Rr Microbiology

Anaerobic bacteria were recovered from most cases of dentoalveolar abscesses that were cultured using proper methods for their isolation (19-23). Studies done at the turn of the century of acute and chronic alveolar abscesses described the recovery of predominantly aerobic streptococci; however, fusiform bacilli and Bacteroides spp. were found in some abscesses, sometimes in pure culture (4). More recent studies report the isolation of a variety of anaerobes in periodontal abscesses, including anaerobic cocci, AGNB, and anaerobic gram-positive bacilli (19-23). The microflora associated with dentoalveolar abscesses was also recently determined and characterized by molecular methods (19). A quantitative and qualitative study of 50 dentoalveolar abscesses reported the presence of 3.3 isolates per abscess (20). Twenty (40%) abscesses harbored anaerobes only, and 27 (54%) abscesses had a mixture of both aerobes and anaerobes. Three-fourths of the isolates were strict anaerobes, the most common Peptostreptococcus spp., Prevotella oralis, and Prevotella melaninogenica.

Anaerobes were the predominant isolates, outnumbering aerobes eight to one in periodontal abscesses in 12 children (21). Anaerobes were recovered in all patients; in two thirds of the patients, they were the only organism isolated, and in the rest they were mixed with aerobes. There were 53 anaerobic isolates (4.4/specimen), 20 AGNB (including nine P. melaninogenica, three P. oralis), 17 anaerobic gram-positive cocci, 5 Fusobacterium spp., and 3 Actinomyces spp. There were six aerobic isolates (0.5/specimen), three S. salivarius, two alpha-hemolytic streptococci, and one gamma-hemolytic Streptococcus. Beta-lactamase production was noticed in four isolates three P. melaninogenica, and one P. oralis.

Brook et al. (22), who studied 39 periapical abscesses detected bacterial growth in 32 specimens. A total of 78 bacterial isolates (55 anaerobic and 23 aerobic and facultative) were recovered (2.4 isolates/specimen). Anaerobic bacteria only were present in 16 (50%) patients, aerobic and facultatives in two (6%), and mixed aerobic and anaerobic flora in 14 (44%). The predominant anaerobic isolates were AGNB (23 isolates, including 13 pigmented Prevotella and Porphyromonas spp.), Streptococcus spp. (20), anaerobic cocci (18), and Fusobacterium spp. (9). Beta-lactamase-producing organisms were recovered from seven of the 21 (33%) tested specimens.

Similar organisms were isolated from aspirate of pus from five periapical abscesses of the upper jaw and their corresponding maxillary sinusitis (23). Polymicrobial flora was found in all instances, where the number of isolates varied from two to five. Anaerobes were recovered from all specimens. The predominant isolates were Prevotella spp., Porphyromonas spp., F. nucleatum, and Peptostreptococcus spp. Concordance in the microbiological findings between periapical abscess and the maxillary sinus flora was found in all instances. However, certain organisms were only present at one site and not the other..

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