Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report.

BACKGROUND: Coronavirus disease 2019 makes patients more susceptible to superinfection of fungal disease as a consequence of immunological system impairment. Mucormycosis is a fungal infection that is rare but has a high mortality rate and mostly affects patients with poorly controlled diabetes mellitus or those receiving corticosteroids. CASE PRESENTATION: Here, we present a case of post-coronavirus disease 2019 mucormycosis in a 37-year-old Persian male presenting with multiple periodontal abscess with purulent discharge and necrosis of maxillary bone (without oroantral communication). Surgical debridement following antifungal therapy was the treatment of choice. CONCLUSION: Early diagnosis and immediate referral are the cornerstone of comprehensive treatment.

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.

Periodontal abscess as a possible oral clinical sign in the diagnosis of undiagnosed diabetes mellitus of elderly in a dental clinic set up - a 7-year cross-sectional study.

OBJECTIVE: To evaluate the periodontal abscess as a possible oral clinical diagnostic criteria for the diagnosis of diabetes mellitus in the elderly. METHODS: In this clinical outpatient department, cross-sectional study of 84 months, 143 212 subjects between the ages of 40 and 84 years were screened for the presence of periodontal abscess. Relevant medical and dental histories were recorded using a questionnaire. The subjects who fulfilled the inclusion criteria of undiagnosed diabetes mellitus, presence of periodontal abscess, and absence of other systemic disease were referred for laboratory diagnosis of diabetes mellitus (HbA1c). The subjects tested positive for the diabetes were noted, statistical evaluation was undertaken to correlate between undiagnosed diabetes mellitus and periodontal abscess. RESULTS: It was found out that 0.05% undiagnosed diabetes was noted among the 143 212 patients. Among the 143 212 subjects, 1352 met the inclusion criteria having periodontal abscess. Mean age of the participants was 57 ± 14.2 years. Among the 1352 subjects with periodontal abscess: 793 (58.65%) subjects had increased HbA1c (≥6.5% or 47.5 mmol/mol or 7.8 mmol/L); 559 (41.35%) individuals reported to have normal HbA1c (≤6.5% or 47.5 mmol/mol or 7.8 mmol/L). The difference was found to be statistically significant. CONCLUSION: Periodontal abscess can be considered as possible oral clinical diagnostic criteria for the diagnosis of diabetes mellitus. Elderly individuals visiting dental clinics need to be given due attention to find out the possibility of having this systemic condition. Medical fraternities are advised to consider oral health parameters in the evaluation of the medical status of elderly individuals.

Immediate loading of implants placed in patients with untreated periodontal disease: a 5-year prospective cohort study.

PURPOSE: To report the 5-year outcome of immediately loaded dental implants in patients with untreated periodontal disease. MATERIALS AND METHODS: This prospective cohort study included 103 consecutive patients (51 females and 52 males) with an average age of 52 years (range: 22 to 80 years) who were rehabilitated with 380 implants supporting 145 prostheses in both jaws (40 single; 33 partial and 72 complete rehabilitations). The implants were inserted in patients with active and untreated periodontitis. The patients did not receive any previous periodontal treatment before implant surgery, except for an oral hygiene session immediately before the implant surgery. In maintenance (every 6 months) patients received periodontal treatment as needed. Outcome measures were: prostheses failures; implant failures; complications; and marginal bone level changes. RESULTS: Fifteen patients dropped out of the study (14.6%). Two patients lost two implants (FDI positions nos.12 and 42), rendering a cumulative survival rate of 97.9% and 99.4% at 5 years of followup using the patient and implant as unit of analysis, respectively. The average (standard deviation) marginal bone resorption was 0.71 mm (0.42 mm) at 5 years. Mechanical complications occurred in 14 patients, consisting of prostheses fractures (10 provisional prostheses and 4 definitive prostheses). Thirteen implants (3.9%) in 13 patients (14.8%) presented peri-implant pathology. CONCLUSIONS: Within the limitations of this study, it is possible to conclude that the rehabilitation of patients with untreated periodontitis using immediately loaded dental implants is feasible in the medium-term, when periodontal therapy is provided after rehabilitation and the patients are regularly maintained.

