Pediatric Odontogenic Infections

Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.

Oral microbiota signatures associated with viremia and CD4 recovery in treatment-naïve HIV-1-infected patients

PURPOSE

Few reports focused on the role of oral microbiome diversity in HIV infection. We characterized the microbiota-immunity axis in a cohort of treatment-naïve HIV-1-infected patients undergoing antiretroviral therapy (ART) focusing on the oral microbiome (OM) and immunological responsivity.

METHODS

The sequencing of 16S rRNA V3-V4 hypervariable region was performed on salivary samples of 15 healthy control (HC) and 12 HIV + patients before starting ART and after reaching virological suppression. Then, we correlated the OM composition with serum cytokines and the Short Chain Fatty acids (SCFAs).

RESULTS

The comparison between HIV patients and HC oral microbiota showed differences in the bacterial α-diversity and richness. We documented a negative correlation between oral Prevotella and intestinal valeric acid at before starting ART and a positive correlation between oral Veillonella and gut acetic acid after reaching virological suppression. Finally, an increase in the phylum Proteobacteria was observed comparing saliva samples of immunological responders (IRs) patients against immunological non-responders (INRs).

CONCLUSIONS

For the first time, we described an increase in the oral pro-inflammatory Proteobacteria phylum in INRs compared to IRs. We provided more evidence that saliva could be a non-invasive and less expensive approach for research involving the oral cavity microbiome in HIV patients.

Rising incidence of severe maxillofacial space infections in Germany

OBJECTIVES

Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time.

MATERIALS AND METHODS

Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors.

RESULTS

The total standardized incidence rate of MSI-associated procedures in the observational period 2005-2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI - related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany.

CONCLUSIONS

Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years.

CLINICAL RELEVANCE

Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.

The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases

PURPOSES

To determine if the empirical use of aminoglycosides is justified in Ludwig's angina based on microscopy, culture and sensitivity results.

METHODS

A retrospective analysis was done on patients that presented with Ludwig's angina to the Maxillofacial and Oral surgery department at the University of Pretoria. Demographical data was extracted from patient files. Pus specimens that were submitted as part of the initial surgical intervention were analysed.

RESULTS

Sixty-three patients were included in the study with the majority, 76.19% (n=48/63), comprising males. The mean patient age was 38.6 years (range 6 months to 78 years). The majority of infections (87.3%) had an odontogenic aetiology (n=55/63). Forty-four percent of the patients had immunosuppressive co-morbidities (n=28/63). Streptococci contributed 71.26% (n=62/87) of the cultured bacteria. Similar bacteria were cultured in the immunocompromised and the immunocompetent patients (p=0.672). Ninety-two percent (n=57/62) of the streptococci cultured were sensitive to penicillin. The addition of aminoglycosides to the study sample would not have made a statistically significant difference (p=0.1556).

CONCLUSION

Based on the findings of this study, the empirical use of aminoglycosides is not warranted in either immunocompromised or immunocompetent patients with Ludwig's angina.

A Retrospective Review of Dental Care and Related Husbandry of Captive Great Apes Over 37 Years (1982-2019) at Milwaukee County Zoo

Milwaukee County Zoo (MCZ) has cared for 25 lowland gorillas (Gorilla gorilla gorilla), 17 orangutans (Pongo pygmaeus) and 38 bonobos (Pan paniscus) since 1982. MCZ has one of the largest captive populations of bonobos in the world, with a current troop of 19 animals and historically as many as 24 in the troop. This article reviews the dental care provided to these animals from 1982-2019.

Treponema denticola Has the Potential to Cause Neurodegeneration in the Midbrain via the Periodontal Route of Infection-Narrative Review

Alzheimer's disease (AD) is a neurodegenerative disease and the most common example of dementia. The neuropathological features of AD are the abnormal deposition of extracellular amyloid-β (Aβ) and intraneuronal neurofibrillary tangles with hyperphosphorylated tau protein. It is recognized that AD starts in the frontal cerebral cortex, and then it progresses to the entorhinal cortex, the hippocampus, and the rest of the brain. However, some studies on animals suggest that AD could also progress in the reverse order starting from the midbrain and then spreading to the frontal cortex. Spirochetes are neurotrophic: From a peripheral route of infection, they can reach the brain via the midbrain. Their direct and indirect effect via the interaction of their virulence factors and the microglia potentially leads to the host peripheral nerve, the midbrain (especially the locus coeruleus), and cortical damage. On this basis, this review aims to discuss the hypothesis of the ability of Treponema denticola to damage the peripheral axons in the periodontal ligament, to evade the complemental pathway and microglial immune response, to determine the cytoskeletal impairment and therefore causing the axonal transport disruption, an altered mitochondrial migration and the consequent neuronal apoptosis. Further insights about the central neurodegeneration mechanism and Treponema denticola's resistance to the immune response when aggregated in biofilm and its quorum sensing are suggested as a pathogenetic model for the advanced stages of AD.

A global science mapping analysis on odontogenic infections

OBJECTIVES

Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends.

METHODS

Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers.

RESULTS

A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management.

CONCLUSIONS

Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.

Normal bacterial flora of the oral cavity in healthy pet rabbits (Oryctolagus cuniculus)

BACKGROUND

Rabbits often suffer from dental disease, including dental abscesses and periodontal/apical infections. With odontogenic infection and abscessation, a bacterial aetiology can be proven by bacterial culture and identification. Although studies exist on the bacterial flora of dental abscesses, the information available to date on the bacterial flora of the oral cavity in healthy rabbits is limited.

OBJECTIVES

This study aims to evaluate the cultivable bacterial flora in the oral cavity of healthy, young, pet rabbits and to compare this flora with the pathologic flora of odontogenic abscesses described in the literature.

METHODS

Samples were collected from the oral cavity of 33 healthy, young pet rabbits undergoing routine procedures. Oral cavity culture specimens were collected by rolling a sterile flocked paediatric swab in the mouth. Identification was first attempted by morphological assessment, Gram staining and mass spectrometry (MALDI-TOF). Colonies that could not be identified by mass spectrometry were identified by amplification and molecular sequencing of a part of the 16s rRNA gene.

RESULTS

Bacteria were recovered from 100% of oral swabs; 220 isolates of 35 different genera of bacteria were cultured. The most frequently isolated bacteria were Streptococcus sp. (19.8%), Rothia sp. (17.9%), Enterobacter sp. (7%), Staphylococcus sp. (6.6%) and Actinomyces sp. (5.7%). Four phyla are represented: Proteobacteria (38.3%), Firmicutes (30.5%), Actinobacteria (26.9%) and Bacteroidota (4.3%).

