Orbital Cellulitis of Odontogenic Origin

Odontogenic orbital cellulitis, although uncommon, has the potential to cause severe vision loss if unsuspected and untreated. Compared to non-odontogenic bacteriology, odontogenic orbital abscesses typically feature a heavy mixed growth with anaerobic organisms. We review the literature and discuss the case of a 26-year-old male who presented with anaerobic orbital cellulitis for treatment.

Dental infection and dermatological diseases: analysis of ninety-two patients and review of the literature

Dental disease has long been proposed as a potential causative agent in certain dermatological diseases. However, literature data on this association are scarce. The aim of this retrospective study was to evaluate dental status in 92 patients with various dermatological diseases who were referred to our Department for elimination of dental disease and to assess the relationship between dental infection and dermatological diseases. Dermatological conditions due to which patients were referred were alopecia, urticaria, eczematoid dermatitis, psoriasis, edema, etc. Out of 92 patients, 42 (45.7%) patients were referred for further dental treatment, while the remaining 50 (54.3%) patients had no observable dental pathology. None of the patients reported improvement following dental treatment. Based on the results of this study, we might conclude that dental infection does not play any role in the development of dermatological disease.

The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women

BACKGROUND

Evidence is emerging that women's poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants.

METHODS/DESIGN

The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women's oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention.

DISCUSSION

This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612001271897.

Dental health and treatment needs in people with leprosy in China

OBJECTIVES

To evaluate the dental health status and treatment needs of people affected by leprosy in China, and provide a basis for the development of national or regional dental health programmes to cover the treatment needs of this population.

DESIGN

A cross-sectional study with 613 former leprosy patients was carried out in six leprosy villages, in three provinces in China (Nanjing, Taixing and Jiangyan in Jiangsu Province, Hanzhong and Shangluo in Shanxi Province and Yongzhou in Hunan Province). A questionnaire about demographic and clinical data was used. The World Health Organization's (WHO) basic methods were used to determine the tooth-based treatment needs. Periodontal status was determined by using the Community Periodontal Index of Treatment Needs (CPITN). In addition, prosthetic normative needs were assessed.

RESULTS

Among the 613 people affected by leprosy, there were 472 people (77%) who had never visited a dentist and 172 people (28.1%) had never brushed their teeth; 302 (49.3%) brushed their teeth once a day. However, there were 267 people (43.6%) who thought their dental health was at an average level and 108 (17.6%) thought they had good dental health. 55.6% of the subjects required dental fillings, 32.7% required pulp care and restoration, and 71.1% required extraction. On CPITN, 23.2% of the subjects scored 2, 28.6% scored three and 48.0% scored four, showing that these people required systematic periodontal treatment. In addition, 84.5% of the subjects needed normative prosthetic treatment.

CONCLUSIONS

Most of the subjects with leprosy in this study lacked self-care knowledge on dental health, and especially self-awareness of dental conditions. Normative treatment needs of people affected by leprosy were very high. This result calls for improved oral health education and oral health care in people with leprosy. Oral health education might preferably be integrated into already existing leprosy rehabilitation programs.

Enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand

BACKGROUND

Although many complications from kidney disease therapy can be prevented or effectively treated, oral health problems are nevertheless a consequence.

OBJECTIVE

The objective of this study was to explore the prevalence of enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand.

MATERIAL AND METHOD

This cross-sectional study was conducted between January and August 2013, at SrinagarindHospital, Khon Kaen University. Ninety-seven pediatric patients with kidney disease were allowed by their parents to participate in this study. Data were collected from medical records, questionnaires and oral examination records. The enamel defect was recorded using the Developmental Defects of Enamel Index. Gingival enlargement was recorded using the GingivalEnlargement Index. An oral examination was conducted using a mouth mirror, explorer and periodontal probe.

RESULTS

The average age of the pediatric patients with kidney disease was 11.53+3.7years (range, 4-17). The majority of subjects were able to (a) come for an appointment (97.9%), (b) take medication according to the medical directions (93.8%) and (c) avoid inappropriatefoodsfor those suffering kidney disease (84.5%). The prevalence of enamel defect was 27.8%. The most common enamel defects were demarcated opacities (13.4%) or diffuse opacities (9.3%). The prevalence ofgingival enlargement was 16.5%.

