Dental Infectious Foci Research Articles

Characteristics associated with occurrence of stroke in patients with infective endocarditis – a retrospective cohort study

BackgroundStroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms.MethodsAll patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité – Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke.ResultsThe study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35–4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06–6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21–8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04–0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14–0.72).ConclusionsStroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.

Management of odontogenic foci of infection (dental caries, periodontal disease and odontogenic infections) in the oral functional management of patients receiving cancer treatments: Guidelines based on a systematic review

AbstractIn cancer treatment, perioperative oral functional management is used as a part of supportive care. Its main objectives are as follows: (1) preventing and reducing adverse events, (2) maintaining or improving nutritional status, (3) improving cancer treatment outcomes, (4) maintaining or improving quality of life, (5) providing high quality medical care through comprehensive oral care, (6) controlling odontogenic foci of infection, and (7) maintaining or improving oral function. A literature search was conducted using the electronic databases of Medical Journal and PubMed. Electronic database searches were performed using various combinations of the following key words: cancer, surgery, treatment, chemotherapy, radiotherapy and dental disease, oral care, oral management, dental intervention, oral health, dental care, and dental management. The selection of literature for inclusion in the review was restricted to dental management of patients receiving cancer treatment. In the course of the literature review, hand searches were also added as needed. The guideline was developed by summarizing the results of the review. Based on a review of the literature on the management of dental foci of infection in the oral functional management of patients undergoing cancer treatment, a guideline was developed by summarizing the results of the review. This report is a secondary publication of our previous review report “J. Stomatol. Soc. 70(4): 279–289. Dec 2021.”

Symptomatic Unilateral Maxillary Sinusitis: A Cross- Sectional Retrospective Study

Objectives: The purpose of the present retrospective cross-sectional study was to identify the etiologies, clinical and radiological aspects of symptomatic unilateral maxillary sinusitis requiring hospitalization and to discuss surgical treatment indications. Material and methods: The medical records of 115 patients suffering from symptomatic unilateral maxillary sinusitis (SULMS) between 2010 and 2019, were examined. A total of 46 patients were selected by collecting data from the patients' medical records. Results: The aetiology of SULMS was in 23.9% of cases of dental origin and in 76.1% of cases of rhinogenic origin. Rhinological signs were predominant, dominated by nasal obstruction (56.52%) and headache (52.17%). The computerized tomography (CT) scan showed diffuse sinus opacity without fluid level in 43.5% of cases. The surgery indication was in 41.3% of cases due to medical treatment failure and to the presence of intra-sinusal foreign body in 10.9% of cases. Conclusions: The results of this study indicate that general state of health, age, sex, sinusitis etiology, middle meatus obstruction and local anatomical factors do not appear to be factors influencing management compared to the chronic evolution of sinusitis (P=0.03). This study has shed light on dental infectious foci involvement in both the initiation and flare up of unilateral maxillary sinusitis.

Hemorrhagic Complications and Dental Management of Patients with Anticoagulant Therapy: Case Report.

Introduction: There are different protocols for the management of anticoagulated patients that can be used when performing oral surgical procedures. Objective: To report the previous evaluation and management of a hemorrhagic complication in the maxillofacial region in a patient undergoing oral anticoagulant therapy and the recommendations described in the literature for these patients. Clinical Case: Sixty-eight year old male patient, hospitalized in the cardiology unit due to heart failure, pending surgery for valve replacement. Treating physician requests evaluation for dental infection foci by a maxillofacial surgeon. Prior to medical examination and corresponding blood tests, four carious teeth are extracted, controlling hemostasis with local measures. During the night of the same day, the patient is referred again to the dental unit because of an alveolorrhagia, being treated and controlled with new local measures; new standard blood tests are performed. Forty-eight hours later the patient presents an increase of volume in the right mandibular region compatible with hematoma and ecchymosis. It is decided to perform treatment, removing sutures, collagen and draining through the alveolus. Subsequently, new local measures are performed and the anticoagulant is suspended for 24 hrs. Conclusion: There are different care protocols for patients undergoing anticoagulant treatment in the literature, so each patient should be studied in advance to define what is the best therapeutic procedure to prevent complications.