CONCLUSIONS

A wide range of commensal bacteria are present in the mouths of rabbits. Bacterial cultures taken from cases of dental abscesses often reveal bacteria. Streptococcus sp., Staphylococcus sp. and Actinomyces sp. are frequently found in cultures from dental abscesses, in contrast to Rothia and Enterobacter species. Our findings enhance the knowledge of rabbit microbial communities throughout oral cavity.

Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.

Antibiotic treatment and supplemental hemin availability affect the volatile organic compounds produced by P. gingivalis in vitro

We have measured the changes in the production of volatile organic compounds (VOCs) by the oral pathogen Porphyromonas gingivalis, when treated in vitro with the antibiotic amoxicillin. We have also measured the VOC production of P. gingivalis grown in the presence and absence of supplemental hemin. Planktonic bacterial cultures were treated with different amounts of amoxicillin in the lag phase of the bacterial growth. Planktonic bacteria were also cultured with and without supplemental hemin in the culture medium. Concentrations of VOCs were measured with proton-transfer-reaction time-of-flight mass spectrometry (PTR-ToF-MS) and further molecular identification was done with gas chromatography-mass spectrometry (GC-MS) using solid phase microextraction (SPME) for sampling. The cell growth of P. gingivalis in the cultures was estimated with optical density measurements at the wavelength of 600 nm (OD₆₀₀). We found that the production of methanethiol, hydrogen sulfide and several short- to medium-chain fatty acids was decreased with antibiotic treatment using amoxicillin. Compounds found to increase with the antibiotic treatment were butyric acid and indole. In cultures without supplemental hemin, indole and short- to medium-chain fatty acid production was significantly reduced. Acetic acid production was found to increase when supplemental hemin was not available. Our results suggest that the metabolic effects of both antibiotic treatment and supplemental hemin availability are reflected in the VOCs produced by P. gingivalis and could be used as markers for bacterial cell growth and response to threat. Analysis of these volatiles from human samples, such as the exhaled breath, could be used in the future to rapidly monitor response to antibacterial treatment.

Microbiota of Dental Abscess and their Susceptibility to Empirical Antibiotic Therapy

Context

Resistant pathogens to purulent odontogenic infections have evolved due to misuse of antibiotics. Hence, it is important to use a suitable antibacterial agent.

Aim

This study aimed to identify the common bacterial species causing odontogenic infections and to determine their antibiotic susceptibility profile to amoxicillin, amoxicillin and clavulanic acid, azithromycin, and linezolid.

Settings and Design

This was an in vitro cross-sectional study.

Material and Methods

Fifty pus samples from odontogenic abscess were cultured and antibiotic susceptibility tests were performed as per the standard microbiological procedures.

Statistical Analysis Used

Binomial test and Pearson's Chi-square test were used for statistical analysis.

Results

Out of the 50 samples cultured, 30 samples showed growth. The distribution of growth among the 30 samples was Gram-positive cocci (n = 23, 67.65%) and Gram-negative bacilli (n = 11, 32.35%). Gram-positive isolates that were grown were Enterococcus faecalis (38.24%) followed by Staphylococcus aureus (29.41%) and Gram-negative bacilli that were isolated were Klebsiella pneumoniae (14.71%), Pseudomonas aeruginosa (8.82%), Escherichia coli (5.88%), and Enterobacter (2.94%). Enterococcus isolates were highly susceptible to amoxicillin (76.92%). An increase in the zone of inhibition to amoxicillin-clavulanic acid was appreciated more for Staphylococcus (50%) than Enterococcus (30.76%). Enterococcus and Staphylococcus showed high susceptibility of 92.31% and 90% to linezolid, respectively. E. coli and Enterobacter were 100% susceptible to amoxicillin. All the Gram-negative bacteria except for P. aeruginosa were 100% highly susceptible to amoxicillin-clavulanic acid.

Conclusions

Culture-guided antibiotic prescriptions are necessary to prevent the emergence of antibiotic-resistant bacteria.

Sonication versus the conventional method for evaluation of the dental microbiome: a prospective pilot study

Objectives

To investigate sonication as a new tool in microbiological probing of dental infections.

Methods

Comparison of a standard probing method: intraoperative swab, with sonication, and vortex of the removed tooth, was performed on 20 carious destructed teeth. Illumina high throughput sequencing of the 16S-rRNA-gene was used for assessing the microbial composition. Antibiotic susceptibility has been assigned based on known resistances of each detected species. Probing procedures were compared using Bland–Altmann-Test, and antibiotic susceptibility using the Friedmann-Test and alpha-adjusted post-hoc-analysis.

Results

In total, 60 samples were analysed: 20 intraoperative swabs, 20 vortex fluids, and 20 sonication fluids. Sonication fluid yielded the highest number of bacterial sequencing reads in all three procedures. Comparing the operational taxonomic units (OTUs) of the identified bacteria, significantly more OTUs were found in sonication fluid samples. Phylum and order abundances varied between the three procedures. Significantly more Actinomycetales have been found in sonication fluid samples compared to swab samples. The assigned resistance rates for the identified bacteria (1.79–31.23%) showed no differences between the tested probing procedures. The lowest resistance rates were found for amoxicillin + clavulanate (3.95%) and levofloxacin (3.40%), with the highest in amoxicillin (30.21%) and clindamycin (21.88%).

Conclusions

By using sonication on extracted teeth, it is possible to get a more comprehensive image of the residing microbial flora compared to the standard procedure. If sonication is not available, vortexing is a potential alternative. In immunocompromised patients, especially when actinomycosis is suspected, sonication should be considered for a more detailed microbiological evaluation of the potential disease-causing microbiome. Due to the high rates of antibiotic resistance, a more targeted antibiotic therapy is favourable. Levofloxacin should be considered as a first-line alternative to amoxicillin + clavulanate in patients with an allergy to penicillin.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02374-0.

Indications for the use of metronidazole in the treatment of non-periodontal dental infections: a systematic review

Background

Dental practitioners are the largest prescribers of metronidazole. Antibiotics should only be prescribed when systemic involvement is clear and should be limited to monotherapy with β-lactams in the first instance.

Objectives

To determine whether metronidazole used as monotherapy or in addition to a β-lactam antibiotic offers any additional benefit over β-lactam monotherapy in non-periodontal dental infections.

Methods

Searches of Ovid Medline, Ovid Embase, Cochrane library and trials registries, forward and backward citations, for studies published between database inception and 2 August 2021. All randomized clinical trials (RCTs) and non-randomized trials comparing either systemic metronidazole monotherapy or metronidazole combined with a β-lactam with β-lactam monotherapy for the treatment of non-periodontal dental infections in adults or children in outpatient settings were included.

Results

Four publications reporting three RCTs comparing metronidazole with a β-lactam antibiotic were recovered. Studies were conducted in the 1970s–80s and aimed to demonstrate metronidazole was as effective as penicillin for the treatment of acute pericoronitis or acute apical infections with systemic involvement. Meta-analysis of results was not possible due to differences in measurement of infection signs. All studies concluded that metronidazole and penicillin are equally effective for the treatment of non-periodontal dental infections with systemic involvement.

