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Background: The authors conducted a study to examine the antibiotic prescribing practices of general and pediatric dentists in the management of odontogenic infections in children., Methods: The authors relied on a cross-sectional study design to assess the antibiotic prescribing practices of general and pediatric dentists in North Carolina. The survey instrument consisted of five clinical case scenarios that included antibiotic-prescribing decisions in a self-administered questionnaire format. The participants were volunteers attending one of four continuing education courses. The authors invited all pediatric dentists in private practice to participate in the study, as well as general practitioners who treated children in general practice. The authors compared the practitioners' responses for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association., Results: A total of 154 surveys were completed and returned (55 percent response rate). The mean age of respondents was 47 years, and the mean number of years in practice was 19. Of the 154 overall, 106 (69 percent) were general practitioners and 48 (31 percent) were pediatric dentists. Across the three in-office clinical case scenarios, adherence to professional prescribing guidelines ranged from 10 to 42 percent. For the two weekend scenarios, overall adherence to the professional prescribing guidelines dropped to 14 and 17 percent. Dentists who had completed postgraduate education (n = 73 [51 percent]) were more likely (P < .05) to have adhered to published guidelines in prescribing antibiotics., Conclusions: The results of this survey show that dentists' adherence to professional guidelines for prescribing antibiotics for odontogenic infections in children was low. There appears to be a lack of concordance between recommended professional guidelines and the antibiotic prescribing practices of dentists. Clearer, more specific guidelines may lead to improved adherence among dentists.

Objective: An audit to ascertain the effectiveness of drainage combined with a three day standard dose antimicrobial regime for patients with acute dentoalveolar abscess and associated systemic symptoms., Method: Patients attending the Primary Care Department at Bristol Dental Hospital with an acute dentoalveolar abscess associated with systemic involvement underwent drainage and removal of the cause of their infection, followed by a three day course of antibiotics. The antibiotic issued was of standard dosage and the choice of antibiotic prescribed varied depending on the type of infection present. The patients were followed up by either telephone or clinical review., Results: From a sample size of 188 patients, an overall review was obtained for 80.3% of patients. When departmental guidelines were followed all reviewed patients achieved a successful outcome. An overall antibiotic prescribing rate of 2.9% was achieved for adult patients attending the emergency department in pain., Conclusion: Following drainage and removal of the cause of infection, a three day standard dose antibiotic regime was effective in the management of the acute dentoalveolar abscess in all reviewed patients showing associated signs of systemic symptoms.

Immediate extraction of teeth in the setting of an acute infection has shown to be beneficial for many reasons. It results in faster resolution of the infection, decreased pain, and earlier return of function and oral intake. The risk of seeding the infection into deeper spaces by performing immediate extraction is low., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Most infections of the head and neck and virtually all of those encountered in the practice of dentistry are caused by bacteria that are organized into biofilms. A biofilm is a complex, usually multispecies, highly communicative community of bacteria that is surrounded by a polymeric matrix. Treatment of these types of infections with traditional antibiotics alone is ineffective, and surgical removal of diseased tissue is still necessary., (Copyright © 2011 Elsevier Inc. All rights reserved.)

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., (Copyright © 2011 Elsevier Inc. All rights reserved.)

More than 30 million pounds of antibiotics are used in the United States per year, more than 90% for nontherapeutic purposes in animals. Environmental contamination by trace amounts of antibiotics and highly resistant bacteria can lead to resistant infections in humans. Oral and maxillofacial infections are largely mediated by biofilms, which are resistant to antibiotics. Primary treatment is surgical debridement, removal of the cause of the infection, and drainage of pus. Current best practices indicate the use of antibiotics as adjunctive therapy to surgery only when regional, distant, or systemic spread of the infection is a significant risk., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: A retrospective study is made of the odontogenic infections treated in La Paz University Hospital (Madrid, Spain) during 2007 and 2008, with an epidemiological and microbiological analysis of a large group of patients., Study Design: A retrospective descriptive study was made, involving the consecutive inclusion of all patients with odontogenic infection requiring admission to our hospital in the period between January 2007 and December 2008., Results: A total of 151 patients were included, with a mean age of 40.3 years and a balanced gender distribution. The most frequently affected teeth were those located in the posterior mandibular segments, caries being the main underlying cause. Most isolates comprised mixed flora, particularly viridans streptococci, different species of Prevotella, Micromonas micros, and different species of Actinomyces. Susceptibility analysis of the microbial isolates showed a high percentage resistance to clindamycin (42.8% of all isolates), particularly among Viridans Streptococci., Conclusions: The use of antibiotics in head and neck infections requires updated protocols based not only on the existing scientific evidence but also on the epidemiological reality of each center. On the other hand, identification is required of the surgical factors determining infection and how they influence morbidity associated with this type of pathology.

