How can I locate case reports of infections that originated from a dental source?

Locating Case Reports of Infections Originating from Dental Sources

Yes, case reports documenting infections originating from dental sources are published in the medical literature and can be located through standard medical databases, though the American Heart Association notes that many such reports are poorly documented and do not prove direct causal relationships. 1

Search Strategy and Available Evidence

Published Case Reports Exist Across Multiple Infection Types

• Brain abscesses from dental origins have been documented, though they represent only approximately 5% of identified brain abscess cases 2

• A specific case report describes Streptococcus intermedius brain and diverticular abscesses occurring two months after dental extraction 2

• Brain abscess case reports linked to dental pathology show a wide range of implicated dental procedures, though in some cases the brain isolate was not actually of dental origin, and many diagnoses were made by exclusion rather than definitive microbiologic confirmation 3

• Persistent fever from occult dental infection has been reported, with a literature review identifying 20 cases of fever of obscure origin arising from dental sources 4

• These dental sepsis cases can escape detection for prolonged periods—one case report documented febrile episodes from an occult tooth abscess lasting 2 years 4

• Prosthetic joint infections following dental procedures have been documented, including a case of total hip arthroplasty infection with Actinomyces species occurring one month after routine dental cleaning without antibiotic prophylaxis 5

Critical Limitations of Case Report Evidence

• The American Heart Association emphasizes that numerous case reports implicating dental procedures in the development of infective endocarditis are poorly documented and do not prove a direct causal relationship 1
• Even when a close temporal relationship exists between a dental procedure and infection, it is impossible to determine with certainty whether the bacteremia originated from the dental procedure or from randomly occurring bacteremia during routine daily activities in the same time period 1
• Many case reports include cases with remote preceding dental procedures (3-6 months before diagnosis), but the typical timeframe between bacteremia and symptom onset is 7-14 days for viridans group streptococci, meaning cases with incubation periods longer than 2 weeks were likely incorrectly attributed to the procedure 1

How to Search for These Case Reports

• Use PubMed/MEDLINE with search terms combining the infection type (e.g., "brain abscess," "endocarditis," "prosthetic joint infection") with "dental" or "odontogenic" (general medical knowledge)
• Focus on case report publication types and case series in the advanced search filters (general medical knowledge)
• For confirming the role of odontogenic infection, modern sampling techniques should identify isolates from both oral and cranial/infection sites to establish definitive causation 3

Important Caveats When Interpreting Dental-Origin Infection Case Reports

Diagnostic Challenges

• Dental infection as a fever source may be suggested by repeated questioning about medical history, repeated physical examination, elevated erythrocyte sedimentation rate, or failure to respond to antibiotic therapy 4
• Dental infection is unlikely when patients have white blood cell count >11 × 10⁹/L, temperature >39.5°C, or positive blood cultures 4
• Diagnosis can be made through repeated focused clinical examination, dental radiography, or radiolabeled leukocyte scintigraphy 4

The Bacteremia Context

• Routine oral activities generate transient bacteremia far more frequently than dental procedures—toothbrushing produces bacteremia in 39-46% of episodes, potentially hundreds of times per year, compared to office-based dental procedures occurring approximately twice yearly 1, 6
• Dental procedures produce bacteremia with highly variable incidence (0-97%) depending on the procedure type: extractions (0-96%), professional cleaning (0-78%), restorations (16-66%), and injections (16-97%) 1, 6
• This means the absolute risk of infection from a single dental procedure is exceedingly small—estimated at 1 case of infective endocarditis per 14 million dental procedures in the general population 1