This attitude flies in the face of published scientific research some of which is even published in the dental journals. In 1996 the Journal of Periodontology devoted a whole issue to this subject relating periodontal disease to a variety of systemic diseases which included coronary heart disease, diabetes and low birth weight babies.
Quintessence International is one of the most highly respected dental journals in the world. They state in 1997:
"The detrimental effect of focal infection on general health has been known for decades. Chronic dental infections may worsen the condition of medically compromised patients." (335)
As is common in these sorts of debates the dental authorities will mention research which is 100 years old - in this case the work of people like Billings, Rosenow and Price - and claim that because it is old research it is no longer relevant. They completely ignore the research which is more current. Interestingly all of the research conducted by Dr Weston Price in the 1920's is fully supported by the recent literature.
It is well accepted in the profession that any form of oral surgery will produce a bacteremia and that this may cause infections in susceptible tissues, especially the heart. What is less accepted is that other sources of sepsis exist in the mouth. These include:
* periodontal infections
* NICO lesions
* dead teeth
Dead teeth are impossible to sterilise and remain infected whether treated with Root Canal Therapy or not. Aside from the actual infective organisms and their by-products a dead tooth also is a source of necrotic tissue breakdown products.
The substances that are spread from such a focus of course include the bacterial, viral and fungal organisms that survive in such foci. It will also include the endotoxins produced by anaerobic organisms in the foci. (354-361) Current research indicates that other toxins produced by anaerobic organisms are also released into the body - these include hydrogen sulphide products and methyl mercaptans, both of which are highly poisonous products. (362-385)
What this means of course is that a dental focus of infection may not only infect other tissues but also poison the body with a variety of toxins. Professor Boyd Haley from Kentucky University has recently demonstrated the presence of these toxins and has developed techniques to test for them. (You can visit Prof Haley's site at
http://www.altcorp.com/oralartc.htm/)
Distribution of organisms and their toxins throughout the body is by various routes: (341-353)
• blood circulation through out the body
• lymphatic distribution locally and then to blood stream
• retrograde axonal transport - transport along nerve fibres and back to the brain.
In 1951 the problem of focal infection was discussed at length in the Journal of the American Dental Association. -Mechanism of Focal Infection J Am Dent Assoc Vol 42 June 1951
DEFINITIONS
"A Focus of infection has been defined as a circumscribed area infected with micro-organisms which may or may not give rise to clinical manifestations.
A Focal Infection has been defined as sepsis arising from a focus of infection that initiates a secondary infection in a nearby or distant tissue or organs."
The article states clearly that "The concept of focal infection in relation to systemic disease is firmly established" and that "The origin of many toxic or metastatic diseases may be traced to primary local or focal areas of infection".
This article also states that there are two major mechanisms of focal infection:
a) an actual metastasis of organisms from a focus
b) the spread of toxins or toxic products from a remote focus to other tissues by the blood stream.
Once the infection passes the abscess area about the tooth:
a) they may multiply in the blood setting up an acute or chronic septicaemia.
b) they may be carried live to a suitable nidus where they infect the surrounding tissue.
c) they may produce a slow but progressive atrophy with replacement fibrosis in various organs of the body.
The authors continue to show a relationship to allergic / immune reactions:
The bacteria at the focus may undergo autolysis or dissolution. Some of the products of this dissolution, diffusing into the blood or lymph , may sensitise in an allergic sense, various tissues of the body."
"A later diffusion of these products on reaching the sensitised tissue may call forth an allergic reaction."
Considering that the above article was published in 1951, it may be claimed in the late 90's that this too is old research. For this reason the first section of references associated with the this article are taken mainly from the last 40 years of Medline data bases after combining the search requests 'focal infection' and 'dentistry'.
Henig and Eliezer state in their paper "Brain Abscess following Dental Infection":
"The elimination of infection from human tissue is a necessary goal based on fundamental biological principles. It is even more essential in an environment in which the natural defence mechanisms of the body are unable to function. Such an environment is the root canal of a tooth." This statement is published in the Journal of Oral Surgery in 1978. Although the authors believed at the time that it is possible to sterilise a tooth (since disproven) their statement underlies the basic principles of Focal Infection Theory.
What is most interesting from this search is the number of reviews of the literature which have been done in this time. Some of the latest being in 1997.
Published case reports include the following disease states as being directly related to Oral infections:
• Mediastinitis
• Maxillary sinusitis
• Cavernous Sinus thrombosis
• Pharyngeal Cellulitis
• Cardiac Problems
• Necrotising Fascititis
• Necrotising Mediastinitis
• Superior Orbital Fissure Syndrome
• Proptosis
• Opthalmoplegia
• Light Reflex Interference
• Blindness
• Endopthalmitis
• Lung Abscess
• Aspiration Pneumonia
• Brain Abscess
• Meningitis
• Acute Hemiplagia
• Psychotic episodes
• Metastatic Paraspinal Abscess
• Gasarion Ganglion
• Trigeminal Neuralgia
• Endocarditis
• Septicemia
• Myocardial Infection
• Deuodenal Ulcers
• Splenic Abscess
• Leg abscess
• Blood disorders
• Immune reactions
• Inflammatory Bowel Disease
• Low birth weight
• Infertility
• Deaths
• Toxic Shock
• Arthritis
• Rheumatic changes
• Infection of artificial joint prosthesis
• Kidney Damage
• Brain Tumors
• Trigeminal Neuralgia
• Atypical Facial Pain
In other words all areas of the body may be effected by the presence of infected foci in the mouth. It has been relatively easy for the medical profession to distinguish particular micro-organisms in an infection and relate them to the oral flora. It is only recently that we have tests, which can demonstrate low molecular weight toxins, which are produced by these organisms.
