The prescription of antimicrobials is a common practice in pediatric dentistry for the management of oral infections, trauma, and prophylactic indications. However, inappropriate use and misuse of these agents remain a significant concern, contributing to antimicrobial resistance, adverse drug reactions, and unnecessary exposure in children. The aim of this review was to evaluate the appropriate indications, clinical considerations, and common causes of misuse of antimicrobials in pediatric dental practice, with particular emphasis on antibiotics and analgesics. Children present unique anatomical, physiological, and behavioral characteristics that influence drug selection, dosage, and administration. Antibiotics are indicated primarily in cases of spreading odontogenic infections, facial cellulitis with systemic involvement, specific traumatic injuries, salivary gland infections of bacterial origin, and selected medically compromised conditions requiring prophylaxis. In contrast, antibiotics are not indicated for localized dental conditions such as irreversible pulpitis, necrotic pulps, localized apical abscesses without systemic signs, plaque-induced gingivitis, or viral infections, where definitive dental treatment and local measures are sufficient. Despite clear guidelines, antibiotic overuse in pediatric dentistry is frequently driven by misdiagnosis, time constraints, parental pressure, and insufficient knowledge of evidence-based indications. Such practices increase the risk of antibiotic resistance and may delay definitive dental care. The review also discusses the role of analgesics and anti-inflammatory drugs in pediatric dentistry, emphasizing that pain management should primarily rely on agents such as acetaminophen and ibuprofen rather than antibiotics. In conclusion, antimicrobials play an essential but limited role in pediatric dental care. Judicious prescribing based on accurate diagnosis, clinical severity, and established guidelines is critical to minimize misuse. Increasing practitioner awareness, improving education, and adhering to evidence-based protocols are key strategies to promote rational antimicrobial use and safeguard both individual and public health.

Reducing pediatric facial cellulitis of odontogenic origin related hospital admissions using an ambulatory protocol.

This study presents 2 cases of elderly edentulous patients with infected, impacted mandibular third molars in severely atrophic mandibles. Both cases were managed surgically with tooth extraction and prophylactic internal fixation to prevent pathologic fracture. The first case involved a 62-year-old woman with a class III atrophic mandible and chronic infection. Surgical treatment included intraoral drainage, odontossection, extraction, and placement of a 2.4mm osteosynthesis plate aided by a stereolithographic model. The second case, a 70-year-old woman with facial cellulitis, was treated initially with drainage and antibiotics, followed by delayed extraction and internal fixation using the intraoral approach. Both cases had favorable outcomes without postoperative complications. Prophylactic osteosynthesis is a safe and effective technique in high-risk cases involving atrophic mandibles and the need for third molar removal. The intraoral approach, combined with 3D planning, enhances surgical precision and minimizes morbidity.

Pediatric odontogenic facial cellulitis is a rare but potentially fatal polymicrobial infection. Diagnosis depends on clinical and radiographic assessment. Treatment typically includes removal of the infected tooth (source control), adjunctive antibiotic therapy, and hospital admission. Infectious disease physicians play a key role in managing severe, complicated, or treatment-resistant cases, working closely with pediatric dental teams. Thus, an in-depth understanding of the pathophysiology, diagnosis, and general treatment approach to odontogenic facial cellulitis is essential.

Aims: This review synthesizes current knowledge on inflammatory complications of odontogenic origin, based on scientific literature from 2005 to 2025. The objective is to identify and characterize the full spectrum of complications, their etiology, pathogenesis, diagnostic approaches, and therapeutic strategies. Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science, covering peer-reviewed articles published between 2005 and 2025. The literature search yielded 2,340 articles, of which 28 met inclusion criteria, including 15 original research articles, 10 review articles, and 3 case reports. Results: The review covers complications including periapical abscesses (periapical, subperiosteal, submucosal), odontogenic sinusitis, osteomyelitis, facial cellulitis, sepsis, orbital abscess, meningitis, cavernous sinus thrombosis, brain abscess, and Lemierre’s syndrome. Contributing factors include untreated caries, periodontal disease, dental trauma, diabetes, and immunosuppression. Infection spread occurs via direct extension, hematogenous dissemination, or lymphatic routes, affecting areas such as the maxillary sinus, orbit, mediastinum, and intracranial spaces. Conclusions: The results emphasize that early diagnosis, targeted antimicrobial therapy, surgical intervention, and patient education are critical for effective management. The discussion underscores the need for interdisciplinary approaches and preventive measures to mitigate these complications.

