Focal Infection - Theory or Reality

Robert Gammal BDS. FACNEM(Dent)

Introduction

In recent years there has been a reawakening of the dangers of oral infections and their potential disastrous effects on systemic health. Dead and infected teeth are often treated 'conservatively' in modern dentistry by performing a treatment called Root Canal Therapy. As dentists we are indoctrinated that it is better to save a tooth at any cost - although the real costs to individual health and the society at large are usually totally overlooked by the teaching institutions. This may at first seem surprising considering that dentistry is touted as a health providing profession. On the other hand, if the dental profession were to accept the reality of Focal Infection (and the potential sources of this oral infection), we would have to reassess some of the fundamental treatment concepts being taught and practiced in dentistry. Root Canal Therapy must surely be one of the prime candidates for this reassessment.

With the resurgence of an interest in this area, there is also a blatant resistance by the dental profession of the reality of Focal Infection Theory. Both the Australian Dental Association and the universities have stated that Focal Infection is a concept dating back 150 years and one, which has been disproven by recent research. This supposed research has never been cited by either the Australian Dental Association or the universities.

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 defense 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 sterilize 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.

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

Immune

168. N. Tani et al J. Endo 18:2 1992

169. Siskin M Oral Surg. 1977 Vol 43 No 3

170. Kaliuzhnaia RA [The role of toxicosis in the development of sensitization and allergic conditions in children and adolescents] Pediatriia (1967 Oct) 46(10):9-14

171. Oral Surg. 1977 Vol 43 No 3 Immune Reaction Induction of Monocyte migration, interlukin 1 production, mitogenic response of lymphocytes, mitogenisis in B lymphocytes.

Ear Nose & Throat

172. Andriutsa VI Ketrar' GI Kuria VI [Odontogenic peritonsillar abscess complicated by parapharyngeal abscess, thrombosis of the internal jugular vein and cavernous sinus, and sepsis] Vestn Otorinolaringol (1977 May-Jun)(3):101-2

173. Bertrand JC Couly G Peret R [Oro-pharyngeal infections due to anaerobic bacteria]Infections oro-pharyngees a germes anaerobies Rev Prat (1977 Jan 11) 27(3):155-61

174. English WJ 2d Kaiser AB Lethal toothache: parapharyngeal cellulitis complicating dental infection. South Med J (1979 Jun) 72(6):687-9, 692

Three patients with parapharyngeal cellulitis arising from dental infection were seen by the Medical Service over a period of ten months. Respiratory distress and/or pharyngeal discomfort prompted all patients to seek medical aid. The extent of infection within the parapharyngeal space, the potential for life-threatening complications, and the significance of the dental lesions were not appreciated initially in all cases. Despite early antibiotic therapy, one patient died and one incurred severe neurologic sequelae. Early recognition, use of antibiotics effective against anaerobic bacteria, and prompt surgical drainage are mandatory to prevent considerable morbidity and mortality. Control of the airway is the most important therapeutic maneuver leading to a favorable outcome.

175. Perovic J Piscevic A [Chronic subcutaneous abscesses of dental origin] Stomatol Glas Srb (1971 Aug-Oct) 18(4):233-5

176. Valdazo A [Peripharyngeal abscesses: various observations apropos of 2 recent observations] Rev Laryngol Otol Rhinol (Bord) (1978 May-Jun) 99(5-6):361-8

Neck

177. Bianchi MA Rosenberg SL Murphy JB Cervical necrosis and sinus tract formation secondary to a dentoalveolar infection: report of a case. J Oral Maxillofac Surg (1986 Nov) 44(11):894-6

178. Chidzonga MM Necrotizing fasciitis of the cervical region in an AIDS patient: report of a case. J Oral Maxillofac Surg (1996 May) 54(5):638-40

179. De Backer T Bossuyt M Schoenaers J Management of necrotizing fasciitis in the neck. J Craniomaxillofac Surg (1996 Dec) 24(6):366-71

180. Y Himelfarb MZ Zikk D Bloom J Cervical necrotizing fasciitis of odontogenic origin. Oral Surg Oral Med Oral Pathol (1991 Jul) 72(1):15-8

181. Janicke S Kettner R Kuffner HD A possible inflammatory reaction in a lateral neck cyst (branchial cyst) because of odontogenic infection. Int J Oral Maxillofac Surg (1994 Dec) 23(6 Pt 1):369-71

182. McAndrew PG Davies SJ Griffiths RW Necrotising fasciitis caused by dental infection. Br J Oral Maxillofac Surg (1987 Aug) 25(4):314-22

183. Mruthyunjaya B Necrotizing faciitis: report of case. J Oral Surg (1981 Jan) 39(1):60-2

184. Roberson JB Harper JL Jauch EC Mortality associated with cervicofacial necrotizing fasciitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod (1996 Sep) 82(3):264-7

185. Reyford H Boufflers E Baralle MM Telion C Guermouche T Menu H Krivosic-Horber R [Cervicofacial cellulitis of dental origin and tracheal intubation] Cellulites cervico-faciales d'origine dentaire et intubation tracheale. Ann Fr Anesth Reanim (1995) 14(3):256-60

186. Sakaguchi M Sato S Ishiyama T Katsuno S Taguchi K Characterization and management of deep neck infections. Int J Oral Maxillofac Surg (1997 Apr) 26(2):131-4

187. Scheffer P Ouazzani A Esteban J Lerondeau JC [Serious cervicofacial infections of dental origin] Infections graves cervico-faciales d'origine dentaire. Rev Stomatol Chir Maxillofac (1989) 90(2):115-8

