Dental Focal Infection Research Articles

Prolonged neutropenia is a risk of oral adverse events-related sepsis but is not associated with prognosis of tooth extraction in hematopoietic stem cell transplant recipients: A retrospective study

BackgroundAlthough the oral cavity has been identified as a potential site of infection in hematologic malignancies and oral adverse events (OAEs) have been reported to cause life-threatening systemic morbidity, OAEs-related risk factors in hematopoietic stem cell transplantation (HSCT) recipients remain unclear. PurposeWe retrospectively assessed OAEs and risk factors in HSCT recipients in a single center in Japan and discussed the effectiveness of tooth extraction as a method of radically removing dental focal infections (DFIs) prior to HSCT. ResultsAfter exclusions, 99 HSCT recipients (61 men, 38 women) with a median age of 54 (range, 17–69) years at the time of HSCT were identified from a total of 525 patients with hematologic malignancy. Of these, 36 patients (36.4%) experienced OAEs following HSCT, including oral mucositis (n = 29; 80.6%), acute periodontitis (n = 3; 8.3%), oral mucosal edema (n = 3; 8.3%), and oral candidiasis (n = 1; 2.8%). Sepsis derived from OAE was seen in 7 out of 36 (19.4%) patients. None of the tooth extraction cases from our work showed surgical site infections (SSI). A lack of continuous oral evaluation and oral care following HSCT were linked to OAEs (P < 0.05). In addition, as a laboratory factor, a prolonged low absolute neutrophil count (ANC) (<500/μL) resulted in a significantly higher tendency to develop OAE and OAE-related sepsis (P < 0.05). ConclusionsSpecialists should continuously monitor the oral health of patients undergoing HSCT. Unpreservable teeth causing dental focal infections should be assessed and extracted prior to HSCT while carefully monitoring the patient’s condition following surgery.

Mental foramen in panoramic radiography can be a reference for discrimination of punched-out lesions in the mandible in patients with symptomatic multiple myeloma: A cross-sectional study.

Multiple myeloma (MM) is a hematopoietic malignancy characterized by monoclonal proliferation of plasma cells. MM features bony radiolucencies called punched-out lesions (POLs), which require appropriate diagnosis due to increased risk of surgically-related adverse events. Although dental surgeons can identify dental focal infections (DFIs) in MM patients, the prevalence and characteristics of POLs in the jawbone of MM patients have not been investigated. We examined the prevalence of POLs in the mandible of MM patients, evaluated its relationship with MM International Staging System progression, and examined panoramic radiographs as a diagnostic reference for POLs in a single center in Japan. We identified 98 patients (55 men, 43 women) with a median age of 63 (range, 34 to 91) years. Of these, 18 patients (18.4%) had POLs in the mandible, including two patients in stage I (2/37; 5.4%), six in stage II (6/43; 14.0%), and ten in stage III (10/18; 55.6%). The prevalence of POLs significantly increased with MM stage progression (p < 0.0001). POLs confirmed on computed tomography (CT) were also detected on panoramic radiographs. The Hounsfield unit value at the site of POLs was nearly the same or lower than that of the mental foramen. Although the prevalence of POLs in the mandible is low, dental surgeons need to differentiate POLs as radiological findings when examining DFIs in MM patients. Confirmation of POLs in the mandible is possible by CT and panoramic radiography, and the mental foramen is likely to be a reference for discrimination.

The oral microbial composition and diversity affect the clinical course of palmoplantar pustulosis patients after dental focal infection treatment

