Cloxacillin in the treatment of dental infection.
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The development of pulpal and periapical changes in rat molars was studied after inoculation of Streptococcus mutans (GS-5) into the pulp chamber. Before injection into the pulp Streptococcus mutans was cultured on a special collagen substrate and "trained" to break down collagen. The destruction of the alveolar bone periapically could be demonstrated both roentgenologically and histopathologically. Large numbers of inflammatory cells in the pulp chamber and the periapical area, as well as carious dentin, were present. The pulpally inoculated bacteria could also be recovered from the systemic blood. The identity between the pulpally inoculated bacteria and the bacteria recovered from the blood was proved by gel precipitation.
A rare, previously unreported case of radicular variety of double dens invaginatus is presented. The probable mechanism of formation is discussed.
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Five thousand endodontic cases treated by three endodontists were reviewed to determine the frequency of the need to leave teeth opened for drainage. The subsequent treatment of these teeth is described. Of the 5,000 cases reviewed, 518 were left open at some point during treatment. Two hundred and eighty-one cases (54.2 percent) remained closed after the first closure. Four hundred and twenty-six (82.2 percent) of the cases opened were eventually completed without surgical intervention. The need to prescribe antibiotics and perform a trephination is also stated.
A 4-year follow-up of a case treated by intentional replantation has been presented. A maxillary molar with a metal core was diagnosed as having acute apical periodontitis, endodontic treatment was determined to be impractical, and the tooth was extracted. Three roots canals which could not be detected roentgenologically were discovered and, after apicoectomy and reversed amalgam filling, the tooth was replanted in its socket. The follow-up reveals periapical repair with no signs of root resorption or ankylosis.
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Although most odontogenic infections spread locally to adjacent fascial spaces, usually contiguous with the offending odontogenic pathosis, occasionally such an infection can spread rapidly across the midline and appear on the opposite side of the face and neck. Debilitated chronic alcohol abusers who are nutritionally deficient are more likely to develop serious life-threatening infections, either through serious airway involvement as seen in Ludwig's angina or manifest as a gram-negative septicemia with life-threatening shock and even cardiac arrest, than the usual dental patient with cellulitis. Early recognition through a high index of suspicion and vigorous monitoring will pick up the initial manifestation of toxic shock, as noted in this case report.
The case reported in this article documents a clinical situation in which an infected tooth resulted in secondary clinical manifestations involving the seventh cranial nerve in addition to the fifth cranial nerve. A theory for the referral mechanism is proposed.