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Periapical destructions caused by experimental pulpal inoculation of Streptococcus mutans in rats.

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.

Alveolar Process↗

Evaluation of 5,000 endodontic treatments: incidence of the opened tooth.

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.

Alveolar Process↗

Intentional replantation of a maxillary molar. A 4-year follow-up.

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.

Adult↗

The presentation and complications of odontogenic septic shock. Report of a case.

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.

Aged↗