Caries management strategies for primary molars: 1-yr randomized control trial results.

Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care-based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists' level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR (ClinicalTrials.gov NCT01797458).

Tooth separation potential problems.

A displaced orthodontic elastic separator was proposed as being the source of a gingival abscess that progresses to severe bone loss and exfoliation in a healthy adolescent patient with sound periodontal status prior to commencement of orthodontic treatment. After one year of undergoing orthodontic treatment, the patient presented with dull pain and mobility in the left upper permanent molar for which there was no apparent etiology. On clinical examination the patient had gingival inflammation, associated with a deep pocket and severe mobility (Grade III) in relation to the same teeth. Radiographic examination ofan Orthopantomogram (OPG) and IntraOral Periapical Radiograph (IOPAR) revealed a chronic periodontal abscess with severe necrosis of the periodontal ligament and severe alveolar bone loss. On curettage it was found that there was orthodontic elastic separator which was displaced sub gingivally. Active orthodontic forces were temporarily removed and splinting was done. 6 month follow up showed no mobility and significant improvement of alveolar bone height.

Pulpal involvement-roots-sepsis index: a new method for describing the clinical consequences of untreated dental caries.

OBJECTIVES: To describe a modification of the index of clinical consequences of untreated dental caries [pulpal involvement, ulceration, fistula and abscess (PUFA/pufa) index] to pulpal involvement-roots-sepsis (PRS/prs) and to compare the two indices using the example of caries in primary molar teeth in children aged 6-8 years. SUBJECTS AND METHODS: The study sample included 542 children aged 6-8 years, from five randomly selected schools in the Bialystok District, Poland. The occurrence of clinical consequences of untreated caries in deciduous molars using the pufa and prs indices was evaluated. Data were analysed to express the prevalence, the experience and the distribution of particular pufa and prs codes in the sample population. The differences in layout of the pufa and prs components were expressed. RESULTS: The response rate was 77.6%. The prevalence of the clinical consequences of untreated caries was 40.77%, mean pufa and prs were the same (0.85 ± 1.33). According to the pufa index, the following mean values were obtained: p = 0.79, u = 0.01, f = 0.04 and a = 0.01. For the prs index, the mean values were as follows: p = 0.45, r = 0.35 and s = 0.05. CONCLUSION: The proposed prs index was a useful epidemiological instrument for the evaluation of the clinical consequences of untreated caries in the surveyed population. The PRS instrument could be a good alternative to the PUFA index.

Early implant loading in the atrophic posterior maxilla: 1-stage lateral versus crestal sinus lift and 8 mm hydroxyapatite-coated implants. A 5-year randomised controlled trial.

PURPOSE: To evaluate the efficacy of long implants (10-16 mm) inserted in maxillary sinuses augmented according to a lateral approach versus short (8 mm) implants placed in crestally augmented sinuses, early loaded after 45 days. MATERIALS AND METHODS: Forty partially or fully edentulous patients having 3 to 6 mm of residual crestal height and at least 4 mm in thickness below the maxillary sinuses were randomised according to a parallel group design to receive either one to three 10 to 16 mm-long hydroxyapatite-coated implants (20 patients) after lateral sinus lifting with 50% an organic bovine (Bio-Oss) and 50% autogenous bone, or 8 mm implants (20 patients) after crestal sinus lifting with autogenous bone. Implants were submerged and left healing for 45 days before loading the implants. Within 1 week after abutment connection, implants were loaded with screw-retained full acrylic provisional prostheses. Definitive metal-ceramic prostheses were provisionally cemented 45 days after abutment connection. Outcome measures were prosthesis and implant failures, any complications, and radiographic periimplant marginal bone level changes. In addition, the stability of individual implants was assessed with Osstell and Periotest at abutment connection (baseline), and at 1 and 5 years after loading by blinded outcome assessors. All patients were followed up to 5 years after loading. RESULTS: One patient dropped out (death) from the longer implant group. One implant failed in the short implant group versus 5 implants in 3 patients of the longer implant group. The difference was not statistically significant. Four complications occurred in 4 patients of the short implant group versus 8 complications in 7 patients of the long implant group, the difference being not statistically significantly different. However, the 2 major postoperative complications occurred in the longer implant group: 1 abscess, and 1 sinusitis that led to the complete failure of the treatment in 2 patients (4 implants lost). A total of 0.72 mm of peri-implant marginal bone was lost after 5 years at long implants and 0.41 mm at short implants, the difference between the two groups was statistically significant (P = 0.028). Osstell values increased and Periotest decreased over time and there were no differences between groups at any time points. CONCLUSIONS: In atrophic maxillary sinuses with a residual bone height of 3 to 6 mm, 8 mm short implants placed in a simultaneously crestally lifted sinus might be a preferable choice than a 1-stage lateral sinus lift for placing longer implants since they appear to be associated with less morbidity. If these implants are placed with an insertion torque >35 Ncm and are joined together under the same prosthesis, they can be early loaded at 6 weeks.