Conclusions

Metronidazole does not provide superior clinical outcomes (alone or in combination with a β-lactam) when compared with a β-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice. Guidelines should reinforce the importance of surgical interventions and if appropriate the use of a single agent narrow-spectrum β-lactam.

Do antibiotics prevent infection after third molar surgery? A network meta-analysis

The aim of this systematic review was to determine whether antibiotics, compared to placebo, can prevent infection or dry socket after third molar surgery. A systematic review and network meta-analysis (NMA) was performed following registration of the protocol (CRD42021276266). Four databases and the grey literature were searched, and papers were selected based on the PICOS question. RoB 2 and GRADE were used to evaluate the risk of bias and certainty of the evidence, respectively. The NMA was performed using Stata. Of 58 randomized clinical trials identified, 34 were included in the NMA. Patients treated with amoxicillin (relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84; low quality of evidence) and those treated with metronidazole (RR 0.51, 95% CI 0.31-0.84; low quality of evidence) showed a lower risk of infection and dry socket when compared to patients given a placebo. Postoperative amoxicillin (750 mg) and amoxicillin plus clavulanate (500 mg + 125 mg, or 2000 mg + 125 mg), and preoperative metronidazole (800 mg) are useful to prevent infection or dry socket when compared to placebo. The low rate of infection after third molar surgery, the correct concept of antibiotic prophylaxis, and antibiotic resistance must be taken into account when choosing to treat healthy patients undergoing third molar surgery with antibiotics.

Long-Term Analysis of Resilience of the Oral Microbiome in Allogeneic Stem Cell Transplant Recipients

Stem cell transplantation (SCT) is associated with oral microbial dysbiosis. However, long-term longitudinal data are lacking. Therefore, this study aimed to longitudinally assess the oral microbiome in SCT patients and to determine if changes are associated with oral mucositis and oral chronic graft-versus-host disease. Fifty allogeneic SCT recipients treated in two Dutch university hospitals were prospectively followed, starting at pre-SCT, weekly during hospitalization, and at 3, 6, 12, and 18 months after SCT. Oral rinsing samples were taken, and oral mucositis (WHO score) and oral chronic graft-versus-host disease (NIH score) were assessed. The oral microbiome diversity (Shannon index) and composition significantly changed after SCT and returned to pre-treatment levels from 3 months after SCT. Oral mucositis was associated with a more pronounced decrease in microbial diversity and with several disease-associated genera, such as Mycobacterium, Staphylococcus, and Enterococcus. On the other hand, microbiome diversity and composition were not associated with oral chronic graft-versus-host disease. To conclude, dysbiosis of the oral microbiome occurred directly after SCT but recovered after 3 months. Diversity and composition were related to oral mucositis but not to oral chronic graft-versus-host disease.

Identifying volatile in vitro biomarkers for oral bacteria with proton-transfer-reaction mass spectrometry and gas chromatography-mass spectrometry

We have measured the volatile fingerprints of four pathogenic oral bacteria connected to periodontal disease and dental abscess: Porphyromonas gingivalis (three separate strains), Prevotella intermedia, Prevotella nigrescens and Tannerella forsythia. Volatile fingerprints were measured in vitro from the headspace gas of the bacteria cultured on agar. Concrete identification of new and previously reported bacterial volatiles were performed by a combination of solid phase microextraction (SPME) and offline gas chromatography-mass spectrometry (GC-MS). We also studied the effect of the reduced electric field strength (E/N) on the fragmentation patterns of bacterial volatiles in online proton-transfer-reaction time-of-flight mass spectrometry (PTR-ToF-MS). We aimed to discover possible new biomarkers for the studied oral bacteria, as well as to validate the combination of GC-MS and PTR-MS for volatile analysis. Some of the most promising compounds produced include: 1-Methyl-1,2,3,4-tetrahydroisoquinoline (1MeTIQ), indole, and a cascade of sulphur compounds, such as methanethiol, dimethyl disulphide (DMDS) and dimethyl trisulphide (DMTS). We also found that several compounds, especially alcohols, aldehydes and esters, fragment significantly with the PTR-MS method, when high E/N values are used. We conclude that the studied oral bacteria can be separated by their volatile fingerprints in vitro, which could have importance in clinical and laboratory environments. In addition, using softer ionization conditions can improve the performance of the PTR-MS method in the volatile analysis of certain compounds.

Firmicutes Dysbiosis After Chlorhexidine Prophylaxis in Healthy Patients Submitted to Impacted Lower Third Molar Extraction

Prophylaxis with antiseptic and antibiotic therapy is common in impacted lower third molar surgeries, despite the lack of consensus among professionals and researchers in the indication for healthy patients. The aim of the present preliminary study was to verify the impact of prophylaxis therapy with antiseptic and antibiotic in healthy patients submitted to impacted lower third molar extraction, according to oral microorganism quantification. Eleven patients submitted to impacted lower third molar extraction, under prophylactic therapy with 0.12% chlorhexidine and amoxicillin in four experimental phases, were evaluated. Our results showed no significant reduction in total bacteria load, as well as in Bacteroidetes and C. albicans loads in the oral cavity, after prophylactic therapy with antiseptic and antibiotic. On the other hand, there was a significant difference between the Firmicutes levels across the follow-up, and this effect seems to be large (ηp²=0.94). Post-hoc test demonstrated that the levels of Firmicutes in T1 were higher than T0, T2, and T3, suggesting a microbiota dysbiosis, when 0.12% chlorhexidine use, which may be responsible for selection of antibiotic-resistant microorganisms. Our results alert for an overuse of antiseptic and antibiotics by dentists and for a better evaluation of the available protocols.

Bulleidia extructa: An underappreciated anaerobic pathogen

Bulleidia extructa is a rarely recognized anaerobic Gram-positive bacterium with an oral and gastroenterological ecological niche. It is difficult to isolate due to slow growth in culture and usually requires identification techniques such as 16S rRNA gene sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). While most often isolated from infections related to the oral cavity (gingivitis, periodontitis, brain and lung abscess), it has also been recovered from cases of prosthetic joint hip infections after unprophylaxed dental procedures.

