Treatment Of Dental Infections Research Articles

Could light be a broad-spectrum antimicrobial?

A review on antimicrobial resistance mechanisms discussing the main light-based antimicrobial approaches including ultraviolet light (UV), antimicrobial photodynamic therapy (aPDT), and antimicrobial blue light (aBL). To describe antimicrobial resistance mechanisms and to present potential light-based alternatives to conventional antimicrobials. The paper was divided into different topics, starting with an approach to antimicrobial resistance mechanisms. Subsequently, emphasis was placed on innovative light-based antimicrobials approaches, including aBL, UV, and aPDT. The review suggests that blue light (400-470 nm) acts on endogenous porphyrins with peak absorption at 405 nm, thus not requiring the administration of photosensitizers, to trigger antimicrobial effects. In this regarding, the direct effect of aBL could be attributed to both the generation of reactive oxygen species (ROS), which induces microbicidal effects, and the inactivation of bacterial defense mechanisms. In turn, blue light combined with curcumin has been used in the treatment of dental infections. Otherwise, green light (495-570 nm) associated with the photosensitizer Rose Bengal has shown promising results both in wound closure due to the induction of additional collagen cross-link formation and in reducing the viability of Pseudomonas aeruginosa. Red light (620-750 nm) is the wavelength most commonly used in aPDT, presenting superior tissue penetration capability compared to blue and green light. Both red and infrared light act directly as photobiomodulation agents, promoting tissue repair with greater penetration depth for the infrared spectrum. Conversely, red light combined with methylene blue is the most commonly used technique in the treatment of localized infections. Meanwhile, infrared light associated with indocyanine green acts as a photothermal and photosensitizing agent, promoting thermal damage and production of ROS. Ultraviolet lights UVA, UVB, and UVC (200-400 nm) have antimicrobial potential related to inducing changes in DNA and generating both ROS and singlet oxygen. Furthermore, light can enhance the efficacy of traditional antimicrobial agents by deactivating microbial resistance, both through increasing the permeability of the cell membrane and by inhibiting the efflux pump and β-lactamases of the bacteria. The antimicrobial potential of light is extensive; however, there is a limitation regarding the depth of penetration of certain wavelengths into infected areas. Furthermore, there is a need for additional studies to determine the safety and efficacy of various approaches using light at its different wavelengths.

Antimicrobial management of dental infections: Updated review.

Dental infections, which include anything from severe periodontal illnesses and abscess forms to routine tooth caries, are a major public health risk. This review article focuses on the pathophysiology and treatment of dental infections. A narrative review was conducted based on several published articles, relevant journals, and books in Google Scholar PubMed using the keywords dental caries, periodontal disease, gingivitis, and related diseases; we excluded duplicated information. Our review illustrated the types of dental infections and the proper antimicrobial drug that is suitable for this disease. Drawing from recent research findings and clinical evidence, we explore the spectrum of bacteria commonly associated with dental infections and their susceptibility profiles to various antibiotics. Emphasis is placed on understanding the mechanisms of antibiotic action and resistance in the context of dental pathogens, shedding light on optimal treatment regimens and potential challenges in clinical management. Additionally, we go over the clinical consequences of antibiotic therapy in dentistry, taking into account factors like patient selection, dose guidelines, and side effects. The management of dental infections through antimicrobial strategies has undergone significant advancements, as evidenced by this updated review. Besides the normal methods, emerging technologies such as 3D printing for drug delivery of antibiotics and disinfectants hold promise in enhancing treatment efficacy and patient outcomes. By leveraging the precision and customization afforded by 3D printing, dentistry can tailor antimicrobial interventions to individual patient needs, optimizing therapeutic outcomes while minimizing adverse effects.

Patients' Opinions on Antibiotics in the Treatment of Dental Infections: A Cross-Sectional Survey.

