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Results for “Periapical Abscess”

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PubMed1995

Infections in elderly patients associated with impacted third molars.

The objective of this study was to determine the clinical characteristics of infections caused by impacted third molars in elderly persons. Infectious disorders (26 pericoronitis, 8 secondarily infected dentigerous cysts, 4 perimandibular abscesses with limited osteomyelitis, 2 chronic mandibular osteomyelitis, and 1 odontogenic skin fistula) associated with the impacted third molars impacted third molars were clinically investigated in 41 patients over 60 years of age. Twenty-nine causative teeth were located in the mandibular angle and nine in the ramus; the three remaining lesions (two cysts one pericoronitis) were associated with the maxillary third molar. Bone resorption was noted in most patients, and this caused the originally embedded tooth to become exposed intraorally. It was concluded that oral infection in elder persons are occasionally caused by retained impacted third molars with overlapping of other factors.

Age Factors↗

PubMed1997

In-vitro activity of spiramycin and metronidazole alone or in combination against clinical isolates from odontogenic abscesses.

One hundred and forty-eight isolates of bacteria from 20 intraoral odontogenic abscesses were tested for their susceptibility to spiramycin and metronidazole alone or in combination. All isolates, except Rothia spp. (one), Enterococcus avium (three), Haemophilus parainfluenzae (one) and Staphylococcus aureus (one) were sensitive to spiramycin and/or metronidazole. Among the anaerobes, spiramycin as well as metronidazole showed good antimicrobial activity against species of Prevotella, Eubacterium, Peptostreptococcus, Bacteroides and Porphyromonas. All the aerobes were resistant to metronidazole. A potential synergic effect was found in 17% of the clinical isolates tested, as the MICs of spiramycin and metronidazole for 25 isolates (21 isolates of Eubacterium, two of lactobacilli, one strain of Peptostreptococcus sp. and one Clostridium clostridiiforme) were significantly reduced by the addition of the other antibiotic.

Anti-Bacterial Agents↗

PubMed2005

[Tooth extraction in cases of dental abscess].

BACKGROUND: Surgical relief and drainage as well as adjunct medicinal and physical therapy of dental abscesses are indisputable treatment options. It is currently controversial at what time the tooth extraction should take place. The aim of this study was to determine whether there are differences in treatment success depending on the time of tooth extraction. PATIENTS AND METHODS: A randomized patient sample (n=177) from two clinics was examined that differed in the therapy only regarding the time of tooth extraction. Post-surgical complications, inpatient care, duration of surgeries and incidents during anesthesia were examined. RESULTS: Statistically significant differences for inpatient care were impressive. done Abscess incision and tooth extraction performed simultaneously led to an average hospital stay of 8 days compared to 11 days when done at two different times. Duration of surgeries was also significantly shorter for the single procedure. Post-surgical complications only occurred in 2-4% of all cases. DISCUSSION: Opinions expressed in the literature include complete refusal to do tooth extraction immediately, or extraction of the causal teeth while providing antibiotic protection or even complete support of immediate extraction. Considering all factors, this study supports a single procedure with a shorter duration of hospital stays depending on local, personnel and logistical circumstances, especially regarding the forthcoming introduction of the DRGs.

Adult↗

PubMed1993

The effect of amoxycillin versus penicillin V in the treatment of acutely abscessed primary teeth.

A clinical study was carried out to compare the efficacy of a short course, high dose amoxycillin versus a conventional penicillin regimen in the treatment of acute abscessed primary teeth. In a blind way children were assigned to either group A (amoxycillin) or group B (penicillin). The efficacy of the antibiotics was assessed using the clinical parameters of pain, swelling, tenderness, mobility and lymphadenitis. The results showed a general trend of less swelling in patients in group A as compared with patients in group B. This was significant at days 1 and 7 for the operators assessment (Mann Whitney U test; z = 2.48 and z = 2.12). More teeth in group A were considered suitable for first stage pulpectomy by day 7 (c2 test; P 0.037 pounds). A short course, high dose amoxycillin regimen proved as efficacious as a conventional penicillin regimen.

Amoxicillin↗

PubMed1989

Antibiotic susceptibilities of bacteria isolated from acute dentoalveolar abscesses.

