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Free rheumatoid factor in dental periapical lesions and gingivae of patients with rheumatoid disease.

To determine whether evidence of rheumatoid inflammation, in the form of free rheumatoid factor, might be found in the teeth-supporting tissues of patients with known rheumatoid disease, tissues from the dental periapical lesions of one group of 50 rheumatoid and 23 control patients, and from the marginal gingivae of a second group of 58 rheumatoid patients were examined by the direct immunofluorescence technique that employed fluroesceinisothiocyanate (FITC)-labelled aggregated human IgG. The gingival tissues contained no free rheumatoid factor. Free rheumatoid factor-producing plasma cells were, however, detected in the dental periapical lesions of 3 of the 50 rheumatoid patients, i.e. in 6%, and in 1 of the control patients i.e., in 4%. This control patient had suffered from nephritis 10 months prior to the investigation. Because free rheumatoid factor did occur, albeit infrequently, in the dental periapical lesions of rheumatoid patients, a search for IgG rheumatoid factor, known to occur in greater abundance than the IgM type although "hidden", was indicated.

Adult↗

Non-surgical management of a chronic periapical lesion associated with traumatised maxillary central incisors: case report.

A case is reported of a chronic periapical lesion involving maxillary central incisors with a history of traumatic injury eight years previously and subsequent development of a painful swelling that occasionally caused partial blockage of the nasal cavities. Retrograde surgery for removal of the suspected cystic lesion was scheduled. As a temporary measure before surgery, the necrotic pulp exudate was removed through standard endodontic access cavities prepared on the palatal surfaces of the crowns of the two central incisors, and a calcium hydroxide paste dressing material was placed inside the root canals up to the apices. The calcium hydroxide dressing was changed every four weeks and the case was followed up until healing of the periapical lesion occurred. The surgical procedure was postponed and finally cancelled when complete healing became evident in recall radiographs.

Adult↗

Management of mandibular fascial space infection of odontogenic origin.

Cellulitis is an acute, painful infection whose swelling is larger with diffuse borders. When palpated, early cellulitis can be very soft or doughfy; a severe cellulitis is almost always described as indurated or even as being "board-like". It can be innocuous in its early stages and extremely dangerous in its more advance, indurated, rapidly spreading stages. Randy, a 16 years old boy who thought that a regularly occurring toothache can advance into a life-threatening complication has a lot to be thankful for. The patient was referred to the Pediatric Dentistry Division by the E.R. doctors for further evaluation and management due to a swelling on the lower quadrant of his face. This was on the 8th day after he experienced the first pain on tooth no. 47.

Adolescent↗

[Swellings in the maxillofacial region (author's transl)].

The most frequent swellings in the maxillofacial region can be traced to odontogenic inflammations. Chronic dental foci exacerbate and break through the soft tissue layer surrounding the jaw. There the purulent material quickly spreads along the muscular pocket and simulates a phlegomonous inflammation. Inflammations of the individual soft part niches have characteristic symptoms. Because of the loose interconnections the infectious material can spread very quickly into the parapharyngeal space and from there downwards into the mediastinum or upwards into the base of the skull. Because of the danger of an advance in these spaces, it will be necessary to incise the swellings on time.

Adolescent↗

Complications associated with maxillary osteotomies.

There are certain complications involved in maxillary ostetomies; devitalization of teeth, loss of part or all of the osteotomized segment, and relapse are possible problems. The paramount cause of the complications in seven different cases seemed to be the interruption of the blood supply to the operative site. A seven-point guideline is formulated; it integrates preoperative planning, surgical procqedures, and postoperative care.

Adolescent↗

Endodontic interappointment emergencies in a Singapore private practice setting: a retrospective study of incidence and cause-related factors.

One thousand and sixteen consecutive records of patients treated by the author for endodontic treatment was surveyed for the incidence of endodontic interappointment emergencies (EIE) and the major factors contributing to it. The overall incidence of EIE was 3.15% and unrelated to the patients' sex or tooth location. Caucasians were more likely to experience flare-ups than Chinese (p < 0.01). Patients < 20 years and > 60 years were less likely to experience EIE (p < 0.05). EIE was significantly higher in necrotic teeth than in vital teeth (p < 0.01). A clinical diagnosis of necrotic pulp with acute apical abcess (NP/AAA) increased the incidence of flare-ups significantly (p < 0.05). Retreatment cases also had a higher incidence of EIE and this was statistically significant (p < 0.01). The possibility of EIE was the highest after the first visit (p < 0.01) and this was reduced significantly with subsequent visits.

Adult↗

[Bacteriological studies during conservative treatment of periapical inflammations].

32 teeth with the diagnosis of periapical osteitis (established by clinical and radiological examinations) were subjected to endodontic treatment (irrigation with hydrogen peroxide), the course of which was followed by bacteriological examinations. The timing of treatment termination depended solely upon clinical evaluation. The examination of smears taken before the last irrigation showed that 26 of the 32 root canals (81%) were germ-free; in 2 cases, an anaerobic infection was still extant; and in 4 cases, an aerobic infection was observed. The high percentage of root canals which were germ-free before the last irrigation testifies to the efficiency of hydrogen peroxide application for disinfecting root canals on the one hand, and demonstrates the good agreement between clinical and bacteriological findings on the other hand. The germs identified belonged mainly to the normal oral flora. Enterococci proved to be particularly resistant. The conservative treatment of periapical osteitis by means of root-canal disinfection with a hydrogen peroxide preparation ans subsequent root-canal filling with a calcium peroxide paste is recommended.

Calcium Hydroxide↗