188. Stoykewych AA Beecroft WA Cogan AG Fatal necrotizing fasciitis of dental origin. J Can Dent Assoc (1992 Jan) 58(1):59-62

189. Schroeder DC Sarha ED Hendrickson DA Healey KM Severe infections of the head and neck resulting from gas-forming organisms: report of case. J Am Dent Assoc (1987 Jan) 114(1):65-8

190. Tasar F Tumer C Yulug N Bayik S Cervicofacial actinomycosis (a case report). J Marmara Univ Dent Fac (1994 Sep) 2(1):389-91

191. Unkel JH McKibben DH Fenton SJ Nazif MM Moursi A Schuit K Comparison of odontogenic and nonodontogenic facial cellulitis in a pediatric hospital population. Pediatr Dent (1997 Nov-Dec) 19(8):476-9

192. Virolainen E Haapaniemi J Aitasalo K Suonpaa J Deep neck infections. Int J Oral Surg (1979 Dec) 8(6):407-11

From January 1967 to August 1978, 65 patients with cervical abscesses were referred to the ENT Clinic of Turku University Hospital. The origin of these deep neck infections was odontogenic in 19, tonsillitis or tonsillectomy in 14, trauma in seven, salivary glands in five and branchiogenic cysts in five and other known causes in three cases. In 12 cases the origin was unknown. The cervical abscesses of odontogenic origin were located mostly in the submandibular space (11/19). The rest of the deep cervical infections were mostly found in the parapharyngeal space (25/46). Etiological factors and treatment of these severe infections are discussed.

SINUS

193. Abrahams JJ Glassberg RM Dental disease: a frequently unrecognized cause of maxillary sinus abnormalities? AJR Am J Roentgenol (1996 May) 166(5):1219-23

a twofold increase in maxillary sinus disease in patients with periodontal disease and have shown a causal relationship.

194. Asiedu WA Calais P [Diagnosis and therapy of odontogenous diseases of the maxillary sinus] Fortschr Kiefer Gesichtschir (1976) 21:80-1

195. Azimov M Ermakova FB [Role of focal odontogenic infection in the pathogenesis of maxillary sinusitis (experimental study)] Stomatologiia (Mosk) (1978 Jan-Feb) 57(1):11-4

196. Bertrand B Rombaux P Eloy P Reychler H Sinusitis of dental origin. Acta Otorhinolaryngol Belg (1997) 51(4):315-22

Bacteria involved in odontogenic sinusitis are specific organisms associated with the teeth (Streptococcus sanguis, Streptococcus salivarius, Streptococcus mutans, anaerobic germs). \

197. Chikhani L Dupont B Guilbert F Improvisi L Corre A Bertrand JC [Uncommon fungal maxillary sinusitis of dental origin due to Scedosporium prolificans] Rev Stomatol Chir Maxillofac (1995) 96(2):66-9

198. Esposito S [Maxillary sinusitis of dental origin] Rass Int Clin Ter (1970 Jan 15) 50(1):39-45

199. Gay D et al Lancet 1986 Is Multiple Sclerosis caused by an Oral Spirochaete?

Evidence of a direct link between chronic sinusitis and Multiple Sclerosis (M.S.) prompted an examination of the old "spirochaetal hypothesis" This hypothesis has not been shown to be eroneous and a spirochaetal infection of the central nervous system could explain the specific pathological, immunological, and epidemiological features of M.S.

200. Gay D et al Lancet 1986;i:815-19 Multiple Sclerosis associated with Sinusitis; case controlled study in general practice.

In an analysis of general practice records the rate of chronic sinusitis was significantly greater in 92 patients with M.S. than in matched controlls. M.S. and chronic sinus infection were also significantly associated in the timing of attacks, in the age at which the patient suffered their attacks, and in the seasonal pattern of the attacks.

201. Guglani L Maxillary sinusitis due to dental infection. Newsl Int Coll Dent India Sect (1970 Sep) 7(3):15

202. Garbarino R Valente S Barbieri M [Odontogenic sinusitis with cutaneous fistulization. A case report] Minerva Stomatol (1995 Jun) 44(6):319-23

203. Guglani L Maxillary sinusitis due to dental infection. Newsl Int Coll Dent India Sect (1970 Sep) 7(3):15

204. Halstead CL Mucosal cysts of the maxillary sinus: report of 75 cases. J Am Dent Assoc (1973 Dec) 87(7):1435-41

205. Ivankievicz D Schumacher GH Ethmoidal complications following maxillary inflammations of dental origin. Dent Mag Oral Top (1968 Jun) 85(3):111-4

206. Maloney PL Doku HC Maxillary sinusitis of odontogenic origin. J Can Dent Assoc (1968 Nov) 34(11):591-603

207. Nortje CJ Farman AG de V Joubert JJ Pathological conditions involving the maxillary sinus: their appearance on panoramic dental radiographs. Br J Oral Surg (1979 Jul) 17(1):27-32

208. Neupokoev NI Neupokoeva NV [Periapical cyst of the maxillary teeth as a cause of odontogenic maxillary sinusitis] Stomatologiia (Mosk) (1991 May-Jun) 70(3):62-3

209. Politi M Rossetti G Consolo U Nocini PF Fugazzola C [Odontogenic sinusitis. An evaluation and the radiologic checkup protocol after a Caldwell-Luc intervention] Minerva Stomatol (1990 Feb) 39(2):119-22

