Cases reported "Periapical Abscess"

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1/6. A new bacterial species associated with failed endodontic treatment: identification and description of actinomyces radicidentis.

    OBJECTIVE: This report describes 2 endodontic patients who had persistent signs and symptoms after conventional root canal treatment. The aim of this study was to determine what microorganisms were present in the root canals of the teeth with failed endodontic therapy. STUDY DESIGN: After removal of the root fillings, the canals were sampled by advanced microbiological techniques and the isolates were characterized by various tests. RESULTS: bacteria, which grew in pure cultures, were isolated in each case. The bacteria were similar to each other and were classified as actinomyces on the basis of phylogenic and phenotypic evidence. The bacteria were different from others within the genus, thus warranting designation as a new species, actinomyces radicidentis. CONCLUSIONS: The 2 cases of endodontic failure were infected with A radicidentis, a new actinomyces species. This bacterium joins a restricted group of other microorganisms that have been associated with failure of root canal treatment.
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2/6. streptococcus oralis as a risk factor for middle cerebral artery thrombosis.

    We reported a case of an 8-year-old boy who was presented to the emergency department with left-sided hemiparesis. Computed tomography showed hypodense areas in the territory of the right middle cerebral artery, indicating acute cerebral infarct. Diagnostic evaluation was performed to identify the etiology. On the eighteenth day of hospitalization, cerebrospinal fluid cultures yielded streptococcus oralis. We hypothesized that the source of the oral pathogen was an abscess belonging to his upper left fourth tooth, which, by a transient bacteremia, had invaded the central nervous system, and skipping the meninges caused local inflammatory arteritis of the carotid artery, leading to cerebral infarction. sulbactam-ampicillin therapy was initiated for 14 days, and he was discharged with anticoagulation therapy.
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3/6. actinomycosis associated with a root-treated tooth: report of a case.

    An unusual case of a persistent infection related to a root-filled tooth is reported. Microscopical evaluation revealed the cause to be a large mass of actinomyces-like filaments, and microbiological culture yielded a low level of actinomyces israelii. The significance of such a presentation is discussed.
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4/6. Necrotizing fasciitis.

    Necrotizing fasciitis is a relatively uncommon severe soft tissue infection that is characterized by rapid widespread superficial fascial necrosis with undermining of surrounding soft tissue. Recent advances in anaerobic culture techniques have allowed identification of anaerobic organisms, which are now considered to have a vital role in the pathogenesis of this soft tissue infection. Therapy requires both rapid institution of a high level of antibiotics and a radical surgical incision and drainage procedure. All of the aerobic and anaerobic organisms isolated in the reported case of necrotizing fasciitis arising from a periapically infected mandibular third molar demonstrated in vitro sensitivity to penicillin.
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5/6. eikenella corrodens: an unusual cause of endocarditis in a patient with silent mitral valve prolapse.

    A 69-year old man with clinically silent mitral valve prolapse developed infective endocarditis secondary to eikenella corrodens after dental work. The patient required surgical removal of abscessed teeth and long-term antibiotic therapy. E. corrodens is a gram-negative coccobacillus which normally inhabits the oropharynx, gastrointestinal tract, and upper respiratory tract. The organism can cause cutaneous and abdominal abscesses, meningitis, osteomyelitis, and endocarditis. patients with mitral valve prolapse and a pre-existent systolic murmur or Doppler echocardiographic evidence of mitral regurgitation should receive prophylactic antibiotics for any procedure associated with a bacteremia. An infection caused by E. corrodens should be considered in patients with fever after dental manipulation or in patients with "culture-negative" endocarditis.
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6/6. Endodontic cellulitis 'flare-up'. Case report.

    Endodontic cellulitis involves facial swelling which can vary from mild to severe and can occur as a primary case or a flare-up following initial treatment of asymptomatic teeth with periapical lesions. The microbial spectrum in primary cases involves a significant mixture of anaerobic and facultative aerobic microbes, chiefly streptococci. In a previous study, cultures from flare-up cases, utilizing the same anaerobic techniques as in primary cases, revealed an absence of obligate anaerobes and an 80 per cent incidence of facultative aerobic streptococci. These cases also revealed a significant time lapse from onset of symptoms to the cellulitis phase. No sex or age factors were noted in the primary or flare-up cases. The purpose of this case report is to restate a traditional theory, namely, the alteration of the oxidation/reduction potential (Eh), as a major factor for endodontic cellulitis flare-ups; to confirm the pathogenic potential of oral facultative streptococci; and that asymptomatic endodontic lesions tend to exist with mixed aerobic/anaerobic microbial flora.
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