BackgroundPalmoplantar pustulosis (PPP) is a chronic pustular dermatosis on the palms and soles. Dental focal infections are known as the major worsening factor for PPP. Recent our study of oral microbiome demonstrated dysbiosis in PPP patients. While almost half of the PPP patients improved after treatment of dental focal infections, a certain number of patients did not improve. ObjectiveTo investigate the oral microbial factors affecting the clinical course of PPP after treatment of dental focal infection. MethodsThe oral microbiota of healthy controls (n = 10), improved (n = 7) and not-improved (n = 6) patients were analyzed by sequencing of bacterial 16S ribosomal RNA gene. ResultsThe UniFrac analysis suggested the differences of oral microbiota between improved and not-improved patients. The prevalence of the phylum Proteobacteria was lower in improved patients than in not-improved patients. When the alpha microbial diversity was assessed by Shannon index, Pielou’s index and the average operational taxonomic units (OTUs), not-improved patients had a lower-diversity microbiota compared to improved patients. The degree of changes of oral microbiota after dental focal infection treatment was higher in improved patients than in not-improved patients. Six genera showed significant correlation with blood test data of PPP patients. ConclusionOur findings suggested that oral microbial compositions and diversity could account for the distinct clinical course of PPP patients after treatment of dental focal infection. Oral microbiome analysis of PPP patients may provide a predictive factor for clinical responsiveness to dental focal infection treatment.

Clinical case of alopecia areata related with dental focal infection

Clinical case of alopecia areata related with dental focal infection

A fogágybetegség és a krónikus obstruktív tüdőbetegség kapcsolatának jelentősége

A fogágybetegség és a krónikus obstruktív tüdőbetegség (COPD) is a leggyakrabban megjelenő krónikus betegségekcsoportjába tartozik. A fogelvesztéssel járó előrehaladott fogágybetegség a világ 6. leggyakrabban előforduló krónikusbetegsége, mely kb. 743 millió embert érint, míg a COPD világszerte évente átlagosan 3 millió emberéletet követel (ez5,3%-a az összes haláloknak világszerte) és 2016 óta a világ 3. vezető halálokává vált. Egy norvég tanulmány szerinta nagyon súlyos COPD-ben szenvedő, tüdőtranszplantáció előtt álló betegek esetén a parodontitisz prevalenciája megközelítia 44%-ot, szemben a nem COPD-s kontrollcsoport 7,3%-os gyakoriságával. A két betegség összefüggése jelenlegdirekt módon nem bizonyított, ám egyre több tanulmány támasztja alá a két betegség közti kapcsolat lehetőségét.Tanulmányunkban összegezni szeretnénk a jelenleg elérhető szakirodalmi adatokat és ez által betekintést nyújtania két betegség kölcsönhatásába és feltételezett patomechanizmusába. Szükség lenne olyan klinikai vizsgálatokra, melyekbennagy esetszámmal vizsgálnak parodontálisan érintett COPD-s betegeket, így megerősítve vagy cáfolva azta feltevést, miszerint a fogágybetegek parodontális terápiája hozzájárulhat-e a COPD-ben szenvedő betegek életminőségénekjavításához.

Screening for dental focal infections in febrile patients with hematologic malignancies who received chemotherapy: a retrospective cohort study.

Source of fever in chemotherapy patients is often unknown. Fever can also be fatal. No observational studies have determined the incidence of dental focal infection (DFI)-associated fever, despite oral cavity being a potential source of infection. We report the incidence of fever after chemotherapy in patients with hematological malignancies and their association with DFIs in 441 patients visiting our institution during a 6-year period. Dental treatments, including tooth extraction, were performed, and their oral and hematological profiles were monitored after chemotherapy. Fever was evident in 87 (38.5%) of 226 patients (≥ 38˚C) after the first cycle of chemotherapy. Sepsis due to DFIs (n = 4; 4.6%) was evaluated. Chemotherapy was delayed due to DFI in one case. Fever after chemotherapy should be differentiated from oral infections. Our study emphasizes the significance of DFI in patients with fever after chemotherapy and can help in improving the prognosis of patients.

A multicenter retrospective investigation on the efficacy of perioperative oral management in cancer patients.

Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy.The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis.The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated.A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously.Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.