Interestingly Dr Weston Price in the 1920's was able to demonstrate the effects of the toxins although he was not then able to identify or isolate them - his research, I believe, is as relevant today as it was when he wrote it.
It is not my intention to do a formal literature review of focal infections, but merely to present you with a list of references, which of themselves validate the reality of focal infection from dental origins. It is my hope that the dental profession will acknowledge this reality and reassess certain treatment concepts, which currently disregard the published literature. All references are available in Medline.
This article was written by Robert Gammal BDS. FACNEM(Dent).
Focal Infection References
Medline 1960 to 1998
General
1. Andra A [Massive infection of odontogenic origin (author's transl)]: Zentralbl Chir (1978) 103(8):527-32
2565 patients with infections of odontogenic origin are reported. In only 34,8% of the cases the correct diagnosis was established. Purulent inflammations of the submaxillar area mostly occurred (49,9%) followed by the pharyngeal area (19,9%). Early signs of the spreading of the inflammation must be the indication to send the patient to the hospital to avoid complications.
2. Berard R [Special characteristics of infection spread in temporary molars] Actual Odontostomatol (Paris) (1973 Dec) 27(104):707-18
3. Cros P Freidel A Parret J [3 studies on general infections with dental etiology and bacteriological proofs] Ann Odontostomatol (Lyon) (1969 Sep-Oct) 26(5):189-93
4. Cadenat H Marcopoulos A Gely P Fabie M Combelles R [2 new cases of Melkersson-Rosenthal's syndrome] Rev Stomatol Chir Maxillofac (1971 Sep) 72(6):635-42
5. Elsner R Koch H [Errors and dangers in treatment of odontogenic infections with antibiotics] Quintessenz (1977 Oct) 28(10):137-40
6. Gawrzewska B Wedler A Fijal D [Results of studies on the removal of active infectious foci in the treatment of diseases caused by odontogenic focal infections] Czas Stomatol (1976 Dec) 29(12):1099-103
7. Huurman PM [Root canal therapy and focal infection] Dtsch Stomatol (1965 Dec) 15(12):938-40
8. Klammt J [Life endangering complications of acute odontogenous infections in the era of antibiotics] Dtsch Gesundheitsw (1969 Sep 4) 24(36):1695-8
9. Hunter N Focal infection in perspective. Oral Surg Oral Med Oral Pathol (1977 Oct) 44(4):626-7
In this article some of the theoretical possibilities arising as a result of focal infection are discussed. Rheumatic fever is discussed as an example of a disease in which a number of possible mechanisms may act to produce tissue damage at a target area. The mechanisms examined are direct dissemination of organisms from the focus to the target area, the induction of L-phase bacteria, and toxic damage to target tissue. Host-mediated tissue damage by hypersensitivity or auto-immune mechanisms is considered as well.
10. Lachard J Cremieu A Jars G Ged S Kaplanski P [4 cases of Osler's disease] Rev Stomatol Chir Maxillofac (1970 Jul-Aug) 71(5):405-10
11. Reil B Koblin I [Catamnestic surveys in 371 cases of abscess of the maxillofacial region in childhood] Dtsch Zahnarztl Z (1976 Feb) 31(2):182-4
Catamnestic surveys of 371 children who suffered from abscesses during the past ten years (1965 to 1974) showed that type and location of the abscesses and their incidence in the various age groups are typical and differ from those of abscesses in adults. These results are discussed and compared with the data found in the literature.
12. Rouchon [Distant manifestations of bucco-dental origin in children] Med Infant (Paris) (1965 May) 72(5):341-9
13. Sadowsky C The tooth and periodontium as a site of focal infection. Diastema (1968) 2(3):43-7
14. Stortebecker TP [Spreading hazards from infection foci] Sprindningsvagar fr~an infektiosa foci. Sven Tandlak Tidskr (1966 Feb 15) 59(2):99-107
15. Sukin L Periodontal disease, focal infection and systemic health. J N J Dent Assoc (1975 Winter) 46(2):26-9, 47
Cardiac
16. Asikainen S Alaluusua S Bacteriology of dental infections. Eur Heart J (1993 Dec) 14 Suppl K:43-50
Oral bacteria may spread into the blood stream through ulcerated epithelium in diseased periodontal pockets and cause transient bacteraemias, which are regarded as increased risk, especially for immunocompromised patients or persons with endoprotheses.
17. Droz D Koch L Lenain A Michalski H Bacterial endocarditis: results of a survey in a children's hospital in France Br Dent J (1997 Aug 9) 183(3):101-5
18. Lieberman MB A life-threatening, spontaneous, periodontitis-induced infective endocarditis. J Calif Dent Assoc (1992 Sep) 20(9):37-9
19. Mattila KJ Dental infections as a risk factor for acute myocardial infarction. Eur Heart J (1993 Dec) 14 Suppl K:51-3
20. Mattila KJ Valle MS Nieminen MS Valtonen VV Hietaniemi KL Dental infections and coronary atherosclerosis. Atherosclerosis (1993 Nov) 103(2):205-11
21. Paunio K Impivaara O Tiekso J Maki J Missing teeth and ischaemic heart disease in men aged 45-64 years. Eur Heart J (1993 Dec) 14 Suppl K:54-6
22. Root TE Silva EA Edwards LD Topp JH Hemophilus aphrophilus endocarditis with a probable primary dental focus of infection. Chest (1981 Jul) 80(1):109-10
23. Seymour RA Steele JG Is there a link between periodontal disease and coronary heart disease? [see comments] Br Dent J (1998 Jan 10) 184(1):33-8 Evidence suggests that dental health, in particular periodontal disease, may be a significant risk factor for coronary heart disease and further coronary events.
