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      Abscesso dentoalveolar crônico em paciente pediátrico com drenagem rara Translated title: Chronic dentoalveolar abscess in a pediatric patient with rare drainage Translated title: Absceso dentoalveolar crónico en paciente pediátrico con drenaje raro

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          Abstract

          RESUMO Introdução: As infecções do complexo maxillomandibular são corriqueiras na odontologia, podendo ser um quadro facilmente revertido, a depender da habilidade do profissional de diagnosticar e tratar precocemente, bem como da imunocompetência do paciente. Seu fator etiológico na grande maioria das vezes é de origem dentária, possuindo microbiota mista com presença de Streptococos e Peptostreptococos. Estas bactérias estão associadas ao processo de necrose pulpar e formação de abscesso dentoalveolar. Quando este quadro se desenvolve a partir dos molares inferiores, a disseminação ocorre normalmente pelo espaço vestíbulo bucal. No entanto, há casos que evadem o padrão, podendo um molar disseminar através dos espaços mastigador, mandibular, submandibular, sublingual e submentoniano. Objetivo: Relatar um caso de infecção odontogênica do dente 36, com disseminação atípica para o espaço submandibular em paciente pediátrico. Relato de caso clínico: Paciente do sexo feminino, 8 anos de idade, constou em seu histórico odonto-médico, junto a sua genitora, episódio de internamento para diagnóstico e tratamento da infecção em face. O diagnóstico de celulite foi determinado e a origem dentária descartada. Iniciou antibióticoterapia e após regressão teve alta. Após 9 meses apresentou reagudização do processo com disseminação para região submandibular. Através da história da doença atual, exame físico e radiográfico foi definido o diagnóstico de abscesso dentoalveolar crônico com disseminação e drenagem para o espaço submandibular, optando-se pela exodontia e antibióticoterapia. Conclusões: Faz-se importante o diagnóstico e tratamento precoce, afim de evitar a progressão para complicações mais severas, como a mediastinite e fasciíte necrosante.

          Translated abstract

          ABSTRACT Introduction: Infections of the maxillomandibular complex are common in dentistry and may be easily reversed, depending on the professional's ability to diagnose and treat promptly, as well as the patient's immunocompetence. In most cases their etiology is dental, i.e. a mixed microbiota with presence of Streptococci and Peptostreptococci. These bacteria are associated to the process of pulp necrosis and dentoalveolar abscess formation. When this condition develops from the lower molars, dissemination usually occurs through the buccal vestibular space. However, there are cases that do not follow this pattern, allowing a molar to spread through the buccal, mandibular, submandibular, sublingual and submental spaces. Objective: Report a case of odontogenic infection from pulp necrosis of the lower first molar (36) with atypical dissemination to the submandibular space in a pediatric patient. Clinical case: Female 8-year-old patient with an episode of hospitalization for diagnosis and treatment of a facial infection, according to her medical / dental record. The infection was diagnosed as cellulitis and dental origin was discarded. Antibiotic therapy was started and the patient was discharged. After 9 months, the infection underwent a process of exacerbation with dissemination to the submandibular region. Analysis of the antecedents of the current condition, alongside physical and radiographic examination, led to the diagnosis of chronic dentoalveolar abscess with dissemination and drainage to the submandibular space, and the consequent indication of dental extraction and antibiotic therapy. Conclusions: Early diagnosis and treatment are vital to avoid progression to severer complications such as mediastinitis and necrotizing fasciitis.

