Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Don't blame the dentist or the mouth!
- Andrew M Morris (16 March 2002)
-
Does Minerva have early onset Alzheimer's disease?
- George Hill (16 March 2002)
-
"The tooth, the whole tooth, it probably isnt the tooth"
- Rajiv Anand, Ram Moorthy, Peter Brennan,Paul McArdle, Paul Flanangan (20 March 2002)
-
Did root canal surgery cause that epidural abscess?
- Margaret A. Corson, John M. Whitworth (20 March 2002)
-
Re: Case report of O'Rourke et al
- Noel F F Ribeiro, Gary C S Cousin (5 April 2002)
|
|
|||
|
Andrew M Morris, Assistant Professor of Medicine Hamilton Health Sciences-General Site, 237 Barton St. E, Hamilton, Ontario, Canada L8L 2X2
Send response to journal:
|
O'Rourke and colleagues have obtained an excellent and instructive image from a most unfortunate patient. However, "dental pus" is almost never due to S. aureus. In such a situation, I would wonder about another unsuspected focus of infection: The patient was bacteraemic--was a search made for infective endocarditis? Because dental procedures are so common, we tend to link them temporally to somewhat catastrophic illnesses, such as endocarditis or bacteraemia. |
|||
|
|
|||
|
George Hill, Executive secretary Doctors Opposing Circumcision, Suite 42 2442 NW Market Street, Seattle, Washington 98107, USA
Send response to journal:
|
Does Minerva have early onset Alzheimer's disease?EDITOR—I see that our lovely Goddess of Wisdom, Minerva, apparently has forgotten that she previously has reported in the 9 February issue of the BMJ on Bailey's opinion piece regarding male circumcision as prophylaxis for HIV infection.1 Loss of memory can be a symptom of Alzheimer's disease. Perhaps, the editors should have our dear Minerva evaluated for early onset Alzheimer's disease. Minerva's repetition of the report of Bailey's efforts to promote male circumcision2 does not make his arguments more valid. He continues to rely on older reports that were produced before the relationship between viral load and transmission of HIV was established.3 These studies and their results are fatally flawed because of their failure to control for the most significant factor affecting HIV transmission and infection.4 In their zeal to introduce male circumcision, Bailey and colleagues beg the question of whether male circumcision would actually be effective in reducing HIV transmission.4 The acceptability of male circumcision to the local inhabitants does not mean that it should actually be introduced. There also must be proof of efficacy and that proof continues to be lacking, as pointed out in my letter in response to Minerva's previous report on Bailey et al.5 Several workers have described immunological functions of the male prepuce.6,7 The glans penis is covered with mucosa, which nature designed to operate in a moist environment. One theory, equally unproven, postulates that the male prepuce, which moisturizes and protects the mucosa of the penis,6 helps to maintain the mucosa of the penis in optimum condition and health, and thus more able to resist penetration by the human immunodeficiency virus. This would help to explain why America, which has the highest percentage of circumcised males amongst the advanced industrialized nations, also has the highest incidence of HIV infection amongst that same group of nations.8 Until these questions about the role of the prepuce are resolved, there is a strong possibility that the implementation of male circumcision would worsen an already alarming epidemic. George Hill, Executive Secretary,
|
|||
|
|
|||
|
Rajiv Anand, Senior House Officer Oral and Maxillofacial Surgery Poole Hospital NHS Trust, Longfleet Road,Poole, Dorset,BH15 2JB., Ram Moorthy, Peter Brennan,Paul McArdle, Paul Flanangan
Send response to journal:
|
Dear Editor, We read with interest the case report published in Minerva(1).To our knowledge there have been only two case reports of epidural abscess presenting secondary to dental treatment(2,3).In these articles, bacteria more synonomous with the oral cavity were isolated, such as STREPTOCOCUS INTERMEDIUS. The authors describe the isolation of STAPHYLOCOCCUS AUREUS from blood cultures and comment on dental pus not being cultured.However it is not routine to culture exudate from root canals and the prescence of pus is by no means the norm. Although S.AUREUS can be isolated from the oral mucosa it is most unlikely to be found in root canals of teeth assuming universal precautions are taken during root canal treatment. In addition genotyping of S.AUREUS isolates from the blood and root canal would have been required , to confirm the mouth as the source of the bacteraemia and thus the epidural abscess. Whilst there may be a temporal association, the suggestion that root canal treatment was the cause of the epidual abscess may be misleading. Yours Sincerely Mr R Anand Dr R Moorthy MR P Brennan Mr P McArdle Dr P Flanagan The authors have no competing interests. References 1.O'Rourke F,Barker R,Khan S. Minerva. BMJ 2002;324:686 2.Larkin EB, Scott SD.Metastatic paraspinal abscess and paraplegia secondary to dental extraction. Br Dent J 1994 Nov 5;177(9):340-342 3.Chandy B,Todd J, Stucker FJ,Nathan CA. Pott's puffy tumor and epidural abscess arising from dental sepsis:a case report. Laryngoscope 2001 Oct;111(10):1732-1734 |
