Negative pressure pulmonary edema following laryngospasm after dental abscess: A case report

Negative pressure pulmonary edema (NPPE), also known as post-obstructive pulmonary edema, is a rare and life-threatening condition. It occurs when a person breathes against an obstructed glottis, causing negative thoracic pressure in the lungs. This negative pressure can lead to fluid accumulation in the lungs, resulting in pulmonary edema. The obstructed glottis might be caused by laryngospasm, which occurs when the muscles around the larynx involuntarily spasm and can lead to complete upper airway occlusion. This report shares the case of a 33-year-old woman hospitalized for periapical dental abscess, facial swelling, and shortness of breath. The patient exhibited signs of poor oral hygiene. After the exacerbation of her symptoms, she showed signs of asphyxia and decreased oxygen saturation, which led to her intubation. Imaging revealed bilateral pleural effusion and patchy ground glass opacities favoring NPPE. After three days of treatment with diuretics and other conservative measures, her condition was alleviated, and she was extubated. Laryngospasm in the presence of a dental abscess is uncommon. Identification of imaging favoring NPPE in this setting is even more rare. In cases of laryngospasm, prompt intubation is crucial. Therapy with diuretics and other conservative measures can effectively treat NPPE following laryngospasm.

Microbial isolates and antibiotic sensitivity in patients hospitalized with odontogenic infections at a tertiary center over 10 years

Objectives

This study investigated causative strains and their antibiotic sensitivity in patients who were hospitalized for maxillofacial odontogenic infections at a tertiary center in South Korea over the past 10 years with the aim of providing guidelines for the selection of appropriate empirical antibiotics.

Materials and Methods

Patients with head and neck fascial space abscesses due to odontogenic infections who underwent incision and drainage surgery with pus culture tests between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery, Dankook University Hospital were included. The bacterial isolates and antibiotic sensitivity of each strain were analyzed for 2013-2022, 2013-2017, and 2018-2022. The affected fascial spaces were classified into primary, secondary, and deep neck spaces.

Results

In the 192 patients included in this study, 302 strains were detected. Viridans streptococcus had the highest frequency (51.7%), followed by Prevotella spp. (16.9%), Staphylococcus spp. (5.6%), and Klebsiella pneumoniae (4.6%). The identification rate of viridans streptococcus significantly increased from 41.8% in 2013-2017 to 60.9% in 2018-2022. Viridans streptococcus showed an antibiotic sensitivity of 80.5% to ampicillin; the sensitivity to penicillin antibiotics decreased over the study period. Antibiotic susceptibility was approximately 94% for third-generation cephalosporins. K. pneumoniae, which was identified at a high percentage in patients with deep neck space infection, showed increasing antibiotic resistance to most antibiotics over the study period.

Conclusion

Viridans streptococcus was identified in head and neck fascial space abscesses with the highest frequency. Empirical antibiotics should be effective against this strain; penicillin antibiotics are considered inappropriate. For effective treatment of deep neck space abscesses, bacterial culture and antibiotic sensitivity tests performed as soon as possible are essential.

Teeth with acute apical abscess vs. teeth with chronic apical periodontitis: a quantitative and qualitative proteomic analysis

OBJECTIVE

To quantitatively and qualitatively analyze the proteomic profile of teeth with acute apical abscesses (AAA) compared with teeth with chronic apical periodontitis (CAP) and to correlate the expression of detected human proteins with their main biological functions.

MATERIALS AND METHODS

Samples were obtained from root canals of 9 patients diagnosed with AAA and 9 with CAP. Samples were analyzed by reversed-phase liquid chromatography coupled to mass spectrometry. Label-free quantitative proteomic analysis was performed by Protein Lynx Global Service software. Differences in protein expression were calculated using the t-test (p < 0.05).

RESULTS

In total, 246 human proteins were identified from all samples. Proteins exclusively found in the AAA group were mainly associated with the immunoinflammatory response and oxidative stress response. In the quantitative analysis, 17 proteins were upregulated (p < 0.05) in the AAA group, including alpha-1-acid glycoprotein, hemopexin, fibrinogen gamma chain, and immunoglobulin. Additionally, 61 proteins were downregulated (p < 0.05), comprising cathepsin G, moesin, gelsolin, and transketolase. Most of the proteins were from the extracellular matrix, cytoplasm, and nucleus.

