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ENDOPERIODONTAL LESION – CASE REPORT INFECÇÃO ODONTOGÊNICA
ORIGINADA DE UMA
LESÃO ENDO-PERIODONTAL – RELATO DE CASO
Paulo Ricardo Saquete MARTINS FILHO * Luiz Carlos Ferreira da SILVA
**
Marta Rabello PIVA *** Daniele Machado REINHEIMER ****
Katheryne Sue DEJEAN *****
Sergipe, Aracaju, SE, Brazil. Professor, Department of Oral
Pathology, School of Dentistry, Federal University of Sergipe, SE,
Brazil. Rua Cláudio Batista, s/n. Bairro Sanatório, Aracaju, SE,
Brazil. E-mail: saqmartins@hotmail.com /
saqmartins@yahoo.com.br
** Professor, Department of Oral Surgery, School of Dentistry,
Federal University of Sergipe, Aracaju, SE, Brazil.
*** Professor, Department of Oral Pathology, School of Dentistry,
Federal University of Sergipe, Aracaju, SE, Brazil.
**** Dental Surgeon Graduated from School of Dentistry, Federal
University of Sergipe, Aracaju, SE, Brazil.
***** Student, School of Dentistry, Federal University of Sergipe,
Aracaju, SE, Brazil.
SPREAD OF ODONTOGENIC INFECTION ORIGINATING FROM ENDO-PERIO LESION
ENDOPERIODONTAL LESION – CASE REPORT
461
ABSTRACT The endoperiodontal lesion is a condition characterized by
the association of periodontal and pulpal disease in the same
dental element. While the deleterious effects of pulpal disease on
the periodontium are well documented, the converse effect of
periodontal disease on the pulp remains unclear. The present study
report a rare case of abscess spread into submandibular space from
primary periodontal infection with secondary endodontic involvement
in a 44- year-old man without systemic disease.
RESUMO A lesão endoperiodontal é uma condição caracterizada pela
associação de doença periodontal e pulpar em um mesmo elemento
dentário. Enquanto os efeitos deletérios da doença pulpar no
periodonto são bem documentados, o efeito inverso permanece
obscuro. O presente estudo relata um raro caso de disseminação de
um abscesso para o espaço submandibular decorrente de uma infecção
periodontal primária com envolvimento endodôntico secundário em um
homem de 44 anos sem doença sistêmica associada. Uniterms:
Endoperiodontal Lesion, Odontogenic Infection, Periodontitis.
Unitermos: Lesão Endoperiodontal, Infecção Odontogênica,
Periodontite.
INTRODUCTION The endo-perio lesion is a condition characterized by
the association of periodontal and pulpal disease in the same
dental element. The relationship between these two diseases was
first described by SIMRING; GOLDBERG (1964) (10), which stated that
pulpal infection may cause a tissue destructive process that
proceeds from the root apex toward the gingival margin. While the
deleterious effects of pulpal disease on the periodontium are well
documented, the reverse effect of periodontal disease on the pulp
remains unclear. However, some authors have suggested a solid
association between periodontal disease and inflammatory and
degenerative processes in the dental pulp (1, 3, 5, 7, 9). This
present study report a rare case of abscess spread into
submandibular space from primary periodontal infection with
secondary endodontic involvement in a 44-year-old man without
systemic disease.
CASE REPORT
A 44-year-old male complaining malaise, fever and facial swelling
were referred by an emergency physician for dental consultation
regarding a suspected odontogenic infection. On clinical
examination, a well-defined, soft, tenderness swelling of 6 x 4 cm
in the right submandibular region was noted (Figures 1 and 2). His
vital signs were as follow: temperature, 37.8ºC; pulse, 80 beats /
min; respiratory rate, 22 breaths / min; and blood pressure, 130 /
80 mm Hg. The patient’s past medical history was
not-contributory.