Dentoalveolar infections represent a wide spectrum of conditions, from simple localized abscesses to deep neck space infections. The initial assessment of the patient with a dentoalveolar infection requires considerable clinical skill and experience, and determines the need for further airway management or emergent surgical therapy. Knowledge of head and neck fascial space anatomy is essential in diagnosing, understanding spread, and surgically managing these infections. Oral and maxillofacial surgeons must make use of their wide spectrum of clinical skill and knowledge to effectively evaluate and treat patients with dentoalveolar infections., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Craniocervical necrotizing fasciitis is a rare infectious process that can be life-threatening. It most commonly occurs as a result of a severe dentoalveolar infection. This article reviews the diagnosis, microbiology, anatomy, and pathophysiology behind this infectious process; the incidence; and the recommended treatments and therapies. It is hoped that this article provides the treating health care provider with an up-to-date review of this serious infectious process., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To determine the impact of antecedent dental procedures and dental health on the course of odontogenic maxillofacial infections requiring hospital care., Patients and Methods: In this retrospective cohort study in a referral center, we evaluated medical records and panoramic radiographs of all patients admitted because of odontogenic maxillofacial infection (n = 84). The predictor variables were preceding dental treatment, antimicrobial therapy, and dental health. The outcome variables comprised infection parameters, length of stay, need for intensive care, and management during hospitalization., Results: The mean age of the patients was 43.2 ± 16.5 years and 60% were men. Dental procedure preceded the spread of the infection in 49 cases (58%): endodontic treatment (n = 22), tooth extraction (n = 19), and minor first aid (n = 8). Twenty-seven patients had not received any dental or antimicrobial treatment in the recent past. Antimicrobial treatment alone had been given to 8 patients. Patients without preceding treatment had the highest C-reactive protein levels on admission and at maximum (P = .020 and P = .011) and the highest white blood cell counts on admission (P = .011). Their length of stay was also longer, and they needed intensive care more often than the other patients. Maximum C-reactive protein levels and white blood cell counts between treatment groups did not significantly differ from each other., Conclusions: The systemic response to the infection was strongest and the course of the infection most severe in the absence of preceding dental treatment and in patients with poor dental health. All types of dental treatment contributed to a less severe course of infection., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: West Virginia has the worst oral health in the United States, but the reasons for this are unclear. This pilot study explored the etiology of this disparity using culture-independent analyses to identify bacterial species associated with oral disease., Methods: Bacteria in subgingival plaque samples from twelve participants in two independent West Virginia dental-related studies were characterized using 16S rRNA gene sequencing and Human Oral Microbe Identification Microarray (HOMIM) analysis. Unifrac analysis was used to characterize phylogenetic differences between bacterial communities obtained from plaque of participants with low or high oral disease, which was further evaluated using clustering and Principal Coordinate Analysis., Results: Statistically different bacterial signatures (P<0.001) were identified in subgingival plaque of individuals with low or high oral disease in West Virginia based on 16S rRNA gene sequencing. Low disease contained a high frequency of Veillonella and Streptococcus, with a moderate number of Capnocytophaga. High disease exhibited substantially increased bacterial diversity and included a large proportion of Clostridiales cluster bacteria (Selenomonas, Eubacterium, Dialister). Phylogenetic trees constructed using 16S rRNA gene sequencing revealed that Clostridiales were repeated colonizers in plaque associated with high oral disease, providing evidence that the oral environment is somehow influencing the bacterial signature linked to disease., Conclusions: Culture-independent analyses identified an atypical bacterial signature associated with high oral disease in West Virginians and provided evidence that the oral environment influenced this signature. Both findings provide insight into the etiology of the oral disparity in West Virginia.

The colonization of oral surfaces by micro-organisms occurs in a characteristic sequence of stages, each of which is potentially amenable to external intervention. The process begins with the adhesion of bacteria to host receptors on epithelial cells or in the salivary pellicle covering tooth surfaces. Interbacterial cell-cell binding interactions facilitate the attachment of new species and increase the diversity of the adherent microbial population. Microbial growth in oral biofilms is influenced by the exchange of chemical signals, metabolites and toxic products between neighbouring cells. Bacterial cells on tooth surfaces (dental plaque) produce extracellular polymers such as complex carbohydrates and nucleic acids. These large molecules form a protective matrix that contributes to the development of dental caries and, possibly, to periodontitis. The identification of key microbial factors underlying each step in the formation of oral biofilms will provide new opportunities for preventative or therapeutic measures aimed at controlling oral infectious diseases., (© 2010 John Wiley & Sons A/S.)