The linkage of oral infection foci and inflammatory diseases of the eye

The paper presents a review of numerous clinical observations that indicate an important role of 'focal sepsis' in the development and persistence of the anterior eye segment inflammation. Possible routes of infection spread from local dental infectious foci to the eye are discussed.

Retroperitoneal Actinomycosis Mimicking a Malignant Neoplasm of Adrenal Gland

Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, and draining sinuses. In this study, we aimed to present the clinical and radiological findings of a rare pathology, retroperitoneal actinomycosis case mimicking adrenal tumor and review the literature. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Actinomycosis manifests as tumor-like lesions mainly in the cranio-cervical region (60-80%), thorax (10-15%), abdomen (5-20%) and exceptionally in retroperitoneal organs. Positron emission tomography (PET) revealed hypermetabolic mass lesion 63 × 52 × 73 mm in size on the left adrenal gland showed a standardized uptake value (SUV) of 18.2. The patient underwent left adrenalectomy. The pathologic examination revealed actinomycosis. The patient was treated with antibiotics. J Med Cases. 2015;6(10):441-443 doi: http://dx.doi.org/10.14740/jmc2282w

Retroperitoneal Actinomycosis Mimicking a Malignant Neoplasm of Adrenal Gland

Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, and draining sinuses. In this study, we aimed to present the clinical and radiological findings of a rare pathology, retroperitoneal actinomycosis case mimicking adrenal tumor and review the literature. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Actinomycosis manifests as tumor-like lesions mainly in the cranio-cervical region (60-80%), thorax (1015%), abdomen (5-20%) and exceptionally in retroperitoneal organs. Positron emission tomography (PET) revealed hypermetabolic mass lesion 63 × 52 × 73 mm in size on the left adrenal gland showed a standardized uptake value (SUV) of 18.2. The patient underwent left adrenalectomy. The pathologic examination revealed actinomycosis. The patient was treated with antibiotics.

Cerebral abscess potentially of odontogenic origin.

Odontogenic origins are rarely implicated in the formation of brain abscesses. The relative paucity of this kind of infection and the difficulty in matching the causative microorganisms of a brain abscess to an odontogenic source can explain the late management of patients. We herein describe a case of a 46-year-old man with a cerebellar abscess that was probably due to an odontogenic infection. The diagnosis supported by imaging and microscopic identification, mini craniectomy for abscess drainage followed by eradication of all potential dental infectious foci, and an antibiotic regimen based on cephalosporins, metronidazole, and vancomycine contributed to a successful outcome.

Actinomycosis: etiology, clinical features, diagnosis, treatment, and management.

Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. Preventive measures, such as reduction of alcohol abuse and improvement of dental hygiene, may limit occurrence of pulmonary, cervicofacial, and central nervous system actinomycosis. In women, intrauterine devices must be changed every 5 years in order to limit the occurrence of pelvic actinomycosis.

Increased infection risk postliver transplant without pretransplant dental treatment

Infections cause considerable morbidity after liver transplantation (LT). Acute liver failure is a rapidly progressing life-threatening condition where pretransplant dental evaluation is not always possible. We investigated how missing pretransplant dental treatment in acute or subacute liver failure correlates with post-transplant infectious complications. Medical and dental data came from hospital records and infection data from the Finnish LT registry. The follow-up was until February 2011. Of 51 patients (LT during 2000-2006), 16 had and 35 did not have dental treatment pretransplant. Univariate Cox regression analysis demonstrated a 2.46-fold (95% CI 1.06-5.69) infection risk among the patients omitted from dental treatment. After adjustment for either pretransplant factors alone or both pre- and post-transplant factors, the corresponding infection risk increased, respectively, to 8.17-fold (95% CI 2.19-30.6) and 8.54-fold (95% CI 1.82-40.1). This increased risk involved a variety of bacterial, viral, and fungal infections of various sources both < 6 and > 6 months after transplantation. High risk of infections was noticed in acute liver failure patients without pretransplant dental treatment, but a more severe medical condition might have influenced the results. We encourage eradication of dental infection foci whenever clinical condition allows.