ObjectiveDental caries is defined by the WHO as a multifactorial non-communicable disease. If left untreated, it can progress to abscesses and then head and neck odontogenic cellulitis. It requires immediate, appropriate, and interdisciplinary treatment. The aim of this study was to draw up an epidemiological profile of these children treated at the Lille University Hospital in northern France and to study the impact of self-medication of anti-inflammatory drugs.Materials and MethodsA single-centre retrospective, cross-sectional study was conducted on children with odontogenic cellulitis admitted to the paediatric emergency department of the Lille University Hospital between March 2013 and December 2021.Results15.3% of the 636 children included had taken nonsteroidal anti-inflammatory drugs before going to the emergency department. The frequency of pain and trismus was higher in children who had taken nonsteroidal anti-inflammatory drugs than in those who had not. Frequency of hospitalisation was higher in children who had not taken nonsteroidal anti-inflammatory drugs than for those who had (70% vs. 57%, respectively; p < 0.05). Inversely, the mean length of stay was longer for children who had taken nonsteroidal anti-inflammatory drugs than in those who had not (1.1 vs. 0.8 days, respectively; p < 0.05).ConclusionThis first French epidemiological study on odontogenic cellulitis in children underlines the need to develop multidisciplinary prevention and patient education.

Factors influencing onset and course of odontogenic pediatric facial cellulitis.

A healthy 50-year-old man was admitted to the emergency room (ER) with a history of 38 ͦC fever and a painful forehead, cheek, and lips edema that started several hours before his admission.

Leprosy is a chronic granulomatous infection generally caused by Mycobacterium leprae and Mycobacterium lepromatosis, which primarily affect the skin and peripheral nerves. A 42-year-old female patient, a resident of Punjab, presented with complaints of recurrent swelling and redness over their chin and left half of their face from 5 years duration. There was no history of fever with episodes of swelling. Every time she was diagnosed with facial cellulitis and was treated with antibiotics orally and intravenously, only to have partial remission. Examination revealed ill-defined, erythematous, indurated swelling with irregular margins over the left cheek, left the periocular area, chin, and submental area giving peau d orange appearance. Based upon the chronic duration, and treatment history a differential of borderline leprosy in type 1 reaction was kept and further detailed examination was done. Histopathological examination gave the impression of borderline tuberculoid Hansen. Based on the clinical picture, history, and histopathology, diagnosis of borderline tuberculoid leprosy was made. The patient was then started on MBMDT pack.

Teledentistry has supplemented current dental healthcare systems and has been proven effective in pediatric dentistry. To investigate the feasibility and acceptability of a virtual pediatric dentistry clinic (VC). This mixed methods study used an explanatory sequential design. First, a quantitative survey assessed parental satisfaction with VC. The second phase involved two parts: (1) qualitative semi-structured interviews with parents and (2) ten observations of virtual appointments were conducted to aid in findings' triangulation. Forty-five VC were conducted with children and parents. Thirty-six parents (80%) were highly satisfied, while nine (20%) had low satisfaction. Fourteen semi-structured interviews were conducted with seven highly satisfied and seven minimally satisfied parents. Eight themes emerged: (1) VC indication; (2) VC outcome; (3) new experience; (4) improvements in the child's behavior; (5) VC limitations; (6) skepticism about delivery of care; (7) convenience and accessibility; and (8) reduction in transportation cost and time. VC observation findings were triangulated with the results from the interviews, which showed that low-satisfaction parents reported pain, facial cellulitis, and complex cases that needed immediate treatment at dental clinics. Teledentistry is a feasible complement to the continuum of care, enabling remote triage and consultation as needed, and is highly accepted by parents.

Background: Acute invasive fungal cellulitis is a potentially leathal infection due to opportunistic fungi of the order Mucorales, mainly affecting immunocompromised individuals. Due to its non-specific symptomatology, dominated mostly by tissue necrosis, diagnosis is often delayed, adversely affecting prognosis. This infection predominantly arises in the nose and paranasal sinuses. Mucormycosis affecting sollely the cheek region are uncommon. We believe this ist he first case of a localized mucormycosis of the cheek. Moreover, Actinomycoses and mucormycoses occur most often in patients with immunodepression, and their association is less well described in the literature. Case Presentation: We present the clinical, biology and imaging findings of a rare case of jugal mucormycosis associated with actinomycosis in a 56-year-old female patient who presented with unbalanced diabetes and discuss diagnostic and therapeutic challenges. Discussion &amp; Conclusion: Mucormycosis and actinomycosis are rare infections that occur most frequently in immunocompromised patients, Mucormycosis is caused by the Rhizopus arrhizus species. The cutaneous localization of mucormycosis is uncommon and is favored by a breach, be it a burn, a catheter or any other cutaneous trauma. Cervicofacial Actinomycosis occurs in over 60% of cases in the maxillofacial region. It is the anatomopathological examination which gives a diagnosis of certainty of these two pathologies and their late diagnosis is coupled with serious complications.

