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It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Actinomyces species are commensal oral cavity flora that can cause jaw osteomyelitis. Osteomyelitis of the jaw by Actinomyces is rare, and its presentation can be confused with many different pathologies., Case Presentation: This is the case of a 61-year-old female with breast cancer and on chemotherapy as well as non-invasive carcinoma of the tongue who initially presented to the dentist with white spots in the right mandible near the incisors associated with right mandible pain and swelling. Actinomyces-induced osteomyelitis of the mandible was diagnosed. The patient was treated with penicillin V for 6 weeks along with a course of hyperbaric oxygen therapy, which resulted in the complete resolution of the infection., Conclusion: In summary, jaw osteomyelitis caused by Actinomyces should always be part of the differential diagnosis; as these organisms are commensal flora. The symptoms manifested are non-specific, and such a diagnosis could be easily missed, resulting in delay of care and disease progression., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

In recent years, several studies have examined the gut microbiome of lepidopteran larvae and how factors such as host plant affect it, and in turn, how gut bacteria affect host plant responses to herbivory. In addition, other studies have detailed how secretions of the labial (salivary) glands can alter host plant defense responses. We examined the gut microbiome of the cabbage looper (Trichoplusia ni) feeding on collards (Brassica oleracea) and separately analyzed the microbiomes of various organs that open directly into the alimentary canal, including the labial glands, mandibular glands, and the Malpighian tubules. In this study, the gut microbiome of T. ni was found to be generally consistent with those of other lepidopteran larvae in prior studies. The greatest diversity of bacteria appeared in the Firmicutes, Actinobacteria, Proteobacteria, and Bacteriodetes. Well-represented genera included Staphylococcus, Streptococcus, Corynebacterium, Pseudomonas, Diaphorobacter, Methylobacterium, Flavobacterium, and Cloacibacterium. Across all organs, two amplicon sequence variants (ASVs) associated with the genera Diaphorobacter and Cloacibacterium appeared to be most abundant. In terms of the most prevalent ASVs, the alimentary canal, Malpighian tubules, and mandibular glands appeared to have similar complements of bacteria, with relatively few significant differences evident. However, aside from the Diaphorobacter and Cloacibacterium ASVs common to all the organs, the labial glands appeared to possess a distinctive complement of bacteria which was absent or poorly represented in the other organs. Among these were representatives of the Pseudomonas, Flavobacterium, Caulobacterium, Anaerococcus, and Methylobacterium. These results suggest that the labial glands present bacteria with different selective pressures than those occurring in the mandibular gland, Malpighian tubules and the alimentary canal. Given the documented effects that labial gland secretions and the gut microbiome can exert on host plant defenses, the effects exerted by the bacteria inhabiting the labial glands themselves deserve further study., (© 2020 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

Hypoxia and limited vascularization inhibit bone growth and recovery after surgical debridement to treat osteomyelitis. Similarly, despite significant efforts to create functional tissue-engineered organs, clinical success is often hindered by insufficient oxygen diffusion and poor vascularization. To overcome these shortcomings, we previously used the oxygen carrier perfluorooctane (PFO) to develop PFO emulsion-loaded hollow microparticles (PFO-HPs). PFO-HPs act as a local oxygen source that increase cell viability and maintains the osteogenic differentiation potency of human periosteum-derived cells (hPDCs) under hypoxic conditions. In the present study, we used a miniature pig model of mandibular osteomyelitis to investigate bone regeneration using hPDCs seeded on PFO-HPs (hPDCs/PFO-HP) or hPDCs seeded on phosphate-buffered saline (PBS)-HPs (hPDCs/PBS-HP). Osteomyelitis is characterized by a series of microbial invasion, vascular disruption, bony necrosis, and sequestrum formation due to impaired host defense response. Sequential plain radiography, computed tomography (CT), and 3D reconstructed CT images revealed new bone formation was more advanced in defects that had been implanted with the hPDCs/PFO-HPs than in defects implanted with the hPDCs/PBS-HP. Thus, PFO-HPs are a promising tissue engineering approach to repair challenging bone defects and regenerate structurally organized bone tissue with 3D architecture., (© 2019 Wiley Periodicals, Inc.)

We report a pediatric case aged 10 years with Granulicatella adiacens-associated chronic mandibular osteomyelitis. The causative pathogen was uncertain because polymicrobial species were detected from the bacterial culture in bone marrow fluid. In contrast, G. adiacens was predominantly identified in the clone library analysis of the bacterial 16S rRNA gene sequence. Vancomycin to which G. adiacens was reported to be susceptible was not administrated sufficiently to this patient because of its adverse event, whereas linezolid and ciprofloxacin was alternatively effective for the treatment of chronic mandibular osteomyelitis., (Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Clinical Introduction: A 77-year-old man presented to the ED with a history of fevers, purulent drainage and right mandibular pain. He had been diagnosed with multiple myeloma 2 years previously and was receiving treatment with pamidronate. On presentation, the lower right lip and chin were anaesthetic, tooth number 31 had grade 2 mobility and a 15 mm long ulceration was present on the lingual aspect of the mandible (figure 1). Antibiotics were administered, and a maxillofacial CT without contrast was performed (figure 2).emermed;36/1/17/F1F1F1Figure 1Clinical examination revealing a 15 mm long ulceration (arrow mark) associated with the lingual aspect of tooth number 31.emermed;36/1/17/F2F2F2Figure 2CT maxillofacial (coronal) demonstrating osseous destruction (arrow mark) of the right mandibular body., Question: What is your diagnosis?Odontogenic abscessBenign fibro-osseous lesionMedication-related osteonecrosis of the jaw (MRONJ)Metastatic malignancy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Osteomyelitis of mandible, if it affects the neonate presents as a diagnostic and therapeutic challenge to the clinician. Symptoms and signs are often non-specific, and the consequences of a missed diagnosis could lead to long-lasting functional limitations. A rare case of a 52 days old infant with osteomyelitis of the mandible following natal tooth extraction is presented in this report. The diagnosis, pathogenesis and management have been explained. The accompanying review briefly summarizes the main clinical, pathophysiological and radiological aspects of the condition and gives an update on the treatment., Competing Interests: There are no conflicts of interest

