1/11. Management of complex multi-space odontogenic infections.The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly peptostreptococcus, fusobacterium, or Bacteroides, that are resistant to penicillin. clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for bacterial identification, timely and aggressive incision and drainage, and removal of the etiology. It is usually preferable to drain multi-space infections involving the submandibular, submental, masseteric, pterygomandibular, temporal, and/or lateral pharyngeal masticator spaces, as early as possible from an extraoral approach. trismus and airway management are important considerations and may preclude the selection of other surgical approaches. The patients with multi-space infections should be hospitalized and patient care provided by experienced clinicians capable of management of airway problems, in administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging studies, and control of possible surgical complications.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
2/11. Endodontic therapy averting major surgery and avoiding keloid formation.Keloids and mandibular unfavorable fractures are reviewed. A case report of a patient with keloid diathesis, who had a mandibular unfavorable fracture, is presented. A grossly carious, abscessed first molar was in the line of fracture. This tooth was the only erupted tooth present in the proximal fragment. Endodontic therapy and restoration of normal contour enabled the surgeons to treat the fractured mandible by means of simple closed reduction. The endodontic treatment pre-empted a major surgical procedure under general anesthesia and also averted a skin incision which would have subsequently formed a disfiguring keloid.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
3/11. A migratory abscess pointing intraorally and extraorally. Case report.A case of migratory abscess pointing both intraorally and extraorally at a considerable distance from the causative site is reported. The anatomy of the area leading to the formation of such an abscess is described.- - - - - - - - - - ranking = 6keywords = abscess (Clic here for more details about this article) |
4/11. Acute hemiplegia in childhood following a dental abscess.The syndrome of acute hemiplegia in childhood is described and a case following dental infection reported. The possible mechanisms responsible for the development of this condition are considered.- - - - - - - - - - ranking = 4keywords = abscess (Clic here for more details about this article) |
5/11. Prophylactic dental treatment for a patient with vitamin d-resistant rickets: report of case.Spontaneous oral dental abscesses in caries-free teeth has been a common sequela in patients with vitamin d-resistant rickets (VDRR). A successful attempt has been made to prevent such abscesses in a 41/2-year-old boy with VDRR by covering susceptible teeth with chrome crowns.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
6/11. Acute pulpal-alveolar cellulitis syndrome. IV. Exacerbations during endodontic treatment. Part 3. A case report.An asymptomatic abscessed maxillary premolar, which had undergone previous endodontic treatment, was retreated. The initial attempt to remove the silver cone seal was unsuccessful. Early the next morning, the patient appeared with a severe cellulitis exacerbation. The silver cone was now loose: a lateral "blowout." Specific cultures of the silver cone and exudate revealed three aerobic microbes: a Streptococcus sp and two obligate pseudomonas spp. Anaerobes were shown to be absent with anaerobic subcultures. This case would appear to substantiate the alteration of the tissue oxidation-reduction potential as the major factor in endodontic cellulitis exacerbations, as previously reported.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
7/11. brain abscess of odontogenic origin: report of case.Advanced dental infection rarely causes brain abscess resulting in death. Good dental hygiene and removing abscessed teeth are advised for prevention of any such occurrence. An intercranial infection is described in a 29-year-old male who also had a dental phobia.- - - - - - - - - - ranking = 6keywords = abscess (Clic here for more details about this article) |
8/11. Anaerobic mediastinitis.Anaerobic bacteria often are neglected in discussions of the bacteriology of mediastinitis. Two cases of anaerobic mediastinitis are reported and the literature in this field is reviewed. Anaerobes are important pathogens in the etiology of mediastinitis secondary to perforation of the esophagus, extension of a retropharyngeal abscess, or extension of cellulitis or abscess of dental origin from the neck. Although anaerobes indigenous to the oral cavity predominate in these cases, there are also a few cases reported involving bacteroides fragilis. The source of the mediastinitis should be considered when antimicrobial therapy is initiated so that appropriate anaerobic coverage can be included when indicated.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
9/11. Occult dental infection causing fever in renal transplant patients.fever secondary to odontogenic infection following successful renal transplantation is reported in three patients. All three patients initially lacked signs or symptoms localizing to the oral cavity, and two of the three patients did not have x-ray evidence of abscess formation. Two patients received antibiotic therapy without any apparent clinical response, and all three patients responded promptly to surgical extractions. Our patients illustrate that fever can be the only sign of dental sepsis in renal transplant recipients, and tooth extraction as empiric therapy may be necessary. Most important, however, is that the dental pathology responsible for their fever could have been detected and treated prior to transplantation. We recommend pretransplant dental evaluation of all patients with extraction of partially impacted molars and treatment of all periodontal disease and dental caries.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
10/11. actinobacillus actinomycetemcomitans infection in the oral cavity.An abscess that developed following the extraction of periodontally involved teeth persisted after surgical drainage and ampicillin therapy. Subsequent culture of pus from this abscess gave a pure growth of actinobacillus actinomycetemcomitans which was resistant to ampicillin. Surgical drainage and the use of appropriate antibiotic therapy cleared the infection. The identification of A. actinomycetemcomitans and the types of infection it causes are described. The probable mechanism of infection by the bacterium is discussed. A case that illustrates the importance of the microbiologic examination of pus from dental abscesses is reported.- - - - - - - - - - ranking = 3keywords = abscess (Clic here for more details about this article) |
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