Periapical actinomycosis: a review.
Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontically treated teeth. This case report shows the classic clinical picture of periapical actinomycosis: persistent periapical disease with recurrent sinus tracts. Although there was no pain or swelling after clinically acceptable initial endodontic treatment, a periapical lesion developed. After retreatment, the periapical lesion persisted, and a sinus tract developed. The sinus tract healed with antibiotic therapy but recurred within a few months. This cycle of sinus tract to antibiotic therapy to recurrence of the sinus tract repeated several times over a period of 5 years. Upon biopsy, periapical actinomycosis was diagnosed, where classic "sulfur granules" were demonstrated in the histologic examination of the periapical lesion. Antibiotic therapy for a period of 6 weeks was prescribed subsequent to the histologic diagnosis because of the possibility of spread of the actinomycotic infection into the maxillary sinus. Considerable healing was evident within 5 months of surgical and antibiotic treatment.
Jeansonne
Billie G
BG
Department of Endodontics, Louisiana State University Health Science Center, School of Dentistry, New Orleans, Louisiana 70119, USA. bjeans@lsuhsc.edu
D000197:Actinomycosis, Cervicofacial / Q000150:complications / Q000209:etiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003751:Dental Fistula / Q000188:drug therapy / Q000209:etiology; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D010483:Periapical Diseases / Q000150:complications / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D019233:Retreatment; D012390:Root Canal Therapy / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D004318:Doxycycline