title: [Infection after dental intervention. Iatrogenic or general medical cause? Case report].
abstract: Whenever a dentist is dealing with abscess formation in the oral and maxillofacial region, it is mostly from dental origins. However, sometimes uncommon (co-)factors are present and responsible for major complications. Many general conditions or  medications can significantly influence the course of  an inflammation. It might spread faster and wider and also be resistant to  "correct" therapy. This case report should raise awareness about general conditions supporting inflammation and  demonstrate the importance of interdisciplinary treatment in these situations. A 76-year-old patient was referred to the  maxillofacial surgery  clinic after  extraction of two  teeth resulted in  therapy-resistant painful swelling. Her dentist already had initiated "standard" therapy including Ponstan® (mefenamic acid) and Clamoxyl® (amoxicillin) without success. Initial blood testing came back with severe agranulocytosis. Immediately all potentially myelosuppressing drugs were  stopped while myelosupporting drugs were  prescribed. Under close  interdisciplinary treatment conditions, healing was  then uneventful without the necessity of surgical intervention. The challenge in inflammation treatment is to identify patients with uncommonly severe, fast-progressing, or therapy-resistant disease as early as possible. Further examination including blood workup for several medical parameters is indispensable in those patients.
authors: Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie Zentrum für Zahnmedizin der Universität Zürich, Zürich, Switzerland.
authors: Thomas
authors: T
authors: Gander
authors: Alperen Sabri
authors: AS
authors: Bingoel
authors: Luana
authors: L
authors: Mascolo
authors: Klaus W
authors: KW
authors: Grätz
authors: Heinz-Theo
authors: HT
authors: Lübbers
mesh_terms: D000368:Aged; D000380:Agranulocytosis / Q000175:diagnosis / Q000209:etiology*; D000658:Amoxicillin / Q000009:adverse effects; D002280:Basal Cell Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008339:Mandibular Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008528:Mefenamic Acid / Q000009:adverse effects; D010508:Periodontal Abscess / Q000188:drug therapy / Q000209:etiology; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology; D014081:Tooth Extraction / Q000009:adverse effects*
chemical_list: D008528:Mefenamic Acid; D000658:Amoxicillin