Introduction: The purpose of this study is to compare a group of patients with Primary Chronic Osteomyelitis of the mandible (PCO) and a group with Secondary Chronic Osteomyelitis of the mandible (SCO) to support the classification of osteomyelitis of the jaws defined by Eyrich et al., Material and Methods: Medical records of patients with chronic osteomyelitis of the mandible were screened and relevant clinical data was recorded retrospectively. The patients were divided into two groups according the criteria proposed by Eyrich et al.: one group with PCO and one with SCO. Comparison was made between these two groups., Results: Twenty-two patients were included, 10 in the PCO group, and 12 in the SCO group. The main differences between the two groups concerned the duration of the symptoms (100% of the cases in the PCO group lasted more than 2years, versus 8.3% in the SCO group, P<0.05), computed tomography images of bone sclerosis and bone hypertrophy (present in respectively 100% and 50% of the patients in the PCO group, vs. 36.4% and 0% in the SCO group, P<0.05), and the treatment (100% of surgical decortication and 80% of Nonsteroidal Anti-Inflammatory Drug or steroids use in the PCO group vs. 25% and 0% in the SCO group, P<0.05)., Discussion: The classification proposed by Eyrich et al. seems relevant according to the results of our study, PCO and SCO differing especially on the duration of the symptoms, the radiologic findings and the treatment and its outcomes., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Some microbes possess the ability to adaptively manipulate host behavior. To better understand how such microbial parasites control animal behavior, we examine the cell-level interactions between the species-specific fungal parasite Ophiocordyceps unilateralis sensu lato and its carpenter ant host ( Camponotus castaneus ) at a crucial moment in the parasite's lifecycle: when the manipulated host fixes itself permanently to a substrate by its mandibles. The fungus is known to secrete tissue-specific metabolites and cause changes in host gene expression as well as atrophy in the mandible muscles of its ant host, but it is unknown how the fungus coordinates these effects to manipulate its host's behavior. In this study, we combine techniques in serial block-face scanning-electron microscopy and deep-learning-based image segmentation algorithms to visualize the distribution, abundance, and interactions of this fungus inside the body of its manipulated host. Fungal cells were found throughout the host body but not in the brain, implying that behavioral control of the animal body by this microbe occurs peripherally. Additionally, fungal cells invaded host muscle fibers and joined together to form networks that encircled the muscles. These networks may represent a collective foraging behavior of this parasite, which may in turn facilitate host manipulation., Competing Interests: The authors declare no conflict of interest., (Copyright © 2017 the Author(s). Published by PNAS.)

Background: Although enamel matrix derivative (EMD) has been used to promote periodontal regeneration, little is known of its effect on the microbiome. Therefore, this investigation aims to identify changes in periodontal microbiome after treatment with EMD using a deep-sequencing approach., Methods: Thirty-nine patients with mandibular Class II buccal furcation defects were randomized to beta-tricalcium-phosphate/hydroxyapatite graft (BONE group), EMD+BONE, or EMD alone. Plaque was collected from furcation defects at baseline and 3 and 6 months post-treatment. Bacterial DNA was analyzed using terminal restriction fragment length polymorphism and 16S pyrotag sequencing, resulting in 169,000 classifiable sequences being compared with the Human Oral Microbiome Database. Statistical comparisons were made using parametric tests., Results: At baseline, a total of 422 species were identified from the 39 defects, belonging to Fusobacterium, Pseudomonas, Streptococcus, Filifactor, and Parvimonas. All three regenerative procedures predictably altered the disease-associated microbiome, with a restitution of health-compatible species. However, EMD and BONE+EMD groups demonstrated more long-term reductions in a higher number of species than the BONE group (P <0.05), especially disease-associated species, e.g., Selenomonas noxia, F. alocis, and Fusobacterium., Conclusions: EMD treatment predictably alters a dysbiotic subgingival microbiome, decreasing pathogen richness and increasing commensal abundance. Further investigations are needed to investigate how this impacts regenerative outcomes.