[Infection after dental intervention. Iatrogenic or general medical cause? Case report]. / Infektion nach zahnärztlichem Eingriff. Zahnärztliche oder allgemeinmedizinische Ursache? Ein Fallbericht.

Whenever a dentist is dealing with abscess formation in the oral and maxillofacial region, it is mostly from dental origins. However, sometimes uncommon (co-)factors are present and responsible for major complications. Many general conditions or medications can significantly influence the course of an inflammation. It might spread faster and wider and also be resistant to "correct" therapy. This case report should raise awareness about general conditions supporting inflammation and demonstrate the importance of interdisciplinary treatment in these situations. A 76-year-old patient was referred to the maxillofacial surgery clinic after extraction of two teeth resulted in therapy-resistant painful swelling. Her dentist already had initiated "standard" therapy including Ponstan® (mefenamic acid) and Clamoxyl® (amoxicillin) without success. Initial blood testing came back with severe agranulocytosis. Immediately all potentially myelosuppressing drugs were stopped while myelosupporting drugs were prescribed. Under close interdisciplinary treatment conditions, healing was then uneventful without the necessity of surgical intervention. The challenge in inflammation treatment is to identify patients with uncommonly severe, fast-progressing, or therapy-resistant disease as early as possible. Further examination including blood workup for several medical parameters is indispensable in those patients.

Complications from submental endotracheal intubation: a prospective study and literature review.

Submental endotracheal intubation, as compared to the use of tracheotomy, is an alternative for the surgical management of maxillofacial trauma, as described by Altemir FH (The submental route for endotracheal intubation: a new technique. J Maxillofac Surg 1986; 14: 64). Although the submental endotracheal intubation is a useful technique, a wide range of complications have been reported in the literature. The core aim of this article is to present additional data from 17 patients who have undergone submental endotracheal intubation and who have received at least 6 months of postoperative follow up. A prospective study was carried out on patients who suffered maxillofacial trauma between 2008 and 2011. Age, gender, etiology of trauma, fracture type, complications, and follow up were evaluated. Case series, as well as retrospective and prospective studies regarding submental endotracheal intubation in maxillofacial trauma, were also reviewed. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas.

Common dental disorders of the degu (Octodon degus).

Dental disease is prevalent in the captive degu (Octodon degus), yet little has been documented on the variety of disorders in this species. In this internet-based study, dental cases presented over a 7-year period were collated, analyzed, and grouped. Of the 137 total cases, the most common dental disorder of the degu was found to be molar malocclusion (42.3 %). Other disorders documented included enamel decoloration (13.1%), molar elodontoma (8.0%), enamel hypoplasia (6.6%), incisor tooth fracture (6.6%), incisor malocclusion (3.6%), oral abscess (2.2%), and impacted molar teeth (0.7%). Details of each condition, pathogenesis, and clinical signs are described. Age was found not to be a significant predictor of dental disease in the degu.