Objective: The oral cavity forms an indispensable part of the human microbiome, for its unique and diverse microflora distributed within various niches. While majority of these organisms exhibit commensalism, shifts in bacterial community dynamics cause pathological changes within oral cavity and distant sites. The aim of this review was to appraise the current and emerging methods of detecting bacteria of the oral cavity paying particular attention to the cultivation independent methods., Design: Literature pertaining to cultivation based and cultivation independent methods of oral bacterial identification was reviewed., Methods: The specific advantages and disadvantages of cultivation based, microscopic, immunological and metagenomic identification methods were appraised., Results: Because of their fastidious and exacting growth requirements, cultivation based studies grossly underestimate the extent of bacterial diversity in these polymicrobial infections. Culture independent methods deemed more sensitive in identifying difficult to culture and novel bacterial species., Conclusion: Apart from characterizing potentially novel bacterial species, the nucleic acid sequence data analyzed using various bioinformatics protocols have revealed that there are in excess of 700 bacterial species inhabiting the mouth. Moreover, the latest pyrosequencing based methods have further broadened the extent of bacterial diversity in oral niches.

Antibiotics work by exploiting differences between human and bacterial cells. They are grouped according to their targets of action: cell wall synthesis, protein synthesis, and nucleic acid replication. Generally they should be used as an adjunct to local measures that aim to remove the source of infection and drain pus, usually when infection has spread to adjacent tissue spaces. They should not be used prophylactically after surgical extractions unless significant pre-existing infection is diagnosed.

Background: The dental literature suggests that a patient's antiplatelet medication schedule should not be altered before invasive dental procedures. The authors conducted a study to examine the frequency of bleeding complications after invasive dental procedures in patients taking antiplatelet medications., Methods: In a retrospective study of 43 dental patients who were receiving single or dual antiplatelet therapy, the authors conducted a chart review of patient records and examining documentation of the medical history. They collected demographic data; medical history; medication history; social history; presence of preoperative infection at any dental visit as evidenced by swelling, purulence or periapical radiolucency; number and type of invasive dental visits; emergency department visits; types of dental procedures performed; use of adjunctive perioperative local hemostatic measures (for example, topical thrombin, absorbable gelatin compressed sponge, sutures); blood products used preoperatively and postoperatively; and postoperative complications., Results: Twenty-nine patients (67 percent) were receiving dual antiplatelet therapy. There were 88 invasive-procedure visits consisting of extractions, periodontal surgery, and subgingival scaling and root planing. The authors found no differences between patients receiving single or dual antiplatelet therapy for all variables, most notably the number of invasive-procedure visits, total extractions and adjunctive hemostatic measures. There were no documented episodes of prolonged postoperative bleeding., Conclusions: The frequency of oral bleeding complications after invasive dental procedures was low to negligible for patients who were receiving single or dual antiplatelet therapy., Clinical Implications: The risks of altering or discontinuing use of antiplatelet medications far outweigh the low risk of postoperative oral bleeding complications resulting from dental procedures.

Since the initial observations of oral bacteria within dental plaque by van Leeuwenhoek using his primitive microscopes in 1680, an event that is generally recognized as the advent of oral microbiological investigation, oral microbiology has gone through phases of "reductionism" and "holism". From the small beginnings of the Miller and Black period, in which microbiologists followed Koch's postulates, took the reductionist approach to try to study the complex oral microbial community by analyzing individual species; to the modern era when oral researchers embrace "holism" or "system thinking", adopt new concepts such as interspecies interaction, microbial community, biofilms, poly-microbial diseases, oral microbiological knowledge has burgeoned and our ability to identify the resident organisms in dental plaque and decipher the interactions between key components has rapidly increased, such knowledge has greatly changed our view of the oral microbial flora, provided invaluable insight into the etiology of dental and periodontal diseases, opened the door to new approaches and techniques for developing new therapeutic and preventive tools for combating oral polymicrobial diseases.

Objectives: To describe dental and periodontal diseases and oral lesions in newly diagnosed leprosy patients., Design: Cohort study with 99 leprosy patients carried out at the Leprosy Control Programme Outpatient Clinic, Serra-ES, Brazil. A questionnaire about demographic and clinical data was used. Clinical oral examination was performed through the decayed, missing and filled teeth index (DMFT index), the use and need of prosthesis, periodontal disease and the presence of mucous membrane oral lesions. Skin and oral mucous biopsies were also undertaken., Results: Decayed teeth were present in 73% of the patients, at least one lost tooth was present in 71.4%, the mean of the number of lost teeth among the patients in this survey was 88; and 603% of the patients did not have their teeth filled. Periodontal disease was present in 80.8%, and gingival bleeding in 92% of the patients. DMFT index average was 14.4. Nine out of the 63 patients presented with oral clinical lesions, however, most of them presented with unspecific chronic inflammation and typical epithelial hyperplasia., Conclusions: These newly diagnosed leprosy patients were similar in respect of oral health to the normal Brazilian population. Serious dental loss and edentulism were observed, as were a high DMFT index and frequency of periodontal diseases. These data highlight a lack of oral health prevention and treatment and poor access even when available.