24. Wahl MJ Clinical issues in the prevention of dental-induced endocarditis and prosthetic joint infection. Pract Periodontics Aesthet Dent (1995 Aug) 7(6):29-36; quiz 37
25. Whyman RA et al Oral Surg Oral Med Oral Pathol 1994 Jul;78(1):47-50 Dens in dente associated with infective endocarditis After dental abscess of the UL Lateral incisor
26. Younessi OJ Walker DM Ellis P Dwyer DE Fatal Staphylococcus aureus infective endocarditis: the dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod (1998 Feb) 85(2):168-72
Chest
27. Bonapart IE Stevens HP Kerver AJ Rietveld AP Rare complications of an odontogenic abscess: mediastinitis, thoracic empyema and cardiac tamponade. J Oral Maxillofac Surg (1995 May) 53(5):610-3
28. Cogan IC Necrotizing mediastinitis secondary to descending cervical cellulitis. Oral Surg Oral Med Oral Pathol (1973 Sep) 36(3):307-20
29. Colmenero Ruiz C Labajo AD Yanez Vilas I Paniagua J Thoracic complications of deeply situated serous neck infections. J Craniomaxillofac Surg (1993 Mar) 21(2):76-81
30. IM Dhanarajani PJ Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Maxillofac Surg (1995 Feb) 53(2):203-8
31. Economopoulos GC Scherzer HH Gryboski WA Successful management of mediastinitis, pleural empyema, and aortopulmonary fistula from odontogenic infection. Ann Thorac Surg (1983 Feb) 35(2):184-7
32. Esgaib AS Silva AC Meira EB Kassab GE Salvestro E de S de Souza MM Steinberg O Lyra R de M Ghefter M [Mediastinitis following dental infection: report of 2 cases] Rev Paul Med (1986 Sep-Oct) 104(5):283-5
33. Esgaib AS Ghefter MC Lyra R de M Guidugli RB Trajano AL Ferreira SM Mediastinitis after cervical suppuration. Rev Paul Med (1992 Sep-Oct) 110(5):227-36
34. Garatea-Crelgo J Gay-Escoda C Mediastinitis from odontogenic infection. Report of three cases and review of the literature. Int J Oral Maxillofac Surg (1991 Apr) 20(2):65-8
35. Gonnon F Perrin-Fayolle M [Incidence of the bucco-dental infections on acute and chronic bronchopulmonary infections] Ligament (1978) 16(129):25-32
36. Guittard P Ducasse JL Jorda MF Eschapasse H Lareng L [Mediastinitis caused by odontogenic anaerobic bacteria] Ann Fr Anesth Reanim (1984) 3(3):216-8
37. Hendler BH Quinn PD Fatal mediastinitis secondary to odontogenic infection. J Oral Surg (1978 Apr) 36(4):308-10
A case of necrotizing mediastinitis that caused death in a 38-year- old man has been reported. The cause of his infection was proved, both radiographically and clinically, to be dental infection associated with the lower molars and their supporting structures. A diffuse cellulitis involving the submandibular, masticator, and parapharyngeal spaces ensued. Sudden onset of severe pleuritic chest pains and a 100% pneumothorax of the left lung developed, which ultimately led to his death.
38. Kruchinskii GV Korsak AK Myshkovskii VA Ryneiskii SP [Experience with the diagnosis and treatment of secondary odontogenic mediastinitis] Stomatologiia (Mosk) (1989 Nov-Dec) 68(6):15-7
39. Lee SH Kim JS Kwack DH Jung Y [A case report of odontogenic infection leading to fatal mediastinitis] Taehan Chikkwa Uisa Hyophoe Chi (1989 Mar) 27(3):279-86
40. Latronica RJ Shukes R Septic emboli and pulmonary abscess secondary to odontogenic infection. J Oral Surg (1973 Nov) 31(11):844-7
41. Larik ML van Zanten TE van der Waal I van der Kwast WA [Lung disease resulting from osteomyelitis of the mandible] Ned Tijdschr Tandheelkd (1978 Nov) 85(11):428-30
42. Levine TM Wurster CF Krespi YP Mediastinitis occurring as a complication of odontogenic infections. Laryngoscope (1986 Jul) 96(7):747-50
43. McCurdy JA Jr MacInnis EL Hays LL Fatal mediastinitis after a dental infection. J Oral Surg (1977 Sep) 35(9):726-9
The pertinent features of life-threatening complications of dental infections have been briefly reviewed with particular emphasis on the alterations of the clinical features of these conditions induced by antibiotic therapy. The clinician who deals with dental infections must exercise a high index of suspicion to consistently abort the development of these complications, especially when treating debilitated patients or individuals with compromised immune functions.
