LymphedemaV1, Istex, Corpus, bibRecord, 005062

Dental work as a cause of acute inflammation of a lymphoedematous limb

Identifieur interne : 005062 ( Istex/Corpus ); précédent : 005061; suivant : 005063

Dental work as a cause of acute inflammation of a lymphoedematous limb

Auteurs : John Chambers ; Katie Mcgovern

Source :

Palliative Medicine [ 0269-2163 ] ; 2004-10.

RBID : ISTEX:AB699B68FC1371198BEE866606D84D2B1DB5EC37
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https://api.istex.fr/document/AB699B68FC1371198BEE866606D84D2B1DB5EC37/fulltext/pdf

DOI: 10.1177/026921630401800717

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ISTEX:AB699B68FC1371198BEE866606D84D2B1DB5EC37

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<title-group><article-title>Dental work as a cause of acute inflammation of a lymphoedematous limb</article-title>
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         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Chambers</surname>
<given-names>John</given-names>
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<aff>Katharine House Hospice, East End, Adderbury, Oxon OX17 3NL, UK</aff>
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         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>McGovern</surname>
<given-names>Katie</given-names>
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<aff>Lymphoedema Nurse Specialist, Katharine House Hospice, East End,                         Adderbury, Oxon OX17 3NL, UK <email xlink:type="simple">dr.ch@mbers.info</email>                     
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         <pub-date pub-type="ppub"><month>10</month>
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<meta-value> Letters to the editor 667 allow a brief, cheap and timely communication to be             made with minimum additional time required by clinical staff to complete this. P Sarah             Galbraith and Sara Booth Addenbrooke's Palliative Care Team Addenbrooke's Hospital,             Cambridge, UK. References 1 Higginson I. Palliative care services in the community: what             do family doctors want? J Palliat Care 1999; 15; 21- 25. 2 Todd J, Edmonds P, Lillie G,             Charman F, Chamberlain J. Use of a discharge letter to improve communication between a             hospital palliative care team and the primary health care team. Palliat Med 1998; 12:             476-77. Dental work as a cause of acute inflammation of a lymphoedematous limb Sir - The             chronic morbidity of lymphoedema typically worsens with successive acute inflammatory             episodes (AlEs), yet little is known about their aetiology. We present two case             histories that apparently link dental procedures with AIEs. A 90-year-old woman with             cancer of the left breast, treated by mastectomy and radiotherapy to the axilla, had a             two-year history of stable lymphoedema of the left arm with no AlEs. Three weeks after a             triple tooth extraction, she had an AIE. Arm volume increased from 1840 to 2230 mL,             associated with warmth and redness. There was no concurrent history of trauma, infection             or physical overexertion. Being allergic to penicillin, she was given cephalexin. It             took six months for the arm volume to reduce back to 1990 mL. A 55-year-old woman with             cancer of the left breast treated by mastectomy, axillary node excision and radio-             therapy to the axilla had a 20-year history of stable lymphoedema of the left arm with             no AlEs. Following root canal work, her left arm volume increased over six weeks from             1422 to 1750 mL. There was no concurrent history of trauma, infection or physical             overexertion. The swelling gradually subsided with a compression sleeve, only to             reappear in exactly the same manner following further dental work. If a legitimate link             exists between dental work and AlEs, it could have a microbiological basis. The             potential role of streptococci in AlEs has been debated for many years. Streptococci             were first isolated from AIE sites in 1892.1 In 1954 it was reported that recurrent AlEs             could be associated with isolation of exactly the same strain of streptococcus from the             inflamed site even when the interval between AlEs exceeded 12 months,2 suggesting that             some patients with recurrent AlEs were subject to reinfection from a protected             streptococcal reservoir. However, the true situation might be less straightforward.             