210. Selden HS The endo-antral syndrome: an endodontic complication. J Am Dent Assoc (1989 Sep) 119(3):397-8, 401-2

211. Smith D Goycoolea M Meyerhoff WL Fulminant odontogenic sinusitis. Ear Nose Throat J (1979 Oct) 58(10):411-2

212. Samant A Malik CP Chhabra SK Tewari A Bilateral facial sinus of odontogenic origin. J Indian Dent Assoc (1975 Oct) 47(10):417-21

213. 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

214. Stefaniu A Czausescu V Popescu N Romascanu G Ceausescu A [Orbito-ocular and meningoencephalic complications in odontogenic maxillary sinusitis] Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol (1982 Jan-Mar) 27(1):59-64

215. 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

216. Yamazaki Y Shimada K Sakuma M Kawashima Y Kobayashi H [Odontogenic maxillary sinusitis: with special reference to surgical therapy] Nippon Jibiinkoka Gakkai Kaiho (1972 Oct) 75(10):1125-6

Septicemia

217. Bridgeman A Wiesenfeld D Hellyar A Sheldon W Major maxillofacial infections. An evaluation of 107 cases. Aust Dent J (1995 Oct) 40(5):281-8

218. Borowsky SA Hasse A Wiedlin R Lott E Dental infection in a cirrhotic patient. Source of recurrent sepsis. Gastroenterology (1979 Apr) 76(4):836-9

A patient with alcoholic cirrhosis had multiple episodes of sepsis with Klebsiella pneumonia. Repeated searches for the source of infection finally revealed the organism in the root of a tooth. Evidence indicated that this site was the primary source of infection. The importance of dental infections in alcoholics and the difficulty in diagnosing those infections are emphasized by this case.

219. Dierks EJ Meyerhoff WL Schultz B Finn R Fulminant infections of odontogenic origin. Laryngoscope (1987 Mar) 97(3 Pt 1):271-4

220. Ghanassia R [Septicemia of dental origin] Inf Dent (1975 Mar 27) 57(13):29-32

221. Kicinski J [Tooth infection as a course of puerperal sepsis] Pol Tyg Lek (1971 Jul 5) 26(27):1047-8

222. Kirch W Duhrsen U Erythema nodosum of dental origin. Clin Investig (1992 Dec) 70(12):1073-8

223. Laly C Javelot-Terziev MJ Bedel C [Root canal filling and microbial flora. Statistical study within the framework of remote infections] Actual Odontostomatol (Paris) (1978)(123):357-74

224. Laine PO Lindqvist JC Pyrhonen SO Strand-Pettinen IM Teerenhovi LM Meurman JH Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs. Eur J Cancer B Oral Oncol (1992 Oct) 28B(2):103-7

225. Loesche WJ Association of the oral flora with important medical diseases. Curr Opin Periodontol (1997) 4:21-8

226. Marques AP Walker PO Intraoral etiology of a life-threatening infection in an immunocompromised patient: report of case. ASDC J Dent Child (1991 Nov-Dec) 58(6):492-5

227. Mitchell CS Nelson MD Jr Orofacial abscesses of odontogenic origin in the pediatric patient. Report of two cases. Pediatr Radiol (1993) 23(6):432-4

228. Navazesh M Mulligan R Systemic dissemination as a result of oral infection in individuals 50 years of age and older. Spec Care Dentist (1995 Jan-Feb) 15(1):11-9

229. Orlenko MA Tsymbaliuk VP Katsnel'son BM [Odontogenic staphylococcus sepsis] Stomatologiia (Mosk) (1975 Nov-Dec) 54(6):81-2

230. Pernice L Ribault JY Fourestier J Gacon J Quilichini R Aubert L Chaffanjon P Roubaudi G [Persistent fever of dental origin] : Rev Stomatol Chir Maxillofac (1990) 91 Suppl 1:137-8

231. Plamieniak Z Medras M Man W [2 cases of odontogenic septicemia with atypical clinical course] Czas Stomatol (1977 Nov) 30(11):947-50

232. Thoden van Velzen SK Abraham-Inpijn L Moorer WR Plaque and systemic disease: a reappraisal of the focal infection concept. J Clin Periodontol (1984 Apr) 11(4):209-20

Fever

233. Berry E Silver J Pyorrhoea as cause of pyrexia. Br Med J (1976 Nov 27) 2(6047):1289-90

Three patients with fever and malaise, one of whom also had joint pains, were extensively investigated before their condition was attributed to dental sepsis. Each patient recovered fully after appropriate dental treatment. Dental sepsis should be added to the list of possible causes of pyrexia of ndetermined origin, and a routine dental examination should be carried out in each case.

234. Hyjek K Mateja W [Rare case of odontogenic subscleral empyema] Czas Stomatol (1966 Mar) 19(3):333-6

235. Levinson SL Barondess JA Occult dental infection as a cause of fever of obscure origin. Am J Med (1979 Mar) 66(3):463-7

Three patients with prolonged unexplained fevers were ultimately found to have deep-seated dental infection. After initial examination failed to elicit symptoms or signs of dental infection, and extensive in-hospital evaluation was nonproductive, dental consultation with roentgenograms provided the diagnosis. All three patients underwent dental extractions with periapical or peridontal debridement; following a brief postoperative febrile period, all three responded with defervescence, without subsequent recurrence of fever. These cases emphasize the importance of periapical and peridontal infection as causes of fever of obscure origin. The pathogenesis, characteristics and bacteriology of periapical abscess are discussed.

