Common dental and periodontal diseases: evaluation and management

Physicians may encounter patients with dental and periodontal diseases in the context of outpatient medical practice. It is important for physicians to be aware of common dental and periodontal conditions and be able to assess for the presence and severity of these diseases. This article reviews common dental and periodontal conditions, their cardinal signs and symptoms, outpatient-setting assessment techniques, as well as common methods of treatment. Physicians detecting gross abnormalities on clinical examination should refer the patient to a dentist for further evaluation and management.

Clinical consequences of untreated dental caries and toothache in preschool children

PURPOSE

The purpose of the present study was to assess the clinical consequences of untreated dental caries related to the occurrence of toothache among Brazilian preschool children.

METHODS

A random sample of 540 two- to five-year-olds underwent a clinical oral examination for the assessment of early childhood caries (ECC) using the dmft (decayed, missing and filled primary teeth) index and pufa (carious lesions with pulpal involvement [p], ulceration of the mucosa due to root fragments [u], fistula [f], and abscess [a]) index to score consequences of dental caries in soft tissues. Parents/guardians were asked to answer a questionnaire addressing sociodemographic characteristics and toothache experience in the children. Descriptive analysis and hierarchically adjusted Poisson regression models were employed.

RESULTS

The prevalence of ECC and pufa (≥1) was approximately 50 percent and 12 percent, respectively. A total of 25 percent of the children had toothache experience. Toothache was significantly associated with: an older age (prevalence ratio [PR]=3.70; 95% confidence interval [CI]=2.09-6.58); carious lesions with pulpal involvement (PR=3.93; 95% CI=3.09-5.01); ulceration of the mucosa due to root fragments (PR=2.73; 95% CI=1.52-4.89); fistula (PR=2.91; 95% CI=1.89-4.49); and abscess (PR=4.43; 95% CI=3.78-5.19).

CONCLUSION

Toothache experience in preschool children was associated with untreated cavitated dentin lesions and their consequences.

Dentoalveolar abscess among children attending a dental clinic in Nigeria

OBJECTIVE

To determine the incidence and causes of dentoalveolar abscess among children attending an outpatient dental clinic in Nigeria.

MATERIAL AND METHODS

This is a retrospective study of paediatric dental patients treated in University of Benin Teaching Hospital, Benin City from October 2010 to September 2011.

RESULTS

The incidence of dentoalveolar abscess was 6.4% (53/824). However only 42 cases had their case notes retrieved for final research analysis. It occurred mostly in the lower right quadrant of the mouth. The affected children were majorly males and first or second child of monogamous family. A total 17 (40.5%) of the affected children were in the 6-11 years age group. This was the first dentist consultation among 35 (83.3%) of the children. The presenting complaint was toothache among two-thirds of the children. History of asthma, tonsillitis, peptic ulcer disease and previous surgery were medical history elicited from 6 (14.3) of the patients. The most implicated tooth was deciduous first molar. The causes of abscess include untreated dental caries 35 (83.3%), trauma 5 (11.9%), failed restoration 1 (2.4%) and periodontal diseases 1 (2.4%). Periapical radioluscency was predominant radiological finding among affected children. Tooth extraction was commonest treatment done.

CONCLUSION

The incidence of dentoalveolar abscess among children was significant. The high frequency of untreated dental caries as the cause of dentoalveolar abscess indicates the need for school and community-based preventive strategies like encouraging infant oral health and preventive dentistry programs and early treatment intervention and dental health education.

[An index for untreated severe caries]

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.

Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK?

Steven J Thomas and colleagues think that recent changes in dental care provision have led to increased numbers of hospital admissions for dental abscess, and they suggest that access to routine and emergency dental care needs to be reviewed

Dental emergencies presenting to a university-based paediatric dentistry clinic in the West Indies

OBJECTIVES

The aims of the present study were to investigate the type and prevalence of dental emergencies presenting at a teaching hospital paediatric emergency clinic in Trinidad, and to describe the socio-demographic factors related to the use of the service.

DESIGN AND METHODS

The authors used a prospective study of consecutive dental patients presenting to a paediatric emergency clinic. Data recorded included type of presenting emergency and socio-demographic variables.

RESULTS

Data were available for 309 participants; 47% were male and 53% female. The average age of the participants was 8.66 years (SD = 3.75 years; range = 1-16 years). Seventy-three per cent of the participants' parents were involved in manual work or unemployed, and 21% were in nonmanual/professional employment; the occupation was not known in 6% of cases. Caries-related problems accounted for 74% of emergencies. Dental trauma mostly affected the upper permanent incisor teeth, with concussion, subluxation and intrusion being the most common injuries.

