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The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. Key words: Odontogenic infections, classification, diagnose, treatment, odontogenic microorganisms, resistance, antimicrobial agents, antibiotics, amoxicilin, clawlanic acid. Although there is very little data regarding the incidence of infections of the oral cavity, no one doubts their relevance. The diagnosis of odontogenic infection is based on anamnesis, observation and examination that allows symptoms and signs to be recorded.
The issue of odontogenic infection must be approached from three, mutually complementary treatment areas.
Generally speaking, the treatment of mild gingivitis does not include systemic antibiotic administration. Debridement, elimination of the calculus and root planning to remove subgingival plaque deposits constitute the first line of treatment.
The treatment of infections located in the cervicofacial aponeurotic spaces include the following measures: 1) aetiological treatment, 2) incision, debridement and drainage of purulent accumulations and 3) antibiotic therapy. WHAT CHARACTERISTICS MUST THE IDEAL ANTIBIOTIC HAVE FOR THE TREATMENT OF ODONTOGENIC INFECTION?
HOW SENSITIVE ARE THE PATHOGENS INVOLVED IN ODONTOGENIC INFECTION TO THE MOST COMMONLY USED ANTIMICROBIAL AGENTS? The increased prevalence of bacterial resistance means that antibiotics that have been useful in the were, as is the case with certain dose levels. Treatment duration with antibiotics depends on the type of infection, the extension of the condition and on the antibiotic chosen. Penicillin, ampicillin and amoxicillin are bactericides that are useful in treating the acute phase of odontogenic infection, in addition to preventing associated complications (7). Cephalosporins are classified in generations, based on their antibacterial spectra, regardless of when they were synthesised. Tetracyclines have classically been the standard antibiotic of use in treating odontogenic infection, although at present, they exert limited activity as a result of increased resistance, particularly in countries such as Spain where there is a high level of antimicrobial use (50). Metronidazole, ornidazole and tinidazole are antibiotics with excellent activity against anaerobic gramnegative bacilli and spirochete, but hardly act, if they act at all, against anaerobic cocci and facultative, aerobic bacteria of the oral cavity (7,52).
Clindamycin continues to be the treatment of choice in patients who are allergic to beta-lactams in most odontogenic infections.
Macrolides are bacteriostatic antibiotics with a spectrum of activity that covers gram-positive bacteria, some gram-negative bacilli, bacteria growing intercellularly and several anaerobic bacteria, including Porphyromonas and Prevotellagenera.
For the diagnosis of Bacteremia and Fungemia, blood culturing is the most common and effective diagnostic tool. For patients, positive blood culturing can determine the existence of infectious pathogens.
Blood culturing has significant clinical implications to the diagnosis, treatment and prognosis of Endocarditis, Typhoid Fever, Streptococcus Pneumoniae and other diseases. Taking daily antibacterial and antifungal prophylaxis is the single most important factor in keeping CGD patients well. IMPORTANT NOTE: The information contained on this website is intended only as a guideline, not as a substitute for medical advice.
Step 6Allow the area to dry thoroughly before removing any dried baking soda and mixture with a vacuum. Before using the hydrogen peroxide and detergent mixture, test on a small section of the carpet for color fastness. To remove urine smell from hard surfaces or floors, clean the area with water and cleanser. 2.1The Licensed Material may not be used in any final materials distributed inside of your company or any materials distributed outside of your company or to the public, including, but not limited to, advertising and marketing materials or in any online or other electronic distribution system (except that you may transmit comps digitally or electronically to your clients for their review) and may not be distributed, sublicensed or made available for use or distribution separately or individually and no rights may be granted to the Licensed Material. 2.2One copy of the Licensed Material may be made for backup purposes only but may only be used if the original Licensed Material becomes defective, destroyed or otherwise irretrievably lost.