Effect of the aetiology and severity of liver disease on oral health and dental treatment prior to transplantation

Elimination of dental infection foci has been recommended before liver transplantation (LT) because lifelong immunosuppression may predispose to infection spread. Association between pre-LT oral health and the aetiology and severity of chronic liver disease (CLD) was investigated retrospectively. A total of 212 adult patients (median age 51.1) who had received LT during 2000-2006 in Finland were included. Their oral health had been pre-operatively examined. Patients were divided into seven different CLD groups. Common indications for LT were primary sclerosing cholangitis (PSC 25.5%), alcohol cirrhosis (ALCI 17.5%) and primary biliary cirrhosis (PBC 14.6%). Patients were also categorized by the Model for End stage Liver Disease (MELD) scoring system. Medical, dental and panoramic jaw x-ray data were analysed between groups. PBC patients had the lowest number of teeth with significant difference to PSC patients (19.7 vs. 25.6, P < 0.005, anova, t-test). ALCI patients had the highest number of tooth extractions with significant difference in comparison to PSC patients (5.6 vs. 2.5, P < 0.005). Lower MELD score resulted in fewer tooth extractions but after adjusting for several confounding factors, age was the most important factor associated with extractions (P < 0.005). The aetiology of CLD associated with the oral health status and there was a tendency towards worse dental health with higher MELD scores.

Multiple liver abscesses with isolation of streptococcus intermedius related to a pyogenic dental infection in an immuno-competent patient

IntroductionStreptococcus intermedius - a member of the Streptococcus anginosus group - is part of the normal microbial flora of the oral cavity. Despite being regarded as a harmless apathogenic commensal, Streptococcus intermedius has been described to cause abscesses in various locations of the body.Case PresentationWe report the clinical case and course of treatment of a 18-year-old male patient presenting with multiple hepatic abscesses associated with an untreated pyogenic dental infection.ConclusionStreptococcus intermedius can cause liver abscesses emerging from dental infectious foci even in previously healthy patients without underlying innate or aquired immunodeficiency. The case illustrates the potential danger and underestimated risk associated with untreated dental infections.

Update on general health risk of periodontal disease

To review the potential of periodontal infections to cause nonoral diseases. Therapeutic recommendations are provided to help patients and dental practitioners prevent systemic complications from periodontal infections. Systemic diseases from oral bacteria are mostly caused by transient bacteraemias, which can occur spontaneously from dental foci of infection, from mastication, brushing, flossing or other daily manipulations, or from dental treatments. Examples of systemic infections that may involve oral microorganisms include infective endocarditis, aspiration pneumonia, HIV-related disseminated candidiasis and cancrum oris, septicaemia associated with cancer chemotherapy and radiotherapy, necrotising faciitis and various other life-threatening infections. Inflamed gingiva constitutes a significant reservoir for herpes viruses, which have the potential to cause serious systemic diseases in immunocompromised patients. Periodontal disease may also aggravate chronic insulin insensitivity and thus interfere with glycaemic control in diabetic patients. Controversy surrounds the involvement of periodontal infections in coronary heart disease. Cumulative evidence suggests that periodontal disease can be an important cause of morbidity and mortality of various systemic diseases, especially in individuals exhibiting compromised host defence. Maintaining a healthy dentition and periodontium by means of daily oral hygiene practice and regular professional care is the most effective way of preventing systemic diseases from oral infections.

Oral infections in home-living elderly patients admitted to an acute geriatric ward.