Odontogenic etiology accounts for 10% to 12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due to the close relationship of the maxillary posterior teeth to the maxillary sinus. If a periapical dental infection or dental/oral surgery procedure violates the schneiderian membrane integrity, infection will likely spread into the sinus, leading to sinusitis. An odontogenic source should be considered in individuals with symptoms of maxillary sinusitis and a history of dental or jaw pain; dental infection; oral, periodontal, or endodontic surgery; and in those people resistant to conventional sinusitis therapy. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes outnumbering the aerobes. Diagnosis requires a thorough dental and clinical evaluation, including radiographs. Management of sinus disease of odontogenic origin often requires medical treatment with appropriate antibiotics, surgical drainage when indicated, and treatment to remove the offending dental etiology.

Erythromycins have been part of our armamentarium against selected bacterial infections since they were discovered in 1952 and approved by the Food and Drug Administration (FDA) in 1964. In 1991, two newer, long-acting erythromycin analogues, azythromycin (brand name: Zithromax) and clarithromycin (brand name: Biaxin) were approved by the FDA. They were joined a few years later by a third long-acting form, dirithromycin (brand name: Dynabac).

Most suppurative orofacial infections are polymicrobial. Information regarding the antimicrobial susceptibility of the microorganisms involved can be useful in the choice of an effective antibiotic therapy. In this study we determined the antimicrobial susceptibility of a total 235 anaerobic and aerobic bacteria recently isolated from pus specimens of orofacial infections. All the viridans streptococci were susceptible to penicillin, cefotaxime, cefoxitin, imipenem and levofloxacin. Imipenem and levofloxacin were active against 100% of the anaerobic Gram-positive organisms isolated. Among the anaerobic Gram-negative rods beta-lactamase production was detected in all species except Campylobacter rectus. Amoxicillin-clavulanate, cefoxitin, imipenem and metronidazole were active against all the isolates of anaerobic Gram-negative species. Isolates resistant to erythromycin were found in all the species tested, however, resistance to clindamycin was only detected in Porphyromonas gingivalis and Bacteroides ureolyticus. Isolates resistant to levofloxacin were detected in P. gingivalis and Prevotella sp.

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an "oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism". In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it's clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It's necessary to administer the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if necessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar.

Multiple-displacement amplification (MDA) has been used to uniformly amplify bacterial genomes present in small samples, providing abundant targets for molecular analysis. The purpose of this investigation was to combine MDA and checkerboard DNA-DNA hybridization to examine the microbiota of endodontic infections. Sixty-six samples were collected from teeth with endodontic infections. Nonamplified and amplified samples were analyzed by checkerboard DNA-DNA hybridization for levels and proportions of 77 bacterial taxa. Counts, percentages of DNA probe counts, and percentages of teeth colonized for each species in amplified and nonamplified samples were computed. Significance of differences for each species between amplified and nonamplified samples was sought with Wilcoxon signed-rank test and adjusted for multiple comparisons. The amount of DNA in the samples ranged from 6.80 (+/- 5.2) ng before to 6.26 (+/- 1.73) mug after MDA. Seventy of the 77 DNA probes hybridized with one or more of the nonamplified samples. All probes hybridized with at least one sample after amplification. Most commonly detected species at levels of >10(4) in both amplified and nonamplified samples were Prevotella tannerae and Acinetobacter baumannii at frequencies between 89 and 100% of samples. The mean number of species at counts of >10(4) in amplified samples was 51.2 +/- 2.2 and in nonamplified samples was 14.5 +/- 1.7. The endodontic microbiota was far more complex than previously shown, although microbial profiles at teeth with or without periradicular lesions did not differ significantly. Species commonly detected in endodontic samples included P. tannerae, Prevotella oris, and A. baumannii.

Background: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm., Methods: Fifty-four periodontally healthy patients were assigned as follows: group 1 (N = 18), root exposure (RE) without non-carious cervical lesions (NCCL) treated with coronally positioned flap (CPF); group 2 (N = 18), RE with NCCL treated RMGI restorations plus CPF; group 3 (N = 18), RE with NCCL treated with MC restorations plus CPF. Probing depth (PD), visible local plaque score (PL), and local bleeding on probing (BOP) were assessed at baseline and 6 months after surgeries. Restored and non-restored root recoverage (RR) was assessed at 6 months. Each experimental tooth was subgingivally sampled (baseline and 6 months) and analyzed by checkerboard DNA-DNA hybridization., Results: Clinical results showed no significant differences among the groups regarding PL, BOP, and PD at baseline and 6 months. The RR means were similar among the groups at 6 months. Intragroup analyses revealed that the proportions of 10 periodontopathogens decreased at 6 months for the control group. For the RMGI group, there was a significant decrease in the proportions of nine periodontopathogens. For the MC group, there was a significant increase in the proportions of Fusobacterium nucleatum polymorphum and Gemella morbillorum and a decrease in five periodontopathogens. Intergroup analyses showed an increase in the proportion of F. nucleatum polymorphum for the MC group., Conclusions: In a 6-month evaluation, well-finished RMGI or MC subgingival restorations did not negatively affect periodontal health. Furthermore, RMGI seems to exert more positive effects on the subgingival biofilm composition than MC.