Background: The aim of this study was to evaluate patients' knowledge and perceptions of the use of systemic antibiotics in the treatment of endodontic infections and to determine the possible contribution of patients to the development of bacterial resistance. Methods: A total of 550 patients were asked to respond to a survey on the perception of systemic antibiotic use in the treatment of endodontic infections and antibiotic resistance during January 2022 and March 2023. A bivariate and multivariate analysis was performed to determine possible correlates in the population regarding antibiotic use in the endodontic world. Results: A total of 514 patients were included in the study, 65.9% of whom were women. While 34.6% of the population studied thought that it was always necessary to take antibiotics prior to endodontics, 49.4% considered that they were necessary after endodontics, regardless of the clinical symptoms. The prevalence of self-medication was 17.3%, and women self-medicate more than men, with significant differences (p < 0.05), although they have a greater knowledge of antibiotic resistance than men (p < 0.05). Forty-four percent of the population expected to take antibiotics when faced with dental pain, mainly women (p < 0.05). Conclusions: The general population is contributing to the serious problem of bacterial resistance. It is necessary to promote educational strategies focused on the correct use of antibiotics in the community. The worst results were found mainly in the population with a low level of education. The level of education was the variable that most influenced the knowledge and attitudes of the population, followed by the sex of the participants.

CHRONIC URTICARIA ASSOCIATED WITH DENTAL INFECTION: AN OVERLOOKED CAUSE

Urticaria is a dermatological disease caused by various aetiologies namely infection, stress and allergy. Chronic urticaria can persist for long duration despite having proper medications. The most common reason for persistent urticaria can be attributed to undetected focus of infection in the body like untreated dental infection. This case report highlights the association of dental infection and persistent urticaria, in which the urticaria lesions persisting since three years got completely cured following the treatment of dental infection in a nine-year-old boy.

Antibiotic prescribing practices for prophylaxis and therapy of oral/dental infections in pediatric patients - results of a cross-sectional study in Turkey.

Antibiotics are often prescribed for the treatment of various infections and prophylactic purposes in dental practice. Their improper use can cause microbial resistance to antibiotics, which poses a world-wide threat. The aim of this cross-sectional study was to evaluate the knowledge and attitudes of dentists and dentistry students about antibiotic prescription practices for prophylaxis and the treatment of dental infections in pediatric patients. A questionnaire was e-mailed to 2,100 dentists and 300 senior dentistry students. The questionnaire was filled out by the participants within a 2-month period (May-June 2020). A 30-point scoring system was developed to assess the knowledge levels of the dentists according to the guidelines. Descriptive statistical analyses were performed. One-way ANOVA test and the Chi-Squared test were used to compare qualitative variables. The response rate was found to be 24.2% for dentists and 49% for senior dentistry students. 19.4% of the participants were found to be moderately knowledgeable and 80.6% of them were highly knowledgeable. Students' knowledge scores were found to be higher than the general dentists and other specialists (p<0.05). There was no significant difference between students and pedodontists. Dentists were found to have sufficient knowledge about the usage of antibiotics in children, but there is still a lack of information about circumstances under which antibiotics should not be prescribed. Dentists and dentistry students should attend continuing education programs to keep their information up-to-date and should also prescribe antibiotics in adherence with the current guidelines to prevent antibiotic resistance.

Plant Extract-Synthesized Silver Nanoparticles for Application in Dental Therapy.

Oral diseases are the most common non-communicable diseases in the world, with dental caries and periodontitis causing major health and social problems. These diseases can progress to systematic diseases and cause disfigurement when left untreated. However, treatment of oral diseases is among the most expensive treatments and often focus on restoration of form and function. Caries prevention has traditionally relied on oral hygiene and diet control, among other preventive measures. In this paper, these measures are not disqualified but are brought into a new context through the use of nanotechnology-based materials to improve these conventional therapeutic and preventive measures. Among inorganic nanomaterials, silver nanoparticles (AgNPs) have shown promising outcomes in dental therapy, due to their unique physicochemical properties and enhanced anti-bacterial activities. As such, AgNPs may provide newer strategies for treatment and prevention of dental infections. However, numerous concerns around the chemical synthesis of nanomaterials, which are not limited to cost and use of toxic reducing agents, have been raised. This has inspired the green synthesis route, which uses natural products as reducing agents. The biogenic AgNPs were reported to be biocompatible and environmentally friendly when compared to the chemically-synthesized AgNPs. As such, plant-synthesized AgNPs can be used as antimicrobial, antifouling, and remineralizing agents for management and treatment of dental infections and diseases.

