OPTION 1

 

•            It is well established that the actinomycete is a common inhabitant of the oral cavity even in the complete absence of any clinical manifestations of specific infection.

 

 

 

•            Thus, the organisms may be cultured from carious teeth, nonvital root canals, tonsillar crypts, dental plaque, calculus, gingival sulcus, and periodontal pockets.

 

•            Furthermore, it does not appear to be an opportunistic infection in a situation of depressed cell-mediated immunity.

 

•            Trauma seems to play a role in some cases by initiating a portal of entry for the organisms, since they are not highly invasive.

 

•            Thus the extracted socket, periodontal pocket, nonvital tooth, or mucosal abrasion may act as the portal of entry for the infection.

 

 

Key concept:

 

•            Cervicofacial actinomycosis is the most common form of this disease and is of the greatest interest to the dentist.

 

•            It has been emphasized by Norman that two-thirds of all cases are of this type.

•            The soft tissue swellings eventually develop into one or more abscesses, which tend to discharge upon a skin surface, rarely a mucosal surface,

liberating pus containing the typical ‘sulfur granules’.

 

•            The skin overlying the abscess is purplish red, indurated and has the feel of wood or often fluctuant.

•            It is common for the sinus through which the abscess has drained to heal, but because of the chronicity of the disease, new abscess develop and perforate the skin surface.

•            The infection of the soft tissues may extend to involve the mandible, or less commonly, the maxilla which results in actinomycotic osteomyelitis