Major Orofacial Infection
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Caries not involving the pulpal tissues are typically asymptomatic and are identified clinically by discoloration and softening of the surface enamel or cementum. Sharp edges from partial collapse of the outer tooth structure may serve as a source of irritation to the tongue or cheek tissues. Clinically observed discoloration, probing with a sharp instrument to detect defects and softening of the tooth's calcified tissues are sufficient to institute definitive treatment. When the pulp becomes involved, the tooth may become percussion sensitive, painful to thermal changes, unresponsive to electrical stimulation, and feels as though the tooth contacts prematurely when biting. Chronic pulpal necrosis may result in a grayish to black discoloration of the tooth crown. Clinical observation is sufficient to diagnose gingivitis. Probing the tissue pocket depth immediately adjacent to the tooth measures attachment loss in periodontal disease. A periodontal abscess is present when pus is expressible from tissues surrounding the teeth.
The Crucial Role of Craniofacial Growth on Airway, Sleep, and the Temporomandibular Joint
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
Periodontitis is generally not a chronically painful disorder. Typically, patients may notice gingival sensitivity and tenderness, or gingival enlargement caused by inflammation and bleeding with brushing or probing examination. There is loss of gingival attachment around the necks of and soft tissue pocketing around the roots of the tooth with loss of bone support, which may result in tooth sensitivity, tenderness, and mobility. Pain secondary to periodontal disease is typically dull, generalized to a larger area, and more constant. In the presence of an acute infection in the periodontal tissues, tenderness to the touch, erythema, and bleeding may be evident. An acute periodontal abscess may cause swelling and purulence. When inflammation or infection occurs in the soft tissue or bone around an erupting or partially erupted tooth (particularly third molars), similar signs and symptoms may be seen with pain as a primary complaint.
Bacterial Infections of the Oral Cavity
K. Balamurugan, U. Prithika in Pocket Guide to Bacterial Infections, 2019
Apical periodontitis is often confused with periapical abscess. Clinical correlation is of utmost importance to diagnose whether it is a periodontal or an endodontic infection. The periodontal abscess can also take the course similar to periapical abscess. Multiple periodontal abscesses and weak periodontium are characteristic of diabetes mellitus. Other diseases like neutrophil dysfunction (Chedak Higashi Syndrome), palmoplantar keratosis (Papillon Levfre Syndrome), hypophosphatasia can be associated with a typical form of periodontitis called as aggressive periodontitis. It can also occur in silos as a separate entity. This periodontitis is formerly known as juvenile periodontitis and presents as early loss of teeth and characteristic bone-loss patterns in a young patient in the molar and incisor areas. Refractory periodontitis is another type of periodontitis where the lesions do not respond to conventional modality of treatments. Periodontal diseases are also found to be aggravated by the presence of systemic diseases and vice-versa where it is understood as a reversal of paradigm in understanding lesions accompanied by systemic diseases. The clinician’s role is to correlate the findings and treat the patient appropriately.
The pharmacological management of dental pain
Published in Expert Opinion on Pharmacotherapy, 2020
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Christopher Gharibo, Giustino Varrassi
A periapical abscess or pulpitis may develop when the tooth’s enamel is damaged by caries, facilitating a bacterial invasion. Pulpitis describes the infection of the pulp of the tooth. Note that if bacterial growth proceeds in such a way that there is a drainage for the infection, the infection may remain asymptomatic or have such mild and diffuse symptoms that they go unnoticed for days or weeks. Severe infections may move apically toward the bone and into soft tissues, becoming a periodontal abscess. In such cases, the abscess must be incised and drained and antimicrobial therapy initiated [66]. Periodontitis describes an abscess that occurs when pathogens invade the periodontal pocket and cannot find escape, spreading to the alveolar bone and/or adjacent tissue. Periodontitis may occur with the eruption of the wisdom teeth, which, in rare cases, may progress to a localized infection [66]. Periodontal disease also includes any of several types of gingival infections, infections of the periodontal ligament, or infection of the alveolar bone which anchors the tooth in the jaw. This condition may proceed without symptoms for a long time. Gingivitis or inflammation of the gingiva causes pain and bleeding of the gums due to infection. Acute infectious gingivitis may involve ulceration and advance to acute necrotizing ulcerative gingivitis (ANUG). Symptoms of ANUG include pain, fever, malaise, and the gingiva will be necrotic [66].
Complete Eye Ophthalmoplegia: the unusual initial presentation of Leptomeningeal Carcinomatosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Lakshpaul Chauhan, Ateeq Mubarik, Abdulmagid Eddib, Mohammad Eid, Ali Vaziri, Salman Muddassir
We present a 60-year-old male with no significant medical history who presented to the emergency room with a rapidly growing lump in the right axilla for three weeks. Associated symptoms included jaw pain and swelling, bifrontal headache, weight-loss, and double vision for a one-week duration. Of note, he recently underwent dental surgery two weeks before presentation for a periodontal abscess associated with cervical lymphadenopathy and was now concerned about the possibility of disease progression.
Prevotella species as oral residents and infectious agents with potential impact on systemic conditions
Published in Journal of Oral Microbiology, 2022
Eija Könönen, Dareen Fteita, Ulvi K. Gursoy, Mervi Gursoy
Odontogenic infections are typically of endodontic or periodontal origin. In acute apical abscesses, the most prevalent Prevotella taxa include P. multisaccharivorax, P. intermedia, P. baroniae, and A. tannerae, as well as occasional recoveries of P. oralis and P. nigrescens [152–156]. Significant variations in the microbiome can be, at least in part, explained by geographic/ethnic differences; for example, P. nigrescens, A. tannerae, and F. nucleatum were more prevalent in endodontic abscess samples from the USA than in those from Brazil [153]. Of the 138 clinical strains isolated from periodontal abscesses, the majority represented Prevotella taxa [157]. Of those, 1/3 were identified as P. intermedia, and around 1/10 as P. nigrescens, P. melaninogenica, P. dentalis, P. denticola, and P. buccae . Occasional recoveries included P. fusca, P. histicola, P. multiformis, P. oris, P. oulorum, P. pallens, P. salivae, P. veroralis, and A. rava. Recently, the microbiome compositions between abscess pus and the corresponding periodontal pocket (coronally from the abscess) and periodontally healthy gingival crevice samples were compared [158]. Based on the beta-diversity analyses, periodontal abscess pus and the periodontal pocket shared similar compositions. In comparison to the healthy gingival crevice, P. intermedia and P. heparinolytica, together with P. gingivalis, were the predominant findings and significantly more abundant in periodontal abscesses [158]. In 50 German patients hospitalized for severe odontogenic abscesses, the frequency of Prevotella was 17.7% in saliva (collected prior to the abscess incision) and 27.2% in the pus samples, being the most abundant genus in odontogenic abscesses [159]. In spreading odontogenic infections, members of the genus Prevotella are common, especially P. buccae and P. oris [160–162].
Related Knowledge Centers
- Abscess
- Alveolar Process
- Dental Abscess
- Periodontium
- Pulp Necrosis
- Pus
- Acute
- Pathogenic Bacteria
- Tooth Mobility
- Periodontal Fiber