Optimum Green Synthesis of Silver Nanoparticles with the Highest Antibacterial Activity against Streptococcus mutans Biofilm

Nowadays, resistance to antibiotics has developed in bacterial microorganisms related to dental and oral infections, leading to major problems in public health. Using nanoparticles, particularly silver nanoparticles (AgNPs) may offer a new strategy for the prevention and treatment of dental infections. In the current study, AgNPs were synthesized using Halomonas elongata at different conditions according to nine experiments designed by the Taguchi method, and their antibacterial effects were investigated on a Streptococcus mutans biofilm. The effects of three factors, including silver nitrate (AgNO3) concentration, incubation time, and temperature at three different levels, were studied to optimize the synthesis of AgNPs under the designed experiments. Then, the antibacterial effects of these NPs on the S. mutans biofilm were examined by the colony‐forming unit (CFU) method. According to the results, green‐synthesized AgNPs under optimal conditions properly inhibit the formation and growth of the S. mutans biofilm. Furthermore, different analyses were applied to investigate the formation, structural, and morphological properties of the green‐synthesized AgNPs under optimum conditions. The obtained results of this study indicated that the green‐synthesized AgNPs could be a promising antimicrobial agent in the dental and medicinal industry.

Oral pathology in patients with cardiovascular diseases

Introduction: Dentists often are the first to identify symptomatic manifestations of various diseases of internal organs when treating inflammatory diseases of the periodontium, caries and its complications. Oral pathology or a random test of clinical laboratory parameters with establishment of deviations in them can refer us to the disease. If dentists neglect and underestimate the problem, complications can arise in the treatment of these patients. Aim: The aim of this article is to evaluate the type of oral pathology in patients with cardiovascular diseases. Materials and Methods : Our study was carried out among 40 patients with cardiovascular diseases. The patients were treated at St. Marina University Hospital and had outpatient monitoring at St. Marina Diagnostic and Consultative Center, Varna. The following methods were used: documentary, clinical dental examination; DMFT; PPD; PBI and CAL; radiographic examinations, electric pulp test; palpation and percussion tests. Results: All patients were with proven and treated cardiovascular diseases. The mean age of examined patients was 53.26 ± 16.22 years (mean ± SD). Their gender distribution was as follows: 53% (21) men and 47.50% women (19). The average DMFT was 14.38, 80% of the patients lacked an average of 8.74 ± 1.75 teeth, 5% had total dentures, 15% partial dentures, and 5% were totally edentulous and without any prosthetics. We established values for PPD 3.74 ± 0.46 mm, and in 15 patients ≥ 5 mm, and for PBI - 2.15 ± 0.25. Apical periodontitis was found in 33% of the patients. Conclusion: The presence of significant oral pathology in patients with cardiovascular diseases indicates that they are immunocompromised and are at greater risk of inflammation due to their underlying disease, therefore prevention and treatment of dental infections are essential for improving their general somatic health.

Case Report: Resolution of chronic urticaria following treatment of odontogenic infection

Background: Chronic spontaneous urticaria (CSU) is a condition characterised by the presence of hives with/without angioedema, that affects individuals on more days than not for 6 weeks or more. The role of infection as a potential trigger for CSU is well described, but the current clinical guidelines do not recommend routine screening for underlying infections. Main observations: We report a case of severe prolonged chronic spontaneous urticaria in a 19-year-old, that went into rapid remission following the treatment of dental infection. Conclusions: Clinicians should recognise the potential role that infection can have in causing chronic urticaria. There should be a low threshold to treat infection in such circumstances.