CONCLUSION

This study revealed that the prevalence ofenamel defect was 27.8% and the prevalence ofgingival enlargement was 16.5%.

Management of dental infections by medical practitioners

BACKGROUND

Patients with dental infections frequently present to primary care practitioners such as emergency physicians or general practitioners. It is important for these healthcare professionals to understand how to assess and treat such conditions, including when to refer and to whom.

OBJECTIVE

This article aims to cover basic principles of managing patients with dental infections who present to emergency departments or general practice surgeries.

DISCUSSION

Maxillofacial surgeons frequently see serious cases of facial and neck infections that can easily be prevented if appropriately managed early.

An Investigation Into the Relationship Between Noncarious Cervical Lesions and Premature Contacts

The aim of the present study was to investigate the relationship between noncarious cervical lesions (NCCL) and dental premature contacts (PC). Following examination of 1,974 teeth from 77 patients referred to the Department of Oral Medicine, Faculty of Dentistry, Mashad University of Medical Science, Iran, a total of 167 teeth were identified to have the criteria set for noncarious cervical lesions (regarded as NCCL group). Also, 167 teeth exhibiting no such lesions were selected randomly from the same population (regarded as control group). The results indicated that within the NCCL group, the frequency of noncarious cervical lesions differed significantly among the various teeth; the first premolar teeth showed the greatest number of cervical lesions, followed by the canine teeth, and the second molar teeth had the least number of lesions. A similar trend was detected in the total number of premature contacts among the seven types of teeth. The results revealed a highly significant and positive correlation between the incidence of NCCL and the PC. The NCCL group and the control group differed significantly in the number of premature contacts in centric relation (CR) and working side, but not in balancing and protrusion.

[Odontogenic maxillary sinusitis: peculiarities of diagnostics and treatment]

The objective of the present work was to improve the quality of diagnostics and the choice of optimal therapy for the management of odontogenic maxillary sinusitis associated with the localization of foreign bodies in the lateral parts of the maxillary sinuses. To this effect, multispiral computed tomography was used to enable the exact location of the foreign body inside the sinus and to choose the optimal approach for the surgical intervention. The modified Coldwell-Luc procedure was employed as the most adequate technique in the given clinical condition.

Hemophilia and oral health

OBJECTIVE

The aim was to overview the oral health aspects in hemophilia patients.

MATERIAL AND METHODS

An electronic search of Medline (Pub Med), Cochrane, SSCI (Social Citation Index), SCI (Science Citation Index) databases from 1982 to the present, using the following search words: hemophilia, oral health, dental caries, dental caries prevalence, gingivitis, periodontitis, primary dentition, permanent dentition, dental treatment and review, was performed. The search yielded 196 titles and abstracts on chosen words. All articles were full-text reviewed and 40 of publications were included.

RESULTS

Nowadays coagulation factor abnormalities are the most common of inherited bleeding disorders, but occur much less frequently approximating 10000-50000 male births than acquired coagulation defects. Von Willebrand disease, Hemophilia A and Hemophilia B account for 95-97% of all coagulation deficiencies. Hemophilias A and B are subdivided according to the factor's activity levels in the blood: mild, moderate or severe. The two main oral diseases affecting patients with hemophilia are the same as for the rest of population, i.e. dental caries and gingivitis/periodontitis. Only a few studies concerning oral health aspects in hemophilia patients were carried out. Some controversy exists concerning caries prevalence in both primary and permanent dentitions in children with hemophilia. People with congenital hemorrhagic diatheses constitute a very small proportion of the total population. Due to that fact treatment of such patients becomes a challenge to the most of dentists due to the fact that most of them have no experience in dealing with dental problems in such patients.

CONCLUSION

There is a lack of epidemiological studies in oral health status of hemophilia patient.

Length of hospital stay and management of facial cellulitis of odontogenic origin in children

PURPOSE

This study's purpose was to assess characteristics of pediatric patients with odontogenic-based facial cellulitis, treatment strategies, and their relationship to length of stay (LOS).

METHODS

This retrospective study was performed on individuals younger than 18 years old who were hospitalized for facial cellulitis of odontogenic origin (FCOO). Medical records were reviewed for all patients with a discharge diagnosis of FCOO or buccal cellulitis. Patients' clinical characteristics were evaluated and assessed for their relationship to LOS.