236. Samra Y Barak S Shaked Y Dental infection as the cause of pyrexia of unknown origin--two case reports. Postgrad Med J (1986 Oct) 62(732):949-50

237. Shinoda T Mizutani H Kaneda T Suzuki M Fever of unknown origin caused by dental infection. Report of a case. Oral Surg Oral Med Oral Pathol (1987 Aug) 64(2):175-8

238. Urmosi J [Clinical and laboratory data supporting the possible relationship between dental foci and erythema exudativum multiforme] Fogorv Sz (1974 Nov) 67(11):342-7

Shock

239. Donoff RB Guralnick W Shock due to odontogenic infection: report of case. J Oral Surg (1977 Jul) 35(7):569-72

240. Egbert GW Simmons AK Graham LL Toxic shock syndrome: odontogenic origin. Oral Surg Oral Med Oral Pathol (1987 Feb) 63(2):167-71

241. Quinn P Guernsey LH The presentation and complications of odontogenic septic shock. Report of a case. Oral Surg Oral Med Oral Pathol (1985 Apr) 59(4):336-9

Death

242. Currie WJ Ho V An unexpected death associated with an acute dentoalveolar abscess-- report of a case. Br J Oral Maxillofac Surg (1993 Oct) 31(5):296-8

243. Gotte P [Death after a dental infection] Minerva Stomatol (1979 Jul-Sep) 28(3):241-3

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 infection 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.

244. Ocampo Flores P Limon Mejia AL Bustillos Lucas J Silva Sanchez V [Death from generalized sepsis of dental origin. Contribution to clinical casuistry] Rev ADM (1991 Jan-Feb) 48(1):45-51

Backache

245. Kolb H [Spontanous remission of severe backache following oral rehabilitation] Quintessenz (1976 Apr) 27(4):35-6

Bone

246. Biberman IaM [Clinical aspects of odontogenic osteomyelitis of the maxilla in adults] Stomatologiia (Mosk) (1974 Nov-Dec) 53(6):31-4

247. Cathelin A Madjidi A Fleuridas G Couly G [Pseudo-tumoral osteitis of the mandible in children] Osteite pseudo-tumorale de la mandibule chez l'enfant. Rev Stomatol Chir Maxillofac (1994) 95(2):109-11

248. McGinnis JP Keene RD Focal osteoporotic bone marrow defect of the jaws--report of a case. Ark Dent J (1976 Mar) 47(1):10-11

249. Mauks G Toth A [Teeth, causing odontogenic periostitis classification by age] Fogorv Sz (1976 Aug) 69(8):330-4

250. Sollmann AH [Mandibular angle and vertebral diseases] Med Klin (1966 Jan 14) 61(2):51-4

251. Wang TD Chen YC Huang PJ Recurrent vertebral osteomyelitis and psoas abscess caused by Streptococcus constellatus and Fusobacterium nucleatum in a patient with atrial septal defect and an occult dental infection. Scand J Infect Dis (1996) 28(3):309-10

Joint Replacement

252. Advisory statement. Antibiotic prophylaxis for dental patients with total joint replacements. American Dental Association; American Academy of Orthopaedic Surgeons. J Am Dent Assoc (1997 Jul) 128(7):1004-8

253. Mulligan R Late infections in patients with prostheses for total replacement of joints: implications for the dental practitioner. J Am Dent Assoc (1980 Jul) 101(1):44-6

254. Jacobsen PL Murray W Prophylactic coverage of dental patients with artificial joints: a retrospective analysis of thirty-three infections in hip prostheses. Oral Surg Oral Med Oral Pathol (1980 Aug) 50(2):130-3

255. Rubin R Salvati EA Lewis R Infected total hip replacement after dental procedures. Oral Surg Oral Med Oral Pathol (1976 Jan) 41(1):18-23

Three cases are reported in which there was a worrisome association between dental work and an infected total hip replacement. The patients had long asymptomatic intervals subsequent to Implantation of prosthetic hip joints. After dental procedures, infections became apparent in these hips. Such infections carry an enormous and crippling morbidity. The potential complications of transient bacteremia in the patient with a cardiac valvular prosthesis are appreciated and the importance of prophylactic antibodies for dental work in such patients is well known. Although we emphasize that there is no proof that the infections in our patients were metastatic from the mouth, the sequence of events is suggestive. We recommend prophylactic antibiotics for dental work in the Patient with a total hip replacement.

256. Schurman DJ Aptekar RG Burton DS Infection in total knee joint replacement, secondary to tooth abscess. West J Med (1976 Sep) 125(3):226-7

257. N. Tani et al J. Endo 18:2 1992 Infected total Hip Replacement after dental procedures

Arthritis

258. Hess JC Victor M [Relation between rheumatology and endodontics] Ligament (1978) 16(129):19-21

259. Iida M Yamaguchi Y [Remission of rheumatoid arthritis following periodontal treatment. A case report] Nippon Shishubyo Gakkai Kaishi (1985 Mar) 27(1):234-8

260. Janecek J [Focal infection of dental origin as the cause of a joint disease] Prakt Zubn Lek (1987 Mar) 35(2):47-9

261. Morer G [Letter: Arthritis of the knee healed after dental avulsion] Arthrites du genou gueries apres vulsion dentaire Nouv Presse Med (1975 Oct 4) 4(32):2338

262. Morer G [Arthritis of the knee due to dental origin] Chirurgie (1977) 103(9):815-8

263. Moses JJ Lange CR Arredondo A Septic arthritis of the temporomandibular joint after the removal of third molars. J Oral Maxillofac Surg (1998 Apr) 56(4):510-2