Ludwig Angina in Pregnancy: Treatment Outcome in 12 Patients and Review of Literature

Ludwig angina is a rare but severe life-threatening cellulitis, classically of odontogenic origin, characterized by an extensive and a rapidly progressive inflammation of subcutaneous tissue of the face and severe systemic toxicity. Its prognosis is potentially worse in pregnancy given the higher vulnerability of both mother and fetus to infection and to the consequences of therapies. Early diagnosis and timely treatment are of paramount importance in the prognosis of this condition but could be however challenging as it is infrequently observed in current daily practice. Moreover, literature dealing with Ludwig’s angina in pregnancy is scarce, consisting mostly in isolated case reports from developed countries. The aim of this article was to improve awareness on Ludwig angina in pregnancy through a report of experience in 12 patients and a literature review on the diagnosis and treatment of this clinical entity. To this end, medical records of 12 patients with Ludwig angina in pregnancy were analysed retrospectively and the diagnosis and treatment approaches discussed through a literature review. Age of pregnancy ranged from 27 to 37 weeks. In all the patients, the cellulitis origin was a carious molar of the mandible. The infection spread extended to the neck (4 patients), the thorax (3 patients) and the temporal fossa (2 patients). One patient presented with necrotizing fasciitis extending from the submandibular and submental regions to the thorax. Bacteriological examination of pus which was possible and successful in 4 patients only, showed staphylococcus aureus (2 patients) staphylococcus SP (1 patient) and staphylococcus epidermidis (1 patient). Death occurred in 2 mothers and in 7 fetus giving mortality rates of 16.7% and 58.3% respectively. Direct causes of death in mothers were sepsis shock and air way compromise. In 6 out of the 7 mothers who had dead fetus, the infection extended beyond the mouth floor. Oral health care providers should be aware for proper treatment of dental infections. They should also be alert for early recognition and multidisciplinary treatment of Ludwig angina in pregnancy in collaboration with obstetricians, specialists of intensive care and infectious diseases.

Case Report: Resolution of chronic urticaria following treatment of odontogenic infection

Background: Chronic spontaneous urticaria (CSU) is a condition characterised by the presence of hives with/without angioedema, that affects individuals on more days than not for 6 weeks or more. The role of infection as a potential trigger for CSU is well described, but the current clinical guidelines do not recommend routine screening for underlying infections. Main observations: We report a case of severe prolonged chronic spontaneous urticaria in a 19-year-old, that went into rapid remission following the treatment of dental infection. Conclusions: Clinicians should recognise the potential role that infection can have in causing chronic urticaria. There should be a low threshold to treat infection in such circumstances.

An evaluation of dental antibiotic prescribing practices in the United States

BackgroundAntibiotic prescribing practices among general dentists and dental specialists in the United States remains poorly understood. The purpose of this study was to compare prescribing practices across dental specialties, evaluate the duration of antibiotics dentists prescribed, and determine variation in antibiotic selection among dentists. MethodsThe authors performed a retrospective cross-sectional analysis of dental care provider specialties linked to deidentified antibiotic claims data from a large pharmacy benefits manager during the 2015 calendar year. ResultsAs a group, general dentists and dental specialists were responsible for more than 2.9 million antibiotic prescriptions, higher than levels for several other medical and allied health care provider specialties. Antibiotic treatment duration generally was prolonged and commonly included broad-spectrum agents, such as amoxicillin clavulanate and clindamycin. Although amoxicillin was the most commonly prescribed antibiotic among all dental specialties, there was substantial variation among other antibiotics each specialty selected. The most common antibiotic treatment durations were 7 and 10 days. ConclusionsThis study’s results demonstrate that dentists frequently prescribe antibiotics for prolonged periods and often use broad-spectrum antibiotics. Further studies are necessary to evaluate the appropriateness of these antibiotic prescribing patterns. Practical ImplicationsThe clinically significant variation in antibiotic selection and treatment duration identified among all dental specialties in this study population implies that further research and guidance into the treatment of dental infections is necessary to improve and standardize antibiotic prescribing practices.

