Acute Periapical Abscess Research Articles

Tratamento de urgência de abcesso periapical agudo em evolução: Relato de um caso clínico

During emergency care, when the patient has pain, it is one of the main duties of the dental surgeon to promote pain relief to the patient. Acute apical abscess (AGA) is one of the most common causes found in urgent care. They are odontogenic infections, consisting mainly of anaerobic microorganisms, which lead to pain and/or edema, and have the potential to diffuse through the cortical bone, with eventual lethal consequences. The present study aims to describe the case report of drainage of an evolved acute periapical abscess and its respective treatment at the Primary Care Clinic II (CAB II) of the Faculty of Dentistry of Pernambuco - University of Pernambuco (FOP/UPE). Where the patient complained of spontaneous, pulsatile, localized pain and edema. Endodontic intervention is essential for immediate symptom relief, and there is no consensus in the literature that establishes a care protocol in these cases. Even though there is no requirement for standardization of the protocol for emergency care, we conclude that it is of great importance to conduct a procedure that performs the drainage of the abscess to avoid systemic compromise.

Drain and Treat: A Rubber Dam Technique for Acute Periapical Abscess

Abstract Patients often report to the dental hospital with a complaint of toothache with extraoral swelling. Worried patients visit the dentist with a lot of apprehension. Acute dental infections with intraoral and extraoral swellings can be emergency and challenging to manage. Reduced mouth opening and severe pain may not allow the dentist to create an orthograde access to root canals. It ensues when the bacteria spread from the dental pulp to the surrounding periapical tissues accompanied by the formation of pus. If left untreated, these infections can be excruciatingly painful and pose a severe risk of spreading to facial spaces and finally, they may propagate to deep neck areas a ascend to intracranial sinuses. Hence, knowledge of its clinical management is of utmost importance. An acute periapical abscess has to be accurately diagnosed to render proper management of these maladies. Treating dentists should have a basic understanding of the pathophysiology, the suitable usage of antibiotics, the medical history of the patient, and standard treatment protocols. Therefore, this case report describes the management of an acute periapical abscess which was an emergency, and its conservative management.

Use of drugs in Endodontics for patients with hypertension and diabetes who present acute periapical abscess

Use of drugs in Endodontics for patients with hypertension and diabetes who present acute periapical abscess

Cracked tooth and endodontic-periodontal lesion: 2-years follow up of a conservative treatment

This study report diagnosis and management of an endodontic-periodontal lesion in a cracked mandibular tooth after a cyclist’s fall. A 34-year-old female patient with a chief complaint of pain and edema in the region of the mandibular right first molar was evaluated and treated. Patient presented excellent oral health. After clinical, radiographical and tomographic exams, it was diagnosed an acute periapical abscess in stage II combined with tooth cracks and a periodontal involvement (endodontic-periodontal lesion). After emergency dental care it was performed subgingival scaling and root planing, definitive endodontic treatment, indirect definitive restoration (overlay) combined with a reinforcement of the tooth structure with a high-resistance polyethylene tape. Patient was periodically followed up until 24 months and treatment was successful. It can be concluded that a correct diagnosis and a conservative and well-planned and -executed treatment of a compromised tooth by cracks can have good results even endodontic-periodontal lesion is present.

Prevalence of acute periapical abscesses in head and neck cancer patients receiving radiotherapy.

Head and neck cancer is a serious condition affecting the life of patients. Radiotherapy is commonly used to treat such conditions. The aim of this study was to assess the prevalence of acute periapical abscesses (PAs) in patients who received radiotherapy for head and neck cancer. Data on acute PAs and oropharyngeal cancer (OPC) diagnosis with or without a history of radiation therapy (RAD) was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with a history of OPC with or without RAD were then calculated. Adjustment for comorbidities such as diabetes, smoking and gingival and periodontal diseases was also done. The prevalence of acute PAs in patients with a history of OPC was significantly higher as compared to the general hospital patient population (OR 2.92, 95%CI, p<.0001). Males were more affected than females and whites were more affected than African Americans and other ethnicities. The prevalence for PAs in patients with a history of OPC and RAD was higher and the difference in prevalence was statistically significant (OR 3.61, 95%CI, p<.0001). Whites were more affected than African Americans by more than 3.5-fold. Adjustment for diabetes comorbidly affected mainly the OPC + RAD group, however, the difference remained statistically significant. Adjustment for smoking and gingival and periodontal disease reduced the OR but the difference remained statistically different. The high prevalence of acute PAs in patients with a history of OPC and RAD may suggest an association between these conditions warranting a meticulous medical and dental examination.