CONCLUSION

Dental emergencies presenting to this university-based clinic were predominantly related to caries and trauma. The service was more frequently utilized by children in the mixed dentition stage, children from lower socioeconomic groups and those living in the local area. The frequency of caries-related problems indicates the need for more community-based preventive strategies, including encouraging greater attendance for routine dental care and dental health education. Strategies for oral health promotion should also be developed to prevent dental trauma.

A study of orofacial bacterial infections in elderly Nigerians

This retrospective study was designed to determine the pattern of occurrence, and principles of management of orofacial bacterial infections in elderly Nigerians. Ninety-two patients aged 55-90 years (mean +/- SD 62.4 +/- 7.5 years), were admitted into the study (male:female ratio 1.1:1). The origin of orofacial infection was predominantly odontogenic and the lower face was three times more commonly involved. The percentage of patients with underlying systemic disease was 16.2%. Patients with underlying disease had a 3.5 times greater risk of developing orofacial infections. Similarly, a significant correlation was demonstrated between both sexes of patients with orofacial infections and underlying illness (P < 0.05). There was a general delay before presenting for treatment (average 19.5 weeks) and the mortality rate was 3.3%. The study findings demonstrate that a significant relationship exists between elderly Nigerians with orofacial infections and systemic disease.

Increasing frequency of dental patients in the urban ED

This study examined the spectrum and frequency of dental disorders presenting to an urban ED. Data were retrospectively collected on all patients presenting with dental complaints between January 1, 1987 and December 31, 1995. Data included age, date and time of presentation, diagnosis, triage acuity and disposition. Of the 3,943 charts reviewed, 1,892 (48%) patients required emergent oral surgery management and 2,051 (52%) emergency physician management only. The frequency of dental patients increased from 4.4/1,000 total ED patients in 1987 to 11.5/1,000 in 1995 (P < .05). The rate of emergent dental trauma, emergent nontraumatic dental care, and nonemergent nontraumatic dental care increased similarly during the study period. There was no significant difference by day of week, but a significantly greater number of nonemergent patients presented between 7:00 a.m. and 3:00 p.m. (72%). The incidence of dental patients presenting to the ED increased significantly between 1987 and 1995. Approximately one-half did not require specialist consultation and could potentially have been managed by a primary care dental practitioner.

The periodontal abscess: a review

BACKGROUND/AIMS

The periodontal abscess is a frequent periodontal condition in which periodontal tissues may be rapidly destroyed. Its importance is based on the possible need of urgent care, the affectation of tooth prognosis, and the possibility of infection spreading. There is scant information in the scientific literature regarding this condition and most of it has been published as case reports and text books, where conclusions are not evidence-based, but rather empirical observations made by recognised clinicians. The aim of this review was to critically analyse all available information on this subject in the dental and medical literature, including information on its prevalence, proposed etiologies and pathogenesis, diagnosis, microbiology and treatment alternatives.

SUMMARY

The periodontal abscess is the 3rd most frequent dental emergency, and it is specially prevalent among untreated periodontal patients and periodontal patients during maintenance. Different etiologies have been proposed, and 2 main groups can be distinguished, depending on its relation with periodontal pockets. In the case of a periodontitis-related abscess, the condition may appear as an exacerbation of a non-treated periodontitis or during the course of periodontal therapy. In non-periodontitis related abscesses, impaction of foreign objects, and radicular abnormalities are the 2 main causes. The abscess microflora seems to be similar to that of adult periodontitis, and it is dominated by gram-negative anaerobic rods, including well-known periodontal pathogens. Complications and consequences include tooth loss and the spread of the infection to other body sites. Diagnosis and treatment is mainly based on empiricism, since evidence-based data are not available. The role of systemic antibiotics, in the treatment of periodontal abscesses, is especially controversial.

[Studies on the continuous culture and pathogenicity of Entamoeba gingivalis]

OBJECTIVE

To establish a method for continuous culture of Entamoeba gingivalis (E. g.) and study the pathogenicity of E. g..

METHODS

The culture conditions of E. g. were compared by observing its growth and reproduction. The pathogenicity of E. g. was studied by investigating its infection rate in humans and observing the relationship between E. g. infection and periodontal abscess in rats and the in vitro effect of some drugs.

RESULTS

The optimal culture condition of E. g. was modified LES medium containing Locke's solution with 20% bovine serum, penicillin, streptomycin and rice starch. Reproduction of E. g. peaked at the fourth day of incubatoin, E. g. could live continuously for 120 to 168 h. The infection rate of E. g. was higher in patients with periondontal diseases than in healthy groups. The animal test showed that E. g. could cause periondontal abscess in rats. The levels of acid phosphatase and MDA were higher in patients with E. g.-positive periondontal disease than in healthy individuals. Metronidazole and SBF are effective against E. g..

