Origins and Recovery from Superinfections and Soft Tissue Necrosis

Abstract

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