Introduction: Our aims were to analyze adhesion of periodontopathogens to self-ligating brackets (Clarity-SL [CSL], Clippy-C [CC] and Damon Q [DQ]) and to identify the relationships between bacterial adhesion and oral hygiene indexes., Methods: Central incisor brackets from the maxilla and mandible were collected from 60 patients at debonding after the plaque and gingival indexes were measured. Adhesions of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), and Tannerella forsythia (Tf) were quantitatively determined using real-time polymerase chain reactions. Factorial analysis of variance was used to analyze bacterial adhesion in relation to bracket type and jaw position. Correlation coefficients were calculated to determine the relationships between bacterial adhesion and the oral hygiene indexes., Results: Total bacteria showed greater adhesion to CSL than to DQ brackets, whereas Aa, Pg, and Pi adhered more to DQ than to CSL brackets. CC brackets showed an intermediate adhesion pattern between CSL and DQ brackets, but it did not differ significantly from either bracket type. Adhesion of Fn and Tf did not differ significantly among the 3 brackets. Most bacteria were detected in greater quantities in the mandibular than in the maxillary brackets. The plaque and gingival indexes were not strongly correlated with bacterial adhesion to the brackets., Conclusions: Because Aa, Pg, and Pi adhered more to the DQ brackets in the mandibular area, orthodontic patients with periodontal problems should be carefully monitored in the mandibular incisors where the distance between the bracket and the gingiva is small, especially when DQ brackets are used., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Actinomycosis is an infection of filamentous, gram-positive anaerobic bacteria. Actinomycosis of jaw bone is rare and the diagnosis is often difficult. The aim of this patient report is to present an actinomycotic osteomyelitis of mandible in a 30-year-old male patient. The patient presented with a chief complaint of pain and unhealed dental socket after mandibular teeth extractions. Radiographs showed ill-defined radiolucencies and perforation of buccal and lingual cortical plate; several biopsies and different therapy could not improve the lesion because of fault diagnosis and improper treatment. Finally, the authors' histopathological examination revealed granulation tissue surrounded bacterial colonies compatible with actinomycotic colonies. Follow-up examinations showed that the patient was well 6 months after prolonged treatment without any pain and discharge from dental socket.

Changes in bacteriological indices through the square of the wound of chemical origin under local impact of the silver nanoparticles (NP), stabilized by 2-ethyl-6-methyl-3-hydroxypyridine succinate (mexidol) and polyvinylpyrrolidone were studied. The wounds of submandibular region were simulated in white rats, using injection of 10% solution of calcium chloride with further opening of necrotic foci and open management of the wound. Beginning from the fifth day, every day the wound was irrigated with liquid, which have contented the stabilized NP of the silver, 0.05% water solution of chlorhexidine or isotonic solution of the the sodium chloride (control). There was established, that the silver NP impact antiseptically and regenerative while the wound treatment, and reduce during 10 days microbial contamination of exudate in 24 times, the wound square--in three times in comparison with original indices. These changes were identical to those while application of chlorhexidine.

Own experience of treatment of a narcotic dependence patients, suffering osteomyelitis of jaws, was analyzed. In those patients, who have had exposed themselves towards toxic impact of narcotic substances (even after arrest of the consumption) for a long period of time, the inflammation spreading on the bones of facial middle zone and the skull base with occurrence of a life3threatening purulent3septic, including intracerebral, complications (cerebral аbscess, meningitis, sepsis) were observed. Additional division of cerebral abscess on open and closed forms for optimization of diagnosis of іntracranial complications was proposed.

Objective: To analyze in vivo mutans streptococci (MS) adhesion to self-ligating ceramic brackets [Clarity-SL (CSL) and Clippy-C (CC)] and the relationships between bacterial adhesion and oral hygiene indices., Materials and Methods: Four central incisor brackets from the maxilla and mandible were collected from 40 patients (20 patients per each bracket type) at debonding immediately after plaque and gingival indices were measured. Adhesions of Streptococcus mutans, S. sobrinus, and total bacteria were quantitatively determined using real-time polymerase chain reaction after genomic DNA was extracted. Factorial analysis of variance was used to analyze bacterial adhesion to the brackets with respect to the bracket type and jaw position. Correlation coefficients were calculated to determine the relationships of bacterial adhesion to oral hygiene indices., Results: Adhesion of total bacteria and S. mutans to CSL was higher than that to CC (P < 0.001). Adhesion of total bacteria to the mandibular brackets was higher than that to the maxillary ones (P < 0.001), while adhesion of S. mutans to the maxillary brackets were higher than that in the mandibular ones (P < 0.001). In particular, the proportion of S. mutans to total bacteria in CSL was higher than CC (P < 0.05) in the maxillary anterior teeth (P < 0.001). There were no significant differences in adhesion of S. sobrinus between the brackets and jaw positions. Interestingly, no significant relationships were found between bacterial adhesions and oral hygiene indices., Limitations: Complex bracket configurations may significantly influence bacterial adhesion to orthodontic brackets. Further in vivo study using bracket raw materials will help to define the relationships between bacteria adhesion and enamel demineralization., Conclusions: Because oral hygiene indices were not significantly correlated with adhesions of MS to self-ligating ceramic brackets, careful examinations around the brackets should be needed to prevent enamel demineralization, regardless of oral hygiene status., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To determine the level of bacterial contamination in immediate implantation or augmentation sites vs pristine bone, before and after saline rinses., Materials and Methods: Bacterial samples were taken from fresh extraction sites (17 patients) and pristine bone (15 patients) before performing implant dentistry surgical procedures. Levels of bacterial contamination were estimated before and after saline rinses. Samples from the socket were placed on an agar plate for total bacterial account and on selective plates for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis counts., Results: The level of bacterial contamination before saline rinse was 1.2 × 10(4) units of bacterial colony (CFU)/mL in fresh extraction sites (study group) and 5 × 10(2) CFU/mL in pristine bone sites (control group). After a saline rinse, the bacterial level was lowered significantly to 5.2 × 10(3) CFU/mL in the study group and to zero in the control group (P < .05). Levels of bacterial contamination were higher in the mandibular sockets (7.5 × 10(3) CFU/ml) than in the maxillary sockets (5.6 × 10(3) CFU/mL), and the difference was statistically significant (P = .034). All implanted/augmented fresh or pristine sites survived in the follow-up period., Conclusion: Fresh extraction sockets with clinical signs of infection show bacterial presence. Pristine bone shows a lower bacterial level. Saline rinse in addition to a decontamination protocol may reduce the level of bacterial contamination significantly both in fresh extraction sites and pristine bone.

Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen with frequent multidrug resistance. The immaturity of the immune system along with intravascular lines and empirical antibiotic treatments place hospitalized preterm infants at major risk of MRSA infection.We report a case of MRSA mandibular osteomyelitis complicating a persistent S. aureus bacteremia in a 23-week preterm infant. From the first weeks of life, the infant showed recurrent C-reactive protein (CRP) elevation, associated with S. aureus bacteremia. Antibiotic courses, including vancomycin and linezolid, were performed with transitory normalization of blood parameters. On day 74, the infant suddenly deteriorated and showed a significant increase of both CRP and procalcitonin. Empiric vancomycin and piperacillin-tazobactam treatment was started; nevertheless, she developed a progressive hard swelling of neck and mandible. Radiological evaluation revealed a mandibular osteomyelitis complicated by an abscess, whose culture grew MRSA. Vancomycin was thus changed to teicoplanin and complete clinical and radiological healing was gradually achieved.In the presence of major risk factors, persistent bacteremia and nonspecific symptoms, a localized focus of infection should be suspected. Microbiological diagnosis should always be attempted and antibiotic treatment should be guided by both susceptibility results and clinical response.

Purpose: The aim of this study was to compare levels of bacterial contamination of autogenous bone collected when using low-speed drilling, a back-action chisel, and a bone filter., Materials and Methods: Bone tissue samples were taken from 31 patients who underwent surgical extraction of their third lower molars. Before surgical removal of the molar, bone particles were collected by a low-speed drill or a back-action chisel. Then, a stringent aspiration protocol was applied during the ostectomy to collect particulate bone by a bone filter. Processing of samples commenced immediately by incubation in an anaerobic or a CO2-rich atmosphere. The number of colony-forming units (CFUs) was determined at 48 hours of culture., Results: No significant difference in the number of CFUs per milliliter was observed between the low-speed drilling group and the back-action chisel group in the anaerobic or CO2-rich condition (P = .34). However, significantly more micro-organisms were found in the bone filter group than in the low-speed drilling group or the back-action chisel group in the anaerobic and CO2-rich conditions (P < .001)., Conclusions: Particulate bone harvested with low-speed drilling or a back-action chisel is safer for use as an autograft than are bone particles collected with a bone filter. These results suggest that bone obtained from low-speed drilling is safe and straightforward to harvest and could be the method of choice for collecting particulate bone. Further research is needed to lower the bacterial contamination levels of autogenous bone particles used as graft material., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Periodontal diseases are multifactorial, caused by polymicrobial subgingival pathogens, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Chronic periodontal infection results in inflammation, destruction of connective tissues, periodontal ligament, and alveolar bone resorption, and ultimately tooth loss. Enoxacin and a bisphosphonate derivative of enoxacin (bis-enoxacin) inhibit osteoclast formation and bone resorption and also contain antibiotic properties. Our study proposes that enoxacin and/or bis-enoxacin may be useful in reducing alveolar bone resorption and possibly bacterial colonization. Rats were infected with 10(9) cells of polymicrobial inoculum consisting of P. gingivalis, T. denticola, and T. forsythia, as an oral lavage every other week for twelve weeks. Daily subcutaneous injections of enoxacin (5 mg/kg/day), bis-enoxacin (5, 25 mg/kg/day), alendronate (1, 10 mg/kg/day), or doxycycline (5 mg/day) were administered after 6 weeks of polymicrobial infection. Periodontal disease parameters, including bacterial colonization/infection, immune response, inflammation, alveolar bone resorption, and systemic spread, were assessed post-euthanasia. All three periodontal pathogens colonized the rat oral cavity during polymicrobial infection. Polymicrobial infection induced an increase in total alveolar bone resorption, intrabony defects, and gingival inflammation. Treatment with bis-enoxacin significantly decreased alveolar bone resorption more effectively than either alendronate or doxycycline. Histologic examination revealed that treatment with bis-enoxacin and enoxacin reduced gingival inflammation and decreased apical migration of junctional epithelium. These data support the hypothesis that bis-enoxacin and enoxacin may be useful for the treatment of periodontal disease.

