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Case challenge. Chronic maxillary inflammation.

A 30-year old male was referred by a dental practitioner to the Department of Oral Radiology at the University of Lund, Sweden, for a radiological evaluation of chronic symptoms of inflammation on the right side of the maxilla. According to the patient, at age 12 he had surgery to remove a non-erupted maxillary right second premolar. Postoperatively, a draining sinus tract appeared on the buccal aspect of the alveolar process. Thirteen years later, at age 25, surgery was again performed and the sinus tract reappeared. Intermittent discharge of exudate from the sinus tract occurred since the second surgery. Clinical and radiological examinations were conducted prior to a third surgery. The clinical examination revealed pus draining from the tract located on the buccal aspect of the alveolar process between the right maxillary first molar and first premolar. The radiological examination included periapical radiographs of the right maxillary first premolar and canine, a panoramic radiograph, and frontal tomograms of the maxillary right premolar area.

Adult↗

Cutaneous dental sinus tract, a common misdiagnosis: a case report and review of the literature.

Cutaneous sinus tracts of dental origin are often initially misdiagnosed and inappropriately treated because of their uncommon occurrence and the absence of symptoms in approximately half the individuals affected. Patients are often referred with a recurrent or chronic cyst, a furuncle, or an ulcer on the face or neck. Correct diagnosis is based on a high index of suspicion and on radiologic evidence of a periapical root infection. Appropriate treatment results in predictable and rapid healing of these lesions. We present a case report of this common misdiagnosis and a review of the literature with regard to diagnosis and treatment.

Cutaneous Fistula↗

[Chronic dental infections in etiology of uveitis].

The authors show the gravity of uveitis, the concepts regarding their appearance, the leading part in fights cavities, insisting on the most frequent fights cavities from bucco-maxilo-facial domain.

Dental Caries↗

Radiodensitometric measurements in cases of chronic periapical changes of endodontically treated teeth.

The purpose of the paper was radiodensitometric evaluation of hard tissues of roots and alveolar bone of endodontically treated teeth with clinically detected chronic periapical inflammatory changes. The material consisted of 139 digital intraoral radiograms of endodontically treated teeth with chronic periapical changes: 54 teeth with granulomatous inflammation, 62 with fibrous changes and 23 teeth with purulent lesions. There was discussed the value of digital radiography and radiodensitometric measurements in cases of periapical inflammations of endodontically treated teeth. It was concluded that radiodensitometric measurements allowed detailed examinations of inflammatory changes at the apices of endodontically treated teeth. Digital radiography is a valuable and objective tool in diagnosis of periapical changes, monitoring of the course of endodontic treatment as well as in follow-up after such treatment. At the same time it allows reduction of ionising radiation dose, thus decreasing diagnostic risks to a patient.

Absorptiometry, Photon↗

[Mycobacteria in the development of periodontal foci of infection].

A total of 162 samples of material from the periodontal foci of infection were examined microbiologically and morphologically to detect mycobacteria and their biologically changed variants. The regularities of the pathologic process development in periodontal tissues of subjects without tuberculosis were found to fully conform to the current concept of a latent tuberculous infection. The periodontal foci of infection may be regarded as reservoirs of persistent mycobacteria, whose main form, L variant, was detected in 71.6% of cases. Clinical and morphologic manifestations of periodontitis depend on the stability of the persistent mycobacteria L forms.

Adult↗

Dental disease in the differential diagnosis of fever of unknown origin.

A patient with a one-year history of fever of unknown origin is presented. Extensive work-up failed to reveal the source of the fever. Treatment of periodontal infection resulted in complete cure, suggesting a cause-effect relationship. A possible role of Interleukin 1 (IL-1), universal pyrogen, in periodontal disease is suggested.

Adult↗

Space maintenance and endodontic follow-up: case reports.

Early extraction of carious primary teeth may result in functional and/or loss of arch length problems. That is the rationale behind root canal therapy and/or space maintenance after the extraction of pulpally involved primary molars. What follows is a short radiographic and photographic history of unexpected results in well established and routine space therapy treatments.

Child↗

Surgical intervention of mucosal fenestration in a maxillary premolar: a case report.

Labial mucosal fenestration of the root apex is an uncommon occurrence. An unusual case involving a maxillary right first premolar is described. When presented, the tooth was nonvital with the buccal root apex readily seen through a soft tissue and bone fenestration. Conventional endodontic treatment with gutta percha failed to resolve the problem. Periodontal surgery with a laterally positioned pedicle flap was thus scheduled. At the 1-month recall, complete healing was evident in the surgical site, and the fenestrated area of the maxillary right first premolar was filled with healthy mucosal tissue. One-year postoperatively, the mucosa remained covered, and there was radiographic evidence of bone infilling in the periapical region.

Adult↗

Infection-related inferior alveolar and mental nerve paresthesia: case reports.

Nerve injury can be related to mechanical, chemical, and thermal factors. Infection-related paresthesia is usually related to mechanical pressure and ischemia associated with the inflammatory process. Another cause of paresthesia could be the toxic metabolic products of bacteria or inflammatory products released following tissue damage. This article presents cases of inferior alveolar and mental nerve paresthesia caused by an infected impacted tooth, an infected cyst, and periapical infection. The possible pathophysiologic mechanism of nerve injury, therapy, and prognosis for recovery are also discussed.

Adult↗

Fatal necrotizing fasciitis of dental origin.

Necrotizing fasciitis is a potentially fatal, acute bacterial infection characterized by extensive fascial and subcutaneous tissue necrosis. Four factors that contribute significantly to the morbidity and mortality of necrotizing fasciitis are: 1) delayed treatment, due to difficulty in recognizing the condition; 2) inappropriate treatment; 3) host debilitation; and 4) a polymicrobial infection.

Adult↗