          Translated abstract

          RESUMEN Introducción: Las infecciones del complejo maxilo-mandibular son comunes en la odontología, pudiendo ser un cuadro fácilmente revertido, que depende de la habilidad del profesional de diagnosticar y tratar precozmente, así como de la inmunocompetencia del paciente. Su factor etiológico en la gran mayoría de las veces es de origen dental, con microbiota mixta y presencia de Streptococos y Peptostreptococos. Estas bacterias están asociadas al proceso de necrosis pulpar y formación de absceso dentoalveolar. Cuando este cuadro se desarrolla a partir de los molares inferiores, la diseminación ocurre normalmente por el espacio vestíbulo bucal. Sin embargo, hay casos que evaden el estándar, pudiendo un molar diseminar a través de los espacios masticador, mandibular, submandibular, sublingual y submentoniano. Objetivo: Describir un caso de infección odontogénica proveniente de necrosis pulpar del diente 36, con diseminación atípica para el espacio submandibular en paciente pediátrico. Caso clínico: Paciente de sexo femenino, de 8 años, constó en su historia médica-dental, episodio de internamiento para diagnóstico y tratamiento de la infección en el rostro. Se determinó el diagnóstico de celulitis y tuvo el origen dental descartado. Se inició antibioticoterapia y se dio alta hospitalaria. Después de 9 meses presentó exacerbación del proceso con diseminación para región submandibular. A través de la historia de la enfermedad actual, examen físico y radiográfico se definió el diagnóstico de absceso dentoalveolar crónico con diseminación y drenaje para el espacio submandibular, y entonces fue posible optar por la exodoncia y antibioticoterapia. Conclusiones: Se hace importante el diagnóstico y tratamiento precoz, a fin de evitar la progresión para complicaciones más severas, como la mediastinitis y fasciitis necrosante.

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          Most cited references20

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          Odontogenic Infections

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            Combating the rise of antibiotic resistance in children.

            Antibiotics are a cornerstone to treat bacterial infections and children received more frequently these drugs than any other class of medication. However, the improper and excessive use of antibiotics in the past decades has increased the emergence of resistant bacterial strains. Moreover, the lack of specific pediatric clinical trials on antibiotics led to a scarcity of high-evidence-level knowledge. The problem of the increase in antibiotic resistance should be known by all medical figures and probably by all members of the society, and a plan for an efficient strategy to improve antibiotic use in the entire world is highly needed. This review summarizes how antibiotics are mainly used in pediatrics and highlights the main problems related to the increase of antimicrobial-resistant bacterial strains, suggesting possible methods for reducing this increase. An excellent instrument to contain the emergence of antimicrobial resistance appeared the antibiotic stewardship program, that should be proposed and actualized in all contests in which antibiotics use is a common practice. Targeting the existing antibiotics with specific updated guidelines is also an essential measure to avoid antibiotics misuse. Moreover, educational on-line tools and their diffusions are useful strategies to diffuse knowledge on when and how to use antibiotics.
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              Criteria for admission of odontogenic infections at high risk of deep neck space infection

              Many patients with odontogenic infections are hospitalised because of the risk of deep neck space infection. The objective of this study was to identify risk factors allowing more reliable selection of patients requiring hospitalisation for both specialists and emergency physicians.
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                Author and article information

                Journal
                est
                Revista Cubana de Estomatología
                Rev Cubana Estomatol
                Editorial Ciencias Médicas (Ciudad de La Habana, , Cuba )
                0034-7507
                1561-297X
                December 2019
                : 56
                : 4
                : e2043
                Affiliations
                [3] Bahia orgnameUniversidade Estadual de Feira de Santana Brazil
                [2] orgnameUniversidade Federal da Bahia UFBA Brasil
                [1] orgnameFaculdade UNIME de Ciências Agrárias e da Saúde Brasil
                Article
                S0034-75072019000400014 S0034-7507(19)05600400014
                d6a0c911-4596-49fb-88aa-ba1e9f6b5ca2

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 19 February 2019
                : 21 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 0
                Product

                SciELO Cuba

                Categories
                PRESENTACION DE CASOS

                absceso periapical,absceso,cellulitis (phlegmon),diagnosis,infection control,dental focal infection,infecção focal dentária,periapical abscess,diagnóstico,controle de infecção,abscesso,infección focal dental,celulitis (flemón),celulite (flegmão),diagnostico,abscess,abscesso periapical,control de infecciones

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