diagnostic and treatment purposes in inflamed cysts.

Descending necrotizing mediastinitis of odontogenic origin--personal experience and literature review.

UNLABELLED: Descending necrotizing mediastinitis is the most severe form of mediastinal infection. The aim of the study was to present the optimal diagnostic and treatment approach to this severe, life-threatening condition. PATIENTS AND METHODS: Three patients (men, aged 75, 73, and 63) with descending necrotizing mediastinitis hospitalised between April 2007 and February 2009 have been included in the study. The diagnosis of the condition was made based on cervico-thoracic computed tomography and surgical findings. The surgical treatment in each of the cases included bilateral longitudinal cervicotomy, transversal suprasternal cervicotomy and posterior-lateral thoracotomy. RESULTS: The period between the initiation of ambulatory treatment of the dental infection and diagnosing the mediastinitis was 9, 8 and 11 days, respectively. Engagement of all cervical spaces and mediastinal sections with polybacterial (three or more agents) dental infection, originating from third and fourth lower molars was present in each of the patients. Chronic alcoholism and diabetes are factors influencing the course of mediastinitis. The outcome in all the three patients was lethal (within 72 hours). CONCLUSION: Success in the treatment of descending necrotic mediastinitis of odontogenic origin may be expected only in case of early diagnose and aggressive cervical and mediastinal drainage, performed by bilateral longitudinal cervicotomy and posterior-lateral thoracotomy.

[The adverse effect of gas formation on prognosis in a patient with deep neck infection]. / Derin boyun enfeksiyonlu bir olguda gaz olusumunun prognoza olumsuz etkisi.

A seventy-one-year-old woman was hospitalized with a suspicion of deep neck infection and poor general health. She had been receiving treatment for hepatitis, diabetes mellitus, and cardiac failure and had a history of tooth ache and severe neck pain lasting for the past 10 days. She had been admitted to another center where she had received antibiotic treatment for five days for widespread swelling in the neck and lower extremities, fatigue, and difficulty in breathing and swallowing. Upon admission, computed tomography showed gas formation in the neck and facial regions. Prompt abscess drainage was performed and intense treatment with antibiotics was continued. Despite all efforts, the patient died on the second day of hospitalization from cardiopulmonary arrest. This case emphasizes how urgent drainage is when gas formation is detected in deep neck infections, with inevitable poor prognosis with antibiotic treatment alone.

[Subdural empyema and cerebritis as a sequela of dentogenous suppurative pansinusitis]. / Subdurales Empyem und Zerebritis als Folge einer dentogenen, eitrigen Pansinusitis.

BACKGROUND: Complications and local extension of dentogenous and paranasal sinus infections most often involve the periorbit and frontal cranium. Because of the widespread use of antibiotics, intracranial extension of maxillofacial sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential for these complications, because late recognition of this condition and delay in treatment can increase morbidity and mortality rates. CASE REPORT: A case report of sinogenic intracranial complications is presented, with sinogenic empyema, cerebritis, and subdural empyema. The mechanisms and potential for intracranial spread of infection from the frontal, sphenoid, and ethmoid sinuses are discussed. The management of complications is outlined, including the use of computed tomography and the role of surgical drainage.

Odontogenic keratocyst of the maxilla presenting as periodontal abscess.

This is a case report of an odontogenic keratocyst of the maxilla initially diagnosed and treated as a periodontal abscess. The occurrence of odontogenic keratocyst in the maxilla with involvement of the antrum is relatively rare. The radiological appearance of this lesion on both conventional and panoramic radiography can be misinterpreted and emphasizes the usefulness of the computed tomography in this region.

Ultrasound-guided needle aspiration of lateral masticator space abscess.

Shortly after admission with facial space infection, ultrasound-guided needle aspiration of lateral masticator space abscess was carried out in 2 adult patients. One abscess was associated with pericoronitis and the other with post-extraction infection. Successful aspiration of pus was followed by an instantaneous improvement in the ability to open the mouth for a period of at least 24 hours. This obviated the need for conscious nasoendoscopic intubation and allowed orotracheal intubation for conventional drainage. We concluded that ultrasonography can be beneficial in the management of orofacial infections.

Specialty endodontics: diagnostic challenges, Part 2.

Endodontic diagnosis and treatment can range from simple to extremely complex. But no matter how simple a case may seem, a thorough examination by the treating endodontist is imperative before any treatment is done. Taking the time to perform an examination in a consistent and methodical approach can rescue the patient from unnecessary treatment, and the treating dentist from potential liability. The patient may be frustrated from repeating many of the same tests performed by the referring dentist, but this situation can be resolved with clear communication from the general dentist and the endodontist as to the benefits of the endodontist's exam. With proper communication, patients will recognize that their general dentist and endodontist are concerned that they receive the best of care.

A bacteriologic aid in the differential diagnosis of periapical and periodontal abscesses.

The aim of the present investigation was to determine whether spirochaetal count could help differentiate between periodontal and periapical abscesses. 23 draining abscesses were included, where 15 were diagnosed as periodontal and 8 as periapical, based on clinical and radiographic data. Exudate samples were collected aseptically and examined by both darkfield microscopy and Gram-stained smear. The results revealed a statistically high increase in spirochaetal count in periodontal abscesses compared to periapical ones. The obvious difference appeared adequate to differentiate both lesions and establish a rapid chairside diagnostic aid.

Spread of infectious complications of odontogenic abscess detected by technetium-99m-HMPAO-labeled WBC scan of occult sepsis in the intensive care unit.

We report a rare case of odontogenic abscess, detected while the patient was in the intensive care unit (ICU), which resulted in sepsis and the patient's death due to mediastinitis, skull osteomyelitis, and deep neck cellulitis. The detection of infectious focus in occult sepsis in ICUs is usually difficult because many diagnostic procedures cannot be conveniently performed. The use of 99mTc-hexamethylpropyleneamineoxime-labeled white blood cells scan allowed accurate diagnosis and appropriate surgical drainage.

Occult infection in the facial area presenting as fever of unknown origin.

Dental infections, otitis media or sinusitis may present as fever of unknown origin (FUO), lacking local symptoms and signs. Physicians are often unaware of this possibility, since current textbooks and major articles do not mention occult facial infections among the causes of FUO. Patients with FUO typically undergo a laborious series of uncomfortable, time-consuming, expensive and often unnecessary investigations in the search for the cause of pyrexia. We report five such patients from a community hospital, representing 14% of cases in a series of patients with FUO. In most of these patients local signs were absent, laboratory investigations were noncontributory, and antibiotic treatment was ineffective. Surgical drainage of pus collections was followed a few days later by defervescence. We suggest that occult infections in the facial area should be considered among the common causes of FUO, and careful dental examination, otoscopy and X-rays of the teeth and sinuses should be included early in the investigation of these patients.

Dental radiography: an overview for the radiologic technologist.

The methods and techniques involved in dental radiography are presented to familiarize the radiologic technologist with this practice. Additionally, the uses and pathologies commonly encountered in dental radiography are discussed. Although dental radiography is seldom performed by many radiographers, the techniques and methods used may be of interest and use to the radiographer.