This study evaluated the in vitro and in vivo performance of antibiotic-releasing porous polymethylmethacrylate (PMMA)-based space maintainers comprising a gelatin hydrogel porogen and a poly(dl-lactic-co-glycolic acid) (PLGA) particulate carrier for antibiotic delivery. Colistin was released in vitro from either gelatin or PLGA microparticle loaded PMMA constructs, with gelatin-loaded constructs releasing colistin over approximately 7 days and PLGA microparticle-loaded constructs releasing colistin for up to 8 weeks. Three formulations with either burst release or extended release at different doses were tested in a rabbit mandibular defect inoculated with Acinetobacter baumannii (2×10(7) colony forming units ml(-1)). In addition, one material control that released antibiotic but was not inoculated with A. baumannii was tested. A. baumannii was not detectable in any animal after 12 weeks on culture of the defect, saliva, or blood. Defects with high dose extended release implants had greater soft tissue healing compared with defects with burst release implants, with 8 of 10 animals showing healed mucosae compared with 2 of 10 respectively. Extended release of locally delivered colistin via a PLGA microparticle carrier improved soft tissue healing compared with implants with burst release of colistin from a gelatin carrier., (Copyright © 2013 Acta Materialia Inc. All rights reserved.)

Impaction or cessation of eruption is a relatively common dental finding. The third molars are the teeth usually associated with impaction, followed by canines and premolars. Impaction of second molars has been rarely reported. This report reviews an extremely rare case of multiple impacted second molars, including a discussion of the clinical and radiological features of the case.

The etiologic agent of mandibulofacial and maxillofacial abscesses in mice is reportedly coagulase-positive Staphylococcus aureus. Although suggested to be through the oral cavity, the exact route of entry has not been documented. Among the clinical cases of mandibulofacial and maxillofacial abscess we report here, each case that was cultured yielded coagulase-positive S. aureus. Histologically, all of the abscesses examined were directly associated with intralesional hair shafts, both vibrissae and pelage, that were introduced into the submucosa via the maxillary or mandibular molar gingival sulci. Grossly, a variable amount of hair was imbedded in the lingual, buccal, or mesial gingival sulci of the maxillary or mandibular molars or both. Computed tomography revealed that the presence of the hair resulted in inflammation and resorption of alveolar bone. With these findings, we propose that mandibulofacial and maxillofacial abscesses are induced by the mastication and fragmentation of hair ingested during the barbering process. From the resulting foreign body periodontitis, abscess formation originates at the maxillary lingual, buccal, or mesial gingival sulci, resulting in infection of the maxillary molar tooth roots with swelling or rupture through the skin inferior to the eye, or at the mandibular lingual, buccal, and or mesial gingival sulci, resulting in infection of the mandibular molar tooth roots and osteomyelitis with drainage through the skin of the ventral mandible.

A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery. Debridement surgery included excision of the lower lip, chin, floor of the mouth, a portion of the tongue, as well as mandibular resection at the level of the horizontal branches. Eight weeks of combined antifungal therapy were followed by secondary prophylaxis with amphotericin B lipid formulation during consolidation chemotherapy after achieving complete response of both leukaemia and mucormycosis. Reconstructive surgery was carried out including insertion of a new biomaterial porous mandibular prosthesis, which showed excellent functionality after long-term follow-up, followed by several plastic surgery procedures once good tolerability and no adverse effects of the prosthesis were observed. This case shows that a well-coordinated multidisciplinary approach is critical to increase the chances of clinical success in this life-threatening infection., (Copyright © 2010 S. Karger AG, Basel.)

Cancrum oris (or noma) is a rapidly progressive disease characterized by destructive necrosis of oral tissues and underlying bone. It is part of a multistage condition and may represent the outcome of untreated necrotizing stomatitis. Necrotising stomatitis and cancrum oris predominantly affect children in developing countries, especially in Africa. Only few cases have been reported in developed countries, and were associated with debilitating diseases and disorders of the immune system. We report a case of noma in an elderly immunosuppressed Italian patient in whom necrosis caused an external buccal communication. This case stresses the importance of an early identification and prompt management of the necrotic condition, in order to avoid diffusion of the destructive process within the oro-facial tissues.

The writer detects changes of density of strontium, calcium, zinc and ratio Ca/Sr, Zn/Sr in oral liquid at examination 162 patients with acute odontogenic inflammatory diseases and 85 ill with a fracture of a mandible and at it inflammatory complication. By her is established the increase density of calcium in a stomatic liquid at all purulent-inflammatory diseases of maxillofacial area. The strontium is reduced only at an acute odontogenic osteomyelitis and odontogenic lymphadenitis complicated by a phlegmon. The ratio Ca/Sr, Zn/Sr is-augmented also only at the data diseases.

Information on lesion distribution and characteristics is essential to determine the significance of a species as a reservoir host for tuberculosis (TB). Herein, we describe the extension and distribution of lesions in 127 Mycobacterium tuberculosis Complex culture positive European wild boars (Sus scrofa), and use this information to discuss the role of this wildlife species in TB epidemiology in Mediterranean Spain. Macroscopic TB-compatible lesions were detected in 105 of 127 wild boars (82.68%). Only microscopic lesions were found in 11 wild boars (8.66%). Lesions were not evident in 11 wild boars (8.66%). A total of 49 wild boars had lesions confined to one anatomical region (42.2%, localized TB), while 67 animals had lesions in more than one anatomical region (57.8%, generalized TB). Head lymph nodes (LNs), particularly the mandibular LNs, were most frequently affected (107/116, 92.24%), and 43 wild boar had only mandibular LN lesions. Histopathology evidenced TB lesions in 38.1% of the lungs, 23% of the livers and 13% of the spleens examined. Mammary gland lesions were observed in three cases. When TB lesions were localized, granulomas characterized by a mixed inflammatory cell population were more predominant, whereas strongly necrotic-calcified granulomas were more prevalent in generalized cases of TB infection. Large lesions in more than one anatomical region were more frequent among juveniles. The histopathological characteristics of the tuberculous reaction and the associated tissue damage in various organs, together with the gross pathology, indicate that at least those wild boar with large lesions and generalized infections have the potential to excrete mycobacteria by several routes. This finding, in the context of unusually high densities of wild boar and fencing and feeding, reinforces the suggestion that wild boar can act as a true TB reservoir under the particular circumstances of Mediterranean Spain. Further studies on the routes of excretion as well as the effect of altering management methods would be of interest to confirm the role of wild boar in TB epidemiology in Spain.