The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review.

Background One controversial issue in the relationship between oral care and cardiovascular diseases is how and whether to manage oral infections prior to cardiovascular surgery or other cardiovascular invasive procedures. Design We designed a systematic review to assess the information available on three main questions. Is there an agreement on the need for dental evaluation and treatment before cardiovascular interventions? Are consistent clinical recommendations or protocols available? Is dental treatment prior to cardiovascular interventions effective? Methods A systematic electronic search of MEDLINE, Scopus and Web of Science was performed from the database inceptions up to 31 April 2016. Searches were performed using Boolean operators to combine medical subject headings and free text words. Because this review included a large, heterogeneous group of study designs and sources, the results were synthesised in a narrative approach. Results In total, 2447 studies were identified: 2099 (+241 duplicates) were excluded after screening; 107 were included for full-text assessment; 55 were excluded for not meeting the inclusion criteria; and 11 were not available. Thus, 44 studies meeting the inclusion criteria were analysed. We found that, for patients undergoing cardiovascular surgery, there is a general agreement on the need for screening and treatment of dental infections, but not on the protocols. We also found that there are conflicting indications on when and to what extent to perform the treatment and that the risk-to-benefit ratios for these treatments are controversial. Conclusion No satisfactory answers regarding dental care before cardiovascular invasive procedures are available.

Antibiotic Utilization in the Dental Clinic over 7 Years; Room for Improvement

BackgroundAt least 30% of antibiotic courses prescribed in the outpatient setting are unnecessary, meaning that no antibiotic is needed at all. Specialty areas such as dental clinic are a common place for antibiotic use and a potential for antibiotic overuse. The duration and indications for antibiotic use in dental clinics have not been clearly defined, except in the setting of endocarditis prophylaxis. Antibiotics are often used and sometimes indicated for endodontic, periodontal, implant and surgical procedures. Our goal was to measure antibiotic usage and duration in the dental clinic at a large VA hospital.MethodsOutpatient antibiotic prescriptions from 2010–2016 for VA Boston were extracted from the VA data warehouse. Prescriptions were classified by date, antibiotic, and duration. Dental clinic visits and associated CPT codes were extracted for visits within 7 days +/- prescription.ResultsOf 119,193 dental visits during the study period, 3.7% (4,358) were associated with a unique antibiotic prescription. CPT diagnoses included periodontal (17.1%), endodontic (5.1%), surgical (36.5%) and implant (26.2%) procedures. The antibiotics prescribed included amoxicillin (62.0%), clindamycin (17.7%), penicillin (10.5%), macrolides (4.3%), augmentin (3.4%), and in less than 1% other classes including fluoroquinolones (0.2%). Mean days of antibiotics were 7.6 +/- SD 5.2 days (7.4 +/- SD 4.0 days for the above CPT codes). Duration did not vary by diagnostic code or by antibiotic class. There were no temporal trends over time.ConclusionThe majority of antibiotic use in dental clinic was for diagnostic codes that may warrant antibiotic use. The spectrum of activity of agents is in keeping with guidelines. However, the duration of antibiotics is longer than what might be anticipated for prophylaxis of dental procedures or treatment of dental infections. Limitations include lack of manual chart review to identify specific indication and potential for missing prescriptions by non-dental providers. Surveillance and stewardship activities can optimize antibiotic use in dental clinic.Disclosures All authors: No reported disclosures.