44. Marty-Ane CH Alauzen M Alric P Serres-Cousine O Mary H Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy. J Thorac Cardiovasc Surg (1994 Jan) 107(1):55-61
45. Marchan Carranza E Gijon Rodriguez J Mantes German I [Septic pulmonary embolism secondary to dental focus. Lemierre's syndrome? (letter; comment)] Arch Bronconeumol (1994 Nov) 30(9):473-4
46. Molchanova KA Stepanova TV [Clinical picture and therapy of odontogenic mediastinitis] Khirurgiia (Mosk) (1971 Jan) 47(1):79-83
47. Moncada R Warpeha R Pickleman J Spak M Cardoso M Berkow A White H Mediastinitis from odontogenic and deep cervical infection. Anatomic pathways of propagation. Chest (1978 Apr) 73(4):497-500
Potentially lethal consequences can quickly occur once the mediastinum is subjected to the ravages of an anaerobic infection. Mediastinitis from odontogenic or deep cervical infections is extremely rare in the era of antibiotic drugs. We have recently encountered five such cases, with a rapid spread of the inflammatory process into the mediastinum resulting in a number of local and systemic complications. All were caused by anaerobic bacteria. Awareness of such complications and early roentgenographic diagnosis lead to prompt surgical drainage, proper antibiotic therapy, and survival after a stormy clinical course. The anatomic pathways between the various fascial planes of the neck and ediastinum will be described.
48. Morey-Mas M Caubet-Biayna J Iriarte-Ortabe JI Mediastinitis as a rare complication of an odontogenic infection. Report of a case. Acta Stomatol Belg (1996 Sep) 93(3):125-8
49. Musgrove BT Malden NJ Mediastinitis and pericarditis caused by dental infection. Br J Oral Maxillofac Surg (1989 Oct) 27(5):423-8
50. Petrone JA Mediastinal abscess and pneumonia of dental origin. J N J Dent Assoc (1992 Autumn) 63(4):19-23
51. Piperno D Gaussorgues P Leger P Gerard M Boyer F Tigaud S Pignat JC Robert D [Mediastinitis caused by anaerobic bacteria. 4 cases] Presse Med (1987 Nov 14) 16(38):1889-90
52. Robustova TG Gubin MA Kharitonov IuM Girko EI [The diagnosis and treatment of contact odontogenic mediastinitis] Stomatologiia (Mosk) (1996) 75(6):28-32
53. Rubin MM Cozzi GM Fatal necrotizing mediastinitis as a complication of an odontogenic infection. J Oral Maxillofac Surg (1987 Jun) 45(6):529-33
54. Sazonov AM Muromskii IuA Plotnikov NA Zubkova LF Troianskii IV [Odontogenic mediastinitis] Grudn Khir (1977 Jul-Aug)(4):82-6
55. Siegel EB Friedlander AH Mongiardo JJ Klebsiella pneumonia facial fistula secondary to non-vital tooth. A case report. N Y State Dent J (1976 May) 42(5):291-2
56. Smith RW Taylor RG O'Connor JF Dental infection: a source of pulmonary emboli. Oral Surg Oral Med Oral Pathol (1967 Aug) 24(2):158-63
57. Sobolewska E Skokowski J Jadczuk E [Pleural empyema as a complication of descending necrotizing mediastinitis] Pneumonol Alergol Pol (1997) 65(5-6):364-9
58. Steiner M Grau MJ Wilson DL Snow NJ Odontogenic infection leading to cervical emphysema and fatal mediastinitis. J Oral Maxillofac Surg (1982 Sep) 40(9):600-4
59. Sugata T Fujita Y Myoken Y Fujioka Y Cervical cellulitis with mediastinitis from an odontogenic infection complicated by diabetes mellitus: report of a case. J Oral Maxillofac Surg (1997 Aug) 55(8):864-9
60. Timosca G Gogalniceanu D Barna M Streba P Vicol C Popescu E [Suppurative cervico-mediastinitis of odontogenic origin] Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Stomatol (1989 Oct-Dec) 36(4):291-301
61. Tamura M Minemura T Kurashina K Kotani A Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome. Oral Surg Oral Med Oral Pathol (1992 Jul) 74(1):15-8
62. Terezhalmy GT Bottomley WK Pulmonary nocardiosis associated with primary nocardial infection of the oral cavity. Oral Surg Oral Med Oral Pathol (1978 Feb) 45(2):200-6
A case of pulmonary nocardiosis associated with primary nocardial infection of the oral cavity in a compromised host is presented. Nocardia asteroides, an aerobic, gram-positive, branching, filamentous fungus, was demonstrated in the sputum and in pathologic specimens from gingival sulci stained by Gram's method and the acid- fast method Kinyoun. The organism was identified in cultures made on Sabouraud's glucose agar. Marked clinical improvement was noted when the patient received high dosage of sulfisoxazole diolamine (8 to 12 Gm. per day) for a prolonged period of time (9 to 12 months). Because of an apparent relative increase in the incidence of nocardiosis and a paucity of information on the subject in the dental literature, this article is timely.
63. Unteanu G Solacolu VI [Problems concerning the etiopathogenesis of bronchopulmonary suppurations] Pneumoftiziol (1976 Jan-Mar) 25(1-2):23-6
The data supplied by analysis of more than 1 000 patients pointed to the wide range of the causal factors, the role of focal infections of the upper respiratory and digestive tracts and the mechanisms that interfere in the determinism of the bronchopulmonary suppurative syndrome, the septic particles migrating as a rule along the bronchogenic route.