Infected osteoradionecrosis (IORN) is one of the major complications of oral cancer radiotherapy. Recent studies showed a high prevalence of Actinomyces in IORN. In this study, the clinical follow up of IORN patients (n=25; 20 male, 5 female) with regard to Actinomyces detection in the mandible was analyzed. Within 1.6-119 months of follow up, disease control was achieved in almost 90% of the patients with Actinomyces-negative bone biopsies, but only in 25% of the Actinomyces-positive group. The presence of Actinomyces was associated with a significantly higher risk of treatment failure (P=0.004; Fisher's exact test). This held true when the data were controlled for 'extent of bone destruction', 'type of surgery' and 'soft-tissue closure' in a logistic regression analysis (P=0.018; Wald test). Since Actinomyces was detected in a significant number of patients with non-healing mucosal defects, this microbe may promote the persistence of chronic non-healing inflammatory processes. Actinomyces positivity defines a subpopulation with a clinically deteriorated course of mandibular IORN.

Early Holocene bison mandibles (Bison antiquus) from Nebraska, ca. 8500 y ago, were examined with a variety of modern histotechnological procedures and staining techniques. A pathological, anatomical diagnosis of moderately severe, locally extensive, mandibular osteomyelitis with intralesional spherules morphologically consistent with fungal pathogens in the genus Coccidioides was made. The modern distribution of the organisms in North America is restricted to the arid Southwest. This implies either the fossil home range of the fungi was larger than it is today or fossil bison migrated between endemic and nonendemic foci during the early Holocene.

Administration of antibiotics and analgesics in surgery or trauma is of great importance for an effective treatment. Trauma, as stress stimulus, causes alterations in various functions of the organism as well as in drug pharmacokinetics. The aim of this study was to determine the effect of trauma upon the serum and bone levels of the antimicrobial ampicillin and cefapirin, with and without co-administration of a non-steroidal anti-inflammatory analgesic (NSAIDs). Fifty-six male Wistar rats were divided into two groups A (control) and B (experimental). Each group consisted of 4 subgroups (n=7) receiving ampicillin, ampicillin with niflunic acid, cefapirin, and cefapirin with niflunic acid. In group B traumatic injury was performed by incision (7 mm length) in the right cheek. The levels of the antibiotics were estimated by the inhibition zone of B. subtilis. An increase in antibiotic levels was observed in group B, being statistically significant only for cefapirin level in the mandible. Upon niflumic acid co-administration a statistically significant rise in serum ampicillin and mandible cefapirin levels was observed in both control and experimental groups (student t-test). It can be concluded that the combination of antibiotics and non-steroid antiinflammatory drugs (NSAIDs) may enhance the antibacterial drug concentration.

Infected osteoradionecrosis (IORN) is a severe complication of radiation therapy for head and neck cancer. Infected osteoradionecrosis can lead to fracture and often requires subsequent jaw resection. It is known that irradiated bone is highly susceptible to infections, mainly with Candida species and cariogenic bacteria. Only very few data exist on Actinomyces in IORN. The study population consisted of 31 patients (7 female, 24 male; median age, 58.3 years). All patients exhibited clinical and radiological signs of IORN (infection, mucosa or skin fistula, and sequestrated bone). To detect Actinomyces colonies, histological examination was performed using several staining procedures (hematoxylin-eosin, Gram, Grocott, periodic acid-Schiff). In addition, a semi-nested polymerase chain reaction (PCR) approach was designed targeting the 16S ribosomal RNA gene. We found prominent Actinomyces colonies in 20 (64.5%) of 31 patients. Most of these lesions were localized in the mandible (16/20). Most interestingly, Actinomyces were almost exclusively found attached to the necrotic bone. PCR testing confirmed the presence of Actinomyces-specific DNA sequences (Actinomyces israelii). We show that Actinomyces is considerably more frequent in IORN than previously demonstrated. We suggest that these organisms are involved in the chronic, nonhealing inflammatory processes and the purulent discharge, which are known as characteristics of IORN. It remains to be investigated whether Actinomyces could be involved in the osteolytic mechanisms. From the histopathologic perspective, detection of Actinomyces is important because these bacteria have been shown to be associated with prolonged treatment duration.