Clonal diversity and antimicrobial resistance of Enterococcus faecalis isolated from endodontic infections

article i nfo Background: Enterococcus faecalis is considered to be one of most prevalent species in the oral cavity, particularly in endodontic infections. The aim of the present study was to investigate the prevalence of E. faecalis in dental root canals, clonal diversity by restriction fragment length polymorphism (RFLP) and randomly amplified polymorphic DNA (RAPD-PCR) analysis, and the antibiotic susceptibility of E. faecalis isolates. Results: Among the bacterial strains isolated from dental root canal specimens (n = 82), E. faecalis was determined to have the highest prevalence followed by Streptococcus viridians, Leuconostoc mesenteroides, Staphylococcus aureus, Streptococcus mitis ,a ndPediococcus pentosaceus. Cluster analysis of RAPD-PCR and RFLP patterns of the E. faecalis isolates discriminated five and six different genotypes, respectively. Among the tested strains, 43%, 52% and 5% were susceptible, intermediate resistant, and resistant to erythromycin, respectively. In addition, one strain (E-12) was intermediate resistant to linezolid, and one isolate (E-16) was resistant to tetracycline. Interestingly, many of the intermediate resistant/resistant strains were grouped in clusters 5 and 6, according RAPD and to RFLP, respectively. Conclusions: E. faecalis demonstrated the highest prevalence in the tested dental root canal specimens collected from Saudi patients and were grouped into five to six different genotypes. Different levels of antimicrobial susceptibility were observed in the tested E. faecalis strains, which clearly indicated that although bacterial strains may be similar, point mutations can result in extreme susceptibility or resistance to various antibiotics. This phenomenon is a cause for concern for clinicians in the treatment of dental infections caused by E. faecalis.

The importance of early intervention in the treatment of dental infection

With recent reports of increasing hospital admissions relating to dental infection, the authors believe it is time to re-visit the importance of its effective early treatment. A series of three cases is used to illustrate the potentially life-threatening progression of what, in the early stages, is an easily treatable condition. The principles of effective management of dental infection are highlighted in the first instance and then indications for specialist maxillofacial referral are discussed.

Ozone therapy in postgraduate theses in Egypt

Systematic reviews of the studies published in the major medical data bases have not shown solid support for the use of ozone therapy. Unpublished or grey literature, including postgraduate theses, may solve this controversy. To review the postgraduate theses published in Egypt in order to assess the clinical safety and effectiveness of ozone therapy in specific medical conditions. The databases of the Egyptian Universities' Library Consortium and the databases of each university were searched for postgraduate theses that evaluated ozone therapy as an intervention for any disease or condition in any age group, compared with any or no other intervention and published before September 2010. A total of 28 quasi trials were included. The theses did not report any safety issues in terms of ozone therapy. With respect to its effectiveness, the studies suggested some benefits of ozone in the treatment of dental infection and recovery, musculoskeletal disorders, diabetes mellitus, chronic diseases, and obstetrics and gynaecology. However, the number of studies included was small and they were of limited quality. There is insufficient evidence to recommend the use of ozone in the treatment of dental infections, in facilitating faster dental recovery after extraction or implantation, in diabetes mellitus, musculoskeletal disorders, or obstetrics and gynaecology.

Characterizing Bubble Dynamics Created by High-Intensity Focused Ultrasound for the Delivery of Antibacterial Nanoparticles into a Dental Hard Tissue

Hig hintensity focused ultrasound (HIFU) has been applied for drug delivery in various disease conditions. Delivery of antibacterial-nanoparticles into dental hard tissues may open up new avenues in the treatment of dental infections. However, the basic mechanism of bubble dynamics, its characterization, and working parameters for effective delivery of nanoparticles, warrants further understanding. This study was conducted to highlight the basic concept of HIFU and the associated bubble dynamics for the delivery of nanoparticles. Characterization experiments to deliver micro-scale particles into simulated tubular channels, activity of ultrasonic bubbles, and pressure measurement inside the HIFU system were conducted. Subsequently, experiments were carried out to test the ability of HIFU to deliver nanoparticles into human dentine using field emission scanning electron micrographs (FESEM) and elemental dispersive X-ray analysis (EDX). The characterization experiments showed that the bubbles collapsing at the opening of tubular channels were able to propel particles along their whole length. The pressure measured showed sufficient negative and positive pressure suggesting that the bubble grew to a certain size before collapsing, thus enabling the particles to be pushed. The FESEM and EDX analysis highlighted the ability of HIFU to deliver nanoparticles deep within the dentinal tubules. This study highlighted the characteristics and the mechanism involved of the bubbles generated by the HIFU and their capability to deliver nanoparticles.