Of these types of infections, odontogenic infections (infections that involve tooth and periodontal tissues) are the most common. In 1999, the American Academy of Periodontology organized an international task force to create a classification of periodontal diseases and conditions (8) in response to the criticisms of previous classifications (9) (obscure diagnostic criteria, overlapping of disease-related groups, too much importance given to the patient s age, onset of illness and rate of progression, which are often difficult to determine). Overall, the Streptococcus, Peptostreptococcus, Veillonella, Lactobacillus, Corynebacterium and Actinomyces genera represent more than 80% of all cultivable flora (11).
Information regarding the patient s history of the following conditions is essential, as it will necessarily influence treatment and prophylaxis: endocarditis, implants, diabetes, immunodepression, etc.
Aetiological odontological treatment, which often includes surgical interventions of varying magnitude and requiring different levels of professional expertise; systemic support treatment, which covers a broad spectrum ranging from symptomatic pain management and controlling the inflammation, all the way to physical measures, hydration, fever control, glycaemic control, etc.
In some cases, surgical treatment is also necessary and in others, the best course of treatment is debridement, irrigation and drainage. Antibiotics are also indicated in cases in which the patient is immunodepressed and requires prophylaxis. It requires local treatment to eliminate dental plaque and to disinfect the gingival grooves.
Antibiotic treatment is reserved for those situations with there is local or systemic dissemination. Subgingival irrigation should also be performed using ultrasound tartar removal equipment to disinfect the gingival sulcus. Local treatment consisting of debridement, irrigation and drainage of the affected areas, or even tooth extraction can also be performed. Rinsing the mouth with chlorhexidine for 30 seconds after brushing teeth may also be useful as coadjuvant treatment (20).
Odontogenic infections are caused by a highly predictable group of bacteria, so the first choice of antibiotic is made empirically. The ploymicrobial component of odontogenic infection advises the use of antibiotics that are active against both aerobic and anaerobic bacteria are recommended, requires that the proper antibiotic be used for treatment.
In this regard, in the last 10-15 years the number of resistant microorganisms in the oral cavity has doubled (22). Overall, treatment duration will vary between 5 and 10 days; in other words, treatment should continue for 3 or 4 days after clinical manifestations have disappeared (30).
Due to their effectiveness against facultative aerobic and anaerobic pathogens, they are considered to be the antibiotics of choice in the treatment of infections of mixed aetiology in the oral cavity (31).
In general, as we move further along the generations, activity against gram-negative germs improves, while effectiveness against grampositive germs decreases (49). Because of their high affinity for bone and dental tissue, its use is not recommended during pregnancy, while nursing or in children less than eight years of age, since when deposited on teeth and bones during development they can produce alterations such as dental hypoplasia, bone deformities and abnormal tooth colour (51).
They should be administered in combination with other antibiotics in mixed infections of the oral cavity that involve oral aerobic or facultative streptococci.
It presents a good level of activity against anaerobic bacteria, although more and more resistant strains are emerging (53,54). There are a host of microorganisms in the oral cavity whose taxonomy is difficult to ascertain and it is not always easy to determine how they relate to clinical presentations. Microbial- and host-related factors play a role in oral and facial infections, which means that the response obtained in vivo may differ from what occurs in vitro.
Many oral bacteria produce beta-lactamases, which can sometimes complicate antibiotic therapy.


There are some individuals who are especially susceptible and in whom microorganisms produce more severe clinical symptoms and are more resistant to certain treatments. Certain factors alter patients susceptibility to different microorganisms (age, blood dyscrasias, drug treatment, hospitalisation, avitaminosis and others).
Antibiotic efficacy is multifactorial and success depends on different parameters being met, such as dosing schedule, time, etc. Blood is drawn from the person once or twice to find and detect infections that are spreading through the bloodstream, such as Bacteremia, Infective Endocarditis and Septicemia.