Introduction: Sickle cell disease (SCD) can manifest with vaso-occlusive crises (VOC) in various anatomical locations. In this case, a mandibular osteomyelitis developed following a VOC but was initially misdiagnosed due to a lack of specific clinical and radiological indicators. This case report is accompanied by a brief review that highlights potential warning signs shared among similar cases, with the aim of aiding early identification and diagnosis. Observation: A 22-year-old male with SCD of Congolese origin was initially referred to the dental service at Henri Mondor Hospital for facial cellulitis during his hospitalization for a hip vaso-occlusive crisis (VOC). Due to the absence of specific clinical and radiological findings, a dental origin was initially suspected. However, as the patient's condition deteriorated, a diagnosis of mandibular osteomyelitis was eventually established. In addition to antibiotic therapy, a sequestrectomy was performed under general anaesthesia. Delayed healing was observed. Conclusion: Diagnosis osteomyelitis of jawbone in SCD patients can be challenging, as clinical and radiological signs may not always be evident. Dental practitioners and oral surgeons should be vigilant when managing these patients, as complications like mandibular osteomyelitis may present similarly to dental conditions but require prompt investigation and intervention to prevent serious health consequences.

Non-traumatic dental conditions (NTDC) that present to the emergency department of a tertiary hospital tend to be related to dental caries, including facial cellulitis, abscess and toothache. This study aimed to report the types of dental conditions and the characteristics of children that presented to an urban tertiary hospital emergency department for NTDC. Medical records were reviewed for children less than 19years of age who presented to the emergency department over a 10-year period with a NTDC. Principal diagnosis, sociodemographic data and source of referral was obtained with treatment and investigations collated for those who were subsequently admitted. Across the total 4483 dental presentations, 2481 were NTDC. The most common age group was from 0 to 3years of age (average 6.3) and 57.2% of children were male. Dental caries related diagnoses were the most common reasons for emergency department presentations. A total of 297 children were admitted for investigations and treatment. Children present to emergency departments with caries related conditions more often than traumatic injuries. Targeted interventions are needed to ensure adequate oral health care access for children to avoid overburdening the emergency services in tertiary hospitals with NTDC.

BackgroundSubcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of non-Hodgkin lymphoma that primarily affects subcutaneous tissues. Its occurrence in the orofacial region is exceptionally uncommon, presenting diagnostic challenges due to symptom overlap with more prevalent orofacial condition.Case presentationThis report details the case of a 15-year-old male who presented with persistent left-sided facial swelling, initially misdiagnosed as facial cellulitis. Diagnostic complexity arose from the similarity of symptoms to common orofacial diseases. Comprehensive diagnostic approaches, including liquid-based thin-layer cytometry, immunohistochemistry, and advanced imaging, were pivotal in identifying SPTCL. The recurrence of symptoms following the cessation of dexamethasone treatment indicated hormone dependency. Surgical intervention and subsequent histopathological analysis confirmed SPTCL, with immunohistochemical profiling playing a critical role in the definitive diagnosis. The patient’s management involved a multidisciplinary approach, leading to a referral to a hematology specialist and subsequent favorable outcomes.ConclusionsThis case underscores the diagnostic challenges of orofacial lymphomas such as SPTCL and highlights the necessity for early, accurate pathological diagnosis. It emphasizes the role of advanced diagnostic techniques and the importance of a comprehensive, multidisciplinary approach in the management of such rare cases. This report contributes to the limited but growing body of literature on SPTCL in the orofacial region, providing insights for clinicians in similar future cases.

