MODERN TREATMENT METHODS OF PHLEGMON IN THE MAXILLO-FACIAL AREA AND NECK

Objective of the investigation - to increase the effectiveness of treatment of phlegmon of the maxillo-facial area and neck with the influence onto the pathogenic factors, complementing the main treatment plan with the injection of a second antibiotic in a regionary lymphatic way. 100 patients with acute inflammatory odontogenic diseases of the maxillofacial area were examined. Patients received both traditional medical treatment and regional lymphotropic antibiotic therapy added to the main method of treatment as well. Regionarnl lymphotropic antibiotic injection in the treatment of phlegmon of the maxillofacial area and neck leads to an accelerated onset of the second phase of the development of the wound process, more rapid detoxification of the body. Key words: acute inflammatory odontogenic diseases, maxillofacial area, lymphatic system.

Management of a Severe Cervicofacial Odontogenic Infection

INTRODUCTION

Odontogenic infections originate from a tooth or from its supporting structures, generally secondary to a pulp necrosis, periodontal disease, pericoronitis, apical lesions, or complications of dental procedures, which can be restricted to the alveolus or can reach the jaws and face through maxillofacial spaces. These are the most common conditions which affect the head and neck regions.

AIM

The aim of this study is to report a severe case of a cervicofacial odontogenic infection while discussing the most relevant aspects.

CASE REPORT

A 47-year-old female patient with a background of diabetes mellitus (DM) had a cervicofacial infection presenting edema and erythema in the left hemiface extending from the frontoparietal to cervical region and was submitted to extensive surgical treatment combined with antibiotic therapy.

CONCLUSION

Although the prevalence and complication rates of odontogenic infections had decreased with the advancement of diagnostic techniques, availability of effective antibiotics, and improvement in oral hygiene, still there are conditions that require attention and accurate treatment to prevent the progression of the pathology to deeper fascial spaces.

CLINICAL SIGNIFICANCE

Odontogenic infections can be treated with fewer complications if approached earlier when diagnosed while their premature clinical manifestations. However, if the treatment is postponed and the infection spreads into deeper fascial spaces, it can damage vital structures, and, consequently, threaten the patient's life. In these cases, extensive and aggressive therapy should be performed.

Antibiotic Therapy in the Treatment of Odontogenic Infections-An Evolving Landscape

Odontogenic infections continue to be the most common reason for people to seek dental care. Antibiotic therapy, combined with appropriate surgical intervention has been the mainstay in treating dental infections for many years. Availability of new antimicrobial agents and reports of decreased efficacy in commonly used antibiotics warrant continued study to assure that the most effective agents are utilized. This paper presents a brief summary of the bacterial populations associated with odontogenic infection and their antibiotic resistance mechanisms. Information from a number of studies, including our own data, concerning antibiotic resistance and efficacy are presented. This paper may provide the practitioner with additional information as a guide for appropriate antibiotic use in odontogenic infections.

What are the antibiotics of choice for odontogenic infections, and how long should the treatment course last?

In the everyday practice of oral and maxillofacial surgeons, empiric antibiotics are prescribed in the face of uncertainty. Is there a highly resistant organism present? Are the old-line antibiotics no longer effective? Should a broad-spectrum antibiotic be used just to cover all the bases in this case? The surprising result of this systematic review is that when combined with appropriate surgery, the usual antibiotics are all effective. Safety and cost become the differentiating factors in this clinical decision.

Infection from an exfoliating primary tooth in a child with severe neutropenia: a case report

In patients with deficient immune defenses, a localized oral infection can progress to a systemic infection. The purpose of this paper was to describe the case of a child with acute lymphoblastic leukemia who presented with fever, trismus, and submandibular swelling in the absence of the typical dental causes of infection such as deep dental caries or clinically significant periodontal disease. Treatment included an aggressive intravenous antibiotic regimen and extraction of the offending tooth after the recovery from bone marrow suppression.