Antibiotic prescribing pattern among dental interns for common dental conditions: A self-reported questionnaire-based survey

Aim: The aim of this study was to investigate about the antibiotic prescribing pattern of dental interns for various dental conditions. Materials and Methods: A survey was carried out with the help of a self-administered questionnaire in a central government-based dental institute. Sixty dental interns were asked to fill out the questionnaire sent electronically, which inquired about their current practice of prescribing antibiotics and their awareness about the use of antibiotic in common dental conditions. Results: The total response rate was 85%. The most prescribed antibiotic was amoxicillin (84.83%), followed by a combination of amoxicillin and clavulanic acid (56.9%). The most common dental condition for which the dental interns prescribed antibiotics was acute periapical abscess (90.2%), followed by periodontal abscess (76.5%). Conclusion: Dental practitioners prescribe antibiotics on a daily basis and its unchecked usage could lead to the development of antimicrobial resistance. The current survey highlights the need for dental professionals to audit their existing antimicrobial prescription practice and keep updating them according to the latest guidelines. In the dental practice, antibiotics should only be used as an adjunct to a dental interventional procedure, and never as a substitute for it.

Acute periapical dental abscesses and increased risk for extracranial carotid artery aneurysms

Aim: To assess the prevalence of acute periapical abscesses (PAs) in patients with a history of extracranial carotid artery aneurysms (ECAA). Materials and methods: History of acute PAs and ECAA diagnosis was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with history of ECAA were then calculated. Results: The prevalence of acute PAs in patients with a history ECAA was significantly higher as compared to the general hospital patient population (p &lt; 0.0001). The OR was 5.5. Females were more affected than males by 1.7 folds (p &lt; 0.001). Whites were more affected than African Americans by 1.6 folds (p &lt; 0.00001). Conclusions: The high prevalence of acute PAs in patients with a history of ECAA may suggest an association between these two conditions warranting a thorough medical examination.

Increased Risk for Acute Periapical Abscesses in Multiple Sclerosis Patients and the Possible Association with Epstein-Barr Virus

IntroductionMultiple sclerosis (MS) is a severe inflammatory neuroimmune degenerative condition affecting more than 2 million individuals worldwide. The purpose of this study was to assess the prevalence of acute periapical abscesses in patients with MS and to evaluate whether acute periapical abscesses (PAs) are more likely to affect patients who were previously infected by Epstein-Barr virus (EBV). MethodsIntegrated data of hospital patients were used. Data from the corresponding diagnosis codes for MS and acute PA were retrieved by querying the appropriate International Classification of Diseases, Tenth Revision codes in the database. ResultsOf the total hospital patient population, 0.18% were diagnosed with a history of MS. Females were more affected than males 3.25-fold. Whites were more affected than African Americans 6-fold. Whites were more affected than African Americans combined with other ethnicities 3.6-fold. The odds ratio (OR) for acute PAs in patients with a history of MS was 2.2 (P < .0001). After adjustment for diabetes mellitus comorbidity, the OR for acute PAs in patients with a history of MS was 2.6. After adjustment for cardiovascular disease comorbidity, the OR for acute PAs in patients with a history of MS was 1.27. Of the patients who presented with PAs, 0.2% were diagnosed with a history of EBV infection. The OR was 3.98, and the difference in prevalence was statistically significant (P < .0001). ConclusionsUnder the conditions of this cross-sectional study, it appears that the prevalence of acute PAs is higher in patients with MS and that EBV may play a role.

Acute periapical abscesses in patients using selective serotonin reuptake inhibitors.