Blood culturing is an important research and is able to provide important indications for the diagnosis and treatment of patients with blood stream infections and potential Pyemia. Furthermore, antibiotic susceptibility tests can be carried out on the pathogens, optimizing the antibiotic treatment. Especially good for children and old people because these population groups are prone to suffer Bacteremia and Septicemia while their immunity is usually weak causing difficulties in blood collection. A gradient of Oxygen concentrations positively influences the growth of microorganisms demanding different Oxygen concentrations.
Advice is aimed at providing a balance between protective precautions and the need to maintain as normal a life as possible. When cats urinate on carpets or rugs, it can be very difficult to remove that offensive cat urine smell. It is easy to spot fresh urine stains, especially on carpets, but it might be difficult when the urine dries.
For carpeted areas, place some paper towels over the urine and press down with your feet to absorb the urine. Pour a sufficient amount of the mixture onto the carpet and allow it to penetrate the carpet fibers.
Remove the mattress from the bed and repeat Steps 2 to 5, then use a hand vacuum to remove any remaining baking soda. Since cat urine contains ammonia, using such a detergent can encourage cats to urinate again on these areas if they sense the ammonia smell. You will be asked to submit information concerning your intended use of the product, which will determine the scope of usage rights granted.Available for Editorial uses. Except as specifically provided in this Agreement, the Licensed Material may not be shared or copied for example by including it in a disc library, image storage jukebox, network configuration or other similar arrangement. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etcA…) confers this pathology vital importance. It is the most frequent reason for seeking odontological consultation and intervention and it affects the entire population from childhood (especially cavities) throughout a person s entire lifespan (periodontitis, implant complications, etc.), which entails a considerable impact both on public health in general, as well as the economic resources destined to maintain public health. The odontogenic infections that present most frequently would be those that result from dental cavities, dentoalveolar infections (infections of the pulpa and periapical abscesses), gingivitis (including necrotising ulcerative gingivitis), periodontitis (including pericoronitis and the periimplantitis), infections of the sub-aponeurotic spaces, osteitis, and osteomyelitis.
In the aetiology of periodontal disease, a whole series of species such as Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Tannerella forsythensis can be especially highlighted due to their frequency and the importance of the complications that may arise from them.
Only anaerobic bacteria were found to be present in 16 patients (50%), only aerobic in 2 (6%) and mixed aerobic and anaerobic flora, in 14 (44%). Radiological diagnosis is fundamental in determining the location, extension and possible complications of these lesions. Finally, antimicrobial treatment should only be applied on rare occasions and on the basis of rational, efficiency criteria. Other useful measures consist of rinsing the mouth with chlorhexidine or brushing with a mixture of sodium bicarbonate and hydrogen peroxide. However, if evolution is unfavourable, the antibiotic chosen can be substituted by another one or more than one after identifying the causal microorganisms by means of culture and antibiogram typing.
It is often necessary to administer combinations of antibiotics that can achieve a spectrum of activity and are more appropriate to the type of infection. We can cite the following example: studies have revealed the presence of beta-lactamase producing species in 74-88% of patients with periodontitis (23,24). However, there are more and more betalactamase producing bacteria, enzymes that are capable of hydrolysing penicillins and, therefore, leading to treatment failure (32-34) particularly when strains of the Prevotella, Porphyromonas and Fusobacterium genera are present (35-37). They present the disadvantage of having very poor activity against anaerobic bacteria, with the exception of cephamycins (cefoxitine, cefminox and cefotetan) for which there are no oral formulations (21). More than 25% of the viridans group streptococci present a high degree of resistance (55) that cannot be overcome with high doses of this antibiotic, nor is it active against some gram-negative bacilli, such as A.