Bactericidal activity of a substituted thiazole against multidrug-resistant Eggerthia catenaformis isolated from patients with dental abscess

Human infections caused by the anaerobic bacterium Eggerthia catenaformis are rare. However, a growing number of case reports have presented the bacterium as the causative agent in many serious complications. This study provides data on the isolation and antibiotic susceptibility profiles of E. catenaformis from dental abscess. Identification of isolates was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). We also investigated the antibacterial activity of 5-acetyl-4-methyl-2-(3-pyridyl) thiazole (AMPT) on E. catenaformis isolates. Minimum inhibitory concentrations (MICs) were determined by an agar dilution method and bactericidal activity was evaluated by a time-kill assay. Moreover, the mechanism of action of AMPT was also explored by cell membrane disruption assay and scanning electron microscopy (SEM). MALDI-TOF MS results revealed unambiguous identification of all isolates with score values between 2.120 and 2.501. Isolates NY4 and NY9 (20% of isolates) were found resistant to multiple antibiotics judged by MIC values. As multidrug-resistant strains of E. catenaformis were not reported to date, we then confirmed the identity of NY4 and NY9 based on 16S rRNA gene sequence. Favorably, all isolates were susceptible to AMPT with an MIC range of 0.25-1 mg/L. Time-kill kinetics of AMPT indicated that it exhibited potent bactericidal activity against the multidrug-resistant isolates NY4 and NY9. Furthermore, this study also hypothesizes that AMPT exerts its antibacterial effect through damaging the cell membrane and thereby induce the release of intracellular components. AMPT could therefore be considered as a therapeutic option for infections caused by multidrug-resistant bacteria.

Antibiotic Therapy in Dentistry

Dental caries, pulpal necrosis, trauma, and periodontal diseases can result in dental infections which could have severe consequences that affect both soft and hard tissues of the oral cavity. Dental infections commonly present with symptoms of pain, fever, and swelling. Surgical and endodontic treatments are the early management of infected teeth, followed by antibiotic therapy. Some alternative methods also exist for treating infection such as low-level laser therapy and photodynamic therapy. Antibiotics are generally used in dental procedures to treat odontogenic infections, nonodontogenic infections, local infection, focal infection, and prophylaxis. Antibiotic prophylaxis is prescribed for patients with immunosuppressed conditions, infective endocarditis, metabolic disorders, and patients with prosthetic joints. To reduce the complications of unnecessary antibiotic prescriptions especially bacterial resistance, comprehensive guidelines should be established. It has been noted that only about 12% of dentists adequately and correctly prescribe antibiotics, which shows the importance of comprehensive guidelines. Antibiotics prescription may result in some adverse effects such as hypersensitivity reactions and dermatological and allergic disorders. Furthermore, unnecessary prescription of antibiotics could result in several serious sequelae, for example, bacterial resistance, gastric and hematological problems, and diversion of bacterial microbiota. The present review attempts to summarize the indications of antibiotic therapy in dentistry and discuss the common types of antibiotics that are routinely used in dental practice based on pharmacologic classes. Moreover, types of antibiotics that are considered safe during pregnancy and childhood are also reviewed.

Porphyromonas, Treponema, and Mogibacterium promote IL8/IFNγ/TNFα-based pro-inflammation in patients with medication-related osteonecrosis of the jaw

Objective: Refractory infection is an important factor affecting the progression of medication-related osteonecrosis of the jaw (MRONJ) from clinical stage I to stage II/III. The aim of this study was to explore the distribution of bacteria and their association with the inflammatory pathway of stage II/III MRONJ.

Materials and Methods: Nine specimens of fresh inflammation tissue, located next to the necrotic bone or sequestrum, were collected from MRONJ patients. Nine specimens from normal oral mucosa were collected from healthy patients. The 16S rRNA gene sequencing method was used to determine the distribution characteristics of the bacterial colony. The protein microarray analysis was used to detect the expression of inflammatory cytokines.

Results: The average relative abundance of Bacteroidetes, Spirochaetes, Synergistetes, and Tenericutes was higher, while Proteobacteria and Actinobacteria were lower in the MRONJ group. Most pro-inflammatory cytokines were up-regulated in the MRONJ group; yet, only IFNγ, TNFα, and IL8 showed statistical differences (P < 0.05). Porphyromonas and Treponema were positively correlated with IL8, and Mogibacterium was positively correlated with IFNγ and TNFα.

Conclusions: IL8/IFNγ/TNFα pro-inflammatory effect caused by Porphyromonas, Treponema, and Mogibacterium may be the leading cause of advancing MRONJ and thus may be used as a new target for infection control.

Is the penetration of clindamycin into the masseter muscle really enough to treat odontogenic infections?

OBJECTIVES

This study aims to determine the penetration of clindamycin into the masseter muscle of rats by microdialysis and correlate with the main microorganisms involved in odontogenic infections.

MATERIALS AND METHODS

Tissue concentrations of clindamycin in healthy muscle tissue were measured by microdialysis after administration of a single intravenous dose of 51 mg/kg and multiple doses of 17 mg/kg (8/8 h). It was quantified in plasma after a single administration of 51 mg/kg. Microdialysis samples were collected at 30-min intervals and clindamycin was assayed by LC-MS. Pharmacokinetic parameters and tissue penetration were determined. Pharmacokinetic/pharmacodynamic index (ƒ%T > minimum inhibitory concentration (MIC)) was considered to assess dosing regimens.

RESULTS

The pharmacokinetic parameters determined by non-compartmental plasma analysis for the dose of 51 mg/kg were similar to that determined by compartmental analysis. The maximum free interstitial concentration (C_max) of clindamycin in muscle tissue was 14.20 (10.63-14.89) and 4.82 (3.35-6.66) mg/L for 51 mg/kg and 17 mg/kg 8/8 h, respectively. In addition, the area under the curve (AUC_0-inf) for plasma and tissue of clindamycin were 44.78 (28.82-65.65) and 16.54 (13.83-18.35) h.mg/L for 51 mg/kg, respectively, and the tissue penetration factor determined was 1.10. Considering that the main bacteria that cause odontogenic infections generally present MIC ≤ 0.5 mg/L, the ƒ%T > MIC index is reached when the dose regimen of 17 mg/kg 8/8 h is employed.

CONCLUSIONS

This investigation showed that clindamycin excellently penetrates muscle tissue of rats. It provides effective antibacterial concentrations at the target site when 17 mg/kg 8/8 h is employed and can be applied to treat the main bacteria causing odontogenic infections.

CLINICAL RELEVANCE

It reinforces the use of clindamycin in odontogenic infections with significant tissue penetration.

Comparative analysis of paediatric and adult surgically drained dental infections at a university teaching hospital

In the United Kingdom (UK) the estimated prevalence of dental infection involving the supporting bone is 2%, and from 2014-2015 there were 2281 admissions in England alone due to dental abscess. We undertook an analysis of 184 dental abscesses that required surgical drainage, as there is surprisingly little in the literature on the subject. This was a retrospective study of 184 consecutive patients with dental abscesses who were admitted between January 2016 and September 2019. On admission, all patients had orthopantomograms (OPG) and baseline blood tests. Surgical drainage was performed under a general or local anaesthetic and a pus swab sent for culture and sensitivity. The submandibular space was the most commonly involved site and paediatric patients most often presented with buccal space abscesses. A lower molar tooth was the cause in 132 patients. White blood cells (WBC) and C-reactive protein (CRP) were both raised in 63.6% (n=117), but were normal in 4.9% (n=9). The remaining patients had either raised WBC (2.7%) or CRP (28.8%). Streptococcus milleri was the most common organism isolated in 66.6% (n=42). There was no association between CRP or WBC values and duration of hospital stay. Paediatric patients had a shorter duration of admission (1.96 days vs 2.81 days) and significantly lower CRP values (120.9 vs 45.7; p=0.001). The submandibular space was the commonest site involved and mandibular molars the most frequent source of infection. An elevated CRP value appeared to be a more sensitive indicator of infection in this study population. Adult and paediatric patients present in a different manner.

Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases

OBJECTIVES

Odontogenic infections descending from the lower jaw may lead to severe health conditions. Commonly, a biphasic treatment of surgical drainage and antibiotic therapy is conducted. The choice of the administered empiric antibiotic agent remains debatable.

MATERIAL AND METHODS

Retrospectively, we analyzed 350 medical records of patients who were consecutively treated with odontogenic infections descending from the lower jaw. All patients received surgical drainage and either cefazolin or ampicillin/sulbactam as empiric antibiosis. In particular, the number of secondary operations, infectious parameters, and length of in-hospital stay were investigated.

RESULTS

The most frequently infected space was the perimandibular/buccal space for both groups followed by the submandibular space. Number of revision procedures, early recurrence, and length of stay presented no significant difference between both groups (p > 0.05). Inflammatory parameters (c-reactive protein, leukocytes) similarly decreased in both groups.

CONCLUSION

Cefazolin targets the majority of the pathogens detected in severe odontogenic neck infections descending from the lower jaw and reveals comparable results to AMP/S in regard to the inflammatory parameters and in-hospital stay.

CLINICAL RELEVANCE

Cefazolin is a feasible empiric antibiosis for odontogenic neck infections descending from the lower jaw if surgical drainage is performed.

Detection of Red complex bacteria, P. gingivalis, T. denticola and T. forsythia in infected root canals and their association with clinical signs and symptoms

Aim:

This study aimed to investigate the association between endodontic clinical signs and symptoms and the presence of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia employing polymerase chain reaction (PCR).

Materials and Methods:

Microbial samples were obtained from 60 cases with necrotic pulp with primary teeth infections. DNA extracted from samples were analyzed for endodontic pathogens by using species-specific primers.

Results:

P. gingivalis/T. denticola were detected in 15 symptomatic teeth associated with periapical lesions. T. forsythia/T. denticola were found in 16 symptomatic teeth associated with pain and swelling. P. gingivalis was detected in 9 teeth which were associated with pain, 2 with tenderness on percussion, and 15 with periapical lesions. Statistically significant associations were found between T. forsythia as well as T. denticola in relation to clinical findings of pain and swelling. (P < 0.05). Red complex bacteria showed no statistical significant association with the presence of signs and symptoms.

Conclusion:

Prevalence of P. gingivalis, T. denticola, and T. forsythia suggested association of these bacteria with symptomatic infected pulp and periradicular diseases.

Comparison of antimicrobial prescribing for dental and oral infections in England and Scotland with Norway and Sweden and their relative contribution to national consumption 2010-2016

BACKGROUND

Prescribing in dental practice has a relatively small but important contribution to the quantity of antibiotics prescribed in primary care. This study aimed to analyse antibiotic prescribing in dentistry over time (2010-2016) in 4 different Northern European countries and their relative contribution to national outpatients consumption.

METHODS

This retrospective study evaluated the frequency and number of national antibiotic prescriptions written by dentists in England, Scotland, Norway and Sweden. The consumption of such antibiotics was measured using WHO defined daily doses (DDDs), DDDs per 100,000 inhabitants per day (DIDs100,000).

RESULTS

A total of more than 27 million prescriptions (27,026,599) archived between 2010 and 2016 from the four countries were analysed. The national contribution of Norwegian dentists to the total primary care prescription during this period was 8%. The corresponding figures for Sweden, Scotland and England were 7, 6, and 8%. Dental contribution to National antibiotic use in all four countries has decreased over the study time period for commonly prescribed antibiotics in dentistry, i.e., the beta-lactams (Phenoxymethyl penicillin/Amoxicillin) and metronidazole. There were less numbers of prescriptions by dentists in Norway and Sweden compared to England and Scotland. Marked differences in some classes of antibiotics were noted with Phenoxymethyl penicillin dominating in Sweden/Norway compared to Amoxicillin and Metronidazole in England/Scotland. In England and Scotland, dentists were the largest prescribers of metronidazole in primary care. Clindamycin prescriptions was higher in Norway and Sweden.

CONCLUSION

Noticeable differences exist in prescribing patterns for the management of oral infections. High levels of metronidazole use in England and Scotland also require further analysis. All countries over the study period showed a decrease in total numbers of antibiotics prescribed.

Mapping the microbiological diversity of odontogenic abscess: are we using the right drugs?

OBJECTIVES

The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy.

MATERIALS AND METHODS

A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab.

RESULTS

Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%).

CONCLUSION

Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy.

CLINICAL RELEVANCE

Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment.

Methicillin-resistant Staphylococcus aureus replication in the presence of high (≥32 µg/ml) drug concentration of vancomycin as seen by electron microscopy

Methicillin-resistant Staphylococcus aureus (MRSA) has unfortunately become a common pathogen in many healthcare facilities. In many institutions, vancomycin remains the preferred agent for treating serious MRSA infections including bacteraemia with or without endocarditis. The mutant prevention concentration (MPC) testing ≥10⁹ colony forming units of bacteria, describes the antimicrobial drug concentration blocking the growth of the least susceptible cell from high density bacterial populations. With blood culture isolates of MRSA, we discovered strains with MPC values ≥32 µg/ml and viable cells could be readily recovered from agar plates containing 32 µg/ml of vancomycin. To investigate MRSA strains surviving in high concentrations of vancomycin on drug containing agar plates, we utilized electron microscopy to measure cell wall thickness as this has been previously reported as a potential mechanism of resistance¹ along with septum thickening. Our data shows MRSA replication from high density bacterial populations in the presence of ≥32 µg/ml of vancomycin. Such observations may explain vancomycin failure in some patients and/or persistent bacteraemia and could potentially question the use of this drug in some critically ill patients in favour of an alternative agent.