[Practical aspects of sepsis from oral bacterial infections]

Infections of the oral cavity are an important morbidity problem due to their frequency, their pluribacterial ethiology as well as their potential severe evolution, especially with the immunodepressive. The odontogenic infections are considered to be the cause of 40% of the deep throat infections. The infections of the submentonier space occur through direct extension from the mandibular incisors, those of the sublingual space start from the anterior mandibular teeth and those of the retrofaringian space start from the mandibular molar teeth.

MATERIAL AND METHOD

The present study included 24 pacients diagnosed with oral sepsis in Iaşi Infectious Diseases Clinic. We analysed the ethiology and the clinical response to the administered antibiotherapy.

RESULTS

In several immunodepressed patients (with diabetus melitus, neutropenia, liver disfunction, carcinomas, tuberculosis) was noted sistemic evolution of odontogenic infection and they mainly came from the Surgery Clinics, where surgery was performed for the drainage of collections. Etiology was confirmed in 8 cases reflecting normal oropharyngeal flora. These infections were treated with antibiotics in synergistic combinations (betalactamines, quinolones, Cloramfenicol) with good results in 19 cases.

CONCLUSION

Infections of the oral cavity are an important morbidity problem due to their frequency, their pluribacterial origin as well as their potential severe evolution, especially in immunodepressed patients.

Facial cellulitis secondary to dens invaginatus: a case report

We describe a case of dens invaginatus in an unerupted permanent maxillary lateral incisor, which led to facial cellulitis in a 10-year-old girl. We review the importance of recognizing dens invaginatus and present strategies for preventing loss of vitality in the affected tooth.

[Diagnosing and treatment of dental foci in Dutch medical centres]

Although not scientifically proven, dental foci are believed to result in severe local or systemic disease. Eradicating dental foci in order to prevent possible interference with a medical treatment may be important in specific patient groups. To gain insight in the number of dental focus examinations, the medical evidence, the number of potential foci determined, as well as the treatment eradicating the focus, all dental focus examinations in 16 Dutch hospitals were registered during 3 months. A total number of 470 examinations were performed. Scheduled heart(valve)surgery and radiotherapy of the head and neck were the main reasons for a dental focus examination. Dental foci were found and treated in more than 50% of the patients examined. There was a significant difference between dentate and edentulous patients in the percentage of patients diagnosed and treated for a dental focus. More than 80% of dentate and less than 20% of edentulous patients were treated.

[Clinical results of perftorane use in comprehensive treatment of patients with odontogenic phlegmons]

Analysis of data collected during observation upon 76 patients with odontogenic phlegmon of maxillofacial region of different severity in complex treatment plan of whom preparation Perftorane was included according to the worked out method. Based upon received clinical, morphological, cytological and biochemical results the conclusion was derived that the application of the worked out method of perftorane use optimized traditional method of treatment of patients with odontogenic phlegmon of maxillofacial region exerting antihypoxic, desintoxicatic and antioxidant actions that led finally to speedy clearing of suppurative focus and to stimulation reparative processes in the wound.

Unilateral facial swelling caused by Ramsay Hunt syndrome resembles odontogenic infection

Facial cellulitis and swellings of the head and neck are worrisome signs of odontogenic infection, which can be life threatening. Most head and neck infections are caused by bacterial pathogens. When treating such infections, dentists must also be aware of possible viral or fungal causes and their associated presentations. This report documents a case of viral infection that initially resembled a bacterial odontogenic infection. It is intended to familiarize dentists with the Ramsay Hunt syndrome and the need for prompt recognition and early definitive treatment.

Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin

PURPOSE

The purpose of this study is to assess the anatomical spaces and causative micro-organisms responsible for deep fascial space head and neck infections and evaluate the resistance of antibiotics used in the treatment of these infections.

PATIENTS AND METHODS

A 6-year retrospective study evaluated hospital records of 103 patients. All patients in this study underwent surgical incision and drainage, received IV antibiotics, and had culture and sensitivity performed. Patient demographics reviewed were gender, age, involved fascial space(s), micro-organisms identified and antibiotic resistance from culture and sensitivity testing.