Purpose: The purposes of the study presented are to identify the microbial content of the collected bone debris and to determine the antibacterial efficiency of chlorhexidine mouth rinse in reducing the microbial content of the collected bone debris., Patients and Methods: Twenty-five patients who had asymptomatic fully impacted mandibular third molars bilaterally underwent surgical removal for prophylactic and orthodontic considerations. Immediately before surgery all patients rinsed with 10 mL of their assigned solution (chlorhexidine or sterile saline) for 2 minutes. Before surgical removal of the teeth, bone debris was collected with a stringent aspiration protocol from the ramus by bone filter. The microbial content of the bone debris was assessed and the bacterial levels between the 2 groups were compared statistically., Results: All samples from both groups (chlorhexidine or sterile saline) yielded viable microorganisms. There was no significant difference between the mean/median colony-forming units (CFU)/g values of both group samples, for aerobes (Streptococcus salivarius) and anaerobes (Bacteroides, Peptococcus, Peptostreptococcus, and Veillonella species). With regard to total microorganisms, the mean CFU/g derived from the chlorhexidine group samples were 1.5 x 10(8) CFU/g per bone sample compared with 1.5 x 10(9) CFU/g for the sterile saline control group (P < .05)., Conclusion: Although chlorhexidine rinsing immediately before surgery reduced the levels of total microorganisms when compared with stringent aspiration protocol alone, it has not been found effective on aerobic Streptococcus salivarius and, importantly, on anaerobes. The reduced bacterial levels may still carry high infectious risk and may lead to failure in autogenous grafting procedures in oral surgery.

Background: Long-term data on microbiological and clinical outcome as well as on patient satisfaction after implant therapy in the edentulous mandible are limited. Especially comparisons between fixed full prostheses (FFPs) and overdentures (ODs), or between anchoring systems for the latter are scarce., Aim: This study aimed to evaluate both of these parameters at the 10-year follow-up in a group of fully edentulous patients rehabilitated via an OD or a FFP (the latter to allow inter-group comparison)., Material and Methods: A total of 37 fully edentulous patients (25 ODs, 12 FFPs, age at implant installation ranged from 36 to 85 years) participated in this study. All subjects received their implants (Branemark System, Nobel Biocare AB, Gothenburg, Sweden) 10 years previously. For the ODs different attachment systems (bar, magnets, ball) had been applied that allowed a further intra-group comparison. At the follow-up visit, 10 years after the abutment insertion, a series of periodontal parameters were recorded, long-cone radiographs were taken and subgingival plaque samples were collected for analysis using checkerboard DNA-DNA hybridization. The clinical and radiographic data were recorded at abutment connection and after 1 and 10 years., Results: After 10 years of loading, mean plaque and bleeding indices and changes in attachment or marginal bone level were not significantly different, neither between the OD and FFP group, nor within the OD group. The marginal bone loss between abutment connection and year 10 was 0.86 and 0.73 mm for OD and FFP groups, respectively. The subgingival microbiota at implant sites from all (sub)-groups was comparable, with low numbers of DNA counts (+/-10 x 10(5)) but high detection frequencies of Actinobacillus actinomycetemcomitans (>90%), Porphyromonas gingivalis (>85%) and Tannerella forsythensis (30%). The composition of the subgingival microbiota was influenced by probing depth and bleeding tendency. Patient satisfaction was very high for both types of prosthetic rehabilitation. The FFP group scored only slightly better for chewing comfort and general satisfaction., Conclusion: These data indicate that from the clinical and microbiological standpoint, as well as patient satisfaction, both an OD and a FFP offer a favourable long-term outcome.

Osteomyelitis attributable to Actinomyces often results in recurrent disease and inconsistent responses to antimicrobial agents. We present data for 4 patients and a review of the 15 previously described pediatric cases of actinomycosis presenting as osteomyelitis. Fourteen cases involved the mandible and 5 cases involved other sites. All mandibular cases required at least 1 debridement, with 4 of the cases requiring multiple debridements.

The aim of the study was to examine the three-dimensional vitality structure of dental biofilms grown simultaneously at different locations in the oral cavity over a 48-hour period. Eight healthy volunteers wore special acrylic appliances. On each buccal side of the upper and the lower jaw three glass slabs were inserted, allowing for growth of a biofilm mimicking approximal plaque. After 48 h, the specimens were removed and biofilms were stained using two fluorescent dyes which selectively stain vital bacteria green and dead bacteria red. Under the confocal laser scanning microscope optical sections of 1 microm throughout the biofilm were made. To assess the vitality values (proportion of vital bacteria) of the whole biofilm as well as the vitality distribution in the different plaque sections an image analysis program was used. Plaque from the different locations revealed mean vitality values between 64.4 and 75.7% in the upper jaw and between 64.3 and 76.8% in the lower jaw, which were not statistically different. However, a great variation of the vitality values for the different layers and among the 8 subjects was found. Nevertheless, the analysis of the data of each single volunteer revealed a very similar vitality pattern in all twelve locations.

The extraction of a tooth led to the acute exacerbation of existing chronic osteomyelitis then phlegmon, and sepsis as a result. Persisting coma developed after three reanimations of the patient, on account of septic shock. Finally, in more than two weeks following the extraction the patient died due to multiorgan failure. This case description wishes to call attention to the risks of complications of diabetes, to summarize the relevant documents of diagnosis and treatment of osteomyelitis and phlegmon and the data of mortality. Hopefully we offer some useful advice to the general dentist about patients with immunosuppressive diseases.