264. Roslawski A [Role of infectious foci in ethiopathogenesis of chronic rheumatoid arthritis and ankylosing spondylitis] Wiad Lek (1972 Feb 1) 25(3):247-50

265. Shimizu K Toyota Y Koh T Ishikawa M Hirose Y [A case of rheumatoid arthritis caused by focal infection from periodontal tissue (author's transl)] Josai Shika Daigaku Kiyo (1977)(6):421-4

266. Wallace DE Chronic periodontitis and a chronic swelling of the right index finger. J N Z Soc Periodontol (1991 May)(71):15

Skin

267. Cepicka W Tielsch R [Focal infections and Psoriasis vulgaris] Dermatol Wochenschr (1967 Feb 25) 153(8):193-9

268. Perovic J Piscevic A [Chronic subcutaneous abscesses of dental origin] Stomatol Glas Srb (1971 Aug-Oct) 18(4):233-5

Alopecia

269. Neceva LJ Lazareva B [Focal effect of diseased deciduous teeth in Alopecia areata] Acta Stomatol Croat (1970) 5(2):110-4

270. Zivkovic S [Endodontic treatment in the therapy of alopecia areata] Stomatol Glas Srb (1990 Jun) 37(3):299-305]

Lupus & Connective Tissue

271. Arellano Ocampo F Rojas Rodriguez J Rosales Perez S Perez MA Ramales E [Systemic lupus erythematosus (presentation of a case)] Lupus eritematoso sistemico (presentacion de un caso). Alergia (1977 Jul) 24(3):149-58

272. Bruszt P Vegh T [Incidence of facial fistulae of dental origin in ambulatory patients of a dental clinic] Orv Hetil (1978 Feb 12) 119(7):405-7

273. Heilelman JF Dirlam JH Severe cellulitis of dental origin with gas-producing bacteria. J Indiana Dent Assoc (1982 May-Jun) 61(3):11-3

274. Roser SM Chow AW Brady FA Necrotizing fasciitis. J Oral Surg (1977 Sep) 35(9):730-2

Necrotizing fasciitis is a relatively uncommon severe soft tissue infection that is characterized by rapid widespread superficial fascial necrosis with undermining of surrounding soft tissue. Recent advances in anaerobic culture techniques have allowed identification of anaerobic organisms, which are now considered to have a vital role in the pathogenesis of this soft tissue infection. Therapy requires both rapid institution of a high level of antibiotics and a radical surgical incision and drainage procedure. All of the aerobic and anaerobic organisms isolated in the reported case of necrotizing fasciitis arising from a periapically infected mandibular third molar demonstrated in vitro sensitivity to penicillin.

275. Samant A Malik CP Chhabra SK Tewari A Bilateral facial sinus of odontogenic origin. J Indian Dent Assoc (1975 Oct) 47(10):417-21

276. Sinclair RJ Oral infection in connective tissue disease. J Br Endod Soc (1967 Spring) 1(1):13-4

Splenic abscess

277. Abu-Dallo KI Manny Y Penchas S Eyal Z Clinical manifestations of splenic abscess. Arch Surg (1975 Mar) 110(3):281-3

Two patients with splenic abscess were successfully treated. In one patient, Streptococcus viridans, possibly arising in a dental abscess, led to inflammatory left upper quadrant signs. An exploratory laparotomy was performed, and the spleen, being found enlarged, was removed. The other patient showed no peritoneal signs. Laparotomy was done for pyrexia of unknown origin, and the removal of a normal-sized spleen was elected on the suspicion of lymphosarcoma. The spleen was abscessed, apparently because of old infarcts. A high index of suspicion is important in diagnosis, and selective angiography, not used in these two patients, is recommended.

Leg Abscess

278. Dugois P Amblard P Gagnaire J Imbert R [Leg abscesses in stages after phlebosclerosus: complication of a septicemia of dental origin] Bull Soc Fr Dermatol Syphiligr (1968) 75(4):518-20

Cancer

279. Plohberger HM [Cancer and focal infection] Osterr Z Stomatol (1974 Apr) 71(4):138-41(Published in German)

Brain Cancer

280. Perna E et al. "Actinomycotic Granuloma of the Gasserian Ganglion with primary site in a dental root" J of Neurosurg 54 (1981) 553-555

Demyelination of Gasserian Ganglion

281. Black R., laboratory model for Trigeminal Neuralgia. Adv. Neuro.1974; 4:651-8

282. 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

283. 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

284. 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. 977;132:347-54

Kidney

285. Sowell SB Dental care for patients with renal failure and renal transplants. J Am Dent Assoc (1982 Feb) 104(2):171-7

286. Suc JM [Renal glomerulus, site of focal infection] Ligament (1978) 16(129):23-4

Abdomen

287. Peterson CM Theander C [Tooth infection spreading to the abdominal cavity] Lakartidningen (1986 Feb 5) 83(6):412-3

Prostate / Infertility

288. Bieniek KW Riedel HH [Diseases of the masticatory system as possible causal factors in infertility] ZWR (1989 Oct) 98(10):850, 852, 854

289. Linossier A Thumann A Bustos-Obregon E Sperm immobilization by dental focus microorganisms. Andrologia (1982 May-Jun) 14(3):250-5

290. Rose JF Jr The prostate and dental infections. Pa Dent J (Harrisb) (1968 Apr) 35(4):84-7

Periodontal Diseasse Relationships

291. J Periodontol 1996 Oct;67(10 Suppl):1123-1137 Periodontal disease and cardiovascular disease. Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S Department of Dental Ecology, University of North Carolina, Chapel Hill, USA. It is

292. J Periodontol 1996 Oct;67(10 Suppl):1138-1142 Effects of oral flora on platelets: possible consequences in cardiovascular disease. Herzberg MC, Meyer MW

293. J Periodontol 1996 Oct;67(10 Suppl):1114-1122 Relationships between periodontal disease and bacterial pneumonia. Scannapieco FA, Mylotte JM.

294. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J Department of Periodontics,J Periodontol 1996 Oct;67(10 Suppl):1103-1113 Periodontal infection as a possible risk factor for preterm low birth weight. Balcheva E Dzherasi E [The incidence of active periodontal foci in focal infections] Nauchni Tr Nauchnoizsled Stomatol Inst (Sofiia) (1969) 13:21-3

295. Sallum AW do Nascimento A de Souza CA [Periodontal infection and disease as potential factors affecting the patients health] Bol Fac Odontol Piracicaba (1974) 75:1-12

296. George W. Brian A, et al. Severe Periodontitis and Risk for poor Glycemic Control in patients with Non-Insulin Dependant Diabetes Mellitus J. Periodontol Oct 1996

297. Mark E et al Exploratory Case Controll Analysis of Psychosocial Factors and Adult Periodontitis J. Periodontol Oct 1996

298. Daniel MA et al Alterations in Phagocyte Function and Periodontal Infection J. Periodontol Oct 1996

299. Genco R Current View of Risk Factors for Periodontal Disease; J. Periodontol Oct 1996

300. Sara G et al Response to Periodontal Therapy in Diabetics and Smokers J. Periodontol Oct 1996

Ludwig's Angina

301. Esquivel Bonilla D Huerta Ayala S Molina Moguel JL [Report of 16 cases of Ludwig's angina: 5-year review] Pract Odontol (1991 Apr) 12(4):23-4, 28

302. Iwu CO Ludwig's angina: report of seven cases and review of current concepts in management. Br J Oral Maxillofac Surg (1990 Jun) 28(3):189-93

303. Merino Galvez E Gil Melgarejo JA Hellin Meseguer D Pelegrin Pelegrin F [A classic case of Ludwig's angina] Un caso clasico de angina de Ludwig. An Otorrinolaringol Ibero Am (1991) 18(5):433-8

304. Mounier-Kuhn P Gaillard J Bernard P Boulud B [Severe Ludwig's angina] JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac (1972 Apr) 21(4):349-50

305. Saadi C ["Ludwig's angina" (diffuse and gangrenous in inflammation of the floor of the mouth] Hospital (Rio J) (1968 Jul) 74(1):213-9

306. Strauss HR Tilghman DM Hankins J Ludwig angina, empyema, pulmonary infiltration, and pericarditis secondary to extraction of a tooth. J Oral Surg (1980 Mar) 38(3):223-9

Osteitis

307. Ratner EJ Langer B Evins ML Alveolar cavitational osteopathosis. Manifestations of an infectious process and its implication in the causation of chronic pain [published erratum appears in J Periodontol 1987 Feb;58(2):77] J Periodontol (1986 Oct) 57(10):593-603

308. 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

309. Schuh E [Residual osteitis in the edentulous jaw as a focus possibility] Therapiewoche (1965 Dec) 15(23):1246-9

310. Schuh E [Residual osteitis in the edentulous jaw and general diseases] Osterr Z Stomatol (1966 Feb) 63(2):52-9.

TB

311. Avdonina LI Gedymin LE Erokhin VV [Intra-dental route of experimental tuberculosis infection] Probl Tuberk (1991)(10):79-83

312. Gambetti G Gelli G [On a case of tuberculous adenopathy possibly of primary odontogenic infection] Mondo Odontostomatol (1966) 8(1):47-51

Testing

313. Ascher M [Diagnosis and therapy of focal infection] Zahnarztl Prax (1969 Aug 1) 20(15):175-7

314. Bermanowa G [The electroinduction test for the evaluation of the activity of odontogenic focal infections] Reumatologia (1969) 7(2):151-5

315. Di Stefano PG [A test for focal infection in dentistry using galvanic current] Ann Stomatol (Roma) (1972 Jan-Feb) 21(1):39-44

316. Freyberger P [Electropotential differences in the mouth as factors in dental focal infection and other disorders] Zahnarztl Prax (1967 Feb 15) 18(4):41-2

317. Kramer F [Electroacupuncture in dentistry] Zahnarztl Prax (1974 Dec 20) 25(24):574-6

318. Kramer F [Diagnosis of focal infection using the electroacupuncture] Zahnarztl Prax (1969 Aug 15) 20(16):183-4

319. [Thermography and focus diagnosisThermographie und Herddiagnostik ZWR (1975 May 25) 84(10):486-8

320. Leonhardt H [Focal process and Voll's electroacupuncture in dentistry] ZWR (1974 Jul 10) 83(13):704-5

321. Leonhardt H [The Voll electro-acupuncture in dentistry] Zahnarztl Prax (1972 Jan 7) 23(1):10-1

322. Lautenbach E [Focal process and electro-skin test with special reference to stomatology] Zahn Mund Kieferheilkd Zentralbl (1975) 63(1):32-41

323. Maresch O [Locus, range and reaction field of interference as basis for electric measurements in focal infection] Osterr Z Stomatol (1973 Mar) 70(3):110-5