First, it is notoriously difficult to isolate pathogens from infected skin that has not             been breached. Secondly, it has been suggested that AlEs might be the result of an             immune response to microbial antigen in lymphoedema- tous tissue rather than infection.3             Thirdly, other plausible pathogens for AlEs include fungi and anaerobes, the latter             being penicillin-sensitive like streptococci. Regardless of how microbes might be             implicated in AlEs, our case histories are compatible with the orophar- ynx serving as a             microbial reservoir that can release inflammatory mediators when dental procedures are             performed. Streptococci, anaerobes and fungi are all commonly isolated from the             oropharyngeal flora and the prevalence of bacteraemia following dental work can range             between 10% and 100%, depending upon the procedure performed. Based on the idea that             people considered high risk for bacterial endocarditis should receive prophylactic anti-             biotic to cover dental procedures, it is tempting to speculate that patients with             lymphoedema should receive prophylactic antibiotic to prevent AlEs attributable to             dental procedures. However, the use of prophylactic antibiotics to prevent bacterial             endocarditis is conten- tious. Whilst 7% of bacterial endocarditis is attributable to             dental procedures,4 the absolute risk of any single procedure is very low in high-risk             patients. Furthermore, antibiotic prophylaxis does not prevent bacteraemia,5 and anyway,             we are all subject to frequent spontaneous episodes of bacteraemia in our daily lives.             Therefore we conclude that dental work might be responsible for a small proportion of             AlEs in lymphoe- dematous tissue and this would not be incompatible with a streptococcal             or alternative microbial aetiology. How- ever, until our understanding of bacteraemias             and AIEs improves, it is hard to confidently suggest ways of reducing the apparent risk.             The breakthrough in our understanding might come from polymerase chain reac- tion             analysis of saline aspirates from sites of AIE to elucidate the nature of any microbial             involvement.6 John Chambers Macmillan Consultant and Medical Director, Katharine House             Hospice, East End, Adderbury, Oxon OXJ 7 3NL, UK Katie McGovern Lymphoedema Nurse             Specialist, Katharine House Hospice, East End, Adderbury, Oxon OX] 7 3NL, UK E-mail: dr.             ch@mbers. info 668 Letters to the editor References 1 Sabouraud R. Sur la parasitologie             de l'elephantiasis nostras. Ann Derm Syph (Paris) 1892; 3: 592. 2 Stevens FA. Behaviour             of local foci causing recurrent streptococcal infections of skin, subcutaneous tissues             and lymphatics. Surg Gynec Obstet 1954; 99: 268-72. 3 Mortimer PS. Managing lymphoedema.             Clin Exp Derma- tol 1995; 20: 98-106. 4 Tomas Carmona T, Diz Dios D, Limeres Posse J,             Gonzalez Quintela A, Martinez Vanquez C, Castro Iglesias A. An update on infective             endocarditis of dental origin. J Dent 2002; 30: 37-40. 5 Pallasch TJ. Antibiotic             prophylaxis: problems in paradise. Dent Clin North Am 2003; 47: 665-79. 6 Harris KA,             Hartley JC. Development of broad-range 16S rDNA PCR for use in the routine diagnostic             clinical microbiology service. J Med Microbiol 2003; 52: 685-91.</meta-value>
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         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Sabouraud R</surname>
</name>
                 .                      <article-title>Sur la parasitologie de l'elephantiasis nostras</article-title>
                 . <source>Ann Derm Syph (Paris)</source>                 
               <year>1892</year>
; <volume>3</volume>
:                      <fpage>592</fpage>
-<lpage>592</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
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<affiliation>Katharine House Hospice, East End, Adderbury, Oxon OX17 3NL, UK</affiliation>
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<name type="personal"><namePart type="given">Katie</namePart>
<namePart type="family">McGovern</namePart>
<affiliation>Lymphoedema Nurse Specialist, Katharine House Hospice, East End, Adderbury, Oxon OX17 3NL, UK</affiliation>
<affiliation>E-mail: dr.ch@mbers.info</affiliation>
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<part><date>2004</date>
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Dental work as a cause of acute inflammation of a lymphoedematous limb

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