64. Webster AC Parnell AG The management of respiratory obstruction secondary to odontogenic infection--case report. Can Anaesth Soc J (1972 May) 19(3):299-304
65. Zachariades N Mezitis M Stavrinidis P Konsolaki-Agouridaki E Mediastinitis, thoracic empyema, and pericarditis as complications of a dental abscess: report of a case. J Oral Maxillofac Surg (1988 Jun) 46(6):493-5
Neurologic and Central Nervous System
66. Aldous JA Powell GL Stensaas SS Brain abscess of odontogenic origin: report of case. J Am Dent Assoc (1987 Dec) 115(6):861-3
67. Andersen WC Horton HL Parietal lobe abscess after routine periodontal recall therapy. Report of a case. J Periodontol (1990 Apr) 61(4):243-7
68. Andrews M Farnham S Brain abscess secondary to dental infection. Gen Dent (1990 May-Jun) 38(3):224-5
69. Balogh G Afra D Inovay J [Endocranial abscess: complication of dental extraction] Rev Stomatol Chir Maxillofac (1972 Apr-May) 73(3):205-9
70. Bayer D. et al Trigeminal Neuralgia an overview. Oral Surg. Oral Med. Oral Pathol. 1979:48:393-9
71. Benech A Barrale S Dalmasso di Garzegna A [Left temporal abscess in bearers of maxillary and mandibular endosseous implants. A clinical case] Minerva Stomatol (1986 Oct) 35(10):999-1003
72. Becarevici V [Acute delusion psychosis (acute delusion crisis) secondary to a dental infection] Rev Med Suisse Romande (1988 Mar) 108(3):257-62
73. Bergouignan H Benoit P Boussagol P Brun G [Neuralgic syndrome of dental origin simulating an essential facial neuralgia] : Rev Odontostomatol Midi Fr (1969) 27(2):124-5
74. Black R., laboratory model for Trigeminal Neuralgia. Adv. Neuro.1974; 4:651-8
75. Churton MC Greer ND Intracranial abscess secondary to dental infection. N Z Dent J (1980 Apr) 76(344):58-60
76. Chuikin SV [Immunological aspects of the effect of inflammatory diseases of the maxillofacial area on the brain] Stomatologiia (Mosk) (1989 May-Jun) 68(3):32-5
77. Dechaume M Laudenbach P [Cerebro-meningeal manifestations of dental etiology] Rev Stomatol Chir Maxillofac (1969 Mar) 70(2):109-14
78. el Fakir Y Jiddane M Abid A [Thrombophlebitis of the cavernous sinus of dental origin. Apropos of a case with a review of the literature] Rev Stomatol Chir Maxillofac (1993) 94(1):55-9
79. Essioux H Burlaton J Legros J Daly JP Molinie C Laverdant C [Recurrent suppurative meningitis of dental origin in Behcet's disease] Actual Odontostomatol (Paris) (1982) 36(139):355-60
80. Fromm G., et al Trigeminal Neuralgia. Current concepts regarding etiology and pathogenisis Arch Neurol 1984;41: 1204-7
81. Feldges A Heesen J Nau HE Schettler D [Odontogenic brain abscess. 2 case reports] Der odontogene Hirnabszess. 2 Fallberichte. Dtsch Z Mund Kiefer Gesichtschir (1990 Jul-Aug) 14(4):297-300 Frequently the bacteria found by aspiration of the brain abscess are the only indication of a dental focus.
82. Gallagher DM Erickson K Hollin SA Fatal brain abscess following periodontal therapy: a case report. Mt Sinai J Med (1981 Mar-Apr) 48(2):158-60
83. Goscinski I Stachura K Uhl H [Thrombosis of the cavernous sinus] Zakrzep zatoki jamistej. Neurol Neurochir Pol (1991 May-Jun) 25(3):386-9
84. Glonti TI Malashkiia IuA Chkhikvishvili TsSh [On the role of chronic odontogenic infection in the genesis of neurologic disorders] Klin Med (Mosk) (1968 Jan) 46(1):112-5
85. Gray RL Peripheral facial nerve paralysis of dental origin. Br J Oral Surg (1978 Nov) 16(2):143-50
The aetiology, diagnosis and treatment of peripheral facial nerve palsy are discussed. Four cases of facial nerve palsy following dental procedures are reported. Following a revision of the world literature during the last 23 years, the 25 cases of facial nerve palsy documented are analysed and divided into four groups on the basis of aetiology, speed of onset and recovery and modes of treatment suggested.
86. Gobel S., Bink J., degenerative changes in primary trigeminal axons and in neurons in nucleus caudalis following tooth pulp extirpation in the cat., : Brain Res. 1977;132:347-54
87. Guerin JM Laurent C Manet P Segrestaa JM [Facial cellulitis and septic thrombophlebitis of the cavernous sinus of dental origin] Rev Med Interne (1987 Sep-Oct) 8(4):416-8
88. Hamlyn JF Acute hemiplegia in childhood following a dental abscess. Br J Oral Surg (1978 Nov) 16(2):151-5
The syndrome of acute hemiplegia in childhood is described and a case following dental infection reported. The possible mechanisms responsible for the development of this condition are considered.
89. Hedstrom SA Nord CE Ursing B Chronic meningitis in patients with dental infections. Scand J Infect Dis (1980) 12(2):117-21
90. Henig EF Derschowitz T Shalit M Toledo E Tikva P Aviv T Brain abcess following dental infection. Oral Surg Oral Med Oral Pathol (1978 Jun) 45(6):955-8
A 48-year-old woman underwent root canal treatment of the upper left lateral incisor and lower right second premolar. Close to the conclusion of the endodontic treatment she complained about headaches. Later on, because of aggravation of her condition, with headaches, fever, malaise, Weakness, and numbness of the right limbs, she was admitted to the hospital. The disease progressed to an epileptic state, with appearance of a right hemiparesis. A brain scan and carotid arteriogram revealed the presence of a mass occupying the left parietal space. Craniotomy disclosed an abscess containing yellow pus from which Streptococcus viridans was cultured. After thorough surgical cleansing of the area, removal of the bone for decompression, and treatment with ampicillin the patient improved gradually and slowly regained the mobility of her right side.