A study on the involvement of dental metal allergy and dental focal infection in palmoplantar pustulosis

A study on the involvement of dental metal allergy and dental focal infection in palmoplantar pustulosis

A renewed focus on extra-oral manifestations of oral infections

Dental focal infections are extraoral manifestations caused by oral pathogens. Pathological oral conditions, such as periapical inflammation and periodontitis, can cause bacteremia. Dissemination of oral pathogens to nonoral sites can subsequently cause infections in extraoral tissues and organs. Cardiovascular infections and brain abscesses are the most common of these. The course of such infections can be lethal. In order to improve patient care, a closer collaboration between dental and medical caregivers is necessary.

Differential Diagnosis of Fever in Patients with Hematologic Malignancy Receiving Chemotherapy: A Retrospective Cohort Study in Japan

Patients with hematologic malignancies are susceptible to infection due to myelosuppression during chemotherapy administration. In addition, presentation of various fevers in conjunction with chemotherapy is well known, these include tumor fever, drug fever, febrile neutropenia, and systemic bacterial infections. Dental focal infections such as severe periodontitis have been reported to cause life-threatening systemic morbidity and an adverse impact on the chemotherapy schedule. It is challenging for clinicians to make a diagnosis and identify the source of the fever as an adverse oral event. However, there are no large-scale studies that have investigated fever after chemotherapy in patients with hematologic malignancies in Japan. The present study aimed to explore the differential diagnosis of fever and emphasize the importance of the intraoral evaluation in patients receiving chemotherapy for treatment of hematologic malignancies.

Treatment decision for periodontal patients with history of cancer

Radiotherapy and chemotherapy might change the healing process of periodontal disease by reducing there storability of the periodontal tissues, leading the increase of attachment lose and alveolar bone absorption. The primary periodontal lesions could be aggravated. Therefore, oral screening should be conducted before periodontal treatment, in order to eliminate dental focal infection, to stabilize the oral environment and to prevent and reduce complications after cancer treatment. The patient's general situation should be evaluated before the periodontal treatment too, so as to ensure the patient could tolerate the radiotherapy and chemotherapy in the short interval between diagnosis and treatment of cancer. The periodontal treatment should be more conservative than normal periodontal patients. The indication for tooth extraction in these patients should be less conservative.

Retrospective analysis of the clinical response of palmoplantar pustulosis after dental infection control and dental metal removal.

Both metal allergy and dental focal infection have been considered as causative factors for palmoplantar pustulosis, and several case reports described that the skin lesions were ameliorated after dental metal removal or dental infection control. However, limited data are available to evaluate the association of these factors with disease severity of palmoplantar pustulosis. This study is designed to analyze the clinical outcome of 85 palmoplantar pustulosis patients after dental infection control (n = 70), tonsillectomy (n = 6) and dental metal removal (n = 9). More than half of the patients (63%, 44/70) showed positive clinical outcome after dental infection control. The skin lesions of all patients with tonsillitis were improved after tonsillectomy (100%, 6/6). On the other hand, one-third of patients (33%, 3/9) showed positive response after dental metal removal. These results suggest that focal infection is more closely associated with palmoplantar pustulosis than dental metal allergy. According to our findings, palmoplantar pustulosis patients should be preferentially examined for focal infections.

Derin Boyun Apsesi ve Peritoneal Sepsis Birlikteliği Nadir Ölüm Olgusu

Derin boyun enfeksiyonları, sıklıkla üst solunum yolu ve odontojenik enfeksiyonlara bağlı gelişebilirler. Gastrointestinal sistem perforasyonları ise birçok nedenle meydana gelebilir ve erken tanı ve acil cerrahi tedavi gerektiren durumlardır. Her iki durumda da geç veya yanlış tam, artmış morbidite ve yüksek mortaliteye neden olabilir.Diş apsesine bağlı derin boyun enfeksiyonu gelişen ve yatarak tedavi edilen bir olgunun “septik şok ve çoklu organ yetmezliği” sonucunda hayatım kaybettiği bildirilmiştir. Otopside “retrofaringeal apse” tanısı doğrulanmış ve ilave olarak antemortem dönemde tam almamış “duodenum perforasyonu” tespit edilmiştir. Otopside tıbbi uygulama hatasına ait bulgu tespit edildiğinde, bunun otopsi raporunda açıkça bildirilmesi gerektiğini düşünmekteyiz.Anahtar Kelimeler: Diş apsesi; Retrofaringeal apse; Pep- tik ülser perforasyonu; Peritonit; Sepsis; Otopsi.

