Remote manifestations of oral and dental infectious foci.
1. Introduction
The causal relationship between dental infectious foci (DIF) and certain general diseases often remains uncertain.
At the beginning of the 20th century , this question hit the medical and scientific headlines, notably with Hunter’s “extractionist” theory, whose radical vision is the cause of many toothless mouths.
However, it seems that today this extreme view has been abandoned due to the difficulties in establishing a causal link between FID and general pathology.
Only Osler’s infective endocarditis or Osler’s disease provides evidence for the focal infection theory.
3. Etiopathogenesis
- Pyophagia: swallowed pus passes into the general circulation and the infection attaches to target organs
- Inhalation: Pus entering the airways through the nose can cause lung infection.
- Bacteremia: from dental infectious foci, germs pass into the bloodstream.
- The toxin theory: bacterial toxins cause visceral lesions from a distance
- The nervous theory: oral infection would cause excitation of the neurovegetative system and, by reflex, cause distant lesions.
- The bacterial allergy theory: there would be sensitization to a germ or its toxin.
4. The terrain
- Hard to pin down
- Some patients seem to have a particular predisposition:
- Diabetic,
- Cardiopath,
- Ethyl,
- Addict
- Under immunosuppressants or corticosteroid therapy,
- Irradiated…
- 5. Manifestations of focal infection
- 5.1. Cardiovascular manifestations:
The major manifestation is infective endocarditis which follows grafting onto an endocardium previously damaged by germs following bacteremia.
Remote manifestations of oral and dental infectious foci.
The rules regarding the prophylaxis of infective endocarditis have been the subject of a consensus conference, and are reinforced by dental recommendations and references. Patients at risk of infective endocarditis are classified into:
- high risk patients
(valve prosthesis, cyanotic congenital heart disease, history of infective endocarditis)
- patients at risk
(aortic and mitral valve diseases, non-cyanotic congenital heart diseases, obstructive cardiomyopathy)
- patients without particular risk who do not require specific prophylaxis.
In patients at risk of infective endocarditis, endodontic treatments are only possible if they are performed under a waterproof dam, in a single session, and if the entire endodontium can be treated. Otherwise, extraction is the rule.
Implants and periodontal surgery are not recommended.
In patients at high risk of infective endocarditis, tooth extraction or any procedure that could lead to bacteremia must be performed under antibiotic prophylaxis.
It should be noted that this antibiotic prophylaxis does not completely eliminate the risk of infective endocarditis.
The protocol is clearly defined, it consists of giving during outpatient care, in the hour preceding the procedure, in the absence of allergy to ß-lactams: 2 g per os of Amoxicillin and in the case of allergy to ß-lactams: 500 mg per os of Azithromycin.
- 5.2. Pulmonary manifestations:
Follow inhalation or bacteremia which could explain the occurrence of acute or chronic pulmonary suppurations or lung abscesses.
- 5.3. Digestive manifestations: Gastritis or entero-colitis.
For some authors, these digestive lesions would be a triggering or promoting factor in periodontal disease, given the analogy that exists between oral flora and intestinal flora.
- 5.4. Renal manifestations:
A bacterial allergy or irritation of the autonomic nervous system is thought to be the cause of certain glomerulonephritis.
Dental procedures likely to cause bacteremia should be performed using broad-spectrum antibiotics , at effective but non-nephrotoxic doses.
- 5.5. Rheumatic manifestations:
The β-hemolytic streptococcus present in the oral cavity is the cause of streptococcal tonsillitis, which is itself responsible for certain acute articular rheumatisms (AAR).
- There are also several observations of healing in certain acute or subacute rheumatic conditions in adults after removal of dental infectious foci.
- 5.6. Ocular manifestations:
A distinction must be made between
* specific eye lesions: Uveitis, keratitis, conjunctivitis, blepharospasms, tearing, where a reflex or allergic origin is often mentioned.
* neighboring lesions: where the infection reaches the eye and the orbital region by microbial migration from a dental focus via the bone, sinus or vein (uveitis, orbital cellulitis, etc.)
- 5.7. Dermatological manifestations:
We especially remember
- Allergic phenomena in certain Quincke’s edemas, eczemas, acnes, etc.
- Reflex phenomena in certain alopecia, depilation or lichen.
- 5.8. Neurological manifestations:
Some symptomatic or idiopathic trigeminal neuralgias, vascular pains, find their explanation in focal infection.
There are also cases of migraines, headaches, dizziness, facial paralysis cured after removal of dental infectious foci.
- 5.9- Unexplained fevers:
A persistent fever requires a complete assessment. Dental etiology should only be considered if the removal of the “doubtful” tooth causes the temperature to drop within 2 to 4 days.
Remote manifestations of oral and dental infectious foci.
- 6. Conclusion
The diagnosis of distant manifestations of dental origin should only be made after all other causes have been eliminated.
- Above all, it must not be abusive or neglected.
- Any oral infection must be treated whether the patient is healthy or not.
Remote manifestations of oral and dental infectious foci.
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.