CONCLUSIONS

The common proteins between the groups were mainly associated with the immune response at both expression levels. Upregulated proteins mostly belonged to the acute-phase proteins, while the downregulated proteins were associated with DNA/RNA regulation and repair, and structural function.

CLINICAL RELEVANCE

The host response is directly related to the development of apical abscesses. Thus, understanding the behavior of human proteins against the endodontic pathogens involved in this condition might contribute to the study of new approaches related to the treatment of this disease.

Effect of an 810 nm Diode Laser on the Healing of a Periapical Abscess

Introduction: The golden standard of the treatment of radicular cysts is mainly root canal therapy or surgical excision with apicectomy. The root canals are usually disinfected by the mechanical and chemical actions of instruments and chemical irrigating solutions respectively. To improve the efficacy of the root canal disinfection process, many techniques have been used and many researchers are still trying to reach the quickest and most convenient way to achieve this goal. Diode lasers have shown antibacterial activity on dentinal tubules, and they can penetrate more than 1000 μm into the dentin. Case Presentation: Our patient was a 25-year-old female with an infraorbital abscess caused by a non-vital maxillary canine with periapical radiolucency. After completing the conventional treatment, the optical fiber was inserted into the canal according to the working length previously measured. An 810 nm diode laser at the output power of 4 W was used to irradiate the root canals, with a 300 μm fiber. The patient was free of pain within a few days. The lesion was resolved in radiographic follow-ups, 3 and 6 months after the root canal treatment. Conclusion: A combination of conventional root canal therapy and an 810 nm diode laser is an effective treatment for non-vital teeth with periapical lesions.

An accurate diagnosis of odontogenic cutaneous sinus tract by different computed tomography unit setting

Due to their rarity and the lack of associated dental symptoms, odontogenic cutaneous sinus tracts (OCSTs) are often misdiagnosed and confused with cutaneous lesions or non-odontogenic infections. It has been estimated that 50% of individuals affected by OCSTs are subjected to inappropriate treatments before the correct diagnosis is established. We describe the diagnosis and treatment of two cases of OCSTs. By using a computed tomography (CT) with soft tissue window setting, the extent of cortical bone destruction and the path of the sinus tract in the soft tissue was easily identified. Thus, we recommend the use of imaging techniques such as CT, which can confirm the odontogenic origin and the exact location of the OCST.

Common Dental and Periodontal Diseases

Oral health is a critical component of overall health and well-being. Dental caries and periodontitis are two of the most common oral diseases and, when not treated, can have irreversible sequelae and overall psychosocial and physiologic impact on individuals, diminishing quality of life. The burden of advanced dental caries and periodontal disease leading to tooth loss is severe. Physicians and allied medical professionals can help in early detection of dental caries, abscess, and periodontal diseases and initiate management followed by prompt referral to dental colleagues.

Comparison between isolated and associated with codeine acetaminophen in pain control of acute apical abscess: a randomized clinical trial

OBJECTIVES

The study aimed to compare the acetaminophen administration efficacy or its combination with codeine for pain control in acute apical abscesses cases.

MATERIALS AND METHODS

Thirty-nine patients who sought emergency treatment in the Faculty of Dentistry of the Federal University of Rio Grande do Sul were included, all of them with acute apical abscess diagnosis. These patients were divided into two groups: acetaminophen group-prescription of acetaminophen (1000 mg) and acetaminophen-codeine group-prescription of acetaminophen (1000 mg) + codeine (30 mg), both with oral intake every 6 h for 3 days. The pain scores were recorded by the patients on their own at 6, 12, 24, 48, and 72 h after finishing clinical assistance, by filling a pain evolution journal, containing a visual analogue scale (VAS). Student t test was conducted to investigate different mean ages between groups 1 and 2. A comparison of weight and means of initial pain scores between groups was carried out using the Mann-Whitney U test. Chi-square test was performed to compare gender, affected tooth, education, initial swelling, and frequency of adverse effect between test and control groups. Mann-Whitney U test was applied to compare groups in the same period. Friedman's test was used to compare results from the same group over time.

