1
|
Graziani F, Tinto M, Orsolini C, Izzetti R, Tomasi C. Complications and treatment errors in nonsurgical periodontal therapy. Periodontol 2000 2023; 92:21-61. [PMID: 36591941 DOI: 10.1111/prd.12478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/14/2022] [Accepted: 10/14/2022] [Indexed: 01/03/2023]
Abstract
Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.
Collapse
Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Manuel Tinto
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Chiara Orsolini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Wang LY, Cao XH, Shi LK, Ma ZZ, Wang Y, Liu Y. Risk factors for intracranial infection after craniotomy: A case-control study. Brain Behav 2020; 10:e01658. [PMID: 32424961 PMCID: PMC7375057 DOI: 10.1002/brb3.1658] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intracranial infection, serving as a severe postoperative infection after craniotomy, poses significant problems for patients' outcomes. OBJECTIVE To explore risk factors for intracranial infection after craniotomy. METHODS A total of 2,174 patients who underwent craniotomy from 1 May 2018 to 30 June 2019 were retrospectively studied. Finally, 196 patients with intracranial infections were classified as case group, and 392 patients randomly selected from patients without intracranial infection were classified as control group. Demographic, clinical, laboratory, microbiological, and antimicrobial data were systemically recorded. The characteristics, pre- and postoperative variables, and other variables were evaluated as risk factors for intracranial infection by univariate analysis and binary logistic regression model. RESULTS There was no significant difference in terms of demographics between two groups, except for gender, hypertension, length of stay (LOS), intraoperative blood loss, tumor, and trauma surgery. The independent risk factors were male, age ≤45, hypertension, tumor surgery, surgery in autumn (compared with spring), surgical duration ≥4 hr, intraoperative blood loss ≥400 ml, and postoperative oral infection, coma, and serum RBC > normal value. Trauma surgery (p < .001, OR = 0.05, 95% CI: 0.017-0.144) was an independent protective factor (p < .05, OR < 1) for intracranial infection. All 196 patients in the case group submitted specimens for cerebrospinal fluid (CSF) cultures, and 70 (35.71%) patients had positive results. Gram-positive pathogens predominated (59 cases, 84.28%). Staphylococcus were the most common causative pathogens, and fully resistant to aztreonam, cefazolin, and benzylpenicillin, but not resistant to linezolid and minocycline. CONCLUSION Identifying the risk factors, pathogens, and pathogens' antibiotic resistance for intracranial infection after craniotomy plays an important role in the prognosis of patients.
Collapse
Affiliation(s)
- Li-Yi Wang
- Hospital Infection-Control Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu-Hua Cao
- Hospital Neurosurgery Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li-Ke Shi
- Hospital Infection-Control Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-Zhao Ma
- Hospital Neurosurgery Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yue Wang
- Hospital Infection-Control Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Liu
- Hospital Infection-Control Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
3
|
Luo J, Wu B, Zhao Q, Guo Q, Meng H, Yu L, Zheng L, Hong Z, Ding D. Association between tooth loss and cognitive function among 3063 Chinese older adults: a community-based study. PLoS One 2015; 10:e0120986. [PMID: 25803052 PMCID: PMC4372206 DOI: 10.1371/journal.pone.0120986] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
Background Oral health has been found to be associated with cognitive function in basic research and epidemiology studies. Most of these studies had no comprehensive clinical diagnosis on cognitive function. This study firstly reported the association between tooth loss and cognitive function among Chinese older population. Methods The study included 3,063 community dwelling older adults aged 60 or above from the Shanghai Aging Study. Number of teeth missing was obtained from self-reporting questionnaire and confirmed by trained interviewers. Participants were diagnosed as “dementia”, “mild cognitive impairment (MCI)”, or “cognitive normal” by neurologists using DSM-IV and Petersen criteria. Multivariate logistic regression model was applied to examine the association between number of teeth missing and cognitive function. Results The study participants had an average of 10.2 teeth lost. Individuals with dementia lost 18.7 teeth on average, much higher than those with MCI (11.8) and cognitive normal (9.3) (p<0.001). After adjusted for sex, age, education year, living alone, body mass index, cigarette smoking, alcohol drinking, anxiety, depression, heart disease, hypertension, diabetes, and APOE-ε4, tooth loss of >16 were significantly associated with dementia with an OR of 1.56 (95%CI 1.12-2.18). Conclusion Having over 16 missing teeth was associated with severe cognitive impairment among Chinese older adults. Poor oral health might be considered as a related factor of neurodegenerative symptom among older Chinese population.
Collapse
Affiliation(s)
- Jianfeng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Bei Wu
- School of Nursing and Global Health Institute, Duke University, Durham, North Carolina, United States of America
- School of Sociology and Political Sciences, Shanghai University, Shanghai, China
- * E-mail: (DD); (BW)
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Qihao Guo
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Haijiao Meng
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Lirong Yu
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Li Zheng
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China
- * E-mail: (DD); (BW)
| |
Collapse
|
4
|
Moazzam AA, Rajagopal SM, Sedghizadeh PP, Zada G, Habibian M. Intracranial bacterial infections of oral origin. J Clin Neurosci 2015; 22:800-6. [PMID: 25800939 DOI: 10.1016/j.jocn.2014.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 12/30/2022]
Abstract
Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination.