Other alternatives, such as clarithromycin and azithromycin, complete the therapeutic arsenal. It is of great importance in diagnosing conditions such as Endocarditis, Typhoid Fever, Pneumonia and other diseases characterized by Bacteremia. The earliest possible implementation of effective antibiotic treatment has significant impact on the prognosis. All AUTOBIO™ Blood Culture media are rich in nutrients and special growth factors suitable for the growth of bacteria, especially fastidious bacteria such as Haemophilus. You need to remove the odor and urine stain completely because cats will usually urinate in the same spot again. Upon download of any film Licensed Material, you will be invoiced a non-refundable access service fee of one hundred fifty dollars ($150) USD or such other local currency amount as Getty Images may apply from time to time. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. It has been estimated that odontogenic infections in Spain represent approximately 10% of all antibiotic prescriptions (1,2) Scientific evidence has revealed a relationship between some serious oral infections and specific systemic cardiovascular (3), lung and endocrine (diabetes mellitus) diseases, as well as with alterations during pregnancy (4,5). Facultative gram-negative bacilli are uncommon in healthy adults and are seen almost exclusively in elderly, hospitalised patients with serious medical diseases (12). The main isolates consisted of bacteria belonging to the Peptostreptococcus, Prevotella and Porphyromonas genera.
The role of the laboratory in diagnosing odontogenic infections in routine practice in dentists offices is controversial. In general, antimicrobial treatment must be initiated whenever the condition presents clear clinical manifestations of infection.
Systemic antibiotics are indicated especially for the treatment of aggressive periodontitis (16). 4) Finally, complementary systemic care is also required (hydration, nutritional support, analgesics, antipyretics and anti-inflammatory drugs).
Likewise, over the course of recent years as seen with other pathogens such as Streptococcus pneumoniae, the levels of resistance to macrolides, beta-lacta-mase and clindamycin of several viridans group streptococci species have increased notably (25-28) . Tables 4 and 5 present antimicrobial agents and the dosing schedules recommended for each indication. In fact, penicillin administration has been linked to the appearance of beta-lactamase producing bacilli in the oropha-rynx (38,39). With the addition of sodium polyanetholsulfonate (SPS), a nontoxic anticoagulant, bacterial growth is enabled by counteracting the anti-bacteria or bacteria inhibiting effects.
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The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Because of this association between infection and other systemic diseases, it is essential that odontogenic infections be avoided as much as possible or failing that, that they be identified and treated promptly and appropriately.
Non-specific analytical data (leucocytes, complement, lymphocytes, immunoglobulins, glycaemia, etc.) must be requested when dealing with repeated or unusual infections or infections that are suspicious of any underlying disease that can have repercussions in the oral cavity. Antimicrobial treatment of odontogenic infections aims to prevent local spread and spread to neighbouring areas, to decrease the bacterial inoculum in the infectious focus and to prevent complications derived from disemination via the circulatory system (14,15). Attention must be paid at all times to alert criteria that indicate the need to transfer the patient to a hospital, possibly on an emergency basis (Table 2).
Whereas an increase in the macrolide doses does not lead to increased coverage against the resistant strains, in the case of beta-lactam, higher doses can lead to better coverage (29). Amoxicillin and ampicillin increase penicillin s spectrum to cover enteric gram-negative bacilli.
Amongst representatives of this drug family, clarithromycin show the greatest in vitro activity against anaerobic gram-posi-tive bacilli and azithromycin, against anaerobic gram-negative bacilli. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains.
On occasion, an odontogenic infection can spread and provoke polymicrobial infections in other locations, such as the paranasal sinuses (odontogenic maxillary sinusitis), cervicofacial subaponeurotic spaces, palate, central nervous system (cerebral abscess), endocardium (endocarditis), etc.
Better still, the internist s report should be requested before undertaking any kind of action.
Antimicrobial treatment is not the only treatment option for odontogenic infection, since antibiotic administration alone is often not sufficient to eradicate the infection. In the case of NUG, in addition to antibiotic treatment, debridement with ample irrigation is recommended (16).
Amoxicillin is better than ampicillin because of its superior enteric absorption (60-80% versus 30-55%) (40, 41). Colonies obtained from agar surface may be directly used for susceptivity experiments and strain identification.
Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration.