RESULTS

There were 56 male (54%) and 47 (46%) female patients. The submandibular space was the most frequent location for a single space abscess (30%), followed by the buccal space (27.5%) and the lateral pharyngeal space (12.5%). Sixty-three patients presented with multiple space involvement, totaling 142 spaces involved. A total of 269 bacterial strains were isolated from 103 patients. The bacteria were found to be 63.5% gram-positive. Gram-positive cocci were isolated 57.7% of specimens and gram-negative rods were isolated in 33% of cultures. There were 178 aerobes (65.7%) and 91 anaerobes (34.3%) isolated. The most common bacteria isolated were Viridans streptococci, Provetella, Staphylococci, and Peptostreptococcus. Culture and sensitivities were reviewed on 101 patients.

CONCLUSION

Patients who underwent surgical incision and drainage in the operating room had a tendency for involvement of multiple space abscesses with the submandibular space, submental, and lateral pharyngeal spaces effected most frequently. Cultures and sensitivities commonly showed greater growth in aerobes (65.7%) than in anaerobes. Gram positive cocci and gram negative rods had the greatest growth percentage in cultures.

Case report: brain and liver abscesses caused by oral infection with Streptococcus intermedius

Organ abscesses are a rare and life-threatening complication mostly of hematogenously disseminated infections. We report a case of brain and liver abscesses. Identification of the lesions was made by contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), respectively. An oral examination comprised an oral focus of infection. Streptococcus intermedius was isolated from oral smear, liver and ventricular drainage, and blood sample. After the commencement of antibiotic therapy, drainage of abscesses and oral rehabilitation, complete recovery was noted.

Pharmaceutical prescribing for children. Part 3. Antibiotic prescribing for children with odontogenic infections

This paper is the third in a series on the prescribing of medicines for children by dentists working in primary care. It deals with antibiotics, which may be prescribed for infections arising from teeth, and reviews current best practice.

[Wide-spread subcutaneous emphysema after third molar extraction. Case report]

Two days after wisdom teeth removal an eighteen-year-old man complained of a painful subcutaneous neck emphysema. CT scans showed that the air collections were expanding close to the mediastinum. A conservative intravenous medication with broadspectrum antibiotics was administered and within three days the symptoms resolved completely without any surgical intervention. Subcutaneous emphysema after dental treatment can develop into infectious, potentially lethal fasciitis and mediastinitis. Therefore it must be thoroughly examined and immediately operated on, if suspicious of an infection.

Clindamycin in dentistry: More than just effective prophylaxis for endocarditis?

Clindamycin is a broad-spectrum antibiotic with activity against aerobic, anaerobic, and beta-lactamase-producing pathogens. This antibiotic has been used for many years as prophylactic treatment during dental procedures to prevent endocarditis. However, the spectrum and susceptibility of the bacteria species involved in dental infections indicate that clindamycin would also be an effective treatment option for these conditions. In addition to its antiinfective properties, clindamycin has high oral absorption, significant tissue penetration, including penetration into bone, and stimulatory effects on the host immune system. This review discusses the microbiologic and clinical evidence supporting the efficacy and safety of clindamycin for the successful management of dental infections.

A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital

The aim of this study was to analyze the etiology, presentation, management and outcome of odontogenic maxillofacial infections seen in an urban population that has only one major public hospital, which is also the only level I trauma center. All patients admitted to the Oral and Maxillofacial Surgery Service of San Francisco General Hospital with odontogenic infections over a 5-year period were included. Age, gender, site of infection, investigations performed, treatment carried out and outcomes were studied. Length of hospital stay and any readmissions were also noted. A total of 250 patients were admitted with maxillofacial infections, and in 157 cases the infection was odontogenic in origin. Males outnumbered females (102:55). Children had a preponderance of maxillary buccal infections whilst adults had more mandibular infections. Hospital stays ranged from 1 to 23 days, and only one patient required re-admission. A wide range of antibiotics were prescribed and 122 patients required dental extractions. Odontogenic maxillofacial infections are a public and personal health issue with potential life-threatening complications. This study identifies potential risk factors and suggests that early dental extraction, incision and drainage, coupled with intravenous antibiotic therapy, is the most effective treatment. Antibiotic therapy can be empirical since in no case where cultures were performed did this alter the antibiotic management.