ABSTRACT Purpose To evaluate the results of a minimally invasive combined endoscopic and eyelid crease/medial suprabrow incision approach in collaboration with oculoplastic and sinus surgeons for the treatment of recurrent/recalcitrant sino-orbital mucoceles. Methods Eighteen cases of recurrent/recalcitrant sino-orbital mucoceles, treated in collaboration with oculoplastic and sinus surgeons at the University of Michigan, were retrospectively reviewed. The recurrence of mucocele, reduction in proptosis, and complications were evaluated. Results The mean age at the time of surgery was 49 years (range: 17–76 years). All cases had a history of previous sinus or orbital surgeries for mucoceles. Among 18 cases, eight were due to chronic sinus infections, six due to trauma, three due to Schneiderian papilloma, and one case was secondary to an inflammatory sinus disease. Thirteen cases (72%) presented with orbital or facial cellulitis, while five cases (38%) experienced periocular swelling and limited extraocular motility. Following a mean follow-up of 19 months (range: 1–76 months)), recurrence was observed in two cases (11%): one in a cystic fibrosis patient with chronic sinusitis, and the other in a case of Schneiderian papilloma. The mean pre-operative proptosis in the affected eye was 2.78 mm, with an average decrease of 2.33 mm after surgery. Complications occurred in two cases, including one case of hypoesthesia in the forehead and one case of post-operative strabismus. Conclusion Our series of 18 cases of recurrent/recalcitrant mucoceles, with only two cases of recurrence, demonstrates that this minimally invasive approach can be successfully employed for advanced sino-orbital disease, with a low rate of adverse outcomes and aesthetically pleasing results.

Epidermoid cysts are rare benign lesions that can derive from abnormally situated ectodermal tissue during embryological development or from implanted epithelium after trauma or surgery. In the oral and maxillofacial regions, epidermoid cysts usually develop in the floor of the mouth and rarely in other sites. We describe a rare case of an epidermoid cyst arising in the right maxillary sinus. A 29-year-old man with a known diagnosis of Marfan syndrome presented with progressive swelling and tenderness in the right buccal region, mimicking facial cellulitis, and refractory to medical treatment. Computed tomography scan showed a cystic lesion extending widely into the right maxillary sinus. The cyst was successfully removed with a medial maxillectomy through inferior antrostomy approach under general anesthesia. Histological examination confirmed the diagnosis of an epidermoid cyst, showing a cystic wall lined with a thin layer of keratinizing squamous epithelium and fibroma connective tissue infiltrated with inflammatory cells, with no skin appendages. There has been no evidence of recurrence during the 4 year follow-up. We also conduct a review of the English literature for the reported cases of maxillary epidermoid cyst.

Two cases of sialolithiasis are presented here. One patient presented with an acute inflammatory condition of left submandibular gland with secondary infection and facial cellulitis. CT Scan confirmed as cellulitis with secondary infection from ductal stone at mid left floor of the mouth. Another patient presented with repeated low-grade pain and swelling at left submandibular gland area with difficulty in swallowing that was confirmed by Sialogram. In order to allow the gland to operate normally, the duct was kept intact in the first case where ductal calculus was removed from floor of the mouth only. Sialoadenectomy and ductal calculi excision were performed in the second case due to the chronic infection of the non-functioning left submandibular gland. Bangladesh Med Res Counc Bull 2024; 50: 60-64

Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.

Background: Invasive mycormucosis is a rare opportunistic fungal disease with high morbidity and mortality rates, predominantly affecting immunosuppressed patients. An increasing incidence has recently been described particularly among corona virus epidemic. Dentists should be aware of this possible diagnosis instead of just instituting some useless and devastating treatments, and to ovoid the delay that can cost the patient ‘life juste like our case. Clinical presentation: An unusual clinical manifestation of mucormycosis in a 42–year-old _man, diabetic who was referred by his Otorhinolaryngologist, to our dental surgery unit of the university hospital FARHAT HACHED Tunisia, suspecting a facial cellulitis related to dental infection. Before consulting his Otorhinolaryngologist, the patient was suffering from severe dental pain for two months, without any signs of relief despite dental treatments and the pain killers prescribed by his dentist. He was successfully treated by a combination of surgical intervention and antifungal treatment: Amphotericin B. Conclusion: Invasive mycormucosis is an emerging infection and is probably related to an increase in immunosuppressed patients. Accurate oral examination may lead to early diagnosis avoiding further damages of this agressive disease.

Angiosarcoma is a rare and aggressive soft tissue sarcoma. The cutaneous form of angiosarcoma occurs most commonly in the head and neck region, especially the scalp. Because of its aggressiveness and tendency for distant metastasis and local recurrence, early diagnosis of angiosarcoma is critical. We report a case of cutaneous angiosarcoma of the scalp aggravated by hair dyeing. In this case, it presented as bilateral facial cellulitis because of the progression of an infection. The patient was not aware of his malignant lesions on the scalp since they are typically hidden. Meanwhile, infection caused by chemical stimulation from hair dye exacerbated the lesions. However, an early incisional biopsy revealed angiosarcoma with metastasis to the lymph nodes and parotid glands, leading the patient to appropriate chemotherapy. In conclusion, the variable and non-specific findings of cutaneous angiosarcoma can delay the diagnosis; thus, the importance of an excisional or incisional biopsy, which can result in early diagnosis when suspecting malignancy, is highlighted.