Inflammatory process in mandibular bone was induced in 39 outbred rats by a pure culture of Bacteroides fragilis and by an associative culture of B. fragilis and Staphylococcus aureus. Anaerobic microflora notably aggravated the course of inflammation. In contrast to inflammation in other parts of the skeleton, inflammation of the jaws involves a high risk of infection of the oral cavity by pathogenic microflora. A variety of microorganisms is isolated from the focus: from gram-positive staphylococci to gram-negative enterobacteria, which fact should be borne in mind when planning antibiotic therapy. Combined use of antibiotics active towards the entire spectrum of agents detected in this study is the most effective.

Actinomycosis is an infectious disease that appears throught the world, in cattle and human beings. It is a chronic granulomatous and suppurative lesion, usually affecting the cervicofacial area. Definitive diagnosis, by culture or biopsy, is not always possible, so the clinician must suspect it by its clinical presentation. It is the purpose of this article to present the patients diagnosed and treated in our Department during the last 5 years, and to review the ideal therapy.

Hematogenous osteomyelitis was produced in the tibia or the mandible of rats by drilling a hole into the bone, injecting sodium morrhuate, and inoculating Staphylococcus aureus Phillips into the femoral vein. Animals were sacrificed after 2 weeks and examined. The infection was characterized grossly and radiographically by bone deformation, histopathologically by a characteristic suppurative reaction, and microbiologically by the recovery of S. aureus Phillips from the infected tissue. These findings indicate that the model mimics human osteomyelitis with respect to its inflammatory bone changes. In contrast to earlier rat models in which bacteria were injected directly into the bone, this new experimental model allows study of the initiating events of osteomyelitis such as bacterial attachment and might assist as a model for both prophylactic and therapeutic trials.

Infection complicating craniofacial procedures contributes significantly to patient morbidity and health care costs. The role of fixation materials in this setting remains unclear. As foreign material, does fixation hardware increase patients' susceptibility to developing postoperative infection? Furthermore, once infection is established, should fixation hardware be removed? To answer these questions, we performed an onlay membranous bone grafting procedure to the mandible in 94 New Zealand White rabbits, applied lag-screw fixation in half the animals, and inoculated the wounds with different bacterial doses. We quantified the differential rates of infection and rates of graft union in the presence of infection. The infection rates for the rigidly fixated group were not significantly different from the rates for the nonfixated group for a range of bacterial inoculum doses. There was no significant difference in the rates of resolution of infection and sepsis between the two groups. Gross and histologic assessments revealed a significantly lower union rate for infected grafts when compared with uninfected grafts. Furthermore, grafts rigidly fixated with a lag screw showed a higher rate of union when compared with nonfixated grafts in the presence of infection. In the absence of infection, the union rates for fixated and nonfixated groups did not differ significantly. While fixation hardware has been cited as a risk factor for postoperative infection, we were unable to show that lag-screw fixation contributes to this risk. Although infection impaired the union of membranous bone grafts to the recipient mandible, fixation of the grafts with a lag screw significantly decreased this deleterious effect of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 13 dogs weighing 13-15 kg were infected by intra-dental route with the tuberculosis mycobacterium strain H37R in a dose of 0.5 ml in the 5th dilution according to a turbidity standard. Two dogs were given intravenously the same dose of tuberculosis mycobacteria and they formed a control group. The observation varied from 10 days to 5 months. It was found tuberculosis development in intradental contamination could be attended by generalized specific affection of the viscera and development of a "minor" tuberculosis inflammation in the peridental tissues.

A successful attempt was made to mechanically transmit bovine leukosis virus (BLV) from a BLV-infected cow with a normal lymphocyte count to sheep by inoculation with horse fly (Tabanus abactor) mouthparts. After interrupted natural feeding, horse flies were anesthetized with CO2. Mouthparts were severed and pooled into a tissue grinder containing medium. Five inocula containing the mouthparts of 10 flies each, and 5 inocula containing the mouthparts of 20 flies each, were prepared and inoculated SC in the right axilla of 10 BLV antibody-negative sheep. Five additional sheep served as controls. Serum samples were collected at 2-week intervals and tested by agar gel immunodiffusion for BLV antibodies. One sheep injected with 20 mouthparts developed antibodies to BLV at 10 weeks after inoculation. Six months after inoculation with fly mouthparts, 1 BLV antibody-negative sheep was randomly selected from each treatment group and injected, in the left axilla, with 3 ml of blood from the donor cow to confirm susceptibility of the sheep. All 3 sheep developed antibodies to BLV within 4 weeks.

Mycotic flora was studied from the dentures and denture bearing mucosae of 39 persons who wore soft-lined (Molloplast B) mandibular dentures and heat-cured acrylic resin maxillary dentures. Fungal growth was detected in 85% of the mandibular dentures and in 44% of the maxillary dentures (p less than 0.001). On the mandibular mucosa fungal growth was revealed in 74% and on the mucosa of the maxilla in 69%. In connection with inflamed mucosae fungal growth was always detected on the mandibular denture and on the mandibular mucosa in 93% as well as on the maxillary denture in 50% and on the maxillary mucosa in 75%. Considering the healthy mandibular mucosa fungus was found in 75% on the mandibular dentures and in 62% on the mucous membranes. In connection with healthy maxillary mucosae the corresponding figures were 42% and 68%. The specimens revealed 7 different yeasts and 2 moulds. The most common fungi were Candida albicans (86%), Torulopsis glabrata (31%), and C. tropicalis (14%). The uncured Molloplast material caused a definite inhibition of candida growth in vitro, while the cured material indicated no growth inhibition.