SPREAD OF ODONTOGENIC INFECTION ORIGINATING FROM ENDO-PERIO LESION
ENDOPERIODONTAL LESION – CASE REPORT
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Intra-oral examination revealed poor oral hygiene and the presence
of only one tooth (third molar) in the right side of the jawbone.
Third molar presented high degree of mobility and non-carious
lesion was observed. However, a negative answer to the pulp
vitality test was performed. Periodontal exam revealed a 12 mm
probing depth on the distal root and periapical radiography showed
periodontal bone loss around distal root with furcation involvement
(Figure 3). Thus, on the basis of the clinical and radiographic
features, was established a diagnosis of primary periodontal lesion
with secondary endodontic involvement. By needle aspiration,
purulent exudate was found confirming the spread of this infection
into the submandibular space. Figures 1 and 2 - Clinical photograph
showing facial swelling in the submandibular region. After
diagnosis, incision and drainage were performed with basis at the
point of maximum fluctuation (arrow) (2).
SPREAD OF ODONTOGENIC INFECTION ORIGINATING FROM ENDO-PERIO LESION
ENDOPERIODONTAL LESION – CASE REPORT
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Figure 3 - Periapical radiography of mandibular third molar
involved with the infection. Oral amoxicillin was started, the
third molar was extracted and incision and drainage were performed.
Three days after admission, the swelling was reduced significantly.
The 30 days’ follow-up examination revealed no evidence of residual
infection (Figure 4). Figure 4 - Imperceptible scar at the site of
incision.
SPREAD OF ODONTOGENIC INFECTION ORIGINATING FROM ENDO-PERIO LESION
ENDOPERIODONTAL LESION – CASE REPORT
464
DISCUSSION The relationship between pulpal and periodontal disease
can be traced to embryological development, since the pulp and the
periodontium are derived from a common mesodermal source (4). The
pulp can be invaded from the periodontium through dentin tubules,
lateral and accessory canals and the apical foramen; although
evidence exists for such canals of communication, a mechanism for
the direct transmission of periodontal infection into the pulp
tissues remains unclear. Still there is no consensus about the
deleterious effect of the periodontal infections at the pulp organ,
even so if it knows that the main pathway of communication between
both structures is the apical dental foramen. The apical dental
foramen could serve as an open way of entrance for periodontal
bacteria in the dental pulp, promoting situations of degenerative
and necrotic nature (3, 5, 7, 11). Some studies had suggested that
the communication between pulp and periodontium can occur not only
by apical dental foramen. RUBACH; MITCHELL (1965)(9) had suggested
that the periodontal disease affect the pulp health when it has
exposition of the accessory canals to the oral cavity, what it
would allow that bacteria proceeding from this region invaded the
pulp provoking a chronic inflammatory reaction followed of necrosis
to the pulp. ADRIAENS; DE BOEVER; LOESCHE (1988)(1) and ADRIAENS et
al., (1988)(2) demonstrated that bacteria proceeding from
periodontal pocket have the capacity to cross the root canals in
direction to the pulp and suggested that the dentin tubules can
serve as reservoir for these microorganisms. It is very rare to
find a tooth without pulp vitality and free of caries, restoration
work or trauma (8). However, these features were found in our case,
but the patient had severe periodontal disease-associated. Bacteria
from periodontal pocket probably had access to dental pulp via
apical foramen and/or dentin tubules and caused an inflammatory
irreversible process, leading to death of tooth (Figure 5).
Figure 5 - Primary periodontal lesion with secondary endodontic
involvement. Proposal for a
physiopathological mechanism based on case report.
SPREAD OF ODONTOGENIC INFECTION ORIGINATING FROM ENDO-PERIO LESION
ENDOPERIODONTAL LESION – CASE REPORT
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Although to be common the involvement of facial spaces as a result
of the spread of infections by pulp origin, the same does not
happen when the origin of the infection is periodontal. Therefore,
the reported case is rare in dentistry literature, especially due
to absence of patient’s systemic health alterations.
REFERENCES
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