Role of Occupation in the Presentation of Odontogenic Infection: Two Interesting Case Scenarios
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LETTER TO THE EDITOR
Role of Occupation in the Presentation of Odontogenic Infection: Two Interesting Case Scenarios Charlene D’souza1 • Adarsh Kudva1 • Chithra Aramanadka1 • B. Vasantha Dhara1 Smriti Puri1
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Received: 26 January 2020 / Accepted: 29 February 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
To the Editor, The concept of external heat application to an existing odontogenic infection has been a subject of controversy. We present two cases of patients’ whose occupation regularly exposed them to increased concentrated temperatures on the face and hypothesise the role of occupation in the presentation of odontogenic infection. The first patient, a 28-year-old male, presented with a consolidated swelling in relation to his left submandibular region. After a detailed case history, it was found that the patient, a machine operator at a fish drying company, was repeatedly exposed to steam vapours while evaluating the fish drying process (the process involves converting the final moisture content of fish to 6–8%) (Fig. 1a). In less than a week, a simple periapical infection progressed rapidly to a submandibular space abscess. The second patient, a 19-year-old male, presented with a swelling over one half of his face. His complaint of tooth pain progressed to cellulitis of left buccal space in a matter of 3 days. His case history revealed a daily 12-h shift that involved the mass baking of bread in an open charcoal oven (Fig. 1b). Both patients continued to work until their reporting day to our OPD and were on oral antibiotics. Neither patient had any underlying medical conditions or contributory factor other than their working environment that could have been a factor in the exacerbation of the dental infection.
& Adarsh Kudva [email protected] 1
Thermal agents, known to be responsible for local vasodilation combined with inflammation, increase the influx of inflammatory mediators resulting in tissue oedema. Poultice is a soft moist mass, often heated and medicated, that is spread on cloth over the skin to treat an aching, inflamed or painful part of the body. In the preantibiotic days, poultices were applied to extensive infections of the soft tissues, to induce local vasodilatation by means of their heat and the rubefacient substances which they contained [1]. Seward et al. [1] suggested that poultices hasten suppuration, encourage the drainage of pus and contribute to the spread of cellulitis. Furthermore, when applied after the pus has formed beneath the deep fascia, it induced increased oedema and exudate [1]. According to Laskin, the factors affecting the ability of the infection to spread depends on the type and virulence of the organism, general health of the patient, the anatomical site of the initial infection which decides the drainage of pus and the effectiveness of the patient’s immune mechanism [2]. External heat application to ‘draw’ an abscess to the surface has been regarded as a counterproductive measure. In the cases described above, the occupation, like t
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