91. Hollin SA Hayashi H Gross SW Intracranial abscesses of odontogenic origin. Oral Surg Oral Med Oral Pathol (1967 Mar) 23(3):277-93
92. Ingham HR Kalbag RM Tharagonnet D High AS Sengupta RP Selkon JB Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. Lancet (1978 Sep 2) 2(8088):497-9
The bacterial species found in pus aspirated from brain abscesses in two patients were typical of those found in dental sepsis. Subsequently apical-root abscesses were demonstrated in the upper jaws of both patients. This evidence strongly suggests that these cerebral abscesses were secondary to dental sepsis which could have spread from the teeth to the frontal lobes by several possible antaomical pathways.
93. King R. Interaction of noxious and nonnoxious stimuli in primary sensory nuclei Adv Neurol 1974; 4:659-63
94. Larkin EB Scott SD Metastatic paraspinal abscess and paraplegia secondary to dental extraction. Br Dent J (1994 Nov 5) 177(9):340-2
95. Lewandowski L Serafinowska A [Peripheral facial nerve palsy caused by focal dental infection] Czas Stomatol (1970 Dec) 23(12):1357-60
96. Lutsik LA [Streptococcal chroniosepsis complicated by meningoencephalitis with a fatal outcome] Stomatologiia (Mosk) (1979 Nov-Dec) 58(6):55-6
97. Martinez Garcia W Aleman Lopez ST [Septic thrombosis of the cavernous sinus of dental origin. Case report] Divulg Cult Odontol (1971 Sep-Oct)(171):25-7
98. Marks PV Patel KS Mee EW Multiple brain abscesses secondary to dental caries and severe periodontal disease. Br J Oral Maxillofac Surg (1988 Jun) 26(3):244-7
99. Mojseowicz K Czerwinski F Linnik-Kabat A [Intracranial complications as a consequence of purulent acute inflammatory processes on the face and in the oral cavity] Czas Stomatol (1971 Jun) 24(6):623-7
100. Montejo M Aguirrebengoe K Streptococcus oralis meningitis after dental manipulation [letter] Oral Surg Oral Med Oral Pathol Oral Radiol Endod (1998 Feb) 85(2):126-7
101. Mucke L Clinical management of neuropathic pain Neurol clin 1987;5:649-63
102. Mukharinskaia VS Antadze ZI Devidze NV Emchenko VT Nodiia EI [Neurological complications in chronic suppurative odontogenic infection] Stomatologiia (Mosk) (1981) 60(4):22-3
103. Ogundiya DA Keith DA Mirowski J Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. J Oral Maxillofac Surg (1989 Dec) 47(12):1317-21
104. Perna E Liguori R Petrone G Mannarino E Actinomycotic granuloma of the Gasserian ganglion with primary site in a dental root. Case report. J Neurosurg (1981 Apr) 54(4):553-5
105. Pompians-Miniac L [Apropos of 2 cases of endocranial abscesses of dental origin. Propagation by venous route of apical infection] Rev Fr Odontostomatol (1966 Jun-Jul) 13(6):1161-76
106. Renton TF Danks J Rosenfeld JV Cerebral abscess complicating dental treatment. Case report and review of the literature. Aust Dent J (1996 Feb) 41(1):12-5
107. Ries P Turk R [Histopathologic changes in bone marrow and in dental pulp in patients with trigeminal neuralgia] Dtsch Z Mund Kiefer Gesichtschir (1984 Jul-Aug) 8(4):301-4
108. Ruzin GP Zakharov IuS Bolgov DF [A case of odontogenic osteomyelitis of the maxilla complicated by meningitis] Stomatologiia (Mosk) (1974 Sep-Oct) 53(5):87-8
109. Saal CJ Mason JC Cheuk SL Hill MK Brain abscess from chronic odontogenic cause: report of case. J Am Dent Assoc (1988 Sep) 117(3):453-5
110. Selby G., Diseases of the fifth cranial nerve. In Dyke PJ., Thomas PK., Peripheral Neuropathy. Philadelphia. W.B. Saunders 1984;1224-65
111. Schotland C Stula D Levy A Spiessl B [Brain abscess after odontogenic infection] SSO Schweiz Monatsschr Zahnheilkd (1979 Apr) 89(4):325-9
112. Steiner G J Neuropath. 1952;11:343-72 Multiple Sclerosis "sinus mucosa may become repeatedly infected from diseased teeth, gums and tonsils"
113. Stevenson GW Gossman HH Dental and intracranial actinomycosis. Br J Surg (1968 Nov) 55(11):830-4
114. Strauss SI Stern NS Mendelow H Spatz SS Septic superior sagittal sinus thrombosis after oral surgery. J Oral Surg (1973 Jul) 31(7):560-5
115. Struzak-Wysokinska M [Peripheral paralysis of the facial nerve caused by peridental foci] Czas Stomatol (1967 Mar) 20(3):283-8
116. Taicher S Garfunkel A Feinsod M Reversible cavernous sinus involvement due to minor dental infection. Report of a case. Oral Surg Oral Med Oral Pathol (1978 Jul) 46(1):7-9
Described is a case of a cavernous sinus involvement due to minor dental infection. The early dental diagnosis and treatment reversed the course of cavernous sinus thrombosis.