RESULTS

A total of 106 children were diagnosed with FCOO. LOS was significantly shorter in patients who had a tooth extracted within 48 hours versus patients who had a tooth extracted at 48 hours or longer (P=.007). LOS was significantly shorter in patients with upper face and left face infections than lower face infections (P=.01) and right face infections (P=.01), respectively. Patients with a primary first molar infection had the shortest LOS; patients with a white blood cell count less than 10,000 cells/mm3 had shorter LOS.

CONCLUSIONS

Early tooth extraction may decrease the length of stay in management of pediatric facial cellulitis of odontogenic origin. The type of tooth involved and white blood cell count at admission have a significant impact on length of stay.

Odontogenic maxillary sinusitis: a review

Maxillary sinusitis of odontogenic origin is a well-known condition in both the dental and otolaryngology communities. It occurs when the Schneiderian membrane is violated by conditions arising from dentoalveolar unit. This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure of medical and surgical therapies directed toward sinusitis. Unilateral recalcitrant disease associated with foul smelling drainage is a most common feature of odontogenic sinusitis. Also, high-resolution CT scans and cone-beam volumetric computed tomography can assist in identifying dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent functional endoscopic sinus surgery or Caldwell-Luc operation is required. The aim of this article is to give a review of the most common causes, symptoms, diagnostic and treatment methods of odontogenic maxillary sinusitis. Search on Cochrane Library, PubMed and Science Direct data bases by key words resulted in 35 articles which met our criteria. It can be concluded that the incidence of odontogenic sinusitis is likely underreported in the available literature.

Odontogenic cervico-fascial infections: a continuing threat

STATEMENT OF THE PROBLEM

Dental abscesses are common and occasionally can progress to life-threatening cervico-fascial infections. Despite medical advances, odontogenic cervico-fascial infections (OCFIs) continue to be a threat. The potential seriousness of odontogenic infections (Ols), or dental abscesses, is frequently underestimated. General dental practitioners (GDPs) in primary care face the challenging decision of whether to refer patients to secondary care or to manage them in the community.

PURPOSE OF THE REVIEW

This paper reviews the relevant aspects of Ols that might be helpful to primary care dental practitioners in providing a better understanding of the anatomy and pathology and aims to assist in clinical decision.

METHOD

An up-to-date review of literature on OCFIs, highlighting their potential risks with clinical examples.

RESULTS AND CONCLUSION

Dental abscesses are common and continue to be a major cause for emergency hospital admission to oral and maxillofacial surgery departments. They occasionally spread to fascial spaces of the neck, potentially posing significant morbidity and mortality. GDPs are usually the first point of contact and face the challenge of recognising those at risk of developing OCFIs, which are potentially life threatening and require urgent referral for hospital treatment. We propose a patient care pathway to be used in primary care.

Deep neck infection in elderly patients. A single institution experience (2000–2004)

BACKGROUND AND AIMS

Immunosenescence, the age-related decline in immunologic function in healthy individuals, seems to contribute to increased susceptibility to bacterial infections in the elderly population. The present study describes elderly patients' susceptibility to deep neck infection and prognosis.

METHODS

Between January 2000 and March 2004, 103 patients were admitted to the Department of Otolaryngology, University of Padova for deep neck infection. Twenty-four patients (23%) were over 65 (elderly patients). The remaining 79 patients (77%) aged < or =65 years (adult non-elderly patients) were also studied. Presentation modalities, origin of infection, site of deep neck infection, radiological investigations, bacteriology, treatment and outcome were all studied.

RESULTS

Hypertension and diabetes mellitus were the most commonly associated systemic diseases in both elderly and non-elderly patients. The number of patients with associated systemic diseases was significantly higher in the elderly group. The most common cause of deep neck infection was dental infection in both age groups. In the elderly group, salivary gland origin had the same incidence as dental origin. Twenty-two patients (6 elderly patients) were treated only with intravenous antibiotic therapy and intravenous steroids. Overall, in 81 cases (78.6%) (18 elderly patients) medical plus surgical procedures were indicated. None of the treated patients died of deep neck infection or its complications.

CONCLUSIONS

Although the incidence of associated systemic diseases and complications of deep neck infections were higher in the elderly group, our medical or medical plus surgical approaches to deep neck infections, based on clinical and radiological evidence, were successful in all patients treated.