In vitro activity of moxifloxacin compared to other antimicrobials against streptococci isolated from iatrogenic oral bacteremia in Spain

BACKGROUND/AIMS

Systemic dissemination of oral bacteria to distant body sites may be the cause of focal infections. The unsuitable use and overexposure to antimicrobial therapy in clinical dental practice may contribute to the worldwide problem of antimicrobial resistance. The aim of this study was to determine the susceptibilities of streptococci isolated from the bloodstream after dental extractions against penicillin, ampicillin, amoxicillin, erythromycin, clindamycin, and a new fluoroquinolone, moxifloxacin.

PATIENTS AND METHODS

Eighty-four patients who required dental extractions were studied. Venous blood samples were collected from each patient at baseline (before dental manipulation) and 30 s after dental extractions. The samples were processed in the Bactec 9240. The isolated bacteria were identified by conventional microbiological techniques. The antimicrobial susceptibility of 81 streptococci was determined by the E-test method. The NCCLS performance standards were followed.

RESULTS

88.9-92.5% of the streptococci were sensitive to beta-lactam agents tested with a minimum inhibitory concentration (MIC)(90s) ranging from 0.094 to 0.19 mg/l. The resistance to erythromycin and clindamycin was 40.8% (MIC(90HR) = 256 mg/l) and 21% (MIC(90HR) = 256 mg/l), respectively. The MIC(90) to moxifloxacin was 0.125 mg/l.

CONCLUSION

Most of the streptococci isolated from the bloodstream after dental extractions were susceptible in vitro to penicillin, ampicillin, and amoxicillin. The high percentage of streptococci resistant to erythromycin and clindamycin could restrict their usefulness as prophylactic drugs. All the isolates showed a low MIC of moxifloxacin in vitro, making it a promising antimicrobial alternative for the prevention of streptococcal focal infections associated with certain dental manipulations, when the administration of beta-lactam agents is not indicated.

Paediatric necrotizing fasciitis complicating third molar extraction: report of a case

Necrotizing fasciitis is an uncommon but well-described entity. In the paediatric population compromising risk factors are frequently absent. We describe the successful treatment of a case of cervicofacial necrotizing fasciitis in a healthy 14-year-old male following routine extraction of an uninfected wisdom tooth for orthodontic purposes.

[The odontogenic abscess. Aetiology, treatment and involvement in the orofacial region]

Odontogenic infections are a common problem in daily practice. Occasionally, an odontogenic infection evolves an abscess. This article discusses the aetiology, the treatment and the involvement of odontogenic abscesses in the oro-facial region. Their occurrence, course and treatment are depending on the patient's immune response, and on microbial and environmental factors.

Treatment options in odontogenic infection

Most infections of the oral cavity are primary, odontogenic infections, with dental caries, gingivitis, and periodontitis the most common. Treating these infections will encompass odontologic, antimicrobial, surgical or combined treatment. Antimicrobial treatment includes the use of betalactams, macrolydes, tetracyclins, metronidazole, clindamycin, or combined treatment. The most commonly used ones are administered orally. PK/ PD parameters predict THE clinical and microbiological efficacy of the antibiotic. The three indices that are generally used to measure clinical efficacy are: T >MIC (time during which the concentration is above the minimum inhibitory concentration), Cmax/ MIC (ratio between peak concentration and the minimum inhibitory concentration) and AUC/ MIC (ratio between the area under the curve and the minimum inhibitory concentration). Amoxicillin/ clavulanic acid is one of the antibiotics recommended for the treatment of odontogenic infections due to its wide spectrum, low incidence of resistance, pharmacokinetic profile, tolerance and dosage.

