Apical periodontitis as potential source of infection in patients with lymphoma treated with chemotherapy

Dental Complications and Reasons for Delayed Clearance Before Hematopoietic Stem Cell Transplant

AIM

Dental evaluation before hematological stem-cell transplant (HSCT) is considered a standard of care. Data on the complications of dental treatment before HSCT are scarce. The aim was to analyze the data on dental treatment in patients undergoing HSCT with an emphasis on complications and reasons for delayed dental clearance.

MATERIALS AND METHODS

Retrospective chart review of 125 patients referred for dental evaluation before HSCT was performed. Demographic, medical, dental data, and complications were registered. Number of appointments and days required to obtain a dental clearance for HSCT were registered, as well as reasons for delayed (i.e., > 21 days) dental clearance.

RESULTS

The most common procedure was tooth extraction, performed in 48 (38.4%) patients. Complications, that is, local infection and delayed healing, occurred in 2 (1.6%) patients. Most patients (104; 83.2%) obtained dental clearance for HSCT in 1-2 appointments (median 1 day). No patient experienced dental complications during the early (≤ 30 days) post-transplant period. Seven (5.6%) patients had their dental clearance delayed for more than 21 days due to increased treatment needs and complex medical conditions.

CONCLUSIONS

Dental treatment before HSCT can be performed with an acceptable safety rate. Delayed dental clearance occurs in complex, high-risk patients with significantly increased treatment needs.

Controlling Root Canal Infection in Oncological Patients with Apical Periodontitis

INTRODUCTION

This study evaluated the effectiveness of chemomechanical preparation associated with intracanal medication in reducing the total bacterial load of infected root canals in cancer patients undergoing antineoplastic treatment. The prevalence, levels, and response to treatment of Streptococcus and Actinobacteria species were also assessed.

METHODS

The root canals of teeth with apical periodontitis from oncological and control patients were treated using rotary instrumentation, 2.5% NaOCl irrigation, and 2-week calcium hydroxide medication (n = 23/group). Bacteriological root canal samples were taken before (S1) and after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracted from the samples was subjected to 16S rRNA gene-based quantitative real-time polymerase chain reaction assays for evaluation of the treatment effects on total bacteria, Streptococcus species, and members of the Actinobacteria phylum.

RESULTS

All S1 samples were positive for bacteria. S1-S2 and S1-S3 bacterial reduction values were highly significant (P < .01). Although bacterial counts were reduced from S2 to S3, the decrease was not statistically significant (P > .05). Intergroup comparisons showed no significant differences in S1, S2 and S3 counts (P > .05). In the oncological group, 77% of the cases were positive for bacteria in S2, and 68% in S3. In the control group, corresponding figures were 65% for both S2 and S3. There were no significant differences between groups as for streptococci and actinobacteria prevalence, levels, and response to treatment (P > .05).

CONCLUSIONS

Root canal treatment using rotary instruments, NaOCl irrigation, and calcium hydroxide medication was highly effective in reducing the bacterial populations in infected teeth with apical periodontitis from cancer patients, with no significant differences to controls.

Endodontic Treatment in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study

INTRODUCTION

This study investigated the implications of root canal treatment (RCT) of infected teeth with apical periodontitis (AP) in patients undergoing hematopoietic stem cell transplantation (HSCT).

METHODS

One hundred patients were selected. Clinical data, oncologic and endodontic diagnosis and treatment, and type of HSCT were recorded. Data on the exacerbation of AP were investigated. Leukocyte/neutrophil and C-reactive protein levels were evaluated before and after RCT.

RESULTS

One hundred patients underwent HSCT (55% autologous). The need for RCT was identified in 41% of the participants. AP was diagnosed in 75.6% of these patients and large lesions (≥5 mm) occurred in 45.2%. A higher prevalence of AP was observed in males (P = .012). RCT was performed in 54.8% of the individuals and no AP exacerbation, pain, swelling, bacteremia, and need for additional medications was observed. Blood cultures were negative for bacteria and fungi. C-reactive protein levels were ≥1 mg/dL in 54.9% of the individuals 1 month before RCT and <1 mg/dL in 64.6% 6 months after treatment (P > .05).

CONCLUSIONS

RCT was effective in controlling infection with no complications in patients undergoing HSCT. Given the potential for exacerbation of endodontic infections, RCT and patient monitoring are essential and highly recommended.

Postoperative pain in oncological patients subjected to nonsurgical root canal treatment: a prospective case-control study

OBJECTIVES

The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment.

METHODS

Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups.

RESULTS

Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group.

CONCLUSIONS

No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients.

CLINICAL RELEVANCE

Oncological patients had no increased risk of postoperative pain in comparison with control patients.

Pre-medical assessment of root-canal-filled teeth with asymptomatic apical periodontitis-A multifaceted balancing act

AIM

Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding the pre-medical management of root-canal-filled teeth with asymptomatic apical periodontitis (AAP).

METHODOLOGY

Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root-canal-filled teeth with AAP-one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach.

RESULTS

A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub-categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference.

