[An update on focal infection of oral origin]

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

[Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis]

INTRODUCTION

Temporal cellulitis complicated by temporomandibular osteoarthritis and mandibular osteomyelitis is rare with the availability of antibiotics and the prevention of dental infections.

CASE REPORT

A 56 year-old woman developed a jaw abscess during hospitalization in an intensive care unit following medical drug overdose. Repeatedly surgical drainage was performed guided by CT scans and multiple antibiotherapies. CT scan follow-up revealed temporomandibular arthritis with decrease of the joint space, synovitis, and subchondral cysts. Slow improvement was noted but limited mouth opening was persistent.

DISCUSSION

This case illustrates the insidious evolution of an uncommon infection. It requires both expert clinical evaluation and an early MRI or CT scan investigation to determine the extension of the infection. Treatment is urgent because of the prognosis and is achieved by surgical drainage and adequate long-term antibiotherapy.

[Tooth extraction and anticoagulants]

INTRODUCTION

The purpose of this study was to show the possibility of extracting teeth without modifying the anticoagulant treatment (anti-platelet and anti-vitamin K agents).

MATERIAL AND METHOD

Two hundred patients underwent dental extraction from May 2003 to July 2006 without modifying their anticoagulant treatment; only 137 of them were hospitalized. Most of the teeth were extracted under local anesthesia, and hemostatic pad were inserted in the sockets without suture.

RESULTS

One thousand (and) sixteen extractions were performed with bleeding disorders in 4%, successfully resolved by using local hemostatics.

DISCUSSION

Modifying an anticoagulant treatment is a thrombo-embolic complication risk factor. Performing tooth extraction according to our protocol decreases this risk and bleeding complications, thus proving the validity of our technique.