[Level of lysozyme in saliva of patients suffering from dental infection and treated with herbal drugs]

The aim of this study was to examine the level of lysozyme in saliva of the 17 patients with dental infections treated with herbal drug applied locally. Mixed, unstimulated saliva samples were taken tree times; group 1--before treatment, group 2--3-4 days and group 3--14 days after the treatment had been started. The data were compared with 30 healthy controls. The level of lysozyme was measured according to ELISA method. The statistical analysis (t-Student test) showed differences between examined groups and the control with no significance. Statistically significant differences were between men and women, depending on age. The results suggested that the stimulation of immunological system can be observed in course of the treatment with herbal drug.

Update on antibiotics used to treat orofacial infections

Odontogenic infections are most often composed of many different bacteria. The pathogenesis of odontogenic infections depends on the relationship between anaerobic and aerobic bacteria within the infection. Historically, penicillins have been used to treat odontogenic infections. With the ever-increasing bacterial resistance to penicillin-based antibiotics with dental pathogens and concurrent clinical failures with penicillins, other agents have become increasingly attractive. Clindamycin has more recently become a drug of choice for the management of odontogenic infections because of the bacterial susceptibility to this drug, great oral absorption, low emergence of bacterial resistance and good antibiotic levels in bone. Newer macrolides, such as azithromycin, also have significant clinical efficacy for the management of dental infections and have additional benefits of reduced dosing, which increases patient compliance. Tables 1 and 2 provide additional information for a summary of antibiotics discussed in this article and general oral prescribing information for the adult patient. The general dentist should consider these additional choices of antibiotics to successfully manage odontogenic infections. [table: see text]

The efficacy of azithromycin in the treatment of acute infraorbital space infection

PURPOSE

In this study, we aimed to evaluate the role of azithromycin in the treatment of acute infraorbital space infection.

MATERIALS AND METHODS

Sixty patients (39 men and 21 women; age range, 18 to 47 years) who had acute infraorbital space infection with pain, swelling, and general malaise were included in the study. After initial surgical therapy, patients were randomly allocated to receive either 500 mg azithromycin once daily for 3 days, 250 mg erythromycin stearate every 6 hours for 3 days, or no antibiotic. Patients were assessed at the time of admission and after 1, 2, 3, and 7 days. Pain, swelling, cervical lymphadenopathy, and sublingual temperature were assessed at each visit. Data were collected, and all groups were compared for differences in pain and swelling using the Mann-Whitney U test and for differences in lymphadenopathy and sublingual temperature using Fisher's exact test.

RESULTS

At the time of admission, no 2 groups were statistically different at the.05 level in relation to age, gender, and presenting clinical signs or symptoms. At days 2 and 3, patients who received azithromycin had a significant reduction in pain (P =.002 and P =.02, respectively) and swelling (P =.001 and P =.013, respectively) compared with those who received no antibiotic. At day 3, patients who received erythromycin had a significant reduction in pain (P =.03) and swelling (P =.046) compared with those who received no antibiotic. In a comparison of the patients who received azithromycin with those who received erythromycin, there was no significant difference (P >.05) in the reduction of pain at any time of the study. However, at day 2, patients who received azithromycin had a significantly greater reduction in swelling (P =.002) than those who received erythromycin. In relation to the percentage of the patients with cervical lymphadenopathy and raised sublingual temperature (>37.2 degrees C), no 2 groups were statistically different at any time of the study. After 3 days of treatment, patients who received the antibiotics were clinically improved, and all patients (n = 60 patients) reviewed after 7 days had resolution of their clinical signs and symptoms.

CONCLUSION

This study emphasizes the importance of surgical drainage and proves that both azithromycin and erythromycin are effective adjunctive treatments in the therapy of relatively mild odontogenic orofacial infections.

[Inflammatory ocular diseases associated with oro-dental pathology]

PAPER AIM

It is presented the correlation between the uveitis and the focal dental disease with infection, irritation or allergic pathogenicity.

MATERIAL AND METHOD

This study was performed on a set of 54 patients with uveitis and dental diseases patients hospitalized in the Clinic of Ophthalmology of Craiova, during 1998-1999. This correlation was observed in 38-40% of uveitis. There were also mentioned some dental damages associated with uveitis: radicular focal infections, periodontitis under prosthetic works, fights cavities, inclusions dental chronic maxillary osteitis.