Multiplex Imaging of Polymicrobial Communities-Murine Models to Study Oral Microbiome Interactions

Similar to other mucosal surfaces of the body, the oral cavity hosts a diverse microbial flora that live in polymicrobial biofilm communities. It is the ecology of these communities that are the primary determinants of oral health (symbiosis) or disease (dysbiosis). As such, both symbiosis and dysbiosis are inherently polymicrobial phenomena. In an effort to facilitate studies of polymicrobial communities within rodent models, we developed a suite of synthetic luciferases suitable for multiplexed in situ analyses of microbial ecology and specific gene expression. Using this approach, it is feasible to noninvasively measure multiple luciferase signals in vivo with both spatial and temporal resolution. In the following chapter, we describe the relevant details and protocols used to establish a biophotonic imaging platform for the study of experimental polymicrobial oral biofilms and abscesses in mice. The protocols described here are specifically tailored for use with oral streptococci, but the general strategies are adaptable for a wide range of polymicrobial infection studies using other species.

Antibiotic sensitivity and resistance of bacteria from odontogenic maxillofacial abscesses

Objectives

This study investigated the types and antibiotic sensitivity of bacteria in odontogenic abscesses.

Materials and Methods

Pus specimens from 1,772 patients were collected from affected areas during incision and drainage, and bacterial cultures and antibiotic sensitivity tests were performed. The number of antibiotic-resistant bacteria was analyzed relative to the total number of bacteria that were tested for antibiotic susceptibility.

Results

Bacterial cultures from 1,772 patients showed a total of 2,489 bacterial species, 2,101 gram-positive and 388 gram-negative. For penicillin G susceptibility tests, 2 out of 31 Staphylococcus aureus strains tested showed sensitivity and 29 showed resistance. For ampicillin susceptibility tests, all 11 S. aureus strains tested showed resistance. In ampicillin susceptibility tests, 46 out of 50 Klebsiella pneumoniae subsp. pneumoniae strains tested showed resistance.

Conclusion

When treating odontogenic maxillofacial abscesses, it is appropriate to use antibiotics other than penicillin G and ampicillin as the first-line treatment.

Prevotella brunnea sp. nov., isolated from a wound of a patient

A strain of an obligately anaerobic, Gram-stain-negative rod-shaped bacterium is described by phenotypical, biochemical and genotypical characterization. Strain A2672^T was isolated from a wound of a patient sampled during routine care at hospital. Phylogenetic analysis was based on full-length 16S rRNA gene sequence analysis and revealed the strain to belong to the genus Prevotella, but to be distant from known species, with the closest relationship to Prevotella corporis. The genomic DNA G+C content was 44.0 mol%. Strain A2672^T was moderately saccharolytic and proteolytic. The most abundant cellular long-chain fatty acids were anteiso-C_15 : 0 and iso-C_15 : 0. In view of these characteristics as well as whole-genome sequence analysis, strain A2672^T is considered to represent a novel species within the genus Prevotella, for which the name Prevotella brunnea sp. nov. is proposed. The type strain is A2672^T (=DSM 108033^T=CCOS 1231^T=CCUG 72809^T).

Efficacy of buffered local anaesthetics in head and neck infections

Lignocaine is one of the most commonly-used agents to anaesthetise an area preoperatively. It can, however, cause undesirable effects such as burning on injection, relatively slow onset, and unreliable, or lack of, numbness when injected into infected tissues as a result of the acidic pH of commercial preparations (the pH is between 3.5 and 7.0 compared with the physiological pH, which is between 7.35 and 7.45). The aim of this comparative study was to evaluate the efficacy of buffered local anaesthetic on infected areas by altering the pH with 8.4% sodium bicarbonate, to measure the pain before and after the injection, and to record the time of onset of anaesthesia. All 60 patients were given 2% lignocaine hydrochloride with adrenaline 1:80,000 and 30 patients were randomly allocated to have 10:1 dilution of 8.4% sodium bicarbonate (study group). Pain was assessed on a visual analogue scale and a verbal rating scale. There was a significant difference in the amount of pain between control and study groups (p=0.025). The mean (SD) time (minutes) to onset of local anaesthesia in the study group was 1.06 (0.25) compared with 2.96 (0.81) in the control group (p<0.001). Our results confirm the efficacy of the buffered local anaesthetic solution in reducing pain on injection and resulting in quicker onset of anaesthesia. Increasing the pH of lignocaine solutions with bicarbonate immediately before use, therefore, should be considered when treating various acute infections of the head and neck.

Large-scale identification of pathogen essential genes during coinfection with sympatric and allopatric microbes

Recent evidence suggests that the genes an organism needs to survive in an environment drastically differ when alone or in a community. However, it is not known if there are universal functions that enable microbes to persist in a community and if there are functions specific to interactions between microbes native to the same (sympatric) or different (allopatric) environments. Here, we ask how the essential functions of the oral pathogen Aggregatibacter actinomycetemcomitans change during pairwise coinfection in a murine abscess with each of 15 microbes commonly found in the oral cavity and 10 microbes that are not. A. actinomycetemcomitans was more abundant when coinfected with allopatric than with sympatric microbes, and this increased fitness correlated with expanded metabolic capacity of the coinfecting microbes. Using transposon sequencing, we discovered that 33% of the A. actinomycetemcomitans genome is required for coinfection fitness. Fifty-nine "core" genes were required across all coinfections and included genes necessary for aerobic respiration. The core genes were also all required in monoinfection, indicating the essentiality of these genes cannot be alleviated by a coinfecting microbe. Furthermore, coinfection with some microbes, predominately sympatric species, induced the requirement for over 100 new community-dependent essential genes. In contrast, in other coinfections, predominately with nonoral species, A. actinomycetemcomitans required 50 fewer genes than in monoinfection, demonstrating that some allopatric microbes can drastically alleviate gene essentialities. These results expand our understanding of how diverse microbes alter growth and gene essentiality within polymicrobial infections.

Acute rhinosinusitis - are we forgetting the possibility of a dental origin? A retrospective study of 385 patients

Background: Odontogenic sinusitis (OS) is a common but underdiagnosed form of acute rhinosinusitis (ARS). OS carries no specific characteristics, but unilateral symptoms and certain microbiological as well as radiological findings indicate odontogenic origin. Aims/objectives: We studied the proportion of OS in ARS patients, the presence and associations of unilateral symptoms, and possible OS microbial and radiological findings. In addition, we investigated how this condition is recognised among ear, nose and throat specialists and radiologists. Materials and methods: All 676 ARS patients treated in the Department of Otorhinolaryngology at Helsinki University Hospital in 2013 were retrospectively enrolled. The data were collected from patients' hospital medical records, the laboratory database and radiological reports. Results: Odontogenic origin of ARS was suspected in 59 (15.3%) patients. Altogether (29.9%) 115 patients complained of unilateral symptoms and these were found to associate with probable oral microbial findings (p < .001). These findings covered 20.2% of isolates. Teeth were mentioned in 89.6% of the radiological reports. Conclusions and significance: OS is common among patients with ARS, and good diagnostic tools already exist in routine practice. Microbial and radiological findings should be carefully evaluated, especially in cases of unilateral symptoms.