Analysis of Patients Visiting Niigata University Medical and Dental Hospital with Chief Complaints of Metal Allergy and/or Focal Infection in the Previous 8 Years

Dental metal allergy and dental focal infection are possible causes of dermatological diseases, but have been the subjects of few reports to date. We have been treating such patients in our special clinic for more than 20 years.The purpose of the present study was to investigate the mouths of patients visiting our dental hospital over an 8-year period, with the aim of clarifying whether dental metal allergy and/or dental focal infection affects their dermatologic conditions.We surveyed all clinical records of the 185 patients who visited Niigata University Medical and Dental Hospital with chief complaints of dental metal allergy since 2002. Diagnostics of skin diseases, periodontal records, periapical lesions, dental caries, dental metal series patch test results and Electron Probed Micro-Analysis (EPMA) data were investigated. Ninety-two (49%) patients were suffering from pustulosis palmaris et plantaris and 20 (11%) patients had lichen planus. Eighty-two (49%) patients showed positive reactions on patch testing. Based on the result of patch tests, Ni showed the highest positivity rate (62%, 51 patients), but on EPMA, the number of patients with Ni as an allergen was 14 (27%). On the other hand, more than 98% of patients who showed positive reactions on patch test to Pd and Au had these metals in their dental prostheses. In addition, 112 (60%) patients showed the possibility of dental focal infections

Dental focal infections and alopecia areata

Objective. The aim of this study was to examine the association of dental focal infections and alopecia areata in the adult population. Methods. The research was done in a medical institution, 'Dermato-dento-medik Brcko dr Regoje', and the Clinic for Dermatovenerology of University Clinical Center, Tuzla. The study included 63 patients which were treated surgically and medically according to the current therapeutic guidelines. All patients were divided into three groups. The first group of patients suffering from alopecia areata were treated only surgically, by removing the focus. In the second group there were patients who were treated by removing the focus and local dermatological therapy (most of them had periodontal disease). In the third group there were patients who were treated only with local dermatological therapy (most of them had gingival hyperplasia). Results. In total of 41 subjects the changes of alopecia areata had affected the hairy part, while 22 patients had changes on the chin. The difference in distribution, in relation to the expected even distribution, was statistically significant (x2=5.7, df=1, p=0.017). However, the difference concerning the observed distribution of lesion in hairy parts and in other location between the three study groups was not statistically significant (x2=0.2, df=1, p=0.676). Analysis of the outcomes of treatment for alopecia areata showed the highest effectiveness in the second group (n=21) because the hair growth appeared after 4 to 6 weeks after the initiation of the therapy. In the first group (n=20) the hair growth appeared within 6 to 8 weeks, and in the third group there was no hair growth during the monitoring period up to 8 weeks. Conclusion. Our study present novel data about relationships between dental focal infections and alopecia areata with outcomes after surgical and medical treatment, respectively.

The flavonoids luteolin and quercetagetin inhibit lipoteichoic acid actions on H9c2 cardiomyocytes

Dental focal infections are infections in the mouth that cause subsequent infection and symptoms in other parts of the body. Dental conditions such as periodontitis have been associated with coronary heart disease. In this study, we investigated the effect of flavonoids on activation of mitogen-activated protein kinase (MAPK) family members, protein kinase B (AKT), and IL-1β expression by rat heart embryonic (H9c2) cells upon stimulation with LTA. Pretreatment with four flavonoids, including quercetin, genistein, quercetagetin, and luteolin diminished LTA-induced ERK1/2, JNK, p38, and AKT phosphorylation and IL-1β gene expression. Our findings indicate that flavonoids interfere with LTA signal transduction.

