Dentoalveolar Infection Research Articles

A retrospective cohort study of pediatric hospitalization due to dentoalveolar infection before and after a change in national health insurance

This retrospective cohort study aimed to examine trends in pediatric (0–18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel’s National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002–2010 (group A, n = 531) and 2011–2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel’s National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections.

Influence of CRP on Antibiotics Prescription Pattern for Dental Infections: A Prospective Interventional Study

Introduction: Over the years, antibiotic prescription rates have increased dramatically for the treatment of dentoalveolar infections. A byproduct of this indiscriminate antibiotic prescription by dentists is the antibiotic resistance. Antibiotic resistant infections are a severe global health problem, putting the capacity to treat common diseases and perform complex medical procedures at risk. Aim: To compare the amount of antibiotics prescribed for dental infections with and without analysing C-reactive Protein (CRP) value. Materials and Methods: A prospective interventional study was conducted in Manipal University College Malaysia (MUCM) dental clinic between October 2020 to March 2021 to record the antibiotic prescription by dentists. The study was divided into two phases where phase I had 28 subjects and phase II had 21 subjects and permission from institutional ethical committee clearance was obtained for the study. The study was done to evaluate the effectiveness of C-reactive protein (CRP) to reduce antibiotic prescriptions in MUCM Dental Clinic. Data was summarised by computing frequency and percentages. The antibiotic prescription rate during phase I (n=28) (conventional method or routine pattern of prescribing antibiotics was done) and phase II (n=21) (CRP rapid test was done and the decision whether to prescribe antibiotics or not was done accordingly) was compared. The data was analyzed by using Statistical Package for the Social Sciences software program (SPSS), version 15.0 (South Asia, Bangalore) and compared applying the Chi-square test. Results: There was no significant difference in the distribution of the presence of medical condition (p=0.201) and distribution of clinical features (p=0.804) of subjects included in phase I and phase II. The antibiotics prescription rate reduced significantly from 89.3% in phase I to 52.4% in phase II (p=0.0014), indicating that CRP rapid test helps in reducing antibiotics prescription. Conclusion: The CRP rapid test aid in lowering antibiotic prescription in dental clinic settings. This may be useful to combat antibiotic resistance in general.

Imaging of dental infections.

Dental infections are a common presentation in the emergency department (ED). To help guide clinical management for these infections, the radiologist must be familiar with the anatomy of the oral cavity and neighboring structures, the range of appearance of dental infections, and the routes along which they may spread. Computed tomography (CT) is often performed when severe dental infections are suspected. This pictorial essay reviews the anatomy pertinent to the imaging evaluation of dental infections and depicts a spectrum of pathology that may be encountered, ranging from simple dentoalveolar infections to complex multispatial infections.

Pathological fracture of the jaw due to osteomyelitis after a third molar extraction

The osteomyelitis is an inflammatory process in bone tissue caused by an infection, commonly related to anaerobic pathogens, frequently Staphylococcus aureus and Streptococcus sp. Several causes have been related such as dentoalveolar infection, trauma, radiation and genetic condition, but it is not common after surgery for third molar extractions, especially in healthy patients. The symptoms of chronic osteomyelitis usually include signs and symptoms such as pain, edema, suppuration, areas of bone sequestration, and limited mouth opening. Among the complications associated with this condition, pathological fracture may occur due to local bone fragility. This paper aimed to report a rare case of pathological mandible fracture due to osteomyelitis after third molar extraction in a healthy male patient treated by a surgical procedure. The procedure consisted of decortication and resection of the sclerotic bone followed by reduce and fixation of mandibular fracture with one 2.4 reconstructive plate and one 2.0 plate with standard screws.

Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections-A Systematic Review.

Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.