RESULTS

Both groups showed score reduction over time (P < 0.05). Paracetamol-codeine group showed significant pain score reduction at 48 h registers when compared to baseline and at 6 h scores (P < 0.05). Further, pain scores at 72 h were significantly lower, when compared to the baseline, at 6 h, and at 12 h scores (P < 0.05). Acetaminophen group showed significant pain score reduction observed at 72 h, when compared to the baseline and at 6 h scores (P < 0.05). There were no significant differences in pain score reduction over time between groups (P > 0.05). There was no difference between the groups regarding the frequency of adverse reactions (P > 0.05).

CONCLUSION

Both medications were effective for pain control in acute apical abscess cases. The findings might have inferred in pain control of acute apical abscess associated pain in patients who used an antibiotic drug. External validity of the findings for acute apical abscess cases with no need for an antibiotic prescription is uncertain.

CLINICAL RELEVANCE

This paper suggests acetaminophen 1000 mg can be used for pain control in the treatment of acute apical abscess associated with systemic manifestation.

Odontogenic Sinusitis: Current Concepts in Diagnosis and Treatment

Odontogenic sinusitis is a unique cause of sinus disease that deserves special consideration. An astute clinician can elicit historical findings such as recent dental work, and symptoms such as unilateral facial pain and foul drainage, despite a relatively benign oral cavity examination. Otolaryngologists and dental professionals who care for these patients must be able to interpret imaging studies for dental disorder such as periapical abscesses and periodontal disease. Treatment is frequently some combination of antibiotic therapy, dental procedures, and endoscopic sinus surgery. More prospective studies are needed to determine the best approach to caring for this patient population.

Periapical lymphoma: Review of reported cases in the literature

Oral lymphoma can resemble clinically to other pathologic entities such as periapical radiolucencies, or dental abscess. The aim of this study was to review the literature related to misdiagnosed periapical lymphomas and discuss their characteristics. In this review study, authenticated search engines and databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus were surfed to find articles related to the topic by using related keywords. Out of more than 100 articles approximately, 50 were closely relevant to the title, and ultimately 43 well-documented English articles were chosen. Out of 45 reported cases, 63% were male and 37% were female with mean age of 41.22 years. The majority of such lesions have been detected in the mandible (61%) with a mandibular to maxillary involvement ratio of 1.58:1. The most frequent type of lymphoma was diffuse large B cell lymphoma (DLBCL) (53%). Noteworthy, 49% of periapical lymphoma has been misdiagnosed as pulpal pathology and treated through root canal therapy. The mean time lapse before making the correct diagnosis was 4.3 months. Although rare, periapical lymphoma should be ranked in the differential diagnosis of a periapical lesion especially when vitality pulp tests are positive.

Hospital-based Emergency Department Visits with Periapical Abscess: Updated Estimates from 7 Years

INTRODUCTION

The impact of the Affordable Care Act (ACA) on the utilization of the emergency department (ED) for periapical abscess (PA) is unknown. The objectives of this study were to provide nationwide estimates of hospital-based ED visits with PA and to examine the effect of the ACA on the use of EDs for PAs.

METHODS

We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS) for 2008 to 2014. All ED visits with a diagnosis of PA were selected. The International Classification of Diseases, Ninth Revision-Clinical Modification code was used to identify PA. Patient- and hospital-level characteristics were examined. Descriptive statistics were used to summarize the data.

RESULTS

From 2008 to 2014, a total of 3,505,633 ED visits for PA occurred. The proportion of ED visits with PA significantly increased over the study period (from 460,260 in 2008 to 545,693 in 2014). Medicaid was the primary payer (30.3%) and more than 40% were uninsured. Mean charge per PA-related ED visit was $1080.50 and total PA-related ED charge across the United States was $3.4 billion. Among those hospitalized following PA-related ED visits, mean hospitalization charges were $34,245 and total hospitalization charges were $5.7 billion.

CONCLUSION

Oral health continues to be overlooked in health care. A large proportion of ED visits with PA were made by those covered by Medicaid and uninsured. The passing of the ACA has not reduced the number of ED visits with PA.

A Regenerative Approach for Root Canal Treatment of Mature Permanent Teeth: Comparative Evaluation with 18 Months Follow-up

Aim

SealBio is a novel technique which stimulates the periradicular cells to deposit a biological barrier at the root apex by inducing healing and regeneration. This clinical trial was undertaken to compare the outcome of teeth treated with the SealBio and the obturation technique.