The antibiotic susceptibilities of 166 bacterial strains (43 facultative anaerobes and 123 strict anaerobes) cultured from 50 acute dentoalveolar abscesses was assessed. Firstly, the effectiveness of five antibiotics, penicillin, amoxycillin, erythromycin, clindamycin and metronidazole, which are available to treat acute dental infection, was studied using a Stokes' comparative disc diffusion method. Secondly, the minimum inhibitory concentrations and minimum bactericidal concentrations were determined for isolates of the predominant species, especially those strains deemed resistant by the Stokes' method. It was concluded that the vast majority of bacterial strains (96%) were sensitive or moderately sensitive to the antibiotics tested. However, resistance was recorded for each of the antibiotics tested on at least one occasion. The MIC of penicillin, presently the drug of choice for acute dental infection, was between 0.03 and 2 mg/l for the majority of strains (96%).

Acute Disease↗

PubMed1999

Toothaches and death.

Deaths from dental abscesses today are so rare, that it is difficult to fathom that only 200 years ago, this was a leading cause of death. When the London (England) Bills of Mortality began listing the causes of death in the early 1600's, "teeth" were continually listed as the fifth or sixth leading cause of death. (This does not include the category of "Teething" which was probably erroneously blamed for many children's deaths. As we examine several historic factors of this period, it is apparent that the number of deaths attributed to "teeth" in the seventeenth and eighteenth centuries was probably fairly accurate, and it was not antibiotics, nor the discovery of asepsis, that brought about the dramatic reduction in these dental mortalities, but two much earlier dental innovations.

Anesthesia, Dental↗

PubMed1989

[Two case reports of extraction with the upper central incisors].

Although extraction of the upper central incisors is very rare because of their esthetical importance, they are sometimes extracted when impaction, root resorption, abnormal morphology, severe caries and/or trauma are involved. When extracted, tooth size adjustment, crown-bridge and/or orthodontic treatment are proposed for functional and/or esthetic improvement. Two present cases were reported of Angle class I crowding with root resorption of the upper central incisors caused by apical abscess (case 1) and impacted canines (case 2). The above central incisors were extracted and orthodontic tooth alignment was performed on both cases prior to final occlusal adjustment. Problems we encountered in through these cases were tooth size ratio between the upper and lower teeth causing spacing arch and/or disharmony of occlusion. In case 1, edge to edge anterior relationship was established because the over-all tooth ratio was 93.30% which was out side one standard deviation although the upper lateral incisors were tipped mesially to create some spaces. The over-all tooth ratio in case 2, however, was 92.13% which was inside one standard deviation and normal occlusion was restored. It is suggested that final tooth size adjustment is necessary for good occlusion in extraction cases of upper central incisors.

Adolescent↗

PubMed1996

Regional odontodysplasia: review of the literature and report of a case.

Regional odontodysplasia is a rare and unique dental developmental anomaly that affects tooth morphogenesis. This case is unusual in that it involved the mandibular dentition. However, in this case the mandible was unilaterally involved. The presence of an abscess in relation to the lower right first permanent molar, in the absence of deep caries or periodontal pathology was an interesting finding. The radiographic appearance of bizarre pulpal morphology with high pulp horns extending to the occlusal surface would provide an open communication between the pulpal tissue and oral cavity. The importance of the first permanent molar as a strategic tooth was recognized and an apexification procedure was performed. The care and treatment of a child with odontodysplasia requires a multidisciplinary approach. In this case the right lower primary cuspid and first primary molar had been extracted previously. The early extraction of these teeth and the subsequent delay in hard tissue formation and eruption of the permanent successors could have resulted in altered growth of the alveolus in this region.

Child↗

PubMed2006

["Descending necrotizing mediastinitis" due to deep neck infections. Incidence and management].

BACKGROUND: "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS: Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS: Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS: Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.

Adult↗

PubMed1996

Molecular analysis of microflora associated with dentoalveolar abscesses.

The microflora associated with three dentoalveolar abscesses was determined by cultural and molecular methods. 16S rRNA genes were randomly amplified by means of conserved eubacterial primers and cloned. Restriction fragment length polymorphism analysis of the clones and amplified genes encoding 16S rRNA from the cultured bacteria was used to detect putative unculturable bacteria. Clones representative of five predominant groups of uncultured organisms were sequenced. Two were identified as Porphyromonas gingivalis and Prevotella oris, and one was found to be closely related to Peptostreptococcus micros. The remaining two clones did not correspond to known, previously sequenced organisms. One was related to Zoogloea ramigera, a species of aerobic waterborne organisms, while the other was distantly related to the genus Prevotella. This study has demonstrated the possibility of the characterization of microflora associated with human infection by molecular methods without the inherent biases of culture.

Adult↗

PubMed2003

Antibiotic susceptibility of bacteria associated with endodontic abscesses.