|||
|
|
|||
|
Margaret A. Corson, Sp Registrar in Restorative Dentistry Newcastle Dental Hospital. Richardson Road, Newcastle upon Tyne, NE2 4AZ, John M. Whitworth
Send response to journal:
|
EDITOR- We are concerned that the epidural abscess described by O'Rouke et al was attributed to "root canal surgery", when the organism identified was not likely to be of dental origin.1 It is true that the oral cavity, and indeed the infected root canal is home to a rich and abundant microflora, but Staphylococcus aureus is not a significant contributor, and is not isolated in pyogenic oral lesions, like for example, those requiring root canal treatment.2 Oral manipulation is associated with a transient bacteraemia, and there has long been an association with a-haemolytic streptococci and bacterial endodcarditits.3 Although there are a small number of case reports linking odontogenic infections with brain abscess, often the diagnosis was made on exclusion as opposed to evidence. To identify a causal link the organism should be identified in both sites.4,5 Margaret Corson John Whitworth Newcastle Dental Hospital, Richardson Road, Newcastle upon Tyne NE2 4AZ 1 O’Rourke F, Barker R, Khan S. Case Report in Minerva. BMJ 2002; 324:686.(16 March) 2 Dahlen G, Haapasalo M. Microbiology of Apical Periodontitis. In Orstavik D, Pitt Ford TR (eds) Essential endodontology Prevention and treatment of apical periodontitis. pp106-130. Oxford: Blackwell Science. 3 Seymour RA, Lowry R, Whitworth JM, Martin MV. Infective endocarditis, dentistry and antibiotic prophylaxis: time for a rethink? BrDent J 2000; 189: 610-616. 4 Corson MA, Postlethwaite KP, Seymour RA. Are dental infections a cause of brain abscess? Case report and review of the literature. Oral Dis 2001; 7: 61-65. 5 Murray CA, Saunders WP. Root canal treatment and general health: a review of the literature. Int Endo J 2000; 33: 1-18.s |
|||
|
|
|||
|
Noel F F Ribeiro, Locum Registrar Maxillofacial Surgery North Manchester General Hospital, Gary C S Cousin
Send response to journal:
|
Dear Sir, We were interested to read the case reported by O’Rourke, Barker and Khan 1 of the patient who developed a Staphylococcus aureus epidural abscess after root canal therapy. The authors contend that there is a causal association, but we believe that this is unlikely. Bacteraemia often follows dental procedures, and metastatic infection can follow. Infective endocarditis is a good example of the phenomenon. However, Staphylococcus aureus is not commonly isolated from dental root canals, periapical infections or periodontal pockets 2, 3, 4, 5. In the reported case there is no microbiological evidence to confirm oral Staphylococcus aureus infection. This is important not just for semantics. Reported as it is, the case serves to reinforce the misheld belief that dental infections are caused by Staphylococci, and can therefore be treated with flucloxacillin. Acute dental infections are best treated with other agents such as penicillin V, amoxicillin, erythromycin, clindamycin or metronidazole 6. Life-threatening oro-facial infection can follow inappropriate antibiotic therapy of odontogenic infection 7, especially if the infected teeth are not extracted and pus drained. Yours sincerely, Noel F F Ribeiro FDSRCS(Eng)
Gary C S Cousin FDSRCS, FRCS, FRCS(OMS)
References 1. O’Rourke F, Barker R, Khan S. Minerva. Br Med J 2002; 324: 686. 2. Cheung G S, Ho M W. Microbial flora of root canal-treated teeth associated with asymptomatic periapical radiolucent lesions. Oral Microbiol Immunol 2001; 16 (6): 332 - 337. 3. Vigil G V, Wayman B E, Dazey S E, Fowlwe C B, Bradley D V Jr. Identification and antibiotic sensitivity of bacteria isolated from periapical lesions. J Endod 1997; 23 (2): 110 – 114. 4. Brauner A W, Conrads G. Studies into the microbial spectrum of apical periodontitis. Int Endod J 1995; 28 (5): 244 - 248. 5. Williams B L, McCann G F, Schoenknecht F D. Bacteriology of dental abscesses of endodontic origin. J Clin Microbiol 1983; 18 (4): 770 - 774. 6. Lewis M A, MacFarlane T W, McGowan DA. Antibiotic susceptibilities of bacteria isolated from acute dentoalveolar abscesses. J Antimicrob Chemother 1989; 23 (1): 69 - 77. 7. G C S Cousin. Potentially life-threatening oro-facial infections: a series of six cases. J Roy Coll Surg Edin. (in press) Address for Correspondence: Noel F F Ribeiro, Maxillofacial Unit, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB |
|||