Collapse
Affiliation(s)
- Alan A Moazzam
- Department of General Internal Medicine, Keck Hospital of University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
| | - Sowmya M Rajagopal
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Parish P Sedghizadeh
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mina Habibian
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Pallesen LP, Schaefer J, Reuner U, Leonhardt H, Engellandt K, Schneider H, Reichmann H, Puetz V. Multiple brain abscesses in an immunocompetent patient after undergoing professional tooth cleaning. J Am Dent Assoc 2014; 145:564-8. [PMID: 24878711 DOI: 10.14219/jada.2014.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dental disorders and dental treatment are among the variety of causes of brain abscess. CASE DESCRIPTION The authors present the case of a patient who developed multiple brain abscesses after undergoing professional tooth cleaning. The results of a diagnostic work-up ruled out an underlying immunodeficiency. After receiving neurosurgical intervention and intensive care treatment by means of local and intravenous antibiotics for 24 days, the patient was transferred to another hospital for rehabilitation. Six months after the treatment, the patient still had moderate residual paresis of the left leg. PRACTICAL IMPLICATIONS Although it happens rarely, professional tooth cleaning may be considered a cause of brain abscesses even in otherwise healthy patients.
Collapse
|
6
|
Yoneda M, Kato S, Mawatari H, Kirikoshi H, Imajo K, Fujita K, Endo H, Takahashi H, Inamori M, Kobayashi N, Kubota K, Saito S, Tohnai I, Watanuki K, Wada K, Maeda S, Nakajima A. Liver abscess caused by periodontal bacterial infection with Fusobacterium necrophorum. Hepatol Res 2011; 41:194-6. [PMID: 21269389 DOI: 10.1111/j.1872-034x.2010.00748.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Liver abscess is recognized as a life-threatening disease. However, even in recent years, approximately 50% of liver abscess cases are considered to be cryptogenic. Here, we report a case of liver abscess associated with periodontal bacterial infection by Fusobacterium necrophorum, which is commonly found in the oropharyngeal flora. A 36-year-old man presented with fever and contrast-enhanced abdominal computed tomography revealed multiple liver abscesses. F.necrophorum was isolated from oral smears, liver aspirates and blood samples. Liver abscesses caused by periodontal bacterial infection are rare, however, the incidence is expected to increase in the future, as periodontitis is extremely common and is on the rise as one of the most common chronic infections in the world. A systemic survey including periodontitis may be required for the exact diagnosis of the source of infection.
Collapse
Affiliation(s)
- Masato Yoneda
- Division of Gastroenterology Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama Department of Pharmacology, Osaka University, Graduate School of Dentistry, Suita, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND Numerous studies have linked dementia to the subsequent deterioration of oral health. Few investigators, however, have examined oral disease as a potential risk factor in the development of dementia. The authors conducted a study to investigate a potential association between a history of oral disease and the development of dementia. METHODS Longitudinal dental records supplemented data collected from 10 annual cognitive assessments of 144 Milwaukee participants in the Nun Study, a longitudinal study of aging and Alzheimer disease, who were 75 to 98 years old. Neuropathologic findings at autopsy were available for 118 participants who died. RESULTS A low number of teeth increased the risk of higher prevalence and incidence of dementia. CONCLUSION Participants with the fewest teeth had the highest risk of prevalence and incidence of dementia. CLINICAL IMPLICATIONS Edentulism or very few (one to nine) teeth may be predictors of dementia late in life.
Collapse
Affiliation(s)
- Pamela Sparks Stein
- Department of Anatomy and Neurobiology, College of Medicine, MN 210 Chandler Medical Center, University of Kentucky, Lexington, KY 40536, USA.
| | | | | | | | | |
Collapse
|
8
|
Wagner KW, Schön R, Schumacher M, Schmelzeisen R, Schulze D. Case report: brain and liver abscesses caused by oral infection with Streptococcus intermedius. ACTA ACUST UNITED AC 2006; 102:e21-3. [PMID: 16997089 DOI: 10.1016/j.tripleo.2006.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 11/30/2005] [Accepted: 02/06/2006] [Indexed: 11/25/2022]
Abstract
Organ abscesses are a rare and life-threatening complication mostly of hematogenously disseminated infections. We report a case of brain and liver abscesses. Identification of the lesions was made by contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), respectively. An oral examination comprised an oral focus of infection. Streptococcus intermedius was isolated from oral smear, liver and ventricular drainage, and blood sample. After the commencement of antibiotic therapy, drainage of abscesses and oral rehabilitation, complete recovery was noted.
Collapse
Affiliation(s)
- Kai Wolfgang Wagner
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany.
| | | | | | | | | |
Collapse
|
9
|
Abstract
Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.
