CU and dental infection

[Guest guest]

OK, I know I said the last one was the LAST one, but I ran across this short

piece in a longer discussion about this case where a man had a chronic

ulceration on his chin because of a dental infection. Note that this article

says that it is estimated that as many as 4% of all chronic urticaria cases

are from dental infection. True, it is a small percentage, but look at it

this way - there are almost 600 members in this group, which means as many

as 24 of us may possibly have a dental connection to our urticaria.

At least some doctors are recognizing the connection!

Air hugs,

Jackie

Life is tough, but I'm tougher.

(from article " Chronic factitial ulcer of chin cured by endodontic

(root-canal) surgery for underlying periapical abscess " in the Journal of

the American Academy of Dermatology Volume 40 • Number 5 • May 1999)

DISCUSSION

The most common presenting sign of a periapical abscess is pain and swelling

on the face.[3] Such odontogenic infections usually harbor anaerobic and

facultative aerobic streptococci, which remain largely beyond the reach of

systemic antibiotics. Indeed, radiographic demonstration of a periapical

abscess may be very difficult, as it often becomes apparent only after bone

changes occur. As a consequence, the diagnosis may not be made for 10 to 15

years, causing considerable unnecessary morbidity. Cutaneous sinus tracts

may arise[4] with drainage, but some cases simulate a basal cell

epithelioma.[5] Furthermore, many times, tooth abscesses cause pyogenic

facial lesions, emphasizing the need for careful intraoral examinations.[6]

The antigenemia associated with periapical abscesses may result in chronic

urticaria. [7] We suspect that some examples of reactive arthritis, pustular

eruptions of the hands and feet, erythema nodosum, psoriasis, and alopecia

areata are triggered by hidden periapical abscesses.

It is estimated that as a many as 4% of all chronic urticaria cases arise

from focal dental infection. We reported a striking example in which our

patient suffered daily hives for 9 years until the extraction of an infected

tooth.[8] Her dental abscess was never evident on x-ray films, but was found

by insertion of a probe when pus squirted out. The only clue had been a mild

toothache and the seminal observation that when she was on a liquid diet she

had no hives.

Dental infection, even when low grade and inapparent, must be added to the

causes of factitial ulcers. An extremely thorough dental examination is

necessary. We postulate that bacteria from the left lower molar apical

abscess either drained to the localized skin area on the left side of his

chin or that they initiated nociceptive reflexes in the nerves serving these

areas. The localization of skin lesions, even though factitial, may give a

clue as to the site of underlying disease. Because the mandibular branch of

the trigeminal nerve serves as the sensory nerve to both the teeth and the

skin, such a neurocutaneous correlation is possible.

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