Aim: To investigate in individuals with symptomatic dental abscesses the occurrence of functional polymorphisms within five genes involved with the immune response. The functional gene polymorphisms analysed were CD14 (-260 C/T), IL1B (+3954 C/T), IL6 (-174 G/C,), IL10 (-1082 G/A) and TNFA (-308 G/A)., Methodology: Genomic DNA obtained from oral swabs from individuals with symptomatic dental abscesses and asymptomatic inflammatory periapical lesions, without previous exacerbation, was submitted to restriction fragment length polymorphism (RFLP) analyses to determine each individual genotype. The chi-square and principal components analysis tests were used for statistical analysis., Results: A significant association was observed between the occurrence of the GG genotype or the G allele expression of the polymorphic locus-174 (G/C) of the IL6 gene, and the presence of the symptomatic dental abscesses in women and in individuals < or =35 years old. The principal components analysis suggested predominance of the symptomatic dental abscesses in individuals displaying: high-producer IL6 genotype; intermediate and high-producer IL1B genotypes and low-producer TNFA genotype., Conclusions: The present study suggests that genetic factors are associated with susceptibility to develop symptomatic dental abscesses.

The "Synergistes" group of organisms are a phylogenetic cluster of Gram-negative anaerobes related to Synergistes jonesii, sufficiently distinct from all other phyla to be considered a distinct phylum or Division. They are widely distributed in nature although normally only a minor constituent of the bacterial community in each habitat. They have evolved to adapt to each habitat, and therefore exhibit a wide range of physiological and biochemical characteristics, although all cultivable taxa so far studied have the ability to degrade amino acids. They are found in the human mouth where they appear to be more numerous in tooth and gum disease than health. They have also been found in the human gut and soft tissue infections. Their role in human disease has yet to be established but improved knowledge of the characteristics that enable their identification should increase the likelihood of their recognition when present at diseased sites.

The study was undertaken to characterize the microbiology of dental abscesses in children and to compare clindamycin and ampicillin/sulbactam in the treatment of facial cellulitis of odontogenic origin. Sixty children with acute facial cellulitis of dental origin underwent surgery (extraction or root canal procedure) within 24 hours of presentation. Pus samples were cultured aerobically and anaerobically. Patients were randomized (1:1) to receive intravenous ampicillin/sulbactam or clindamycin for 48 hours followed by oral amoxicillin/clavulanate or clindamycin for 7 days. A total of 211 bacterial isolates were recovered from 54 samples. The most common aerobic and facultative organisms were viridans streptococci, Neisseria, and Eikenella species. Among anaerobes, Prevotella and Peptostreptococcus species were the most frequent. No treatment failure occurred in either group. Dental abscesses in children are polymicrobial aerobic/anaerobic infections. Treatment of complicated dental infections with ampicillin plus a beta-lactamase inhibitor or clindamycin in combination with surgical drainage is very effective.

In addition to saliva, other oral components such as gingival crevicular fluid, epithelial cells, bacteria, breath, and dental plaque have diagnostic potential. For oral diseases such as caries and periodontal disease, visual diagnosis is usually adequate, but objective diagnostic tests with predictive value are desired. Therefore, prediction models like the Cariogram have been developed that also include oral aspects such as saliva secretion, buffering capacity, and Streptococcus mutans counts for the prediction of caries. Correlation studies on salivary components and caries have not been conclusive, but correlation studies on functional aspects, such as saliva-induced bacterial aggregation and caries, look promising. Modern proteomic techniques make it possible to study simultaneously the many salivary components involved in these functions.

Persistent undiagnosed fever remains a common problem in clinical practice. In a variable number of cases, no definitive diagnosis is made. This lack of a clear etiology indicates that certain disorders are not being detected despite the recently developed technology usually applied in this situation. On occasion, dental disease is one potential cause of persistent fever. Oral symptoms usually are not present, thus allowing the oral cavity to be overlooked during physical examination. We describe three patients with persistent fever due to dental disease and discuss the pathogenesis of this disease.

Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI)., Patients and Methods: In this study, 37 consecutive hospitalized patients with odontogenic infection were treated with intravenous penicillin (PCN) (unless allergic), and prompt incision and drainage. Standardized data collection included demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications information. Appropriate descriptive statistics were computed., Results: The sample consisted of 37 subjects (38% female) with a mean age of 34.9 years. Three subjects (8%) had immunocompromising diseases. Caries was the most frequent dental disease (65%) and the lower third molar was the most frequently involved tooth (68%). Trismus and dysphagia were present on admission in over 70% of cases. The masticator, perimandibular (submandibular, submental, and/or sublingual), and peripharyngeal (lateral pharyngeal, retropharyngeal, and/or pretracheal) spaces were infected in 78%, 60%, and 43% of cases, respectively. Abscess was found in 76% of cases. PCN-resistant organisms were identified in 19% of all strains isolated and in 54% of patients with sensitivity data. PCN therapeutic failure occurred in 21% of cases and reoperation was required in 8%. Length of hospital stay was 5.1 +/- 3.0 days. No deaths occurred., Conclusions: This study indicated that PCN resistance, resulting in PCN therapeutic failure, was unacceptably high in this sample. Alternative antibiotics, such as clindamycin, should be considered in hospitalized patients with OI. Masticator space infection occurred much more frequently than previously reported. Trismus and dysphagia should be appreciated as significant indicators of severe OI.