A case acute hepatitis where diagnosis was delayed due to concomitant (concurrent) dental focal infection

A case acute hepatitis where diagnosis was delayed due to concomitant (concurrent) dental focal infection

General health risk of periodontal disease

The possibility that periodontal disease might influence the morbidity and mortality of systemic diseases constitutes a research topic of great current interest. Human periodontal disease is associated with a complex microbiota containing approximately 500 microbial taxa and various human viruses, many of which possess significant virulence potential. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and other periodontopathic bacteria that are unique to the oral cavity and may disseminate to other body sites comprise the best-documented form of dental focal infection. However, systemically healthy individuals seem to be at low risk of acquiring acute non-oral diseases from direct infections by periodontal pathogens. Research data from various laboratories point to periodontal infections as a risk factor for chronic medical disorders, including cardiovascular disease, cerebrovascular accidents and low-birth-weight infants. However, recent epidemiological studies have failed to show a significant relationship between periodontal disease and cardiovascular disease. This review paper evaluates the current status of knowledge on dental focal infection and suggests avenues for further research into the topic of general health risks of periodontal disease.

Dental Focal Infection Associated with Skin Diseases. A Specific Reference to .ALPHA.-Hemolytic Cocci.

To elucidate the pathogenesis of dental focal infection associated with skin lesion, serological and bacteriological studies in 52 patients with various dermatoses were performed. None of the 52 patients were accompanied with tonsillar or sinus lesions, but they all had chronic dental lesions. The isolation of causative microbes and the evaluation of serum anti-streptolysin O (ASO), anti-streptokinase (ASK), anti-deoxyribonuclease B (ADN-B) were performed. Alpha-hemolytic cocci were most frequently isolated and ASO, ASK, and ADN-B values, which are the inarkers for β-hemolytic streptococcal infection, were negative in many cases. In patients in whom α-hemolytic streptococci were isolated, agglutinin titers were examined and we found that these patients generally had high agglutination titers against the isolated α-hemolytic streptococci. Some humoral immunological reactions to bacterial surface determinants may play a role in the pathogenesis.

Prevalence of Helicobacter pylori–Associated Gastritis in Chronic Urticaria

Background: Chronic urticaria and concurrent angioedema are frustrating problems for both physicians and patients. Methods: 100 patients with chronic urticaria (mean duration 33.3±48.2 months) attending the urticaria consulting hour of our Department of Dermatology within 1 year were carefully analyzed for pathogenesis to avoid extensive unnecessary diagnostic approach in the future. Results: In 43 cases a potential infectious trigger could be identified, 35 were of idiopathic origin, and 15 demonstrated pseudoallergic reactions to acetylsalicylic acid or food additives, 5 had antibodies to thyroid gland, and 2 had malignant diseases. Of patients with foci, 26 had Helicobacter pylori–associated gastritis, 9 chronic tonsillitis or sinusitis, 4 infections with Epstein–Barr virus or cytomegalovirus, 2 dental focal infections and 2 suffered from Yersinia infection. High prevalence of H. pylori gastritis was found since 47% of patients showed elevated H. pylori–specific IgA and/or IgG antibodies. 27 patients underwent endoscopy and in all but 1 (96%) antral H. pylori infection was found. In contrast, a prevalence rate of 37% among asymptomatic adults has been published. Disappearance (67%) or improvement of urticaria (24%) occurred in most antimicrobially treated patients after 3–12 weeks. In contrast, only 50% of untreated H. pylori–seropositive patients with chronic urticaria showed spontaneous remission or improvement within 12 weeks. Prevalence of H. pylori infection may even be underestimated since only 27/100 patients underwent endoscopy. It is suggested that H. pylori infection may be present at least in all seropositive subjects (47%). Moreover, we found H. pylori infection in 2 seronegative subjects demonstrating gastric complaints. Conclusions: Thus, measurement of H. pylori–specific antibodies and/or gastroscopy should be included in the diagnostic management of chronic urticaria to identify patients who may profit from eradication treatment with disappearance of long–standing and annoying urticaria symptomatology.