1991 Volume 37 Issue 2 Pages 524-533
Three cases of poorly controlled diabetic patients who developed severe infection from odontogenic inflammation were reported.
Case 1 was a 48-year-old male with uncontrolled diabetes mellitus (DM), who showed a high blood glucose level two years ago. He received an endodontic treatment and medication for acute apical periodontitis of the right lower second premolar by a general practitioner, but the abscess quickly progressed through the right submandibular region down to the neck and the supraclavicular region.
Case 2 was a 49-year-old female who had undergone extraction of the left upper second molar with acute periodontitis. The inflammation promptly extended to the left pterygomandibular space, the parapharyngeal space, and the infratemporal fossa. She was diagnosed to be DM by blood examination after admission to our clinic.
Case 3 was 51-year-old male who had been suffering from DM for 20 years. His DM had been treated by diet and medication. The inflammation originated from the acute periodontitis of the left lower second molar, and it extended to the left submasseteric space, the submandibular space, and the sublingual space.
It was suggested that in these patients the host defence system to bacterial infection had deteriorated because of the uncontrolled DM. Anaerobic bacterias were detected from case 1 and case 3. Anaerobic bacterial infection was also suggested in case 2 in terms of abscess formation in the deep soft tissue, gas formation, and the smell of the pus, although bacterias isolated were not anaerobics. It was considered that the prompt drainage, systemic antibiotic treatment, and the control of DIM by insulin treatment were necessary in such life-threatening severe infections.
The physiologic differences in the defense systems of the diabetic versus the nondiabetic patients as well as the significance of anaerobic bacteria as a cause of odontogenic infection were discussed.
