Cases reported "Focal Infection, Dental"

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1/85. Pyorrhoea as cause of pyrexia.

    Three patients with fever and malaise, one of whom also had joint pains, were extensively investigated before their condition was attributed to dental sepsis. Each patient recovered fully after appropriate dental treatment. Dental sepsis should be added to the list of possible causes of pyrexia of undetermined origin, and a routine dental examination should be carried out in each case.
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2/85. Toxic shock syndrome secondary to a dental abscess.

    A 9-year-old girl presented with arthralgia and myalgia which progressed to developing renal failure and overwhelming septic shock. The underlying cause was assumed to be a periodontal abscess from an upper right deciduous canine tooth. The pus from the abscess grew a toxic shock syndrome toxin 1-producing staphylococcus aureus. This case illustrates the importance of an oral surgical review of patients presenting with features of toxic shock syndrome if the source of the infection is not immediately obvious.
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3/85. Chronic factitial ulcer of chin cured by endodontic (root-canal) surgery for underlying periapical abscess.

    In a determined search for the cause of a "factitial" ulcer of the jaw, consultation with 3 dentists was required before an underlying periapical abscess was discovered. Within 3 months of endodontic surgery, this ulcer of 12 years duration had completely healed and remains healed. Too often dental infection is neither suspected nor detected as a cause of skin disease.
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4/85. An unusual case of a relationship between rosacea and dental foci.

    rosacea is a chronic disorder affecting the facial convexities, characterized by frequent flushing, persistent erythema, and telangiectases. During episodes of inflammation, additional features are swelling, papules, and pustules. The exact etiology of this dermatitis is unknown, and theories abound. Infectious foci, especially dental foci, seem to be rarely associated with the onset and progression of this disease. Dermatologic treatments are determined by the severity of the disease. But eradication of infectious foci, and in this case eradication of dental foci, may generate a significant improvement and may lead to a recovery.
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5/85. Bacterial endocarditis of dental origin: report of case.

    Although appreciated by most practitioners, the fact that dental infection may be the source of bacteremia without a history of recent dental procedures is occasionally overlooked. The case reported here illustrates what we feel is an example of such a phenomenon. The eradication of the oral foci of infection enhanced the patient's response to therapy and prompted his ultimate recovery.
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6/85. sinusitis as the first indication of sarcoidosis an incidental finding in a patient with presumed 'odontogenic' sinusitis: case report.

    Involvement of the paranasal sinuses and nose by sarcoidosis is uncommon, and has been reported in only 1-4% of patients with sarcoidosis. Clinical symptoms are nasal obstruction, epistaxis, nasal pain, discharge, anosmia or hyposmia, epiphora, and dyspnoea. We present a case of sarcoidosis in which sinusitis was the first clinical sign of the disease.
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7/85. Infected total hip replacement after dental procedures.

    Three cases are reported in which there was a worrisome association between dental work and an infected total hip replacement. The patients had long asymptomatic intervals subsequent to implantation of prosthetic hip joints. After dental procedures, infections became apparent in these hips. Such infections carry an enormous and crippling morbidity. The potential complications of transient bacteremia in the patient with a cardiac valvular prosthesis are appreciated and the importance of prophylactic antibodies for dental work in such patients is well known. Although we emphasize that there is no proof that the infections in our patients were metastatic from the mouth, the sequence of events is suggestive. We recommend prophylactic antibiotics for dental work in the patient with a total hip replacement.
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8/85. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases.

    PURPOSE: Although most cases of cervical necrotizing fasciitis (CNF) are odontogenic in origin, reports of this disease in the dental literature are sparse. The purpose of this study was to review the cases treated on our service, and to analyze the features of this disease and the responses to management, to supplement the understanding of this relatively rare and life-threatening disease. patients AND methods: All cases of infection admitted to the OMS service in a period of 10.5 years were studied retrospectively. The diagnosis of CNF was established by the findings on surgical exploration and histologic examination. The patients' age, sex, medical status, causes of the infection, bacteriology, computed tomography scan findings, surgical interventions, complications, survival, and other clinical parameters were reviewed. RESULTS: A total of 422 cases of infection were admitted, and 11 cases of cervical necrotizing fasciitis were found. The incidence of CNF was 2.6% among the infections hospitalized on the OMS service. There were 7 male and 4 female patients. Eight patients were older than 60 years of age. Seven patients had immunocompromising conditions, including diabetes mellitus in 4, concurrent administration of steroid in 2, uremia in 1, and a thymus carcinoma in 1. All patients showed parapharyngeal space involvement; four also showed retropharyngeal space involvement. Gas was found in the computed tomography scan in 6 patients, extending to cranial base in 3 of them. Anaerobes were isolated in 73% of the infections, whereas streptococcus species were uniformly present. All patients received 1 or more debridements. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. All major complications developed in the immunocompromised patients, leading to 2 deaths. CONCLUSION: The mortality rate in this study was 18%. Early surgical debridement, intensive medical care, and a multidisciplinary approach are advocated in the management of CNF.
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9/85. Nasal fistula associated with dental infection: a report of a case.

    Most clinicians have come across a patient with difficult symptoms to diagnose. Often confusion occurs between odontogenic and nonodontogenic causes of sinus discomfort. On many occasions, sinus pain is due to purely dental causes, whereas in other situations dental pain is reported when the sinuses are infected. Due to the intimate association between the roots of the maxillary teeth and the floor of the nasal cavity and maxillary sinuses, diagnosis may be difficult. The following is a case report of a nasal fistula that developed from an abscessed maxillary central incisor.
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10/85. Infected total knee replacement following a dental procedure in a severe haemophiliac.

    This article documents the late infection of a total knee replacement in a haemophiliac following a dental procedure. It underlines the need for reconsideration of the current British guidelines regarding antibiotic prophylaxis for dental procedures in patients with total joint replacement.
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