Abscesos, ¿origen endodóntico o periodontal? / No disponible

Los abscesos dentales son patologías frecuentes que necesitan tratamiento de urgencia debido a la sintomatología que presentan, a la rápida destrucción de tejidos que producen y la posibilidad de que aparezcan complicaciones. Un correcto diagnóstico es básico para poder diferenciar estas patologías con características clínicas tan similares que pueden dar lugar a errores a la hora de escoger el tratamiento más adecuado para cada caso. La elevada cantidad de bacterias presentes en la cavidad oral hace necesario conocer aquellas que intervienen en la formación y desarrollo de estas patologías. Debemos conocer cuándo y qué antibiótico utilizar en cada caso, eligiendo el más efectivo frente al tipo de bacterias que vamos a tratar para evitar la aparición de resistencias y consiguiendo una rápida resolución de la lesión. El objetivo de esa revisión es hacer un diagnóstico diferencial entre los principales abscesos dentales a través de sus manifestaciones y su microbiología, así como de los antibióticos más utilizados para el tratamiento de estas infecciones orales (AU)

Dental abscesses are common condition that need emergency treatment because the symptoms they present, the rapid destruction of tissues that produce and the possibly of complications appear. A correct diagnosis is essential to differentiate these diseases with similar clinical characteristics as that can lead to errors in choosing the most appropriate treatment for each case. The high amount of bacteria in the oral cavity is necessary to meet those involved in the formation and development of these pathologies. We must know when and what antibiotics should be used in each case, choosing the most effective against the bacteria that we will try to avoid the emergence of resistance and getting a quick resolution of the lesion. The aim of this review is to make a differential diagnosis between major dental abscesses through its manifestations and microbiology, as well as, most commonly used antibiotics for the treatment of these oral infections (AU)

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial.

AIM: This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. MATERIALS AND METHODS: A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. RESULTS: Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. CONCLUSIONS: The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Gingival abscess due to an unusual nail-biting habit: a case report.

AIM: Nail-biting is one of the most frequent deleterious oral habits in children. It can result in systemic diseases or oral traumatic lesion. This report describes a case of gingival abscess in a child due to a fingernail-biting habit. CASE DESCRIPTION: A 5-year, 6-month-old female presented gingival swelling and fistula in the primary maxillary left central and right lateral incisors as an unusual sequelae to the periodontal tissues from fingernail-biting. A periodontal curette was used to remove the fragments and to curette the area. After the curettage, an exudate of blood and pus was drained. Then the area was irrigated with 0.12% chlorhexidine solution; applying finger pressure controlled the secretion. After one week, the patient returned with gingival swelling present in the same teeth. The same curettage procedure was performed. It was suggested that the deleterious habit was related to emotional tension and anxiety behaviors and the patient was referred for psychological treatment. When the patient returned one month later, she was still biting her fingernails, but she had stopped placing fragments into the gingival crevice. No more gingival inflammation or swelling was observed. SUMMARY: his paper presents an unusual case report of a gingival abscess due to a fingernail-biting habit in a child, probably related to an emotional condition. CLINICAL SIGNIFICANCE: The fingernail-biting habit can induce a periodontal traumatic injury yielding a more serious complication such as a gingival abscess.

Abscesos del periodonto: conducta odontológica / The periodontal abscess: dentist behaviour

En la cavidad bucal se pueden producir una variedad de enfermedades de diferente etiología, por ello es muy importante que el odontólogo las identifique y conozca las consecuencias que ocasiona si no se previenen o tratan a tiempo. Se funda como premisa que el cuidado periodontal es, en esencia, labor del odontólogo general y que éste no puede pasar por alto la responsabilidad de proveer atención a todos los pacientes. La incidencia excesivamente alta de los problemas periodontales entre las población, dificulta que un número reducido de especialistas los pueda enfrentar. Asimismo, el estrecho vínculo entre los tratamientos dentales restaurativos y los regímenes periodontales hace muy importante que el odontólogo general disponga de conocimientos a fondo sobre periodoncia. En la cavidad bucal se producen variedades de enfermedades de etiología infecciosa bacteriana, lo más común son los abscesos del periodonto, estas entidades clínicas han sido reconocidas desde finales del siglo XIX. Es una infección localizada destructiva compuesta de colecciones sero-purulentas restos celulares, bacterianos con/sin fistulización. Es importante que el odontólogo, las identifique, así como las consecuencias que ocasionan si no se tratan a tiempo. El propósito de este reporte es describir de los abscesos del periodonto, su etiología, características clínicas, diagnósticos diferenciales y diferentes métodos de tratamiento, así como valorar sus complicaciones y cuidados postoperatorios. Para ello se realizó basado en los lineamientos de la investigación descriptiva documental, una revisión de la literatura nacional e internacional