Dental infections increase the likelihood of hospital admissions among adult patients with sickle cell disease

THE OBJECTIVE

To determine if dental infections increase the likelihood of hospital admission among adult patients with sickle cell disease (SCD).

BASIC RESEARCH DESIGN

Cross-sectional analysis of data from the Nationwide Emergency Department Sample (NEDS) pooled for the years 2006 through 2008. Prevalence ratios (PR) for the effects of interest were estimated using Poisson regression with robust estimates of the variance.

PARTICIPANTS

Adults, aged 18 and over, diagnosed with SCD using ICD-9-CM codes excluding participants discharged with a code for sickle cell trait.

MAIN OUTCOME MEASURE

Emergency department (ED) visit disposition, dichotomised to represent whether or not the ED visit ended in admission versus being treated and released.

RESULTS

Among patients having a sickle cell crisis, those with dental infections were 72% more likely to be admitted compared to those not having dental infections (PR = 1.72, 95% CI 1.58-1.87). No association was observed among adult SCD patients not having a sickle crisis event. Based on preliminary data from this analysis, prevention of dental infection among patients with SCD could result in an estimated cost saving of $2.5 million dollars per year.

CONCLUSIONS

Having a dental infection complicated by a sickle cell crisis significantly increases the likelihood of hospital admission among adult SCD patients presenting to the ED.

The evolutionary paradox of tooth wear: simply destruction or inevitable adaptation?

Over the last century, humans from industrialized societies have witnessed a radical increase in some dental diseases. A severe problem concerns the loss of dental materials (enamel and dentine) at the buccal cervical region of the tooth. This “modern-day” pathology, called non-carious cervical lesions (NCCLs), is ubiquitous and worldwide spread, but is very sporadic in modern humans from pre-industrialized societies. Scholars believe that several factors are involved, but the real dynamics behind this pathology are far from being understood. Here we use an engineering approach, finite element analysis (FEA), to suggest that the lack of dental wear, characteristic of industrialized societies, might be a major factor leading to NCCLs. Occlusal loads were applied to high resolution finite element models of lower second premolars (P₂) to demonstrate that slightly worn P₂s envisage high tensile stresses in the buccal cervical region, but when worn down artificially in the laboratory the pattern of stress distribution changes and the tensile stresses decrease, matching the results obtained in naturally worn P₂s. In the modern industrialized world, individuals at advanced ages show very moderate dental wear when compared to past societies, and teeth are exposed to high tensile stresses at the buccal cervical region for decades longer. This is the most likely mechanism explaining enamel loss in the cervical region, and may favor the activity of other disruptive processes such as biocorrosion. Because of the lack of dental abrasion, our masticatory apparatus faces new challenges that can only be understood in an evolutionary perspective.

[Age associated clinical features of odontogenic maxillary sinusitis]

Detailed analysis of odontogenic maxillary sinusitis clinical course allowed identifying clinical features of the disease specific for elderly and senile patients. The paper describes the peculiarities of odontogenic maxillary sinusitis in elderly and senile patients including those having oroantral sinus tract.

Children's dental health, school performance, and psychosocial well-being

OBJECTIVE

To assess the effects of dental health on school performance and psychosocial well-being in a nationally representative sample of children in the US.

STUDY DESIGN

We analyzed data from the 2007 National Survey of Children's Health for 40,752-41,988 children. The effects of dental problems and maternal-rated dental health on school performance and psychosocial well-being outcomes were evaluated using regression models adjusting for demographic, socioeconomic, and health characteristics.

RESULTS

Dental problems were significantly associated with reductions in school performance and psychosocial well-being. Children with dental problems were more likely to have problems at school (OR = 1.52; 95% CI: 1.37-1.72) and to miss school (OR = 1.42; 95% CI: 1.23-1.64) and were less likely to do all required homework (OR = 0.76; 95% CI: 0.68-0.85). Dental problems were associated with shyness, unhappiness, feeling of worthlessness, and reduced friendliness. The effects of dental problems on unhappiness and feeling of worthlessness were largest for adolescents between 15 and 17 years.

CONCLUSION

Preventing and treating dental problems and improving dental health may benefit child academic achievement and cognitive and psychosocial development.