CONCLUSIONS

The current interview study found pre-medical decision-making regarding root-canal-filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.

Assessment of oral health condition in recipients of allogeneic hematopoietic cell transplantation

INTRODUCTION

The optimization of oral health before allogeneic hematopoietic cell transplantation (HCT) is important for preventing infectious complications during treatment.

OBJECTIVE

The objective of this study was to evaluate the oral health condition and dental treatments performed in patients in pre-allogeneic HCT.

METHOD

The records of patients treated during 2018 at a Brazilian HCT service were reviewed. The following oral health data were obtained: 1. Decayed, missing and filled teeth / correlated index for primary dentition (DMFT/dmft); 2. Quality of oral hygiene and 3. Dental pathologies: 3.1 Periodontal infectious focus, 3.2 Endodontic infectious focus and 3.3 Carie incidence. All dental procedures performed were surveyed.

RESULTS

Thirty-three patients were included, with a mean age of 28.42 (±16.37), 20 male (60%) and 13 female. The average DMFT/dmft found in this study was 10.24 (± 8.37), similar to the index found in the population in southeastern Brazil. The younger study population presented a DMFT/dmft considered high, when compared to the general population. A total of 27.2% of the patients had active caries lesions, 33.3%, foci of periodontal infection, 15.1%, endodontic infectious focus and 40%, poor oral hygiene. Almost half of the patients (48.4%) had to undergo dental intervention, 24.2% needing periodontal scaling, 21.2%, fillings and 12.1%, tooth extractions.

CONCLUSION

We conclude that the studied population had an important incidence of dental pathologies and infectious conditions that could complicate throughout HCT, especially in younger patients, therefore presenting a high demand for dental treatment in the pre-HCT. Studies that assess the impact of dental conditioning on the outcomes of HCT with an emphasis on dental infectious complications, days of hospitalization and survival are necessary."

Pre-medical dental evaluation and treatment of oral infection - a survey study among hospital-affiliated dentists in Sweden

OBJECTIVE

To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention.

MATERIALS AND METHODS

A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis.

RESULTS

Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%.

CONCLUSION

Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.

Brain abscess of odontogenic origin in patients with malignant tumors: A report of two cases

Background

Oral infection and dental manipulations can lead to the development of brain abscesses, a rare but potentially life-threatening condition. Herein, we report patients undergoing cancer treatment who developed brain abscesses of odontogenic origin at our hospital.

Case Description

Two patients developed brain abscesses during cancer treatment. Both underwent neurosurgical aspiration, and the causative microorganism was identified as Streptococcus intermedius of the Streptococcus anginosus group, which is a part of the normal bacterial flora in the oral cavity. There was clinical and radiographic evidence of dental infection in one of the patients diagnosed with a brain abscess of odontogenic origin. No infectious foci were found in the other patient during hospitalization for the abscess. However, the patient had undergone extraction of an infected tooth approximately 3 months before admission for the abscess, suggesting origination from an oral infection or dental manipulation. The patients' cancers rapidly worsened because cancer treatment in both patients was interrupted for several months to treat the brain abscess.

Conclusion

Oral infections can cause severe infections, such as brain abscesses, particularly during the treatment of malignant tumors. Improving the oral environment or treating oral infections before initiating treatment for malignant tumors is highly recommended. In addition, the possibility of odontogenic origin should always be considered as a potential etiology of brain abscesses.

Prevalence of Apical Periodontitis in patients with Multiple Myeloma

BACKGROUND

Aim Previous reports have been analyzed the prevalence/association of apical periodontitis (AP) with systemic diseases. The present study aims to analyze the prevalence of healthy/diseased periapex and endodontic treatments in patients with Multiple Myeloma (MM) and compare the results with those of control subjects.

MATERIAL AND METHODS

Methodology Panoramic radiographs of 50 individuals with MM were evaluated and compared with 50 controls that were sex and age matched exactly with the diseased group. Radiographic analysis was performed by 2 two experienced endodontists under standardized conditions. The periapical status (presence or not of AP) was assessed using the periapical index (PAI). Data included systemic health, technical quality of root fillings, total number of teeth, quality of restoration, and periapical status. Statistical evaluation of differences between groups included used chi-squared tests and Fisher's exact tests.

RESULTS

The prevalence of root canal-treated teeth was 10.11% in the MM group and 12.05% in the control group (p=0.90). The average root canal-treated teeth in the test group was 2,34 and 2.48 in the control group, where the difference was statistically significant (p=0.05). AP in 1 or more teeth was found in 86 % and in 78% of the patients in the MM and the control groups, respectively. When analyzed by subject, there was no statistically significant difference in the prevalence of AP (p>0.72). Similarly there was also no statistically significant difference in the prevalence of PA (p=0.85), when analyzed by tooth, AP was found in 63.2% and 62.9% in MM and control groups.

CONCLUSIONS

The presence of AP and endodontic treatment was not significantly different in individuals with MM compared with control subjects. Future studies are needed to elucidate and confirm the association between MM and AP.