VOC Profiles of Saliva in Assessment of Halitosis and Submandibular Abscesses Using HS-SPME-GC/MS Technique

Halitosis and submandibular abscesses are examples of mouth-related diseases with the possible bacterial origin. Salivary volatile organic compounds (VOCs) are potential biomarkers of them, once they can be addressed as metabolites of bacterial activity. Healthy patients (n = 15), subjects with submandibular abscesses located in fascial deep space (n = 10), and subjects with halitosis (n = 5) were enrolled in the study. Saliva samples were subjected to headspace solid-phase microextraction (HS-SPME) and gas chromatography coupled to mass spectrometry (GC/MS) analysis. A total number of 164 VOCs was detected by the developed methodology, 23 specific for halitosis and 41 for abscess. Halitosis’ profiles were characterized by a larger number of sulfur compounds, while for abscess they had a higher variety of alcohols, aldehydes, and hydrocarbons—biomarkers of inflammatory processes. Principal components analysis allowed visualization of clusters formed according to the evaluated conditions. Kruskal-Wallis test indicated that 39 VOCs presented differentiated responses between the studied groups, with statistical relevance (p < 0.05). Random forest was applied, and a prediction model based on eight VOCs (2-butanone, methyl thioacetate, 2-methylbutanoic acid, S-methyl pentanethioate, dimethyl tetrasulfide, indolizine, pentadecane, and octadecanal) provided 100% of sensitivity, 82% of specificity, and 91% of balanced accuracy, indicating the specific presence of submandibular abscess.

The Oral Bacterium Fusobacterium nucleatum Binds Staphylococcus aureus and Alters Expression of the Staphylococcal Accessory Regulator sarA

Staphylococcus aureus, an opportunistic pathogen member of the nasal and skin microbiota, can also be found in human oral samples and has been linked to infectious diseases of the oral cavity. As the nasal and oral cavities are anatomically connected, it is currently unclear whether S. aureus can colonize the oral cavity and become part of the oral microbiota, or if its presence in the oral cavity is simply transient. To start addressing this question, we assessed S. aureus ability to directly bind selected members of the oral microbiota as well as its ability to integrate into a human-derived complex oral microbial community in vitro. Our data show that S. aureus forms aggregates with Fusobacterium nucleatum and Porphyromonas gingivalis and that it can incorporate into the human-derived in vitro oral community. Further analysis of the F. nucleatum-S. aureus interaction revealed that the outer-membrane adhesin RadD is partially involved in aggregate formation and that the RadD-mediated interaction leads to an increase in expression of the staphylococcal global regulator gene sarA. Our findings lend support to the notion that S. aureus can become part of the complex microbiota of the human mouth, which could serve as a reservoir for S. aureus. Furthermore, direct interaction with key members of the oral microbiota could affect S. aureus pathogenicity contributing to the development of several S. aureus associated oral infections.

Native Valve Infective Endocarditis with Osteomyelitis and Brain Abscess Caused by Granulicatella adiacens with Literature Review

Granulicatella adiacens is a type of NVS (nutritionally variant streptococci) rarely causing infective endocarditis (IE). NVS are fastidious and unable to sustain growth on routine culture media due to lack of specific nutrients. Endocarditis caused by NVS due to their virulence is associated with higher treatment failures and mortality rates. New antimicrobial susceptibility patterns are indicative of a significant rise in penicillin resistance and susceptibility differences between NVS subspecies. Initial empirical therapy is essential as a delay in using the appropriate agent leads to poor results. We present a case of an immunocompetent young female with recent intravenous drug abuse resulting in native mitral valve endocarditis with ruptured chordae tendineae and septic embolization, causing brain abscess and lumbar spine osteomyelitis. She was transferred to a tertiary center where she underwent mitral valve replacement successfully and treated with six weeks of intravenous vancomycin and ertapenem. To our knowledge, ours is the first case report of G. adiacens endocarditis in an adult with brain abscess and osteomyelitis with an excellent response to antibiotic therapy. Based on our case report, literature review, and new antimicrobial susceptibility patterns, updates to treatment guidelines are suggested to improve the therapeutic outcomes.

Management of odontogenic infection in paediatric patients: a retrospective clinical study

PURPOSE

To investigate the outpatient and inpatient management of odontogenic infections among paediatric patients attending a university hospital.

METHODS

A retrospective study (2013-2015) was carried out which involved retrieving relevant data from past records (manual/electronic) of paediatric patients (under 18-years-old) who presented with odontogenic infections to the Paediatric Dentistry and Oral and Maxillofacial clinic. Data collected was organised using descriptive statistics with SPSS version 12.0.1.

RESULTS

A total of 153 patients were identified, of which 83.7% were managed as outpatients. Odontogenic infections were more common in females (52.9%) and preschool children (58.2%). The most cases were seen in 2014 and maximum number of cases per month was 12. Common presentations were pain (62.1%), intraoral swelling (37.9%) and spontaneous pus discharge from the tooth and/or surrounding tissues (67.3%) with higher involvement of primary right molars. Dental panoramic tomograph was the most common radiographic investigation done. Outpatients were commonly managed chairside with pulpal opening (46.1%) at the paediatric dental clinic and 7% underwent extraction under general anaesthesia in day-care setting. Inpatients were admitted for 3 days on average and most commonly definitive care was extraction under local/general anaesthesia (68%). There were 22.7% outpatients and 72.0% inpatients who were prescribed antibiotics.

CONCLUSIONS

Overall, treatment and medications prescribed adhered to current guidelines. There was a tendency to solely prescribe antibiotics in 8.6% of outpatients which is contrary to recommendations.

The effect of DNA methylation on the miRNA expression pattern in lipopolysaccharide-induced inflammatory responses in human dental pulp cells

Endodontic infection is a widespread oral problem. DNA methylation is a key epigenetic modification that plays important roles in various inflammatory responses, but its role in dental pulp inflammation is poorly understood. In this study, we assessed the expression of DNA methyltransferases (DNMTs) in human dental pulp cells (hDPCs) during lipopolysaccharide (LPS)-induced inflammation and found that DNMT3B mRNA expression was reduced and DNMT1 mRNA and protein levels decreased significantly. Pretreatment with the DNMT inhibitor 5-Aza-2'-deoxycytidine (5-Aza-CdR) significantly enhanced the expression of the inflammatory cytokines IL-6 and IL-8 in LPS-stimulated hDPCs, indicating that DNA methylation may play a role in hDPC inflammation. Studies have reported that some microRNAs (miRNAs) are involved in dental pulp infection. DNA methylation can modulate the inflammatory response by regulating miRNA expression, but this phenomenon has not yet been reported in pulp inflammation. The present study used next-generation sequencing to examine the effect of 5-Aza-CdR on the miRNA expression profile of LPS-treated hDPCs, and the results showed that 5-Aza-CdR pretreatment changed the miRNA expression pattern in hDPCs during inflammation. Among the changed miRNAs, miR-146a-5p, which is a pulp inflammation-related miRNA, demonstrated the most noticeably altered expression. miR-146a-5p could be induced by LPS in hDPCs, and 5-Aza-CdR preincubation or DNMT1 knockdown markedly increased its expression level. However, no significant difference was found in the methylation pattern of the MIR146A promoter with 5-Aza-CdR pretreatment or DNMT1 knockdown in LPS-stimulated hDPCs. These results indicate that DNA methylation may regulate the LPS-induced inflammatory response by changing the miRNA expression in hDPCs.