CONCLUSION

E. g. could grow very well in modified LES medium, and cause periondontal abscess in patients with low immunity.

The prevalence of periodontal abscess

The records of 5,467 periodontal patients in a military practice were reviewed for ADA case type 3 or 4, resulting in 203 patients (3.71 percent) in the two categories. These records were then examined for 1) sex of the patient; 2) occurrence of a periodontal abscess; 3) whether or not the patient was in active periodontal treatment at the time of the abscess; and 4) which tooth or teeth were involved. Periodontal treatment was shown to greatly reduce the incidence of periodontal abscesses among case type 3 patients. ADA case type 4 patients were much more likely to develop an abscess than case type 3 patients, and treatment had no effect on the rate of abscess formation in these patients. In those patients who developed an abscess while undergoing periodontal treatment, women showed a greater tendency toward abscess formation. Maxillary incisors and first premolars had the lowest rates of involvement.

[Correlation of odontogenic soft tissue infection and thermal effects with special reference to temperature sense. Statistical analysis of 2,111 patients]

A possible correlation between the thermal effects of the weather and the frequency of odontogenic soft-tissue infections was investigated with special regard to the so-called felt temperature (gT). Clinical data of 2111 patients of the years 1992-1996 in whom an incision was made because of an odontogenic soft-tissue infection were evaluated retrospectively and correlated to meteorological data for Aachen, collected or calculated by the "Deutsche Wetterdienst". In order to describe the thermal exchange between the human organism and the surroundings in a satisfactory way, the gT was chosen. The gT is a complexly calculated meteorological parameter which allows physiologically adequate estimation of the thermic surroundings of humans. Over the whole study time there was no impressive correlation between course and changing of the gT and the frequency of odontogenic soft-tissue infections. This result agrees with our finding that there was no seasonal accumulation of odontogenic soft-tissue infections over the year in Aachen. Nevertheless, there was a statistically significant negative correlation between values or weighted changes of the gT and the frequency of abscess and/or infiltration in the winter and less in springtime. A similar statistically significant correlation could not be found for summer or autumn.

Brief communication: prehistoric dentistry in the American southwest: a drilled canine from Sky Aerie, Colorado

A prehistoric Native American mandible from a Fremont site (circa AD 1025) in Colorado has a conical pit in the worn occlusal surface of the lower right canine. Natural causes for this modification are ruled out by the presence of internal striae, a finding confirmed by experimental replication. The canine was artificially drilled before the individual's death and is associated with a periapical abscess. This is one of a very few examples of prehistoric dentistry in the world, and the first from the American Southwest.

Incidence of infections requiring hospitalization associated with partially erupted third molars

A retrospective study of patients hospitalized for infections associated with partially erupted third molars during a 10-year period (1985-94) showed a total of 17 cases: 6 women and 11 men, aged 18 to 57 years. Eight patients were in the third decade. No deviation from the habits of the general population with regard to cigarette smoking and alcohol consumption or overrepresentation of general health problems was found. All infections were of pericoronal origin. Bacteriologic cultures from six patients showed mixed aerobic-anaerobic oral flora, without any penicillin-resistant strains. The incidence rate of serious orofacial infections associated with partially erupted third molars was calculated to be 0.016 cases per year per 1000 patients at risk.

Incidence of caries and abscesses in archeological Eskimo skeletal samples from Point Hope and Kodiak Island, Alaska

The incidence of caries and abscesses in 246 archeologically derived skeletal specimens from the Ipiutak and Tigara levels at Point Hope, Alaska, and 79 specimens excavated from Jones Point, Kodiak Island, Alaska were investigated. All three collections span long periods of time. Only pre-white contact specimens were used. Each specimen was sexed and aged in five year groupings, using standard techniques. Caries and abscesses were recorded by type and degree of severity and correlated with age, sex, and site of origin. All samples displayed very low caries rates and few abscesses per tooth and per individual (both observed frequencies, and frequencies corrected for postmortem loss of teeth). DMF scores were tabulated using both observed and corrected frequencies. Very heavy occlusal wear in all three samples could account for the majority of abscesses and pulp exposures, while the low caries rates are attributable to traditional diets totally devoid of refined sugars, starches, and food additives.

[Odontogenic soft tissue abscesses in the maxillofacial region. An analysis of 1386 cases from 1957--1976 at the Northwest-German Dental Clinic in Hamburg]

Between 1957 and 1976, 1386 patients with odontogenous abscesses in the area of the mouth, jaw, and face were treated on an in-patient basis at the Hospital for Jaw Surgery (Nordwestdeutschen) in Hamburg. The catamneses of these patients were evaluated noting the localization and frequency of each abscess, the age and sex distribution of the patients, and the possible teeth responsible for the abscess. Any pathogens demonstrated were carefully recorded. The degree of sensitivity and/or resistance of the various groups of pathogens were also included in the study, particularly streptococcus and staphylococcus. Uncritical and undifferentiated administration of antibiotic therapy for pyogenic inflammations in the area of the mouth, jaw, and face is not to be recommended.