Purpose: The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation., Patients and Methods: We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables., Results: The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 +/- 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF., Conclusion: Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.

Most infections of the oral cavity, including the major dental diseases caries and periodontitis, are opportunistic in nature. They are caused or maintained by microorganisms of the resident or transient flora normally present in low numbers and not pathogenic, but in certain circumstances develop infections. Mucosal infections have some degree of specificity [e.g. Candida spp., Staphylococcus aureus, and enterics] and a microbiological test can be interpreted accurately for clinical diagnosis and choice of treatment. Subepithelial or deep infections, however, include a number of species from the resident flora, mainly anaerobes whose role in the infections is difficult to interpret. However, microbiological tests and the presence of certain bacterial species could be used for treatment control, risk-evaluation and even for patient motivation in the prevention of these diseases. Microbiological diagnosis can be used in general practice for several purposes and in various situations that can be of great value for the dental patient.

Background and Aims: Immunosenescence, the age-related decline in immunologic function in healthy individuals, seems to contribute to increased susceptibility to bacterial infections in the elderly population. The present study describes elderly patients' susceptibility to deep neck infection and prognosis., Methods: Between January 2000 and March 2004, 103 patients were admitted to the Department of Otolaryngology, University of Padova for deep neck infection. Twenty-four patients (23%) were over 65 (elderly patients). The remaining 79 patients (77%) aged < or =65 years (adult non-elderly patients) were also studied. Presentation modalities, origin of infection, site of deep neck infection, radiological investigations, bacteriology, treatment and outcome were all studied., Results: Hypertension and diabetes mellitus were the most commonly associated systemic diseases in both elderly and non-elderly patients. The number of patients with associated systemic diseases was significantly higher in the elderly group. The most common cause of deep neck infection was dental infection in both age groups. In the elderly group, salivary gland origin had the same incidence as dental origin. Twenty-two patients (6 elderly patients) were treated only with intravenous antibiotic therapy and intravenous steroids. Overall, in 81 cases (78.6%) (18 elderly patients) medical plus surgical procedures were indicated. None of the treated patients died of deep neck infection or its complications., Conclusions: Although the incidence of associated systemic diseases and complications of deep neck infections were higher in the elderly group, our medical or medical plus surgical approaches to deep neck infections, based on clinical and radiological evidence, were successful in all patients treated.

Background: The authors conducted a study to determine if odontogenic signs and symptoms in the emergency department predicted the development of overt odontogenic infection at a follow-up dental visit., Methods: One hundred ninety-five patients with odontalgia, but without overt signs of infection, were enrolled in a prospective, double-blind, randomized clinical trial. Data included dental diagnosis, pain characteristics, presence of caries and restorations, presence and size of periapical radiolucencies and other diagnostic test results., Results: Thirteen of 134 subjects for whom data were available had signs of infection at the follow-up visit. Subjects in the follow-up infected (FU-I) group had larger baseline radiolucencies than did subjects in the follow-up noninfected (FU-NI) group, and restorations were more prevalent for involved teeth in the FU-I group than in the FU-NI group., Conclusions: A relationship exists between radiolucency size and the presence of amalgam restorations in patients who develop clinical signs of infection. Penicillin did not appear to influence this progression., Clinical Implications: Antibiotics are not effective in preventing the development of odontogenic infection when definitive dental therapy cannot be provided for acute pain in the absence of clinical signs of infection. Although the overall risk of developing infection is low, early treatment is indicated for teeth with larger periapical radiolucencies, amalgam restorations or both.

The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency and cleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paper aims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.

Bacterial biofilms have been found to develop on root surfaces outside the apical foramen and be associated with refractory periapical periodontitis. However, it is unknown which bacterial species form extraradicular biofilms. The present study aimed to investigate the identity and localization of bacteria in human extraradicular biofilms. Twenty extraradicular biofilms, used to identify bacteria using a PCR-based 16S rRNA gene assay, and seven root-tips, used to observe immunohistochemical localization of three selected bacterial species, were taken from 27 patients with refractory periapical periodontitis. Bacterial DNA was detected from 14 of the 20 samples, and 113 bacterial species were isolated. Fusobacterium nucleatum (14 of 14), Porphyromonas gingivalis (12 of 14), and Tannellera forsythensis (8 of 14) were frequently detected. Unidentified and uncultured bacterial DNA was also detected in 11 of the 14 samples in which DNA was detected. In the biofilms, P. gingivalis was immunohistochemically detected in all parts of the extraradicular biofilms. Positive reactions to anti-F. nucleatum and anti-T. forsythensis sera were found at specific portions of the biofilm. These findings suggested that P. gingivalis, T. forsythensis, and F. nucleatum were associated with extraradicular biofilm formation and refractory periapical periodontitis.