The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections

Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.

Dental Infection and Resistance-Global Health Consequences

Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20⁻50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care.

Institutional microbial analysis of odontogenic infections and their empirical antibiotic sensitivity

Most purulent orofacial infections are of odontogenic origin. It is well established that odontogenic infections are polymicrobial in nature. Empiric antibiotics were administered before the culture and sensitivity test results were obtained and specific antibiotics were administered based on the culture and sensitivity test results. But resistance was a challenging problem all throughout along with development of more virulent strains of microorganisms which were more infectious and resistant to many known antibiotics.

Objective

To identify the causative aerobic and anaerobic micro-organisms responsible for orofacial infections and to evaluate the resistance against empirical antibiotics used in the treatment of space infections.

Method

142 patients with head and neck fascial space infections of odontogenic origin were randomly taken, the pus samples and aspirates were collected aseptically from patients for aerobic and anaerobic microbiological study.

Results

In this study the most common aerobic organism isolated was streptococcus viridians (34.49%), most common anaerobe was peptostreptococci, (61.11%) and the most common mixed organism was streptococcus with peptostreptococci (30%). Amoxicillin was the most commonly used empirical drug in all cases and showed highest resistance (96.55%) for all the organisms. But linezolid (100%) was sensitive to all the aerobic, anaerobic and mixed group of organisms. Metronidazole (100%) turned out to be sensitive to the entire anaerobic group. Clindamycin (100%) appeared sensitive to the entire aerobic group.

Conclusion

Knowledge about the pathologic flora involved in head and neck infection in a locality and their sensitivity and resistance to commonly used antibiotics will help the clinician in administering appropriate antibiotics.

Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana

Introduction

Odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana.

Methods

A retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review.

Results

A total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection.

Conclusion

This study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management.

Oral health is a mediator for disease severity in patients with Behçet's disease: A multiple mediation analysis study

OBJECTIVES

The aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behçet's disease (BD).

METHODS

In the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behçet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study.

RESULTS

Dental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P < 0.05). Disease severity score was found to be higher in males (5.3 ± 2.4) compared to females (4.4 ±2.5) in the whole group (P = 0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 ± 2.4; 5.5 ± 2.5) compared to others (4.2 ± 2.3; 4.4 ± 2.4; P < 0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B = -0.8822, P = 0.0145) and indirectly mediated through the presence of dental caries (B = 0.9509 P = 0.0110) and need of tooth extraction (B = 0.8758, P = 0.0128).

CONCLUSION

Both presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.

The rachitic tooth: The use of radiographs as a screening technique

This study investigates morphological changes in pulp chambers of living and archaeological individuals with past vitamin D deficiency. Living individuals (n=29), four with detailed medical and dental records and three groups of archaeological individuals (n=25) were radiographed; selected individuals were further evaluated histologically for the presence of incremental interglobular dentin (IIGD), indicative of deficiency (28 living; 17 archaeological). Measurements of pulp horns/chambers from radiographs were conducted to quantify morphological observations. One group had clear skeletal evidence of rickets from St. Matthew, Quebec (n=1) and St. Jacques, France (n=4); a second group had slight skeletal indicators from Bastion des Ursulines, Quebec (n=6); and a third group lacked both skeletal and radiological evidence of deficiency from St. Antoine (n=6) and Pointe-aux-Trembles (n=4). Results showed archaeological individuals with clear and slight skeletal evidence of past deficiency displayed constricted or chair shaped pulp horns. Living individuals with deficiency exhibited similar pulp chamber morphology. Radiographic pulp horn/chamber measurements corroborated morphological findings and significant differences were found in pulp horn/chamber measurements between those with and without deficiency. Results suggest that radiograph assessment of teeth can be used as a screening technique to elucidate patterns of deficiency and select individuals for microCT or histological assessment.

Resistance profile to antimicrobial agents in the main circulating bacteria isolated from acute periodontal and endodontic infections in Latin America (MICROBE- DENT): A systematic review protocol

BACKGROUND

Antimicrobial resistance is currently considered the main risk to global health. A variety of microbial species have been isolated from endodontic and periodontal infections. However, clinical endodontic and periodontics bacterial isolates have not been sufficiently characterized with regard to their capacity for antibiotic resistance. We aim to assess the existing evidence to estimate the prevalence of the main antimicrobial resistance and multidrug resistant organisms in endodontics and periodontics and to describe their geographic distribution in Latin America.

METHODS

All types of designs and will be restricted to Latin American studies will be included in this systematic review. MEDLINE, Embase, CINAHL, BVS (LILACS, BBO - bvsalud.org), IBECS (bases.bireme.br), Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science databases will be searched from 2013 to December 31, 2018 for all types of study designs that report microbial infection in endodontics and periodontics and their resistance and that define the microbiological methods used to identify microorganisms. The selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. The Cochrane and ROBINS-I risk of bias assessment tools will be used to assess the methodological quality of randomized control trials. The Newcastle-Ottawa scale will be used to assess the quality of methodology in observational studies. The overall quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) using the same principles and domains applied in the quality assessment of prognostic studies. The heterogeneity of the findings will be assessed using both the χ test and the I statistic. Sensitivity analysis will be performed by subgroup analyses and meta-regression to investigate the effect of study-level characteristics, such as age, gender, and methodological quality score, whenever possible. Publication bias across studies will be evaluated by visual inspection of the funnel plots and Begg's test for the results covered in 10 or more studies.

RESULTS

The evidence derived by this study will inform best practices for patients with endodontic and periodontal problems receiving antimicrobial agents.

CONCLUSION

Successful completion will significantly impact clinical practice and contribute to improved prescribing competency.

PROTOCOL REGISTRATION

PROSPERO-CRD42018077810.

Head and Neck Masses

Head and neck cancers comprise 4% of the cancer burden in the United States each year. Many types of head and neck cancers present as an asymptomatic, nontender neck mass or nonspecific symptoms, such as hoarseness, sore throat, and pain. Head and neck cancers are frequently diagnosed incidentally by the primary care physician or dentist. This review summarizes the epidemiology, clinical manifestations, diagnosis, and treatment of several common head and neck cancers in order to provide an increased awareness for the internist to facilitate early detection of these diseases.