Collapse
Affiliation(s)
- M A Corson
- Newcastle upon Tyne NHS Trust, Dental Hospital and School, Richardson Road, Newcastle Upon Tyne, NE2 4AZ, UK
| | | | | |
Collapse
|
10
|
Abstract
Bacteremia originating from the oral cavity is common, but the role of bacteremia in the genesis of infective endocarditis and other distant site infections is unclear. Only a small percentage of oral flora have been associated with distant site infection. Important issues remain unresolved concerning the identification of patients at risk, the relative risk from invasive dental procedures versus naturally occurring bacteremia, and the impact of prophylactic antibiotics on the incidence, nature, magnitude, and duration of bacteremia from the oral cavity. This article addresses the controversies in infection management in patients at risk for distant site infection.
Collapse
Affiliation(s)
- P B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | |
Collapse
|
11
|
Affiliation(s)
- B L Mealey
- Department of Periodontics, Eglin Air Force Base Hospital, Eglin Air Force Base, Florida, USA
| |
Collapse
|
12
|
Abstract
Brain abscesses are rare but can be life-threatening infections. Recent progress in microbiological classification and identification has indicated that they are sometimes caused by oral infection and dental treatment. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. In the direct extension, oral infections spread along the fascial planes. Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack valves, through the cavernous sinus and into the cranium. Another hematogenous pathway is through the general circulation. Oral bacteria may cause systemic infections, e.g., endocarditis, and then indirectly initiate brain abscess. Microbiota, complications, and the prevention and management of odontogenic brain abscesses are also discussed in this review.
Collapse
Affiliation(s)
- X Li
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Norway.
| | | | | |
Collapse
|
13
|
Affiliation(s)
- H N Newman
- Department of Periodontology, Eastman Dental Institute and Hospital, London, England
| |
Collapse
|
14
|
Abstract
The oral pathosis caused by systemic disorders in middle-aged and elderly adults has been the focus of many publications in recent years. The intraoral soft and hard tissue changes associated with systemic disorders, medications, chemotherapy, and radiation treatment have been well-investigated and -documented. Far less attention has been paid to the role of oral infection as the etiology of systemic disorders. A literature review (1980-1994) is provided here focusing on well-documented cases in which systemic disorders were caused by oral foci of infections. This paper attempts to raise the level of awareness of practitioners in considering possible systemic complications caused by oral infection. It also emphasizes the need for further longitudinal studies in this field involving healthy and medically compromised elderly individuals.
Collapse
Affiliation(s)
- M Navazesh
- Department of Dental Medicine & Public Health, University of Southern California, School of Dentistry, Los Angeles 90089-0641, USA
| | | |
Collapse
|
15
|
Abstract
Spontaneous cavernositis is a distinctly uncommon entity. Corporeal infection and abscess formation have been described in association with priapism, cavernosography, intracavernous injection therapy, trauma and penile prostheses. We report a case of acute necrotizing cavernositis in a diabetic patient, which presumably originated with hematogenous seeding from a periodontal abscess. Isolation of typical oral pathogens from corporeal cultures provides bacteriological evidence of a dental source for the corporeal infection.
Collapse
Affiliation(s)
- M S Pearle
- Department of Urology, Northwestern University Medical School, Chicago, Illinois
| | | |
Collapse
|
16
|
Abstract
We treated four patients who developed a homonymous hemianopsia from a bacterial abscess in the occipital lobe of the brain. All four patients were treated successfully by surgical drainage of the abscess and administration of parenteral antibiotics for at least six weeks. Despite cure of the brain abscess, each patient was left with a permanent residual homonymous visual field defect. Cultures from the abscess fluid in three of the four patients grew oral flora. Moreover, each patient had a history of dental care two to four weeks before the onset of visual symptoms. A history of recent dental treatment in a patient with a new hemianoptic field defect should alert the ophthalmologist to the possibility of a bacterial abscess in the occipital lobe.
Collapse
Affiliation(s)
- T A Wohl
- Department of Ophthalmology, University of California, San Francisco 94143-0350
| | | | | | | | | |
Collapse
|
17
|
Abstract
The microorganisms in periodontitis of special patient categories have been only partially elucidated. The periodontitis microbiota of HIV-infected individuals, cancer patients on myelosuppressive therapy, and persons with other medical disorders includes common suspected periodontal pathogens as well as enteric rods, pseudomonads, staphylococci and yeasts. Failing implants also may be associated with classical periodontal pathogens as well as primarily nonoral potential pathogens. Refractory periodontitis in systemically healthy adults can show a great variety of oral and nonoral organisms. The frequent occurrence of unusual periodontal organisms in special patient categories may be due to a weakened host response and/or usage of various chemotherapeutic regimens. The unusual organisms may contribute to progressive periodontitis and in leukemia patients may even give rise to life-threatening systemic manifestations. The primary therapeutic goal in special periodontitis patients is control of pathogens and amid the wide range of pathogenic microfloras, an effective treatment strategy should include a comprehensive microbiological analysis, especially if systemic antimicrobial therapy is contemplated.
Collapse
Affiliation(s)
- J Slots
- University of Southern California, School of Dentistry, Los Angeles 90089-0641
| | | |
Collapse
|