324. Maresch O [Area of disturbances--reaction area as basis for electrical impulses in focal infection] Osterr Z Stomatol (1973 Mar) 70(3):110-5

325. Marschner G [Detection of foci and troubled areas by the directed and reproducible method according to Voll] Zahnarztl Prax (1967 May 1) 18(9):114-5

326. Reich H [A case of focal infection, discovered by means of the electroacupuncture test] Dtsch Zahnarztl Z (1974 Nov) 29(11):1043-4

327. Rost A [Possibilities and limits of electroacupuncture in dentistry] Zahnarztl Prax (1975 May 16) 26(10):226-7

328. Rost A [Focal infection and focal diagnosis from the viewpoint of thermoregulation] Freie Zahnarzt (1985 Oct) 29(10):82, 84, 86 passim

329. Rozenfel'd LG Timofeev AA Borisenko ON Stupko TN [Thermographic diagnosis of diseases of the maxillofacial area] Stomatologiia (Mosk) (1989 Jan-Feb) 68(1):54-8

330. Schuh E [Critical examination of electrical, thermal and humoral methods in localizing focal infections] Wien Med Wochenschr (1968 Jan 6) 118(1):13-8

331. Schwarz E [Mechanism and process of focal infection]: Zahnarztl Prax (1974 Apr 5) 25(7):168-72

Reviews

332. Debelian GJ Olsen I Tronstad L Systemic diseases caused by oral microorganisms. Endod Dent Traumatol (1994 Apr) 10(2):57-65

333. Harsanyi L Schweitzer K [The focus of dental infection] Adatok a fogaszati goc kerdesehez. Fogorv Sz (1991 Dec) 84(12):369-74

334. Hollister MC Weintraub JA The association of oral status with systemic health, quality of life, and economic productivity. J Dent Educ (1993 Dec) 57(12):901-12

Dental disease accounts for many lost work and school days. Lower wage earners and minorities are disproportionately affected.

335. Meurman JH Dental infections and general health. Quintessence Int (1997 Dec) 28(12):807-11

336. Newman HN Focal infection revisited--the dentist as physician [editorial] J Dent Res (1992 Nov) 71(11):1854

337. Newman HN Focal infection revisited. J West Soc Periodontal Periodontal Abstr (1993) 41(3):73-7

338. Preda EG Pasetti P [Focal pathology and infectious dental foci. Theoretical and clinical aspects]

339. Patologie focali e foci infettivi dentari. Aspetti teorici e clinici. Dent Cadmos (1990 Jul 15) 58(12):34-43

340. Walsh LJ Serious complications of endodontic infections: some cautionary tales. Aust Dent J (1997 Jun) 42(3):156-9

Mechanisms of Transport of Substances from Teeth

341. Arvidson J. Gobel S. "An HRP study of the Central Projections of Primary Trigeminal Neurons which innovate tooth pulps in the cat. Brain Res. 210 (1981) 1-16

342. Capra N. Andersopn KV. Pride JB. Jones TE simultaneous "Demonstration of Neuronal Somata that innovate the tooth pulp and adjacent periodontal tissues using two retrogradely transported anatomic markers." Exp. Neurol 86(1984) 165-170

343. N. Economedes et al J. Endo 21:3 1995

344. Marfurt C. Turner D Uptake and transneuronal transport of Horseradish Peroxidase - Wheat Germ aglutinin by Tooth Pulp Primary Afferent Neurons' Brain Res. 452(1988) 381-387

345. Marfurt C. Turner D 'The central Projections of tooth pulp afferent neurons in the rat as determined by the Transganglionic transport of Horseradish Peroxidase" J. of Comp.Neuro 223 (1984) 535-547.

346. Stortebecker. Mercury Poisoning from Dental Amalgam 1985 p38

347. Stortebecker 3rd Int Cong of Neurological Surgery Copenhagen 1965

348. Stortebecker P "Dental Infectious Foci and diseases of the nervous system - spread of microorganisms and their products from dental infectious foci along direct cranial venous pathways eliciting a toxic - infectious encephalopathy" Acta. Psych Neural Scand 36 Suppl. 157 (1961) 62

349. Stortebecker P "The cranial venous system filled from pulp of a tooth - Proceedings 3rd Int. Congress of Nero Surg. Copenhagen Aug 1965

350. Stortebecker P "Dental significance of pathways for dissemination from infectious foci." J Can Dent Assoc 33:6 1967 pp301-311

351. Stortebecker P Chronic dental infections in the etiology of Glioblastomas. 8th int congress" Neuropathy. Washington D.C. J Neuropth. Exp. Neurology 37(s) 1978

352. Kristensson K., Olssan Y., Diffusion Pathways and Retrograde Transport in peripheral nerves" Prog. In Neurobio. 1 (1973)

353. Price DL., Griffin J., Neurons and ensheathing cells as targets of disease processes. Ed. P.S. Spencer. Experimental and Clinical Neurotoxicology (Schaumburg: Wilkens and Wilkens 1980

Endotoxins

354. Alves J.A., Barrieshi K, Walton R. E., Wertz P. Wilcox L., Drake D. J Dent Res 1996; 75 (special issue):373 abstract 2847).

355. Horiba et al. Oral Surg. Oral Med. Oral Path. 1991 Vol 71

356. R. Nissan et al J. Endo 21:2 1995

357. Schein B J. of Endodontics 1975 Vol 1 No 1

358. Penner A et al. J Exp Med 1960;111:145-53

359. Palmiro C J Exp Med 1962 ;115:609-12

360. Alper M Proc Soc Exp Biol Med 1967;124:537-8

361. Parnas I Science 1971;171:1153-5

Hydrogen Sulfide and Methyl Mercaptan Production by Oral Bacteria.