117. Tassarotti B [A case of spheno-palatine ganglionic syndrome of dental origin] Rass Int Stomatol Prat (1969 Sep-Oct) 20(5):307-13
118. Unteanu G Solacolu VI [Problems concerning the etiopathogenesis of bronchopulmonary suppurations] Pneumoftiziol (1976 Jan-Mar) 25(1-2):23-6
The data supplied by analysis of more than 1 000 patients pointed to the wide range of the causal factors, the role of focal infections of the upper respiratory and digestive tracts and the mechanisms that interfere in the determinism of the bronchopulmonary suppurative syndrome, the septic particles migrating as a rule along the bronchogenic route.
119. Urbani G Ferronato G Bertele GP [Trigeminal neuralgia with chronic infection due to the presence of a large root fragment in the mandibular canal] G Stomatol Ortognatodonzia (1982 Jul-Sep) 1(2):17-20
120. Urmosi J Wittmann K Tamus I [Successful treatment of thrombophlebitis of the sinus cavernosus originating from a cuspid] Orv Hetil (1972 Mar 26) 113(13):766-8
121. Urmosi J [Thrombophlebitis of the sinus cavernosus]: Stomatol DDR (1975 Nov) 25(11):776-8
A short survey of the relevant literature is followed by the description of the clinical course of a thrombophlebitis of the cavernous sinus. In this case, the initial focus was an infection of a canine which caused thrombophlebitis via the anterior facial vein. The healing must be attributed to the immediate application of broad spectrum antibiotics and removal of the primary focus.
122. Uppgaard RO Tic douloureux--multicauses include dental origin. Northwest Dent (1968 Sep-Oct) 47(5):273-7
123. Vitzthum HE Erle A Lambrecht R [Intracranial complications induced by odontogenic pyogenic infections] Stomatol DDR (1985 Nov) 35(11):637-42
124. Valachovic R Hargreaves JA Dental implications of brain abscess in children with congenital heart disease. Case report and review of the literature. Oral Surg Oral Med Oral Pathol (1979 Dec) 48(6):495-500
There is a high morbidity and mortality associated with brain abscesses in children with congenital cyanotic heart disease. A case is reported here which implicated an endodontically treated primary molar in the etiology of a brain abscess in a boy with congenital cyanotic heart disease.
125. Westrum LE., Canfield RC., Black R., Transganglionic Degeneration in the spinal trigeminal nucleus following the removal of tooth pulps in adult cats. Brain Res 1976; 6:100:137-40
126. Westrum LE., Canfield RC., Electron microscopy of degenerating axons and terminals in the spinal trigeminal nucleus after tooth pulp exterpation. Am J Anat. 1977; 149:591-6
127. Yun MW Hwang CF Lui CC Cavernous sinus thrombosis following odontogenic and cervicofacial infection. Eur Arch Otorhinolaryngol (1991) 248(7):422-4
128. Zachariades N Vairaktaris E Mezitis M Triantafyllou D Papavassiliou D Cerebral abscess and meningitis complicated by residual mandibular ankylosis. A study of the routes that spread the infection. J Oral Med (1986 Jan-Mar) 41(1):14-20
Trigeminal neuralgia
129. Bayer D. et al Trigeminal Neuralgia an overview. Oral Surg. Oral Med. Oral Pathol. 1979:48:393-9
130. Fromm G., et al Trigeminal Neuralgia. Current concepts regarding etiology and pathogenisis Arch Neurol 1984;41: 1204-7
131. King R. Interaction of noxious and nonnoxious stimuli in primary sensory nuclei Adv Neurol 1974; 4:659-63
132. Mucke L Clinical management of neuropathic pain Neurol clin 1987;5:649-63
133. Selby G., Diseases of the fifth cranial nerve. In Dyke PJ., Thomas PK., Peripheral Neuropathy. Philadelphia. W.B. Saunders 1984;1224-65
Opthalmic
134. Artis JP Artis M Bowyer M Durivaux S [On uveitis of dental origin. On 200 cases] Inf Dent (1979 Feb 1) 61(5):325-30
135. Boyer R Fourel J Martin R Barkat A [Eye manifestations of dental origin] Actual Odontostomatol (Paris) (1966 Dec) 76:455-68
136. Bermanowa G Pietrowa N Lalek A Bujalska H [Dental focal infection in eye diseases (preliminary report)] Czas Stomatol (1969 Oct) 22(10):923-6
137. Bocca M Zombolo L Coscia D Moniaci D [The correlation between dental pathology and ophthalmic pathology] Minerva Stomatol (1989 Oct) 38(10):1117-20
138. Cordier J Vexler C Watrin E Barisain P [Ocular inflammation of dental origin] Bull Soc Ophtalmol Fr (1965 Mar) 65(3):221-2
139. Francois J Van Oye R [Eye diseases and odontologic affections] Rev Belge Med Dent (1968) 23(2):129-37
140. Harris M Dental infection and the eyes. Dent Health (London) (1966 Jul-Sep) 5(3):47-50
141. Harris M Dental infection and the eyes. Pak Dent Rev (1968 Jul) 18(3):107-11
142. Krudysz J Baranowa A [Rare case of ocular complications of dental origin] Klin Oczna (1970) 40(3):411-4
143. Ivanov I [Maxillary sinuisitis and orbit phlegmon from dental origin] Maksilaren sinuit i flegmon na orbitata. Stomatologiia (Sofiia) (1973 Oct-Nov) 55(6):467-70
144. May DR Peyman GA Raichand M Friedman E Metastatic Peptostreptococcus intermedius endophthalmitis after a dental procedure. Am J Ophthalmol (1978 May) 85(5 Pt 1):662-5
145. Murphy NC Mahar PJ Fair R Uveitis and its relation to periapical-periodontal infection. Ohio Dent J (1979 Sep) 53(9):24-5
A 46-year-old man developed symptoms of a chronic progressive uveitis in his right eye aproximately one week after a dental procedure. The patient's intraocular inflammation was not diminished by massive treatment with topical and systemic corticosteroid therapy or intravenously administered adrenocorticotropic hormone. The inflammatory process progressed to an overt endophthalmitis during a period of three weeks and the eye eventually required evisceration. A pure culture of Peptostreptococcus intermedius was isolated from the eye. The most likely source of this organism was hematologic transport following a dental procedure.