Depression and anxiety are severe health problems affecting millions of individuals worldwide. Consequently, the use of antidepressants has constantly been on a rise. Selective serotonin reuptake inhibitors (SSRIs) antidepressant are now commonly used due to fewer side effects as compared to other types of antidepressants. The aim of this study was to assess the prevalence of periapical abscesses (PAs)in patients using SSRIs. Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for SSRIs and acute PAs was retrieved by searching the appropriate query in the database. The different diagnoses were coded using the international coding systems ICD 10. Diagnosis was made by calibrated dentists in a hospital setting based on clinical examination and imaging data. The odds ratio (OR) for the prevalence of acute PAs and its association with the use of SSRIs were calculated and analyzed statistically. It was found that the prevalence of acute PAs was significantly higher in patients using SSRIs as compared to the other hospital patient population. The OR was 2.8 and the difference between patients using SSRIs and patients who do not was statistically significant (p<.0001). Under the conditions of this study, it appears that the prevalence of acute PAs is higher in patients using SSRIs.

Endodontic treatment of dens invaginatus with periapical lesion

Dens invaginatus or dens in dente represent anomaly of the developing tooth due to invagination of the enamel organinto the dental papilla. Dens invaginatus is usually diagnosed by standard radiological methods (RVG, OPG, and 3DCBCT).Clinical examination may reveal a mottled, dilated or conical shape of the crown. Endodontic treatment of dens invaginatuscan be difficult and complex due to the deviated anatomy. This report describes the successful endodontic treatmentof a maxillary lateral incisor that had dens invaginatus and a large periapical lesion. Clinical examination in a 30-year-oldpatient revealed an acute periapical abscess, and a dens invaginatus type II was diagnosed after radiography. Due to theexisting anatomy, endodontic treatment of the main canal was performed through two access cavities, which enabledchemo-mechanical treatment and access to all parts of the root canal. The canal of the invaginated tooth was treatedthrough the third access cavity.

Management of acute alveolar abscess

The article is a case report on the management of acute periapical abscess associated with maxillary left first premolar by conventional root canal treatment and incision drainage. Radiographic examination on follow up showed healing of the endodontic lesion. Clinical evaluation also revealed no pain and sensitivity in relation to the upper left first premolar. Early diagnosis and proper management of the endodontic lesion led to successful resolution of this infection.

Acute periapical abscesses in patients with herpes simplex type 1 and herpes zoster

Aim: To assess the prevalence of acute periapical abscesses (PAs) in patients infected with herpes simplex type 1 (HS-1) and herpes zoster (HZ). Materials and methods: Integrated data of hospital patients was used. History of HS-1 and HZ diagnosis was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists in a hospital setting for patients admitted to urgent care. Diagnosis was made based on clinical examination and imaging data confirming the diagnosis of acute PAs without sinus tract. The odds ratio (OR) for the prevalence of acute PAs and its association with history of HS-1 and HZ were then calculated. Results: The prevalence of acute PAs in patients with a history HS-1 was 2.43% as compared to 0.59% in the general patient population of the hospital. The OR was 4.12 and the difference in prevalence was statistically significant (p &lt; 0.0001). The prevalence of acute PAs in patients with a history HZ was 2.78% as compared to 0.59% in the general patient population of the hospital. The OR was 4.71 and the difference in prevalence was statistically significant (p &lt; 0.0001). Conclusions: Under the conditions of this study, it appears that the prevalence of acute PAs is significantly higher in patients with a history of HS-1 and HZ infections and may warrant an antiviral therapy in certain resistant periapical abscesses.

Successful regenerative endodontic treatment in a tooth with incomplete root apex and posttreatment apical periodontitis: A case report

This case report describes the procedure and outcome of regenerative endodontic treatment (RET) in a tooth with incomplete root apex and posttreatment apical periodontitis. A 44-year-old patient was referred to the endodontist because of a periapical lesion on tooth #21 and a recent episode of acute periapical abscess. On clinical and radiographic examination, this tooth presented with tenderness to percussion and palpation, periapical radiolucent lesion, external apical resorption, and incomplete apex formation. After coronal access, the filling material was removed, and the canal was gently prepared with hand files, using 1% NaOCl as the main irrigant followed by final irrigation with 17% EDTA, activated with XP-endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The root canal was filled with a double antibiotic paste with ciprofloxacin and metronidazole (1:1). After three weeks, RET was performed by stimulating bleeding into the canal, and when a clot was formed, a bioceramic (EndoSequence BC Sealer, Brasseler USA, Savannah, GA) plug was placed on it, followed by coronal restoration. The tooth remained asymptomatic since RET was concluded. Clinical and radiographic follow-ups showed complete repair of the apical periodontitis lesion and the absence of symptoms after eight months. This satisfactory outcome was confirmed after 34 months. Key words:Bioceramic material; ciprofloxacin; metronidazole; persistent apical periodontitis; regenerative endodontic treatment.

Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study.

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Thermography as a non-ionizing quantitative tool for diagnosing periapical inflammatory lesions

BackgroundThermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA).MethodsAAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured.ResultsA total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P < 0.001). The result of the Kappa coefficient of agreement between the combination of clinical and radiographic assessments and the thermographic evaluation was significant (P < 0.001).ConclusionsThermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of periapical inflammatory lesions. The results of the present study indicated that the highest thermal image temperatures were recorded for AA. Thermography might be able to detect inflammatory reactions during the preclinical stage, leading to early diagnosis.

Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Background There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors. Purpose To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF. Methods A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR). Results In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p &amp;lt; 0.01). Conclusions An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions. Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) &amp;lt;0.0001 1.076 (1.075-1.076) &amp;lt;0.0001 Gender (male) 1.640 (1.629-1.651) &amp;lt;0.0001 1.0498 (1.487-1.509) &amp;lt;0.0001 Hypertension 2.849 (2.829-2.869) &amp;lt;0.0001 1.114 (1.487-1.509) &amp;lt;0.0001 Diabetes mellitus 1.951 (1.935-1.968) &amp;lt;0.0001 1.106 (1.096-1.116) &amp;lt;0.0001 Heart failure 3.893 (3.857-3.930) &amp;lt;0.0001 1.434 (1.416-1.452) &amp;lt;0.0001 Ischaemic stroke 2.289 (2.23902.340) &amp;lt;0.0001 1.140 (1.114-1.165) &amp;lt;0.0001 smoker 0.903 (0.891-0.917) &amp;lt;0.0001 1.052 (1.036-1.069) &amp;lt;0.0001 Liver disease 1.141 (1.119-1.164) &amp;lt;0.0001 1.082 (1.059-1.105) &amp;lt;0.0001 Previous myocardial infarction 2.128 (2.082-2.176) &amp;lt;0.0001 0.903 (0.880-0.926) &amp;lt;0.0001 Inflammatory disease 1.036 (1.020-1.052) &amp;lt;0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) &amp;lt;0.0001 0.821 (0.807-0.836) &amp;lt;0.0001 Illicit drug use 0.288 (0.263-0.317) &amp;lt;0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years). Abstract Figure. Flow Chart of the study patients

Nonsurgical endodontic treatment of a mandibular canine presenting with dens invaginatus type IIIb: Case report

Dens invaginatus consists of a malformation that occurs during the tooth development phase. More-severe cases may affect both the crown and the root. The endodontic treatment is more complex and challenging. The purpose of this article is to report the nonsurgical endodontic treatment of a mandibular canine diagnosed with an Oehler’s dens invaginatus type IIIb with an acute periapical abscess. The treatment consisted of treating the invagination while maintaining the vitality of the pulp tissue. A radiographic six-month follow-up confirmed the apical pathosis’s resolution, while the clinical evaluation confirmed the maintenance of a healthy pulp. The endodontic treatment can be successfully performed when an early and correct diagnosis is established. Cone-beam computerized tomography and magnification are extremely useful when approaching such cases.

Avaliação da prescrição de antibióticos pelos endodontistas em abscesso periapical agudo

