Origins and Recovery from Superinfections and Soft Tissue Necrosis

Abstract

The aim of the study was to gather further information regarding the reasons<br/>for superinfections and soft tissue necrosis, and to compare them with common<br/>gingivitis and periodontitis. A further aim is to see if there are differences<br/>in the recovery from these diseases which all are associated with microorganisms.<br/>The information was gathered retrospectively from 250 patients and altogether<br/>4022 visits to a specialist. The material was chosen randomly according<br/>to the first letter of the patient’s surname, among the 250 patients that<br/>were selected. The treatments of 155 patients took place between 1987-2016.<br/>The treatment of some patients had started earlier, but the controls had been<br/>continued for a long time after 1987. The examinations have been clinical,<br/>microbiological, and based on anamnesis, roentgenograms and histopathological examinations. The follow-up time was between 1 to 40 years. The patients who had periodontitis or superinfection were treated in the same way.<br/>Antibiotic therapy was prescribed for recurring infections, or if the patient<br/>had a difficult disease. In periodontal-endodontic infections, root canals were<br/>treated. Periapical lesions were surgically treated. Both periodontitis and superinfections occurred predominantly in the age group between 41 and 60<br/>years. Narcotic- or snuff-addicts were not included in the material, nor were<br/>alcoholics, although 6 patients did report moderate use of alcohol. Diseases<br/>and other infections had been treated both in patients with periodontitis and<br/>in the superinfection group. Oral symptoms were the same, except that the<br/>superinfections were violent. The difference in diagnosis was based on the<br/>anamnestic information of the antibiotics which induced the acute reaction,<br/>on the clinical and microbiological studies. The patients had received 12 different antibiotics, from which 10 induced superinfection. Extraction of teeth<br/>did not prevent normal infection, nor superinfection. The infections appeared<br/>as ulcers, white coverings or the flush of mucosa, and if the teeth remained,<br/>gingival pockets were purulent. The found micro-organisms were yeasts,<br/>mould, bacteria, also periodontopathogens. In the superinfection group, some<br/>multiply resistant organisms were found. The prognosis of the treatment was<br/>good both for patients with periodontitis and superinfection. Flap necrosis is<br/>a local, rare surgical complication, in which one factor is superinfection. Incorrect treatment of soft tissue did not lead to flap necrosis in this study. Superinfection is a different disease to periodontitis or gingivitis, because it is<br/>induced by antibiotics, and it is linked with multiply resistant microorganisms<br/>that are not sensitive to the antibiotics used. Normal periodontal, surgical<br/>and endodontic treatments are suitable for patients with periodontal-<br/>endodontic problems or superinfection. Superinfection can be very severe,<br/>locally or in the whole periodontium, if the infection is bacterial. When the<br/>infection was due to yeasts or moulds, local infection was not found. The recovery prognosis is good both in periodontitis and in superinfection. The<br/>connection to other diseases is not clear. Cardiovascular diseases, rheumatoid<br/>arthritis, diabetes mellitus, accidents and other infections were in anamnesis<br/>both in patients with periodontitis and in patients with superinfection. Patients<br/>with urinary tract infections who were prescribed antibiotic treatments<br/>were more prone to superinfection. Anyone can contract a superinfection. In<br/>a healthy gingival, it appears as ulcers, coverings, flushing or gingival bleeding,<br/>whereas in patients with periodontitis, the superinfection is mainly purulent.<br/>Endodontic superinfection is also possible.