Acute focal infections of dental origin

Comparing the clinical effects of local administration of minocycline ointment and doxycycline solution in the treatment of acute periodontal abscesses: a retrospective clinical study

PURPOSE

The objective of this retrospective clinical study was to provide evidence supporting the adjunctive local application of doxycycline solution or minocycline ointment, in conjunction with drainage, for the treatment of acute periodontal abscesses.

METHODS

The study included 63 patients who had received treatment for acute periodontal abscesses through drainage supplemented with 1 of 3 types of adjunctive medications during their initial visit (visit 1; baseline): 1) saline irrigation (the control group), 2) 2% minocycline ointment (the TM group), or 3) 300 mg/mL doxycycline irrigation (the TD group). The same adjunctive medication was administered at visit 2, which took place 1 week after visit 1. Probing depth (PD), bleeding on probing (BOP), plaque index, gingival recession, clinical attachment level, and tooth mobility were clinically evaluated at visits 1, 2, and a third visit (visit 3; 4 weeks after visit 1). Statistical significance was considered to be indicated by P values <0.05.

RESULTS

By visit 3, all clinical indices and tooth mobility had significantly decreased in each group. At this visit, PD and BOP on the abscess side were significantly lower in the TM and TD groups compared to the control group. The TD group showed a significantly greater improvement than the TM group, with mean PD reductions of 1.09 mm in the control group, 1.88 mm in the TM group, and 2.88 mm in the TD group. Similarly, mean BOP reductions were 45% in the control group, 73.02% in the TM group, and 95.45% in the TD group.

CONCLUSIONS

Local and adjunctive administration of doxycycline and minocycline in combination with drainage exhibited clinical advantages over drainage alone in improving PD and BOP. Notably, a doxycycline solution of 300 mg/mL was more effective than a 2% minocycline ointment.

IMMUNITY CHANGES IN PATIENTS WITH ACUTE MAXILLOFACIAL ODONTOGENIC INFECTIONS DURING TREATMENT STAGES: AN ANALYSIS

OBJECTIVE

The aim: Evaluate the expediency of using different methods of treatment for patients with acute purulent-odontogenic inflammatory processes in both the main and control groups. This assessment will be based on various indicators of non-specific immunity.

PATIENTS AND METHODS

Materials and methods: This study involved the evaluation of the humoral component of nonspecific immunity in 114 patients. We assessed changes in total protein and its fractions, C-reactive protein (CRP), lysozyme, and immunoglobulins (A, M, and G) during three distinct time intervals: 1-3 days, 5-7 days, and 8-14 days after treatment initiation. Statistical analysis was conducted using Statistica 10.0 (StatSoft, Inc., USA) and Microsoft Office Excel 2010.

RESULTS

Results: At different postoperative follow-up periods, a significant improvement in humoral nonspecific immunity indicators (p>0.05) was observed when comparing patients treated with and without platelet-rich plasma. This improvement is expected to enhance reparative processes and expedite recovery.

CONCLUSION

Conclusions: The incorporation of platelet-rich plasma, immunocorrective, and adaptogenic therapy into the comprehensive treatment of acute purulent odontogenic inflammatory processes in the maxillofacial region not only leads to pronounced and enduring positive outcomes but also results in substantial improvements, including the potential normalization of key humoral and cellular factors associated with innate immunity.

Healthy microbiome – a mere idea or a sound concept?

Hundreds of studies in last decades have aimed to compare the microbiome of patients suffering from diverse diseases with that of healthy controls. The microbiome-related component was additionally identified in pathophysiology of many diseases formerly considered to depend only on the host physiology. This, however, opens important questions like: “What is the healthy microbiome?” or “Is it possible to define it unequivocally?”. In this review, we describe the main hindrances complicating the definition of “healthy microbiome” in terms of microbiota composition. We discuss the human microbiome from the perspective of classical ecology and we advocate for the shift from the stress on microbiota composition to the functions that microbiome ensures for the host. Finally, we propose to leave the concept of ideal healthy microbiome and replace it by focus on microbiome advantageous for the host, which always depends on the specific context like the age, genetics, dietary habits, body site or physiological state.

The inception of a hospital-based dental emergency department in a precarious region decreases the incidence of severe cellulitis of odontogenic origin

INTRODUCTION

Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay.

MATERIAL & METHODS

In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected.

RESULTS

The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001].

CONCLUSION

The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

Biofilm is the trigger for the majority of infections caused by the ability of microorganisms to adhere to tissues and medical devices. Microbial cells embedded in the biofilm matrix are highly tolerant to antimicrobials and escape the host immune system. Thus, the refractory nature of biofilm-related infections (BRIs) still represents a great challenge for physicians and is a serious health threat worldwide. Despite its importance, the microbiological diagnosis of a BRI is still difficult and not routinely assessed in clinical microbiology. Moreover, biofilm bacteria are up to 100–1000 times less susceptible to antibiotics than their planktonic counterpart. Consequently, conventional antibiograms might not be representative of the bacterial drug susceptibility in vivo. The timely recognition of a BRI is a crucial step to directing the most appropriate biofilm-targeted antimicrobial strategy.

Brain abscess and periodontal pathogens (Fusobacterium Nucleatum). Report of a case

Patients who develop brain abscesses must be evaluated through a complete set of diagnostic tests including a microbiological and clinical periodontal assessment. A genetic comparison of the pathogens from intracranial/extracranial sites is necessary.

Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report

Sternoclavicular joint septic arthritis results from hematogenous spread of a bacterial infection, usually in the immunocompromised. It commonly presents as a chest wall abscess. Cervical abscess resulting from sternoclavicular joint septic arthritis is a rare complication with only one reported case in the English literature. We describe a case of sternoclavicular joint septic arthritis in an elderly diabetic adult with cervical abscess as initial presentation.

Calibrated interdental brushing for the prevention of periodontal pathogens infection in young adults - a randomized controlled clinical trial

Periodontal disease is clearly correlated with systemic disease. The presence of periodontal pathogens in interdental spaces in young, healthy adults is a strong indicator of the need to introduce daily interdental prophylaxis. Twenty-five subjects (aged 18–35 years), diagnosticated clinically as periodontally healthy, were enrolled in this study. One hundred interdental sites were included. Among these sites, 50 “test” sites were cleaned daily with calibrated interdental brushes (IDBs), whereas the other 50 sites were not cleaned and considered “controls”. The interdental biofilm at these interdental sites was collected at the beginning of the study (basal) and at 1 week, 2 weeks, 3 weeks, 4 weeks, and 3 months. Real-time polymerase chain reaction (PCR) methodology was used to quantify (i) 19 periodontal bacteria, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, and (ii) total bacteria. In the test sites, the quantity of total bacteria decreased over time with the use of IDBs. The bacteria from the red and orange Socransky complexes, which are associated with periodontal disease, significantly decreased in the test sites but not in the control sites. Bacteria from the yellow, and purple Socransky complexes, which are associated with periodontal health, increased significantly in both groups whereas bacteria from the blue Socransky complex increased significantly only in the test sites. Furthermore, at basal, 66% of test sites and 68% of control sites bled during interdental brushing. These percentages decreased by 85% in 3 months for the test sites and by 27% in the control sites. In conclusion, the daily use of calibrated IDBs can reduce periodontal pathogens, reestablish symbiotic microbiota and, decrease interdental inflammation in interdental sites of healthy young adults.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

An unpublished case of focal infection on a vascular endoprosthesis graft

Observation: A patient with a prosthetic superior vena cava graft had complications of thrombosis and infection. The blood cultures were positive for Peptostreptococcus micros and Prevotella denticola. The latter are known to exist in oral cavities. Clinical and radiological examinations of the oral cavity revealed the presence of oral infectious foci. Commentary: Superior vena cava prosthetic graft infections of oral origin have not previously been described in the literature. The highlighting of oral infectious foci, their eradication, and the follow-up of patients who had been subject to a vascular graft procedures are essential elements in preventing any associated lesions.

Dental biofilm infections - an update

Teeth are colonized by oral bacteria from saliva containing more than 700 different bacterial species. If removed regularly, the dental biofilm mainly comprises oral streptococci and is regarded as resident microflora. But if left undisturbed, a complex biofilm containing up to 100 bacterial species at a site will build up and may eventually cause development of disease. Depending on local ecological factors, the composition of the dental biofilm may vary considerably. With access to excess carbohydrates, the dental biofilm will be dominated by mainly gram-positive carbohydrate-fermenting bacteria causing demineralization of teeth, dental caries, which may further lead to inflammation and necrosis in the pulp and periapical region, i.e., pulpitis and periapical periodontitis. In supra- and subgingival biofilms, predominantly gram-negative, anaerobic proteolytic bacteria will colonize and cause gingival inflammation and breakdown of supporting periodontal fibers and bone and ultimately tooth loss, i.e., gingivitis, chronic or aggressive periodontitis, and around dental implants, peri-implantitis. Furthermore, bacteria from the dental biofilm may spread to other parts of the body by bacteremia and cause systemic disease. Basically, prevention and treatment of dental biofilm infections are achieved by regular personal and professional removal of the dental biofilm.

From the Acta Prize Lecture 2014: the periodontal-systemic connection seen from a microbiological standpoint

OBJECTIVE

To give an overview of the periodontal-systemic connection seen from a microbiologist.

METHODS

Original research papers, review articles and workshop proceedings were consulted.

RESULTS

Periodontal bacteria can cross epithelial cells, enter the circulation, invade endothelial cells, induce endothelial cell dysfunction and activate inflammatory and immune responses. Several studies support the association between periodontitis (PD) and cardiovascular disease. Severe PD involves a risk for development of type 2 diabetes. Maternal PD is moderately associated with adverse pregnancy outcome and pre-eclampsia. Dental plaque can contain respiratory pathogens able to promote chronic obstructive pulmonary disease and pneumonia. Periodontal bacterial DNA has been detected in synovial fluid of patients with rheumatoid arthritis. Minor evidence exists for associations between PD and chronic kidney disease, obesity, cancer, metabolic syndrome and cognitive impairment. Concerns can be raised as to the interpretation of some study results due to heterogeneity in definitions used for PD, too much weight upon in vitro studies with a few selected organisms and failing recognition that the majority of the periodontal microbiota is not yet cultivated.

CONCLUSION

Periodontal bacteria may participate in extra-oral infections such as CVD, diabetes, APO, pre-eclampsia, COPD, pneumonia, RA, CKD, obesity, cancer, MetS and cognitive impairment. Most knowledge is based on associations which do not necessarily imply causality. Future studies should reach consensus on the definition of PD and systemic disease outcomes, recognize the full spectrum of the microbiota in PD and bacteremia, including not-yet-cultivated organisms and delineate the clinical significance of genetic strain variations and the role of periodontopathogenic vs gut organisms within atheromatous lesions. For demonstration of causality, large, long-term clinical studies should use well-defined criteria for PD and robust disease outcomes to elucidate the importance of PD intervention and prevention.