A variety of different etiologies pathologies can affect the oral cavity, due to this reason, dentists must be able to identify them and their consequences if they are not treated on time. It is primordial for the general practitioner dentists the periodontal care of their patients. Among the population the periodontal diseases are very common and only a reduced number of specialists can treat them. The close relation between restorative dental treatments and periodontal treatment procedures lead to the tendency that de general practitioner has enough knowledge in the periodontal field. A variety of etiologies infectious bacterium different disease can affect the oral cavity, the most common is the periodontal abscess, this clinical lesions These clinical entities have been recognized from the ends of the XIXth century. Localized destructive infections which consists in serum purulents cellular debris, bacteriae with or without sinus tract formation. Dentist must be able to recognize and treat them. The purpose of this research is to describe the possible etiologic, clinical features and treatment of this disease and also to recommend the multidisciplinary attention to these patients. For this paper was made a study based on the lineaments of the descriptive documental research, mainly with scientific bibliographic references literature national and international

Periodontal abscess during supportive periodontal therapy: a review of the literature.

AIM: The aim of this review is to present the current status of the occurrence and management of a periodontal abscess during supportive periodontal therapy (SPT). BACKGROUND: A periodontal abscess depicts typical features and has been described in patients under SPT in clinical trials. Common periodontal pathogens have been observed in this lesion and some etiologic factors may be responsible for its recurrence. This condition can be isolated or associated with factors that can change the prognosis of affected teeth. REVIEW RESULTS: Although it has been frequently noticed in untreated periodontitis, the periodontal abscess can also occur in patients under SPT and has been regarded as one of the possible complications of SPT. Patients with a high susceptibility to periodontal disease lost more teeth than those with a healthy periodontium. CONCLUSION: Early diagnosis and appropriate intervention for periodontal abscesses in patients under SPT are extremely important for the management of the periodontal abscess since this condition can lead to loss of the involved tooth. A single case of a tooth diagnosed with periodontal abscess that responds favorably to adequate treatment does not seem to affect its longevity. CLINICAL SIGNIFICANCE: An accurate diagnosis and adequate treatment can preserve the longevity of affected teeth.

Endodontic-periodontic bifurcation lesions: a novel treatment option.

AIM: The purpose of this preliminary clinical report is to suggest a novel treatment modality for periodontal bifurcation lesions of endodontic origin. METHODS AND MATERIALS: The study consisted of 11 consecutive patients who presented with periodontal bifurcation lesions of endodontic origin (endo-perio lesions). All patients were followed-up for at least 12 months. Treatment included calcium hydroxide with iodine-potassium iodide placed in the root canals for 90 days followed by canal sealing with gutta-percha and cement during a second stage. Dentin bonding was used to seal the furcation floor to prevent the ingress of bacteria and their by-products to the furcation root area through the accessory canals. RESULTS: A radiographic examination showed complete healing of the periradicular lesion in all patients. Probing periodontal pocket depths decreased to 2 to 4 mm (mean 3.5 mm), and resolution of the furcation involvement was observed in post-operative clinical evaluations. CONCLUSIONS: The suggested treatment of endo-perio lesions may result in complete healing. Further studies are warranted. CLINICAL SIGNIFICANCE: This treatment method improves both the disinfection of the bifurcation area and the healing process in endodontically treated teeth considered to be hopeless.