RESULTS

The correlation uveitis-dental diseases was noticed in 1.2-1.8% of the hospitalized patients, comparing with 3-5% in literature (including the ocular adnexa diseases).

CONCLUSIONS

This study shows the reality of the correlations between uveitis and dental diseases. It was relieved the importance of correlation ophthalmologist-stomatologist.

[Systemic infections of dental origin]

Microorganisms harbored in the oral cavity have long been recognized to cause systemic disease with a well known mechanism of spread via the blood stream. Different factors, including the presence of periodontal disease, the number of dental extractions or the duration of dental surgery have an influence on the risk of bacteremia. Infectious endocarditis is classically cited, but there are other potential problems including brain abscess, meningitis, lung or lie abscess, and even for some authors, a risk of thrombotic heart disease. It is important to keep in mind that some of these focal infections may be possible complications of dental (or buccal) infection. Prevention is crucial.

[Dentogenic infection due to Streptococcus constellatus in a child]

An 8-year-old boy was admitted with a pain-full swelling at the right mandible and symptoms of septicemia. The illness was caused by a dental infection due to Streptococcus constellatus proved by isolation from blood culture, the origin was a decayed tooth. Treatment comprised suitable antibiotics, extraction of the tooth and local irrigations with chlorhexidine solution. General condition improved rapidly, the local situation rather slowly, however.

Orbital infection arising from a primary tooth: a case report

Odontogenic infections may spread to the orbit by one or more of several paths. Such extension is potentially dangerous and may lead to loss of vision. A case of infection from a primary tooth, which extended to the retrobulbar area is presented in this report. Treatment included surgical drainage of the resulting subperiosteal orbital abscess through a Caldwell-Luc approach as well as aggressive antibiotic therapy. The importance of early suspicion of this entity and its potential sequelae are discussed.

[The use of nitatsid and gipozol'-N in the combined treatment of acute inflammatory diseases of the maxillofacial area]

Combined drugs with a hydrophilic base, nitacide and hyposol-n, were used in combined therapy of acute purulent inflammations of the maxillofacial area. Time course of clinical parameters and changes in microflora were studied in patients administered different local treatments with different inflammatory reactions. The data indicate a high efficiency of the drugs, which optimized local therapy of suppurative wounds and are recommended for wide practical use.

Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections

OBJECTIVE

The purpose of this study was to determine the current status of beta-lactamase-producing bacteria in orofacial odontogenic infections.

STUDY DESIGN

Microbiologic data regarding purulent exudate from 111 cases with orofacial odontogenic infections were analyzed in relation to the past administration of beta-lactams.

RESULTS

beta-lactamase-producing bacteria were isolated more frequently from the beta-lactam-administered group (38.5%) than from the beta-lactam-nonadministered group (10.9%; P <.005), and they were isolated more frequently as the duration of administration increased. The predominant bacteria isolated included Prevotella (the most frequent isolate), viridans streptococci, Peptostreptococcus, and Fusobacterium, and 7.1% of total isolates produced beta-lactamase. Penicillin and cefazolin worked well with beta-lactamase-nonproducing Prevotella but were remarkably affected by beta-lactamase-producing Prevotella. Cefmetazole, sulbactam/cefoperazone, and imipenem worked well against both types of Prevotella.

CONCLUSIONS

beta-lactams are still suitable for the first antimicrobial therapy in the treatment of these infections. However, because past beta-lactam administration increases the emergence of beta-lactamase-producing bacteria, beta-lactamase-stable antibiotics should be prescribed to patients with unresolved infections who have received beta-lactams.

[An extensive left subperiosteal frontotemporal orbital abscess and left suppurative pansinusitis with an odontogenic origin]

A 28-years-old patient with pansinusitis and orbital abscesses to odontogenic infection origin were present. Treatment, complication and evolution are discussed.