Materials and methods

Thirty patients met the inclusion criteria and consented to participate in the study. Patients were randomly assigned to the SealBio and the obturation group. The time taken for both the techniques and periapical healing was evaluated. The patients of both the groups were evaluated at 6, 12, and 18 months follow up. The periapical index (PAI) was the primary outcome measure to check the apical bone density and healing. The secondary outcome measure was the presence/absence of signs and symptoms. The final outcome measure was the sum of the primary and secondary outcome measures.

Results and conclusion

The time taken to perform endodontic treatment with the SealBio technique was significantly lesser than that of obturation. Both groups showed equally favorable outcomes at the end of 18 months without any statistically significant differences.

Clinical significance

The results of the present study have demonstrated that SealBio technique gives similar results as that of conventional gutta-percha obturation. The shortcomings of obturation such as difficulty in obtaining a fluid-tight seal and difficulty in obturating tortuous canals can be overcome by the SealBio method. The SealBio method is cost effective, less technique sensitive, and takes lesser chair time.

How to cite this article

Jha P, Virdi MS, et al. A Regenerative Approach for Root Canal Treatment of Mature Permanent Teeth: Comparative Evaluation with 18 Months Follow-up. Int J Clin Pediatr Dent 2019;12(3):182–188.

Common pitfall of plastic surgeon for diagnosing cutaneous odontogenic sinus

Dental origins are a common cause of facial cutaneous sinus tracts. However, it can be easily overlooked or misdiagnosed if not suspected by a surgeon who is not familiar with dental origins. Cutaneous odontogenic sinuses are typically nodulocystic lesions with discharge and are most frequently located on the chin or jaw. This article presents two cases of unusual cutaneous odontogenic sinus presentations, as deep dimpling at the middle of the cheek. The patients were undergone surgical excision of sinus tract and dimpling immediate before and after treatment of causal teeth and the lesions resolved without recurrence. Surgeons should consider dental origins of facial dimpling lesions with discharge and provide appropriate treatment.

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

BACKGROUND

The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.

METHODS

All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.

RESULTS

Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.

CONCLUSIONS

ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.

Non-Surgical Management of Mandibular Molar with Multiple Intra-oral Sinus Tracts: A Case Report

Multiple intra-oral sinus tracts of dental origin are an uncommon condition. Patients with this condition may undergo surgical extraction, biopsies and antibiotic regimens, but all of them fail with the recurrence of the sinus tract. A proper diagnosis and management are important, to avoid any complications. This case report has described the conventional root canal treatment of a patient who had three distant intra-oral sinuses which had occurred due to an intact tooth with pulp necrosis, who had a history of accidentally biting on a hard food object and having a periapical radiolucency which indicated a chronic periradicular abscess. At follow up examination, the tooth was found to be asymptomatic and radiographically, it showed repair of the lesion.

Outcomes in Patients Hospitalized for Periapical Abscess in the United States

BACKGROUND.

Severe infections resulting from periapical abscesses may warrant hospitalization. The authors conducted a study to investigate the factors affecting outcomes for patients hospitalized for periapical abscess in the United States in 2007.

METHODS.

The authors used the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for 2007. They selected for analysis all hospitalizations attributed primarily to periapical abscess. Outcomes examined included hospitalization charges, length of stay and type of admission (emergency or urgent versus elective). They used multivariable regression analysis to examine the effects of patient-related factors (including age, sex, presence of comorbid conditions, insurance status, type of periapical abscess and discharge disposition) on outcomes.

RESULTS.

In 2007, 7,886 hospitalizations were attributed primarily to periapical abscess. Total hospital charges were $105.8 million. Periapical abscess also resulted in a total of 23,001 hospitalization days. The mean hospitalization charges and length of stay were $13,590 and 2.92 days, respectively. The authors found an association between patients with comorbid conditions and higher charges and longer length of stay (P < .05). Of all hospitalizations, 91 percent occurred on an emergency or urgent basis. The percentage was significantly higher among uninsured patients than among those with private insurance (P < .05).

CONCLUSION.

The study provides nationally representative estimates of outcomes associated with hospitalizations due to periapical abscess, and it highlights the substantial resources needed to treat patients hospitalized for this condition.