Little is known about the oral health of the frail and home-living elderly. The effects of dentogenic infections on the general condition of the elderly are also unknown. We therefore set out to investigate 191 elderly patients referred to an acute geriatric hospital due to sudden worsening of their general health. The patients' mean age was 81.2 +/- 6.4 years (range, 67 to 96 years), and they had lived at home before hospitalization. The patients were examined and their diagnoses set by a team of physicians. The dentist's examination was also made bedside. Panoramic x-rays were taken for those who were able to stand (n = 148). Particular attention was paid to the occurrence of dental infection foci and systemic infection parameters of blood. Only patients free from other than dental infections were included in the statistical analyses (n = 184). Panoramic x-rays revealed dentogenic infection foci in 71.1% of the dentate patients. Periodontal condition was poor in 96.2% of the patients (CPI score, 2 to 4). All infection parameters were high in patients with high periodontal treatment need, but the differences were not statistically significant. Neither were there statistically significant correlations between the number of dentogenic infection foci recorded from the radiographs and infection parameters of blood. More of the edentulous patients had positive salivary yeast counts than did the dentate patients (84.4% vs. 66.1%; P < 0.05). No correlation was found between the main systemic diagnoses and dental infections. Since the prevalence of dentogenic infection foci in our subjects was high, and they did not cause marked increase in the hematological infection parameters investigated, it seems clear that geriatricians should refer their patients for dental examinations. Although our patients represent the home-living elderly population in a Nordic country with a high standard of living and good medical care, dental care had been neglected regardless of the patients' systemic disease.

Paradontal nidus and consequences of its elimination

The role of dental foci of chronic infection is well known. The majority of works are devoted to tonsillar and dental (periapical) foci. Although the focus of chronic inflammation in the periodontium is considered to be well-drained, modern periodontologists believe that it has exceptional pathogenicity. Currently, the connection between the pathogenic action of periodontal disease and periodontal pockets has been revealed, and, as confirmed by us, regardless of the nosological affiliation of periodontal disease. Thus, comparing the indices of immunobiological state of the body (the activity of lysozyme of mixed and parotid saliva, blood serum, the concentration in blood of serum immunoglobulins G, A and M, the level of circulating immune complexes (CIC) and the frequency of microbial sensitization) in patients with chronic gingivitis, periodontitis and periodontitis we found significant changes in these indicators only in patients burdened with periodontal pockets.

Odontogenic focal diseases

The pathogenic role of dental foci of infection in the emergence of a very wide range of diseases of various localization is generally recognized. In accordance with modern ideas, the dental focus is considered as a source of hetero- (microbial, medicinal) and autosensitization of the body. The realization of the pathogenic effect of the dental focus is to a large extent connected with its depressing effect on the nonspecific resistance of the organism.

IV: Epileptic fits and dental infectious foci

Acta Psychiatrica ScandinavicaVolume 36, Issue S157 p. 18-26 IV: Epileptic fits and dental infectious foci First published: September 1961 https://doi.org/10.1111/j.1600-0447.1961.tb08687.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume36, IssueS157September 1961Pages 18-26 RelatedInformation

VII: Optic neuritis, disseminated sclerosis and dental infectious foci

Acta Psychiatrica ScandinavicaVolume 36, Issue S157 p. 35-40 VII: Optic neuritis, disseminated sclerosis and dental infectious foci First published: September 1961 https://doi.org/10.1111/j.1600-0447.1961.tb08690.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume36, IssueS157September 1961Pages 35-40 RelatedInformation

III: Pathways for spread of micro‐organisms and their products from dental infectious foci

Acta Psychiatrica ScandinavicaVolume 36, Issue S157 p. 11-17 III: Pathways for spread of micro-organisms and their products from dental infectious foci First published: September 1961 https://doi.org/10.1111/j.1600-0447.1961.tb08686.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume36, IssueS157September 1961Pages 11-17 RelatedInformation

V: Headache and dental infectious foci

Acta Psychiatrica ScandinavicaVolume 36, Issue S157 p. 27-31 V: Headache and dental infectious foci First published: September 1961 https://doi.org/10.1111/j.1600-0447.1961.tb08688.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume36, IssueS157September 1961Pages 27-31 RelatedInformation