146. Niho M [2 cases of rhinogenic retrobulbar optic neuritis and a case of odontogenic retrobulbar optic neuritis with abducent palsy] Nippon Jibiinkoka Gakkai Kaiho (1972 Jul) 75(7):783-99
147. Nemetz U [Ophthalmology and focal infections] Osterr Z Stomatol (1974 Nov) 71(11):414-5
148. Papakonstantinou A Papakonstantinou P [Dental focal infections and optic neuritis] Stomatol Chron (Athenai) (1969 Sep-Oct) 13(5):185-91
149. Rousselie F [Eye infections of dental origin] Ligament (1978) 16(129):15-7
150. Rubin et al Oral Surg 1976 Vol 41 No 1 Abscess involving the left eye that originated as a dental abscess
151. Ruban JM Breton P Cognion M Freidel M [A conjunctival tumor of dental origin. Apropos of a case] Rev Stomatol Chir Maxillofac (1991) 92(4):262-4
152. Sela M Sharav Y The dental focal infection as an origin for uveitis. Isr J Dent Med (1975 Jan) 24:31-5
153. Stone A Straitigos GT Mandibular odontogenic infection with serious complications. Oral Surg Oral Med Oral Pathol (1979 May) 47(5):395-400
Orbital cellulitis usually begins as an infection of the paranasal sinuses. While a small percentage of cases are of dental origin, these usually involve the maxillary teeth. In the case reported here orbital cellulitis originated from an infection in the mandible and spread through the pananasal sinuses, deep facial circulation, and orbital tissues, resulting in unilateral blindness. Principles of management and possible pathways for the spread of the infection are discussed.
154. Szak O Belan J [Endogenous uveitis in 4-year-material of the Eye Clinic in Bratislava] Cesk Oftalmol (1967 May) 23(3):163-7
155. Soofi MA The tooth and the eye. Pak Dent Rev (1968 Apr) 18(2):73-5
156. Takahashi T [A case of retrobulbar neuritis with long-term remission] Nippon Ganka Kiyo (1967 Feb) 18(2):169-73
157. Yates C Monks A Orbital cellulitis complicating the extraction of infected teeth. J Dent (1978 Sep) 6(3):229-32
158. Zoltan N Gyula M [Odontogenic orbital phlegmon] Orv Hetil (1976 DEC 5) 117(49):2995-6
Blood & Blood Vessels
159. Carter TB Blankstein KC White RP Jr Severe odontogenic infection associated with disseminated intravascular coagulation. Gen Dent (1992 Sep-Oct) 40(5):428-31
160. Fleischhacker H Stacher A [On the effect of dental focal infection on the course of hematologic diseases] Osterr Z Stomatol (1969 Jun) 66(6):210-4
161. Marculescu A Ursuleac S Pralea E Anghel I [Vascular diseases of the posterior pole caused by focal infections] Rev Chir [Oftalmol] (1978 Oct-Dec) 22(4):301-2
162. Madeira AA Lopes GV [Study of the hematological changes in thirty patients with chronic dental infection, before and after surgical treatment (author's transl)] Arq Cent Estud Fac Odontol UFMG (Belo Horiz) (1976 Jan-Dec) 13(1-2):177-88
163. Marini R Succo M Modica F [Focal infection in dentistry: the in vitro specific lymphocyte blast test] Minerva Stomatol (1991 Nov) 40(11):689-94
164. Salgarelli A Morana G Beltramello A Nocini PF Pseudoaneurysm of the lingual artery: a case report. J Oral Maxillofac Surg (1997 Aug) 55(8):860-4
165. Shurin SB Socransky SS Sweeney E Stossel TP A neutrophil disorder induced by capnocytophaga, a dental micro- organism. N Engl J Med (1979 Oct 18) 301(16):849-54
We recovered capnocytophaga, a gram-negative anaerobe implicated in the pathogenesis of periodontal disease, from two patients with a history of dental infections. Neutrophils from both patients failed to acquire the asymmetric shape characteristic of normal neutrophils. Fluorescein staining of the patients' living neutrophils remained diffuse and patchy instead of showing the normal pattern in which the fluorescence is swept into the rear of the cell. The locomotion of one patient's neutrophils in vitro was less than 50 per cent of that of normal neutrophils, and migration of this patient's neutrophils into dermal abrasions was reduced, although phagocytosis and nitroblue tetrazolium reduction were normal. All abnormalities of neutrophil morphology and function disappeared after eradication of the capnocytophaga infections. Sonicates and culture medium of capnocytophaga contained a dialyzable substance that caused normal neutrophils to behave like neutrophils obtained from the infected patients.
166. Stypulkowski C Lagan W Stypulkowska J [Chronic focal oral infection as a factor causing the appearence of hemorrhagic hyperglobulinemic purpura of Waldenstrom] Pol Tyg Lek (1965 May 17) 20(20):734-5
167. Shaker MA Level of plasma proteins in patients with severe odontogenic infection and fever. Egypt Dent J (1995 Apr) 41(2):1189-94
