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Discomfort manifesting in the gingival tissues prompts patients to seek emergency treatment. Several clinical entities should be included in the differential diagnosis. Accurate diagnosis and appropriate therapy is essential to resolving the problem.
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Left submandibular adenophlegmon was initially attributed to local dental disease. Recurrence of the symptoms when this was corrected, however, showed that E. coli was responsible, and suitalbe antibiotic management quickly led to a complete cure.
Bacteriologic analysis of pathogens from pyogenic infections of the jaw in 71 patients revealed that bacteria normally found in the buccal cavity predominated in 86% of the specimens. Considering the fact that no pathogens could be identified in 7% of the specimens, this then means that pathogens were only found in 7% of the specimens. Six to 12 strains were usually isolated in the mixed bacteria population of the buccal cavity. A total of 430 strains of bacteria were cultured and tested for their response to 20 common antibiotic preparations. We were able to confirm the high effectiveness of penicillin and/or broad spectrum penicillin 92% of the cases (8600 determinations of resistance). Tetracycline was effective in 89% of the cases; trimethoprim sulfamethoxazole, in 83%. The effectiveness of newer, more expensive, antibiotic preparations was not significantly better than that of pencillin. Administration of such antibiotic preparations therefore should be limited to problematic pathogens.
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This paper reports a case in which an odontogenic infection extended into a maxillary sinus in an otherwise well 3-year-old child. The resulting sinusitis and orbital cellulitis were caused by an organism which does not usually cause disease in this age group, group B β-hemolytic streptococcus.
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