Complications of Teeth Affected by Molar-Incisor Malformation and Pathogenesis According to Microbiome Analysis

A molar-incisor malformation (MIM) is a recently reported dental anomaly that causes premature loss of the first molar with severe dentoalveolar infection. However, there has been no research on the pathogenesis yet. The aim of this study was to report the clinical process of MIMs and investigate the pathogenesis by conducting a microbiome analysis. An eight-year-old girl was diagnosed with MIM and after two years, four permanent first molars were sequentially extracted due to severe dentoalveolar infection. We recorded the patient`s clinical progress and collected oral microbiome samples from the extracted teeth with MIM and sound teeth as controls. The sites of microbiome sampling were represented by five habitats in two groups. Group (1) was the perio group: ① supragingival plaque, ② subgingival plaque, and ③ a pical abscess; and group (2) was the endo group: ④ coronal pulp chamber and ⑤ root canal. The perio group was composed predominantly of genera Streptococcus, Veilonella, and Leptotrichia. Spirochetes appeared in one sample from a severe periodontal abscess. Aggregatibacter actinomyces were not identified. In the endo groups, pulp necrosis was observed in all MIM and the genera Peptostreptococcus and Parvimonas predominated. In conclusion, MIM teeth caused localized tooth-related periodontitis with pulp necrosis rather than localized juvenile periodontitis, resulting in a poor prognosis, and timely extraction is highly recommended.

Six year analysis of admissions made for dentoalveolar infections to a maxillofacial unit – can CRP predict the severity of dental infections?

Introduction: Dentoalveolar infections account a large proportion of hospital admissions under the Maxillofacial Department. The severity of these infections can range from a mild local swelling to the life-threatening condition Ludwig's angina

Neutrophil to lymphocyte ratio as a prognostic marker of deep space neck infections secondary to dentoalveolar infection

Neutrophil to lymphocyte ratio as a prognostic marker of deep space neck infections secondary to dentoalveolar infection

Knowledge and Attitudes Towards Antibiotic Prescribing Among Dentists in Sudan

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists’ awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.

Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai.

The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5years. A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study. Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few. We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.

Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports

BackgroundWe report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon.Case presentationThe clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day.ConclusionsThe possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.

Clinical oral microbiology and antimicrobial susceptibility – does it matter?

ABSTRACTLittle surveillance data is undertaken on the antimicrobial susceptibility of isolates from acute dento-alveolar infections. We present data collated from routine diagnostic microbiology specimens submitted over a 27 year period in Glasgow, UK. Over the study period isolates were identified using the API system, VITEK 2 and MALDI-TOF. Antimicrobial susceptibility tests were undertaken using combinations of Stokes method and/or E-tests. Baseline data based on Lewis et al., (JAC 23,69-77 1989) and compared to isolates from 1998-2015. From 621 specimens, we isolated Anginosus group streptococci (n = 196), Mitis group Streptococci (n = 448), anaerobic streptococci (n = 116), Fusobacteria (n = 121) and Prevotella (n = 140) species. No discernable increase in resistance patterns over the 27 year time period of analysis was observed. A 6 month audit (May-Oct 2016) in Glasgow recorded 37 patients hospital admissions for 142 bed days (mean 3.5 days) to incise and drain severe odontogenic infections. But, dental practitioners in England (2015) prescribed 10,717 items of cephalosporins and 18, 630 items of augmentin (Source: Health and Social Care Information Centre) – why?Diagnostic oral microbiology matters in guiding antimicrobial stewardship programs but more collaborative working on processing methods and routine susceptibility data would help overcome limited data from single centers.

Pediatric Sepsis Secondary to an Occult Dental Abscess: A Case Report

BackgroundIn general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection. Case ReportThe patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with “fever, mottling, and shaking chills.” In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. Why Should an Emergency Physician Be Aware of This?It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy.