Antibiotics to treat endodontic infections are routinely prescribed based on previously published susceptibility tests. There is increased concern that bacteria have increased resistance to the currently recommended antibiotics. The purpose of this investigation was to perform antibiotic susceptibility tests on a panel of bacteria recently isolated from endodontic infections. The bacteria in this study were aseptically aspirated with a needle from endodontic abscesses, cultivated, and identified at the species level. Each of the 98 species of bacteria was tested for antibiotic susceptibility to a panel of six antibiotics using the Etest. The antibiotics were penicillin V, amoxicillin, amoxicillin + clavulanic acid, clindamycin, metronidazole, and clarithromycin. The percentages of susceptibility for the 98 species were penicillin V: 83/98 (85%), amoxicillin: 89/98 (91%), amoxicillin + clavulanic acid: 98/98 (100%), clindamycin: 94/98 (96%), and metronidazole: 44/98 (45%). Metronidazole had the greatest amount of bacterial resistance; however, if it is used in combination with penicillin V or amoxicillin, susceptibility of the combination with penicillin V or amoxicillin increased to 93% and 99%, respectively. Clarithromycin seems to have efficacy, but it is still considered an antibiotic under investigation because the minimum inhibitory concentration has not been established.

Amoxicillin↗

PubMed2001

"Red complex" (Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola) in endodontic infections: a molecular approach.

OBJECTIVE: The "red complex," composed of Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola, is implicated in severe forms of periodontal diseases. The purpose of this study was to assess the occurrence of the red complex in root canal infections through the use of a sensitive technique-the 16S rDNA-directed polymerase chain reaction (PCR). STUDY DESIGN: Samples were obtained from 50 necrotic pulps with periradicular pathosis. Ten cases were diagnosed as acute periradicular abscesses. DNA was extracted from the samples and analyzed with a PCR-based identification assay. RESULTS: At least 1 member of the red complex was found in 33 of 50 cases. T denticola, P gingivalis, and B forsythus were detected in 44%, 30%, and 26% of the cases, respectively. The red complex was found in 4 of 50 cases. No particular signs or symptoms were associated with the presence of these bacterial species. CONCLUSIONS: Despite what is indicated in reports with respect to marginal periodontitis, red complex bacteria-either singularly or collectively-was not associated with any particular pattern of clinical symptoms. However, because the bacterial species from the red complex are recognized oral pathogens, their occurrence in root canal infections suggests that they may play a role in the pathogenesis of periradicular diseases.

Adolescent↗

PubMed2000

Bulleidia extructa gen. nov., sp. nov., isolated from the oral cavity.

Five strains of anaerobic non-sporing Gram-positive bacilli isolated from advanced periodontitis (four strains) and a dentoalveolar abscess (one strain) that did not correspond to existing species were subjected to phenotypic and genetic characterization. Following 16S rDNA sequence analysis, they were found to constitute a novel branch of the low G+C Gram-positive division of the phylogenetic tree related to Erysipelothrix rhusiopathiae and Holdemania filiformis. A new genus Bulleidia, and the species Bulleidia extructa, are proposed. Growth of B. extructa in broth media was poor but was enhanced by the addition of fructose, glucose or maltose together with Tween 80. Glucose and maltose were fermented and arginine was hydrolysed. Acetate, lactate and trace amounts of succinate were the end products of glucose fermentation. The G+C content of the DNA of the type strain is 38 mol%. The type strain of Bulleidia extructa is DSM 13220T.

Bacteria, Anaerobic↗

PubMed1999

[Diagnostic and therapeutic concepts of canine fossa abscess. Evaluation of a multicenter study of 55 German-speaking departments of oromaxillofacial surgery].

A possible complication of fossa canina infections is reactive thrombosis of the vena angularis, which can lead to cavernous sinus phlebothrombosis. According to the literature there are different opinions about the treatment protocol of fossa canina abscesses. Therefore a multicentre study was undertaken in which 55 departments of oral surgery were interviewed using a standardized questionnaire about their procedures. The basis of diagnosis consists of clinical examination (100%), antibiogram (77.1%) and radiography (97.1%). A total of 28.6% use additional imaging procedures. Sonography is used by 20.0% and is found to be helpful in the diagnosis of vena angularis thrombosis. The painful palpation of the medial angle of the eye is of major diagnostic importance (100%) although anatomic variations of the vena angularis have to be considered. Extraoral incisions are not used in most cases (25.7% in exceptional cases) as well as ligations of the vena angularis in case of thrombosis (8.6% in exceptional cases). There is an agreement in the use of antibiotics (elective administration in 14.3%, obligatory administration in 85.7%); 77.1% don't use heparin to treat thrombosis of the vena angularis. In heparin therapy risks such as bleeding complications and thrombocytopenia have to be considered.