Esse estudo teve como objetivo avaliar a prescrição de antibióticos nos abscessos periapicais agudos pelos endodontistas da região metropolitana do Recife - PE. Um estudo transversal com uma amostra de 100 endodontistas, que exerciam suas atividades em faculdades de odontologia e clínicas odontológicas particulares ou públicas. Eles responderam um questionário sobre prescrição de antibióticos sistêmicos no tratamento de abscesso periapical agudo e os dados foram analisados descritivamente por meio de frequências absolutas e relativas. Para avaliar associação entre duas variáveis categóricas foi utilizado o teste Qui-quadrado de Pearson ou teste Exato de Fisher e o programa estatístico utilizado foi o SPSS (Statistical Package for the Social Sciences) na versão 23. A associação de amoxicilina com clavulanato de potássio em pacientes adultos sem alergia a penicilina foi prescrita por 50% dos endodontistas e em casos de alergia a penicilina, a clindamicina foi a droga de primeira escolha com 67%. A maioria dos endodontistas realizava a prescrição do antibiótico por 7 dias. Com relação a prescrição de antibióticos a maioria respondeu que não prescrevia em todas as fases do abscesso periapical agudo, no entanto, quando houve determinação das fases evolutivas dessa doença, resultados mostraram que existiu prescrição em todas as fases, porém com percentuais diferentes, sendo mais indicados quando existia comprometimento sistêmico do paciente. Concluiu-se que a prescrição de antibióticos pelos endodontistas pesquisados não foi coerente com a literatura científica, no entanto, mostrou uma preocupação com a saúde e risco de complicações sistêmicas graves do paciente.

Identification of bacteria associated with periapical abscesses of primary teeth by sequence analysis of 16S rDNA clone libraries

ObjectiveThis study aims to detect the predominant bacteria in acute periapical abscesses of primary teeth using culture-independent molecular methods based on 16S ribosomal DNA cloning. MethodsPurulent material was collected from nine children diagnosed with abscesses of endodontic origin. DNA was extracted and the 16S rRNA gene amplified with universal primer pairs 27F and 1492R. Amplified genes were cloned, sequenced by Applied Biosystems, and identified by comparison with known 16S rRNA gene sequences. ResultsBacterial DNA was present in all nine purulence samples. A total of 681 clones were classified into 8 phyla, 78 genera, and 125 species/phylotypes. The phyla were Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes, Actinobacteria, Tenericutes, Deinococcus-Thermus, and Spirochaetes. The most dominant genera were Streptococcus (13.3%), Fusobacterium (11.8%), Parvimonas (7.8%), Prevotella (6.7%), Sphingomonas (5.8%), and Hafnia (5.2%). Fusobacterium nucleatum (11.5%), Parvimonas micra (7.8%), Streptococcus intermedius (6.6%), Sphingomonas echinoides (5.3%), Hafnia alvei (5.2%), and Citrobacter freundii (4.9%) were the most common species/phylotypes. Among these species/phylotypes, F.nucleatum was the most prevalent (7/9). C. freundii, Carnobacterium maltaromaticum, and H. alvei were seldom detected species in acute periapical abscesses but had relatively high abundance and prevalence. ConclusionAcute periapical abscesses are polymicrobial with certain prevalent bacteria, especially anaerobic bacterium. The most predominant and prevalent bacteria of acute periapical abscesses in children was F. nucleatum.

Investigation of acute periradicular abscess videos from one virtual platform

Objetivo: avaliar vídeos postados nos últimos dez anos na plataforma virtual YouTube ™ com o tema "abscessos periapicais agudos". Materiais e métodos: foi realizada uma busca na plataforma de vídeos do YouTube ™ usando as palavras-chave "abscesso periapical", "abscesso periradicular", "abscesso alveolar apical", "abscesso apical dentário-alveolar", "periodontite periapical supurativa" e "periodontite apical supurativa" ( Descritores Science Health (DeCS)) e "abscesso oral" e "abscesso bucal" (não indexados). Uma vez identificados, seus conteúdos foram avaliados, bem como sua concordância com a literatura, data de publicação, número de visualizações, duração, entre outros. Resultados: 1.106 vídeos foram identificados e 28 incluídos na amostra final (critérios de inclusão e exclusão). Dos vídeos excluídos, 85,5% não abordaram os temas nos termos buscados. 78,6%, foram divulgados em 2017 e 2018, principalmente nos meses de junho e novembro. 64,3%, excederam dois minutos, sendo o assunto mais abordado, o tratamento de abscessos perirradiculares agudos (75%), seguidos de etiologia (50%) e sintomas (50%). Conclusões: a internet é uma ferramenta importante na disseminação de informações em odontologia; no entanto, a qualidade dessas informações deve ser revisada por profissionais treinados