Objectives: : To study the microbiology of sinusitis associated with odontogenic origin., Methods: : Aspirates of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection were processed for aerobic and anaerobic bacteria., Results: : A total of 66 isolates were recovered from the 20 cases of acute sinusitis (3.3/specimen), 16 aerobic and facultatives, and 50 anaerobic. Aerobes alone were recovered in 2 (10%) specimens, anaerobes only in 10 (50%), and mixed aerobic and anaerobic bacteria in 8 (40%). The predominant aerobic were alpha-hemolytic streptococci (5), microaerophilic streptococci (4), and Staphylococcus aureus (2). The predominant anaerobes were anaerobic Gram-negative bacilli (22), Peptostreptococcus (12), and Fusobacterium spp. (9). A total of 98 isolates were recovered from the 28 cases of chronic sinusitis (3.5/patient): 21 aerobic and facultatives and 77 anaerobic. Aerobes were recovered in 3 (11%) instances, anaerobes only in 11 (39%), and mixed aerobic and anaerobic bacteria in 14 (50%). The predominant aerobes were alpha-hemolytic streptococci (7), microaerophilic streptococci (4), and S. aureus (5). The predominant anaerobes were Gram-negative bacilli (41), Peptostreptococcus (16), and Fusobacterium spp. (12). Thirteen beta-lactamase-producing bacteria (BLPB) were recovered from 10 (50%) patients with acute sinusitis and 25 BLPB from 21 (75%) patients with chronic sinusitis. No correlation was found between the predisposing odontogenic conditions and the microbiological findings., Conclusions: : These data illustrate the similar microbiology of acute and chronic maxillary sinusitis associated with odontogenic infection where anaerobic bacteria predominate in both types of infections.

A previously undescribed filamentous, beaded, Gram-positive, rod-shaped bacterium was isolated from pus of a human dental abscess. Based on its cellular morphology and the results of biochemical testing the organism was tentatively identified as a member of the genus Actinomyces, but it did not correspond to any currently recognized species of this genus. Comparative 16S rRNA gene sequencing studies showed the bacterium represents a distinct subline within the genus Actinomyces, clustering within a group of species that includes Actinomyces bovis, the type species of the genus. Sequence divergence values of >8 % with other recognized species within this phylogenetic group clearly demonstrated that the organism represents a hitherto unknown species. Based on biochemical and molecular phylogenetic evidence, it is proposed that the unidentified organism recovered from a dental abscess be classified as a novel species, Actinomyces dentalis sp. nov. The type strain is R18165T (=CCUG 48064T=CIP 108337T).

Objective: To evaluate the efficacy of antimicrobial therapy in oral odontogenic infections using estimated pharmacokinetic/pharmacodynamic parameters or efficacy indices, and to compare pharmacokinetic/pharmacodynamic breakpoints with National Committee for Clinical Laboratory Standards' (NCCLS) breakpoints., Study Design: Retrospective literature search to obtain minimum inhibitory concentration (MIC) values, pharmacokinetic parameters of antimicrobials and NCCLS breakpoints. Pharmacokinetic simulations were carried out using WinNonlin software (Pharsight Corporation, Mountain View, CA, USA)., Methods: For antimicrobials with time-dependent activity, the time that the plasma drug concentration exceeds the MIC as the percentage of dose interval at steady state was calculated. For antimicrobials with concentration-dependent activity, the total area under the plasma concentration-time curve over 24 hours at steady state divided by the MIC was calculated. Pharmacokinetic/pharmacodynamic breakpoints were calculated according to these parameters., Results: Only amoxicillin/clavulanic acid and clindamycin showed adequate efficacy indices against the most commonly isolated bacteria in odontogenic infections. Metronidazole reached good indices against anaerobes only. Pharmacokinetic/pharmacodynamic susceptibility breakpoints do not coincide exactly with NCCLS breakpoints., Conclusion: Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results.

Both caries and periodontal disease, as well as many diseases of the mucous membranes, tongue, and salivary glands, are infectious. If left untreated or inadequately treated, they have profound systemic, as well as local, effects. Maintenance of oral health goes beyond the physiological needs of proper nutritional intake and protection of the oral tissues. It also includes protection against oral sources of systemic infection and encompasses a range of social and psychological attributes. The rising expectations of patients in the pursuit of comfort and esthetics has provided evidence of the oral contribution to quality of life. Oral infections and their sequela account for the major portion of annual dental expenditures.