The patient can be spared serious medical complications and the professional can avoid legal complications. Topical application of mouthwash containing chlorhexidine or saline solution is effective in controlling the pain and ulceration that accompanies this condition. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period.
The increased resistance of some species of oral streptococci indicates that high doses of amoxicillin be used to treat infections in which these pathogens might be involved. Hence, this document is the result of bibliographic review, but, above all, it represents the fruit of the experience accumulated over many years of the participating specialists and of the group discussions held for the purpose of drafting it. Insofar as microbiological studies are concerned, pathology samples will be taken prior to commencing with antibiotic treatment and will be sent to the laboratory following proper standards.
Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection. The main objective of this document, which has been elaborated by specialists representing 10 public universities in Spain in collaboration with specialists in the microbiology of these kinds of infections, is none other than to establish recommendations that will be of use for all those involved in the daily clinical management of patients suffering from these diseases. Furthermore, this new formulation, when administered along with high doses of Amoxicillin, can delay or decrease the risk of increasing the prevalence rate of oral streptococci resistance, as seen in children with Streptococcus pneumoniae and a high dosis, short course of treatment with amoxicillin (5-7 days) (47,48).
The microbiological diagnosis seeks to rule out a specific aetiology, identify the aetiology of the condition and obtain overall information that is currently lacking, as well as to determine sensitivity to antimicrobial agents. These data will be useful in deciding on the treatment to be administered, whether to effect a change in the event that the empirical treatment fails and to establish general empirical therapies. Bases farmacomicrobiolA?gicas del tratamiento antibiA?tico de las enfermedades periodontales y periimplantarias.
Beta-lactamase producing bacteria in the subgingival microflora of adult patients with periodontitis.
In vitro activities of 22 beta-lactam antibiotics against Penicillin- Resistant and Penicillin-susceptible viridans group streptococci isolated from blood. Ioannidou S, Tassios PT, Kotsovili-Tseleni A, Foustoukou M, Legakis NJ, Vatapoulos A, et al. Antibiotic resistance rates and macrolide resistance phenotypes of viridans group streptococci from the oropharynx of healthy Greek children. Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States.
High prevalence of erythromycin- resistant and clindamycin-susceptible (M phenotype) viridans group streptococci from pharyngeal samples: a reservoir of mef genes in commensal bacteria.
Bacteriologic features and antimicrobial susceptibiliry in isolates from orofacial odontogenic infections. The prevalence of beta-lactamase producing bacteria in subgingival plaque and their sensitivity to Augmentin. Beta-lactamase- producing Bacteroides species in the oral cavity in relation to penicillin therapy. Multicenter survey of the changing in vitro antimicrobial susceptibilities of clinical isolates of Bacteroides fragilis group, Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus species.
Prevalence of beta-lactamase-producing strains among 149 anaerobic gram-negative rods isolated from periodontal pockets.
Emergence of beta-lactamase- producing aerobic and anaerobic bacteria in the oropharynx of children following penicillin chemotherapy. Emergence of beta-lactamase producing microorganisms in the tonsils during penicillin treatment. Van Winkelhoff AJ, Herrera GonzA?lez D, Winkel EG, Dellemijn-Kippuw N, Vandenbroucke- Grauls CM, Sanz M.
Antimicrobial resistance in the subgingival microflora in patients with adult periodontitis.
Surveillance of susceptibility patterns in 1297 European and US anaerobic and capnophilic isolates to co-amoxiclav and five other antimicrobial agents.
A compilation of studies assessing the in vitro activity of meropenem and comparators in 84 laboratories throughout Europe. Distribution of mef(A) and erm(B) genes in macrolide-resistant blood isolates of viridans group streptococci.
Clindamycin promotes phagocytosis and intracelluar killing of periodontopathogenic bacteria by crevicular granulocytes: an in vitro study.
Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998- 1999) multicenter surveillance study in Spain. High proportion of pharyngeal carriers of comensal streptococci resistant to erythromycin in Spanish adults.



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