Périartérite noueuse cutanée de l’adulte et infections dentaires. Rôle des streptocoques.

Introduction. – Periarteritis nodosa can be associated with streptococcal infections in children. We report two cases of adult cutaneous periarteritis nodosa that disappeared after the treatment of dental infection. Exegesis. – A 23-year-old woman presented with necrotic ulceration on the legs for 6 months, with a histology of necrotizing vasculitis. Many sites of dental infections could be noted. Immunological data were negative and so were serologies of hepatitis. Corticosteroid therapy failed. The teeth removal with antibiotic therapy allowed the disappearance of cutaneous lesions in a month. A 26-year-old woman was hospitalized for growing thin, fever, diffuse arthralgia and myalgia and cutaneous nodules on the legs with necrotizing vasculitis on dermal vessels at histological analysis. The biology showed no pecularity. Radiography of the teeth showed many dental infection sites. The removal of six teeth with antibiotic therapy led to the disappearance of vasculitis in 6 weeks. Conclusion. – The search for an infectious problem is important when vasculitis is diagnosed, in particular periarteritis nodosa. The treatment of dental infection could occasionally mean avoiding immunosuppressive therapy in certain cases.

Antibiotic prophylaxis in orthognathic surgery: A 1 -day versus 5-day regimen

16. Fridrich KL, Partnoy BE, Zeitler DL: Prospective analysis of antibiotic prophylaxis for orthognathic surgery. Int J Adult Orthod Orthognath Surg 9:129,1994 17. Heit JM, Farwood VM, Edwards RC: Survey of antibiotic prophylaxis for intraoral orthognathic surgery. J Oral Maxillofac Surg 49:340, 1991 18. Martis C, Karabouta I: Infection after orthognathic surgery with and without preventive antibiotics. lnt J Oral Surg 13:490,1984 19. Garner JS, Jarvis WR, Emori TG, et al: CDC definitions for nosocomial infections 1988. Am J Infect Control 16:128, 1988 20. Greenberg RN, James RN, Marier RL, et al: Microbiolagic and antibiotic aspects of infections in the ora and maxillofacial region. J Oral Surg 37:873, 1979 21. Bartlett JG, O’Keefe P: The bacteriology of perimandibular space infection. J Oral Surg 37:407, 1979 22. Chow A, Rosen SM, Brady FA: Orofacial odontogenic infections. Ann Intern Med 88:392, 1978 23. Kannangara DW, Thadepalli H, McQuirter JL: Bacteriology and treatment of dental infections. Oral Surg Oral Med Oral Pathol 50:103, 1980 24. Burns SJ, Dippe SE: Postoperative wound infections detected during hospital stay and after discharge in a community hospital. Am J Infect Control l&60, 1982 25. Rosendorf LL, Octavia J, Estes JP: Effect of methods of postdischarge wound infection surveillance on reported infection rates. Am J Infect Control 11:226, 1983 26. Anonymous: Controversy surrounds reportings of surgeonspecific SW%. Hosp Infect Control 18:13, 1991 27. Taylor G, McKenzie M, Kirklqnd T, et al: Effect of surgeon’s diagnosis on surgical wound infection rates. Am J Infect Control 18:295, 1990 28. Watts JM, McDonald PJ, Woods PJ: Clinical trials of antimicrobials in surgery. World J Surg 6:321,1982 29. Olson M, O’Conor M, Schwartz ML: Surgical wound infection: A 5 year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Ann Surg 199:253, 1984 30. Peterson LJ: Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery. J Oral Maxlllofac Surg 48:617, 1990 3 1. Miles AA, Miles MM, Burke J: The value and duration of defense reactions of the skin to the primary lodgement of bacteria. Br J Exp Path01 38:79,1957 32. Kooke R, Egyedi P: Postoperative contamination of mandibular osteotomy sites with saliva. IntJ Oral Maxillafacial Surg 16:554, 1987