Cavernous Sinus Thrombosis↗

PubMed1999

Direct detection of Prevotella intermedia and P. nigrescens in suppurative oral infection by amplification of 16S rRNA gene.

A specific 16S rDNA PCR and subsequent hybridisation reaction was designed to discriminate between strains of Prevotella intermedia (n = 15) and P. nigrescens (n = 15). This technique was then used to detect the presence of these two bacterial species in acute suppurative oral infection. A total of 36 pus samples aspirated from 26 peri-apical abscesses, three root canals, three periodontal abscesses, two cases of refractory periodontitis, one cyst and one haematoma was examined. A portion of the pus sample was processed by PCR and the remainder of the specimen was subjected to routine culture. The PCR-based technique gave an identical pattern of detection of P. intermedia or P. nigrescens to that obtained by culture for 30 of the 36 specimens. Either P. intermedia or P. nigrescens was present in 14 samples and neither species was detected in 16 samples. In the remaining six samples the PCR method indicated the presence of one (n = 3) or both (n = 3) of the Prevotella species but neither or only one species was isolated by culture. It is concluded that the presence of P. intermedia and P. nigrescens in pus can be detected rapidly and specifically by direct PCR amplification of 16S rDNA. P. nigrescens was detected more frequently than P. intermedia in suppurative peri-apical infection both by culture and PCR.

Bacteroidaceae Infections↗

PubMed1986

Anaerobic bacteria in dentoalveolar abscesses.

The present study was initiated to determine the bacteriology of 40 orofacial abscesses of dental origin in patients who had taken antibiotics for several days. Bacteria were isolated from all but 2 specimens. Aerobic or facultative anaerobic bacteria were isolated in 21 cases, obligate anaerobic bacteria in 17 cases, whereas in 11 cases, polymicrobial growth was revealed. The average number of bacterial species was 2.1 per specimen. Gram positive aerobic micro-organisms predominated, namely, Staphylococcus epidermidis followed by Streptococci (group A) and Staphylococcus aureus. Among obligate anaerobes, Gram positive micro-organisms, peptostreptococci and peptococci were more often isolated, in the following decreasing order: Ps. productus, Ps. intermedius, Ps. parvulus, Ps. anaerobius, Pc. constellatus, Pc. prevotii. Gram negative anaerobic rods were detected in a small number of cases, namely B. corrodens, B. fragilis, B. melaninogenicus, B. ochraceus, B. oralis. Quantitative determination did not show any meaningful difference between aerobic and anaerobic isolates. Susceptibility tests against a series of antibiotics showed that ampicillin was the most active in aerobes and cefoxitin in anaerobes.

Adolescent↗

PubMed1990

[Clinical feature of odontogenic maxillary sinusitis--symptomatology and the grade in development of the maxillary sinus in cases of dental maxillary sinusitis].

Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of the second and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal discharge from an early stage. The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.

Adolescent↗

PubMed2006

Prevalence of selected bacterial named species and uncultivated phylotypes in endodontic abscesses from two geographic locations.

Evidence is mounting that the prevalence of some putative endodontic pathogens can significantly vary according to the geographic location in which samples were taken. This study aimed to provide additional knowledge on this subject by comparing the frequencies of 10 selected candidate endodontic pathogens in samples of acute apical abscesses obtained from two distinct geographic locations; Portland, OR, and Rio de Janeiro, Brazil. DNA was extracted from aspirates and used as template in nested PCR assays using 16S rRNA gene taxon-specific oligonucleotide primers. Of the target species/phylotypes, Treponema denticola (73% of the cases), Porphyromonas endodontalis (70%), and Tannerella forsythia (57%) were the most prevalent taxa found in Brazilian samples. Dialister invisus (70% of the cases), P. endodontalis (63%) and Dialister pneumosintes (55%) were the most frequent taxa in the Portland, OR samples. Data analysis revealed that T. denticola and T. forsythia were significantly more detected in Brazilian samples than in the Portland, OR samples. Although D. invisus, Filifactor alocis, and Synergistes oral clone W090 were detected in many more samples from the Portland, OR patients, differences were not found to be statistically significant. These findings confirmed that some bacterial taxa can markedly differ in the frequencies they occur in samples from different locations. It remains to be clarified whether this observation translates into relevant therapeutic implications.

Bacterial Infections↗