(from http://www.altcorp.com/oralartc.htm)

362. The formation of hydrogen sulfide and methyl mercaptan by oral bacteria. Persson et al., (1990). Oral Microbiol. Immunol. 5:195-201.(2082242)

363. Desulfuration of cysteine and methionine by Fusobacterium nucleatum. Piannotti et al., (1986). J. Dent. Res. 65:913-917.(3458742)

364. On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth. Waler (1997). Eur. J. Oral Sci. 105:534-537.(9395120)

365. Production of volatile sulfur compounds by various Fusobacterium species. Claesson et al., (1990). Oral Microbiol. Immunol. 5:137-142.(2080068)

366. Competition for peptides and amino acids among periodontal bacteria. Tang-Larsen et. al., (1995). J. Periodont. Res. 30:390-395.(8544102)

367. Relationship between volatile sulfur compounds, BANA-hydrolyzing bacteria and gingival health in patients with and without complaints of oral malodor. De Boever et. al., (1994). J. Clin. Dentisrty 4:114-119. (8031479)

368. Peptostreptococcus micros has a uniquely high capacity to form hydrogen sulfide from glutatione. Carlsson et. al., (1993). Oral Microbiol. Immunol. 8:42-45.(8510983)

Hydrogen Sulfide and Methyl Mercaptan Toxicity

(from http://www.altcorp.com/oralartc.htm)

369. Modulation of human gingival fibroblast cell metabolism by methyl mercaptan. Johnson et al. (1992). J. Periodontal Res. 27:476-483.(1403576)

370. The effect of methanethiol and methionine toxicity on the activities of cytochrome c oxidase and enzymes involved in protection from peroxidative damage. Finkelstein and Benevenga (1986). J. Nutr. 116:204-215.(3003292)

371. Effects of methanethiol on erythrocyte membrane stabilization and on Na+,K+-adenosine triphosphatase: relevance to hepatic coma. Ahmed et al., (1984). J. Pharmacol. Exp. Ther. 228:103-108.(6319665)

372. Acute and subchronic toxicity studies of rats exposed to vapors of methyl mercaptan and other reduced-sulfur compounds. Transy et al., (1981). J. Toxicol. Environ. Health 8:71-88.(7328716)

373. Cytotoxic effects of hydrogen sulfide on pulmonary alveolar macrophages in rats. Khann et al., (1991). J. Toxicol. Environ. Health 33:57-64.(2033644)

374. Alteration of the morphology and neurochemistry of the developing mammalian nervous system by hydrogen sulfphide. Roth et al., (1995). Clin. Exp. Pharmacol. Physiol. 22:379-380.(7554437)

375. Growth and development in the rat during sub-chronic exposure to low levels of hydrogen sulfide. Hayden et al., (1990) Toxicol. Ind. Health 6:389-401.(2237925)

376. Exposure to low levels of hydrogen sulfide elevates circulating glucose in maternal rats. Hayden et al., (1990). J. Toxicol. Environ. Health 31:45-52.(2213921)

377. Hydrogen sulfide exposure alters the amino acid content in developing rat CNS. Hannah et al. (1989). Neurosci. Lett. 8:323-327.(2566964)

378. Chronic exposure to low concentrations of hydrogen sulfide produces abnormal growth in developing cerebellar Purkinje cells. Hannah and Roth (1991). Neurosci. Lett. 28:225-228.(2027523)

379. Hydrogen sulfide: a bacterial toxin in ulcerative colitis? Pitcher and Cummings (1996). Gut 39:1-4.(8881797)

380. Effects of repeated exposures of hydrogen sulfide on rat hippocampal EEG. Skrajny et al., (1996). Toxicol. Lett. 84:43-53.(8597177)

381. Sulfide-induced perturbations of the neuronal mechanisms controlling breathing in rats. Greer et al., (1995). J. Appl. Physiol. 78:433-440.(7759410)

382. Low concentrations of hydrogen sulfide alter monoamine levels in the developing rat central nervous system. Skrajny et al., (1992). Can. J. Physiol. Pharmacol. 70:1515-1518.(1296865)

383. Monoamine oxidase inhibition as a sequel of hydrogen sulfide intoxication: increases in brain catecholamine and 5-hydroxytryptamine levels. Warenycia et al., (1989). Arch. Toxicol. 63:131-136.(2730337)

384. Toxicology of hydrogen sulfide. Reiffenstein et al., (1992). Ann. Rev. Pharmacol. Toxicol. 32:109-134.(1605565)

385. Hydrogen sulfide. Guidotti (1996). Occup. Med. 46:367-371.(8918153)

386. Acute hydrogen sulfide poisoning. Demonstration of selective uptake of sulfide by the brainstem by measurement of brain sulfide levels. Warenycia et. al., (1989). Biochem. Pharmacol. 38:973-981.

387. The actions of hydrogen sulfie on dorsal raphe serotonergic neurons in vitro. Kombian et. al., (1993). J. Neurophysiol. 70:81-96.(8395590)

388. Hydrogen sulfide and reduced-sulfur gases adversely affect neurophysiological functions. Kilburn and Warshaw (1995). Toxicol. Ind. Health 11:185-197.(7491634)

389. Effect of volatile thiol compounds on protein metabolism by human gingival fibroblasts. Johson et. al., (1992). J. Periodont. Res. 27:553-561.

Go to top of page