Objectives: Azithromycin has recently replaced clindamycin oral suspension for prop hylaxis of infective endocarditis (IE) in children. It is also currently recommended by the American Heart Association as an alternative to penicillin, along with clindamycin for prophylaxis of infective endocarditis in adults. The objectives of this paper were to firstly, review the current literature on the efficacy of azithromycin as a suitable prophylactic agent in the prevention of infective endocarditis; and secondly, to review its pharmacological properties as a suitable therapeutic agent in the management of odontogenic infections., Design: A review of the literature., Conclusions: The available evidence from animal models on infective endocarditis supports the efficacy of this drug as a prophylactic agent against oral streptococci. The pharmacological properties of this agent would make it a very promising therapeutic adjunct in the management of odontogenic infections. At present there are only a small number of studies available with valuable data on the efficacy of this relatively new drug. Further investigations comparing this compound with other commonly used adjuncts would be of great benefit.

The polymicrobial nature of the odontogenic infections as well as the variety of associated conditions are a consequence of the diversity of the buccal microbiota and the anatomical and functional complexity of the oral cavity. In addition to this, all these processes can give way to multiple complications which range from the local to the systemic level. The appropriate choice of antibiotic and posology is crucial in the successful management of these infections. Pharmacodynamics provides those parameters that make it possible to assess how antibiotics activity varies in time. As a general rule, the first step in the initial management of orofacial infections in adults, included odontogenic infections, will be the administration of 875 mg of amoxicillin and 125 mg of clavulanic every 8 hours. Therapeutic compliance is paramount to avoid resistance, therefore patient acceptance must be sought. In this sense, it has been proved that Augmentine Plus (2000/125) every twelve hours both as profylaxis and as treatment significantly decreases the rate of infective complications associated to extraction of the third molar.

A previously undescribed Actinomyces-like bacterium was isolated from a human dental abscess. Based on its cellular morphology and the results of biochemical testing the organism was tentatively identified as a member of the genus Actinomyces, but it did not correspond to any currently recognized species of this genus. Comparative 16S rRNA gene sequencing studies showed the bacterium represents a hitherto unknown subline within the genus Actinomyces, clustering within a group of species, which includes Actinomyces bovis, the type species of the genus. Based on biochemical and molecular phylogenetic evidence, it is proposed that the unknown organism recovered from a dental abscess be classified as a new species, Actinomyces oricola sp. nov. The type strain of Actinomyces oricola is R5292(T) (=CCUG 46090(T)=CIP 107639(T)).

In most cases the diagnosis of any molar dental disease in horses is made at an advanced stage, so that permanent restoration of the diseased teeth is not feasible. Complications such as bacteraemia and septicaemia due to infections as a result of dentogenous sinusitis and following dentosurgical procedures have been described in human medicine and in veterinary medicine. Twenty patients were available for examination from the Clinic for Horses of the School of Veterinary Medicine Hannover with molar dental disease in upper or lower jaw. As a result of this disease the infected tooth had to be removed surgically. The aim of this study was to determine the presence of and to identify microbes in 20 patients. Swab samples were taken from infected pulpa, from dental abscesses and from involved nasal sinuses. The samples were examined microbiologically and tested for aerobes and anaerobes at the same time. Infectious agents were found in 19 of 20 horses. In all, 27 different species of infectious agents were isolated, including both aerobic and anaerobic microbes. Fifteen patients (75%) showed a mixed flora. Further differentiation indicated a preponderance of the group of gram-negative obligatory anaerobic agents isolated from a total of 17 horses. In all these samples there was a high concentration of infectious agents of these genera, the most common of which were Prevotella spp (n = 16) and Fusobacterium spp. (n = 15). Pre-surgical antibacterial therapy is recommended to reduce the risk of intra- and/or post-surgical bacteraemia and its serious consequences. In light of these microbiological results and considering the high degree of resistance among all anaerobic microbes, all patients in this study were treated with Amoxicillin.

The purpose of this study was to evaluate the susceptibility of facultative and anaerobic odontogenic infectious flora to various antibiotics. We assessed 178 bacterial strains isolated from 74 patients with odontogenic infections. The E-test was used to determine susceptibility. The microbial flora was predominantly facultative gram-positive organisms and anaerobic gram-negative bacilli. The results of antimicrobial susceptibility test showed that ampicillin resistance was found with a very high level of minimum inhibitory concentration (MIC) in approximately one third of Fusobacterium nucleatum, Prevotella intermedia, Peptostreptococcus micros, and Eikenella corrodens isolates (MIC > or = 8 microg/mL). Greater activity was generally noted with amoxicillin than with ampicillin, but even beta-lactamase inhibitor incorporated amoxicillin showed resistance in more than 10% of all groups except viridans group streptococci and Porphyromonas gingivalis. Tetracycline and erythromycin were considerably less active against the majority of the tested bacterial strains, while minocycline and doxycycline exerted strong antimicrobial activity and could inhibit strains grown at a very low concentration. Among all the tested antibiotics, travofloxacin appears to be a promising drug expressing the highest activities (MIC90 < or = 1 microg/mL), and was regarded as a potent bactericidal drug in odontogenic infections.