The impact of obesity on prosthodontic treatment

Obesity has become a worldwide epidemic and an increasing public health concern that has a negative impact on both overall systemic and oral health. At the same time, the need for prosthodontic treatment has increased and has been projected to be more in demand in the future. It has also been predicted that the need to provide prosthodontic treatment to an increasing number of obese patients may become routine. However, delivering prosthodontic treatment to obese patients may be a challenge due to their anatomy, physiology, and physical characteristics. It is important to recognize the potential comorbidities and assist patients in seeking necessary help. It may be necessary to modify hardware, equipment, techniques, treatment positions, and/or prosthodontic protocols to ensure that these patients receive the proper care and avoid unforeseen complications. An obese patient with a compromised medical history and complex dental status may be managed best by a multidisciplinary team approach.

Behavioral and healthcare-associated risk factors for chronic hepatitis C virus infection in Korea

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (≥ 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, ≥ 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.

[Diseases of the maxillary sinus: an overview]

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.

Acute cervicofacial necrotizing fasciitis: three clinical cases and a review of the current literature

Cervicofacial necrotizing fasciitis (NF) is a rare condition that can quickly become life-threatening if appropriate treatment is delayed. This condition is observed as a rapidly progressive infection that causes extensive necrosis of the superficial fascia. This report presents a case of cervicofacial NF with microbiological isolation of methicillin-resistant Staphylococcus aureus in a patient with a history of uncontrolled diabetes mellitus following a minor scalp trauma. The article also presents two cases of NF secondary to odontogenic infection. The radiographic finding of the presence of gas locules in the facial planes on the CT scan helped to confirm the diagnosis. Patients were treated with broad-spectrum antibiotic therapy, extensive surgical drainage, debridement, and supportive care. Awareness in the dental community of the signs of NF will facilitate optimal patient management.

Oral health of Chinese people with systemic sclerosis

The aim was to study oral health status, salivary function, and oral features of Chinese people with Systemic Sclerosis (SSc). Chinese people with SSc attending a university specialist clinic were invited for a questionnaire survey and a clinical examination. Ethics approval was sought (UW 08-305). Gender- and age-matched individuals without SSc who attended a university dental hospital were recruited for comparison. Forty-two SSc patients with a mean age of 54.0 ± 12.2 were examined. This study found no Chinese people with systemic sclerosis were periodontally healthy and many (76%) had periodontal pockets despite most of them (93%) practiced daily tooth-brushing. They all had caries experience (DMFT = 10.5) and many (65%) had untreated decay. Mucosal telangiectasia was a common oral feature (80%). They had lower resting salivary flow rates (0.18 ± 0.17 ml/min vs. 0.31 ± 0.21 ml/min; p = 0.003) and pH values (6.90 ± 0.40 vs. 7.28 ± 0.31; p < 0.001) and reduced maximal mouth opening (40.1 ± 6.5 mm vs. 43.6 ± 7.0 mm) than people without SSc.

Oral and radiographic findings in patients undergoing continuous ambulatory peritoneal dialysis

OBJECTIVE

To compare the oral status, cortical and spongy bone density of the mandible, and dental pulp calcification between the patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and age- and sex-matched healthy controls.

MATERIAL AND METHOD

Thirteen end stage renal disease patients undergoing CAPD and 17 age- and sex- matched healthy volunteers were enrolled. The questionnaires, oral radiography, and intraoral examination, including number of decayed teeth, filled teeth, missing teeth, plaque index, gingival index, calculus index, and oral hygiene index were performed in both groups. Two views of oral radiology, comprising panoramic and bite-wing radiographs, were taken to evaluate mandibular bone density and pulp calcification. The data were analyzed with t-test and Mann-Whitney U tests.

RESULTS

Both groups were similar in baseline demographics, including age, sex, and education. Plaque index, calculus index, and oral hygiene index of the CAPD patients were significantly worse than the controls' (p = 0.025, 0.015, and 0.014, respectively). Percentage of decayed teeth and missing teeth of the CAPD patients had a trend to be higher than control. The percentage of filled teeth, decayed missing filling tooth (DMFT) index, sum of percentage DMFT, gingival index, average of spongy and cortical bone densities, and the percentage of pulp calcification were comparable in both groups.

CONCLUSION

CAPD had poorer oral hygiene than the healthy; however; DMFT pulp calcification, and bone density were not differenct from the healthy. This urges the medical personnel to examine all CAPD patients in order to prevent hematogenous spreading of occult oral infection.