Interleukin-1 and estrogen protect against disseminating dentoalveolar infections

Dentoalveolar bacterial infections cause localized tissue and bone destruction, but usually remain well-localized within teeth in immunocompetent hosts. However, in certain cases these infections may invade head and neck tissues, resulting in orofacial abscesses, cellulitis and sepsis, with resultant high morbidity and even mortality. In the present studies, we developed a novel model of spreading dentoalveolar infections in mice by treatment with neutralizing antibodies against both interleukin-1α (IL-1α) and IL-1β. Surprisingly male but not female mice given anti-IL-1 antibodies developed orofacial abscesses, weight loss, splenomegaly and sepsis. Female mice developed abscesses and sepsis comparable to males following ovariectomy (OVX), which was reversed by estrogen supplementation. Anti-IL-1 blockade inhibited IL-12, interferon γ (IFNγ) and IL-6 but not IL-10 expression in infrabony lesions, suggestive of a local anti-inflammatory response. There was greater infiltration of neutrophils and other inflammatory cells into lesions in anti-IL-1-treated animals; however, blood leukocytes had reduced bacterial phagocytic and killing activity ex vivo. Estrogen directly stimulated IL-1 production by macrophages, suggesting that the resistance of females to disseminating dentoalveolar infections may be due to their heightened pro-inflammatory responses following bacterial challenge, leading to enhanced localization of these infections.

Elevated CD14 (Cluster of Differentiation 14) and Toll-Like Receptor (TLR) 4 Signaling Deteriorate Periapical Inflammation in TLR2 Deficient Mice.

Apical periodontitis (periapical lesions) is an infection-induced chronic inflammation in the jaw, ultimately resulting in the destruction of apical periodontal tissue. Toll-like receptors (TLRs) are prominent in the initial recognition of pathogens. Our previous study showed that TLR4 signaling is proinflammatory in periapical lesions induced by a polymicrobial endodontic infection. In contrast, the functional role of TLR2 in regulation of periapical tissue destruction is still not fully understood. Using TLR2 deficient (KO), TLR2/TLR4 double deficient (dKO), and wild-type (WT) mice, we demonstrate that TLR2 KO mice are highly responsive to polymicrobial infection-induced periapical lesion caused by over activation of TLR4 signal transduction pathway that resulted in elevation of NF-kB (nuclear factor kappa B) and proinflammatory cytokine production. The altered TLR4 signaling is caused by TLR2 deficiency-dependent elevation of CD14 (cluster of differentiation 14), which is a co-receptor of TLR4. Indeed, neutralization of CD14 strikingly suppresses TLR2 deficiency-dependent inflammation and tissue destruction in vitro and in vivo. Our findings suggest that a network of TLR2, TLR4, and CD14 is a key factor in regulation of polymicrobial dentoalveolar infection and subsequent tissue destruction. Anat Rec, 299:1281-1292, 2016. © 2016 Wiley Periodicals, Inc.

Antibiotic usage - Ectopic Impacted Lower Third Molar.

Dear Editor, The failure of eruption of third molars is very common in our part of the world (Turkey, Ankara) and the removal of third molars is a routine procedure that is carried out in our department. While searching literature for articles about “impacted third molars”, the article ‘Extra-Oral Approach for Removal of Ectopic Impacted Lower Third Molar: A Case Report’ caught our attention. However, there are some points that we would like the authors to clarify. Many years have passed since the first publication about antibiotic usage appeared in the international literature [1]. Although antibiotics have transformed our ability to treat infections, they also pose some problems: As antibiotic resistance increases, these lifesaving drugs do not work as well as they once did and their ability to treat infections decrease [1]. Due to the presence of antimicrobial resistance all over the world, the usage of third generation Cephalosporins, especially Cetaxim, is critical. Because Cefataxim crosses the blood-brain barrier, they are important medical agents for the treatment of infections like meningitis [2]. In the case presented by the authors, we hold the opinion that a microbiological examination could have been carried out to identify the causative microorganisms and to determine their susceptibility to certain antibiotics so that the prescription of potent antibiotics like Cefataxime could have been avoided for that kind of dentoalveolar infection. Like the choice of an appropriate antibiotic, the administration pathway of antibiotics is also a very important issue for infection treatment [3]. With reference to the authors’ case report it has been stated that intravenous antibiotic usage was preferred for the patient. The practice of antibiotic usage is based on certain fundamental principles [3]. Today it is accepted that drug usage should be comfortable for the patient [3]. This is an important point to avoid psychological and physical stress to the patient. Furthermore some antibiotics can be used intravenously as well as orally and both administration pathways share the same absorption parameters [4]. According to the study by Lamp and Freeman, 1gr loading dose of metronidazole have been applied intravenously on seven patients, and it was followed by 500mg every 8 hours either intravenously or orally and same absorption parameters were observed [4]. Several studies [2,5] have shown that Cefataxime cannot be used orally, however there are some other third generation Cefalosporins which can be used for oral applications [5]. If the authors felt the need to use Cefalosporin, would it not be better to use another third generation Cefalosporin orally? Lastly can you clarify us about the day of antibiotic cover that the surgery was realized? Please let us have some explanatory information on the points above.

Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses.

General dentists issue approximately 10% of antibiotic prescriptions across the global medical community consummation. The use of antibiotics for the management of dentoalveolar infections should be considered only in the presence of an increased risk of a systemic involvement or to prevent metastatic infections. This study aimed to investigate the prophylactic and therapeutic antibiotic prescription patterns of Lebanese dentists for the management of dentoalveolar abscesses. The aim was to evaluate the influence of the patients' medical condition and clinical signs data on the patterns of antibiotics prescription. Only patients with a dentoalveolar abscess were included in the study. Age, medical history, reason for consultation, clinical signs and symptoms, diagnosis, type of local treatment, and type of antibiotherapy were collected for each patient attending dental clinics in Beirut. The data were analyzed with chi-square test and multivariate regression. Out of the 563 initial patients, 127 were selected for the study and received a local treatment. The patient's medical condition and age did not affect the decision to prescribe antibiotics 36.2% patients with pain and 11.8% patients with swelling were prescribed antibiotics. Pain and swelling contributed to a higher level of antibiotic prescription compared to other signs and symptoms. Antibiotics were prescribed inappropriately to 51.76 and 38.10% among patients with an acute or chronic dentoalveolar abscess respectively. The main prescribed antibiotic was amoxicillin. This study showed that dentists often did not follow the current prophylactic and therapeutic antibiotic prescription guidelines. Antibiotics prescriptions in dentistry will be more pertinent, leading to a decrease in inadequacy of prescriptions, microbial resistance, and the development of multiresistant germs against antibiotics.

Summary of: general dental practitioners' perceptions of antimicrobial use and resistance: a qualitative interview study.

Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem. This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.

General dental practitioners' perceptions of antimicrobial use and resistance: a qualitative interview study.

Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem.Objective This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.

IL-17 Receptor A Signaling Is Protective in Infection-Stimulated Periapical Bone Destruction

IL-17 is a pleiotropic cytokine produced by Th17 T cells that induces a myriad of proinflammatory mediators. However, different models of inflammation report opposite functional roles of IL-17 signal in terms of its effects on bone destruction. In this study we determined the role of IL-17RA signal in bone resorption stimulated by dentoalveolar infections. Infrabony resorptive lesions were induced by surgical pulp exposure and microbial infection of mouse molar teeth. IL-17 was strongly induced in periapical tissues in wild-type (WT) mice by 7 d after the infection but was not expressed in uninfected mice. Dentoalveolar infections of IL-17RA knockout (KO) mice demonstrated significantly increased bone destruction and more abscess formation in the apical area compared with WT mice. Infected IL-17RA KO mice exhibited significantly increased neutrophils and macrophages compared with the WT littermates at day 21, suggesting a failure of transition from acute to chronic inflammation in the IL-17RA KO mice. The expression of IL-1 (both α and β isoforms) and MIP2 were significantly upregulated in the IL-17RA KO compared with WT mice at day 21 postinfection. The development of periapical lesions in IL-17RA KO mice was significantly attenuated by neutralization of IL-1β and MIP2. Taken together, these results demonstrate that IL-17RA signal seems to be protective against infection-induced periapical inflammation and bone destruction via suppression of neutrophil and mononuclear inflammation.