Dental implications of brain abscess in children with congenital heart disease. Case report and review of the literature

A rare case of multiple brain abscesses caused by apical periodontitis of deciduous teeth in congenital heart disease: a case report

Background

A brain abscess is a focal infection in which abscesses form in the brain. A brain abscess is a rare but fatal disease when rupture occurs into the ventricles. We report a case of multiple brain abscesses caused by a hematogenous infection from the apical periodontitis of deciduous teeth.

Case presentation

The patient was a 7-years and 8-months-old male with congenital heart disease. The patient sought medical attention due to fever and headache, for which he was started on three antibiotics with a diagnosis of multiple brain abscesses. Given that apical periodontitis of deciduous teeth was strongly suspected as the source of the brain abscess, the deciduous teeth were extracted. Immediately after deciduous teeth extraction, the patient’s headache and neurological symptoms disappeared.

Conclusions

After teeth extraction, a clear shrinkage of the brain abscess was observed, and the patient was discharged from the hospital.

Are dental infections a cause of brain abscess? Case report and review of the literature

Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.

Brain abscesses caused by oral infection

Brain abscesses are rare but can be life-threatening infections. Recent progress in microbiological classification and identification has indicated that they are sometimes caused by oral infection and dental treatment. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. In the direct extension, oral infections spread along the fascial planes. Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack valves, through the cavernous sinus and into the cranium. Another hematogenous pathway is through the general circulation. Oral bacteria may cause systemic infections, e.g., endocarditis, and then indirectly initiate brain abscess. Microbiota, complications, and the prevention and management of odontogenic brain abscesses are also discussed in this review.

Cerebral abscess complicating dental treatment. Case report and review of the literature

A case history and brief literature review of cerebral abscess related to dental therapy is presented. The 19-year-old male patient presented with a cerebral abscess caused by Actinobacillus actinomycetamcomitans. He was otherwise healthy, and had a recent history of periodontal surgery prior to the onset of symptoms. The patient was treated successfully with stereotactic aspiration and antibiotics.

Brain abscess of odontogenic origin: report of case

Advanced dental infection rarely causes brain abscess resulting in death. Good dental hygiene and removing abscessed teeth are advised for prevention of any such occurrence. An intercranial infection is described in a 29-year-old male who also had a dental phobia.

Use of computed tomography in the localization of head-and-neck-space infections

Three cases are reported in which results of CT scanning were of significant use in determining the presence and location of abscesses in the head and neck region. The authors believe CT should be employed as an adjunct to thorough physical examination in head and neck infections of a complex or chronic nature.

Plaque and systemic disease: a reappraisal of the focal infection concept

The review presented here covers metastatic local and systemic disease secondary to the accumulation of plaque or the formation of other pathogenic microbial depots in the mouth. At least 3 pathways may link oral infection to secondary disease, to wit metastatic infection due to transient bacteremia, metastatic immunological injury, and metastatic toxic injury. The available evidence is presented and examples are provided. They concern among others such divergent diseases as acute bacterial myocarditis, infective endocarditis, brain abscess, uveitis and iridocyclitis, trigeminal and atypical facial neuralgia, unilateral facial paralysis, fever of "unknown' origin, and neutrophil dysfunction.