Dental therapeutic indications for the newer long-acting macrolide antibiotics

BACKGROUND

When treating oral infections, clinicians have used the macrolide antibiotic erythromycin as an alternative antibiotic for patients who have documented allergic reactions to penicillins. In this article, the author reports on his assessment of the pharmacology of erythromycin and the newer macrolide antibiotics, as well as of their indications for the prevention of bacterial endocarditis and their possible use for oral-dental infections.

TYPES OF STUDIES REVIEWED

The author reviewed the current clinical pharmacology literature with specific emphasis on reports indicating these antibiotics' efficacy in treating oral-dental infections.

RESULTS

Azithromycin, clarithromycin and dirithromycin are erythromycin analogues that are currently marketed in the United States. All three have the therapeutic advantages over erythromycin of longer durations of action, enhanced acid stabilities and improved tissue distributions. A lower incidence of gastrointestinal distress and abdominal cramping is reported for all three of these newer agents than for erythromycin. Azithromycin and dirithromycin do not appear to compete for the same hepatic drug-metabolizing enzymes as erythromycin and therefore are not associated with the same drug interactions.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The newer macrolide antibiotics offer the advantage of fewer adverse gastrointestinal effects than erythromycin and dosing regimens of only once or twice a day. Yet, the extremely high price of the newer macrolides compared with that of erythromycin limits their routine use.

Orbital cellulitis as a sole symptom of odontogenic infection

A case of periapical infection resulting in unilateral maxillary sinusitis and cellulitis of the ipsilateral lower eyelid is presented. The sole symptom was right orbital swelling. The possible pathway for the spread of this type of infection predisposing factors and possible complications are reviewed. The value of radiographic examination and antibiotic therapy are also discussed.

Antimicrobial treatment options in the management of odontogenic infections

Most acute orofacial infections are of odontogenic origin. In normal hosts, however, they usually do not occur without some type of predisposing condition. Early recognition and management of acute orofacial infections is critical, because rapid systemic involvement can occur, especially in children. Antimicrobial therapy has an essential role in the management of these infections. If it is initiated before surgery, it can shorten the period of infection and minimize associated risks. The etiology of odontogenic infections is usually attributed to the endogenous flora of the mouth, and not to the introduction of non-resident bacteria. Odontogenic infections are typically polymicrobial; however, anaerobes generally outnumber aerobes by at least four fold. The penicillins have historically been used as the first-line therapy in these cases, but increasing rates of resistance have lowered their usefulness. Bacterial resistance to this class of agents is predominately achieved through the production of beta-lactamases. Clindamycin, because of its broad spectrum of activity and resistance to beta-lactamase degradation, is an attractive first-line therapy in the treatment of odontogenic infections.

Antimicrobial resistance: dentistry's role

The resistance of bacteria, fungi and viruses to antimicrobials is increasing rapidly, with deleterious consequences. Dentistry's role in this development is unclear, because the necessary information has not yet been collected. Nevertheless, dentists should recognize that it is essential to use antimicrobials in an appropriate and responsible manner, both to treat infection effectively, and to minimize the likelihood that the bacteria in the general population will develop resistance to antimicrobials. The purpose of this article is to make dentists aware of the concerns raised by antimicrobial resistance, and how it can be avoided.

[Dental foci. Role, treatment and prophylaxis in patients at risk]

A dental focus usually is a localized chronic infection that under certain circumstances may result in severe local or systemic disease. The most important dental foci are periodontitis, periapical lesions, advanced carious lesions, nonvital pulp, partially impacted teeth and root tips. Local effects of dental foci particularly are processes that may come to expression because of a compromised immunological defence, such as osteoradionecrosis. Systemic effects are mainly caused by transient bacteraemia which can occur spontaneously out of dental foci or after manipulations such as brushing, flossing and dental treatment. Well known examples are infectious endocarditis, fever during chemotherapy and hematogenous infections of total joint prostheses. For all patients at risk (a.o. endocarditis, endoprosthesis, chemotherapy, radiotherapy) it is important that dental foci are treated. Because in most patients the risk factors are present lifelong, a healthy dentition and a healthy periodontium are the best way of prevention.