Conclusion: And suggested that the difference of a fewsequence of the PCR products were related to express ofbe-ta lactamase in the CfxA2.

References

Oral Microbiol Immunol 2002:17:85-88J Clim Microbiol 2004:42:888-890J Antimicrobiol Chemotherapy 1997;41:2757-2759

POSTER 022Osteonecrosis of Jaw Associated WithOral Application of BisphosphonatesSuguru Hamada, DDS, PhD, 377-2 Ohohigashi,Osakasayama, Osaka, 589-8511, Japan (Adachi T;Nakashima M; Tsuju H; Otani T; Otsuki A; Yamazaki K;Yuasa A; Kurimoto T; Watatani K)

Statement of the Problem: Bisphosphonates (BPs) arepowerful inhibitors of osteoclastic activity, widely usedin the management of hypercalcemia related to malig-nancy and bone metastases from breast cancer intrave-nously. However, osteonecrosis of the jaw (ONJ) isknown as an adverse side effect of BPs therapy. Widelyspread use of BPs orally in the management of osteopo-rosis resulted increasing reports of ONJ cases.

Materials and Methods: Case 1: A 68-year-old womanwas referred to our department with spontaneous painof left lower jaw in June 2006, who received steroidstherapy for twenty years in the management of rheuma-toid arthritis, and BPs (risedronate, Benet R) for fouryears in the management of osteoporosis. She com-plained swelling of the left parotid region and trismus,formation of small gingival abscess of the left lower jawand excreting of small sequestrum, and a clinical diag-nosis of ONJ was made. Case 2: A 70-year-old womanwas referred to our department with mobility and painof the first molar of right upper jaw at 11th September2006, who had diabetes mellitus and received bypassoperation of coronary artery for the acute myocardialinfarction few years ago. The tooth was extracted, butthe wound did not heal and spread to ONJ of the maxilla.Afterwards the patient said received BPs (alendronate,Fosamax R) therapy for two years in the management ofosteoporosis. Case 3: A 79-year-old woman was referredto our department with pus discharge from the gingivaof the left lower jaw and paresthesia of the left lower lipat 11th January 2007. She had anamnesis of gastric car-cinoma and extraction of the teeth two years ago atanother hospital. She received BPs (alendronate, Bona-lon R) therapy for few years in the management ofosteoporosis.

Method of Data Analysis: The clinical course, labora-tory data and diagnostic imaging including X-ray, CT andMR imaging of the three cases were analysed and com-pared to the literature.

Results: We experienced three cases of ONJ associ-ated with BPs. In all cases, conservative approacheswere successful and acute inflammatory symptoms al-most disappeared using antibiotics and chronic symp-toms were followed up.

Conclusion: Dentists should be aware of potentiallyserious complication in periodontal patients receivingtreatment with oral applied BPs.

References

Woo S-B, Hellstein JW, Kalmar JR; Systematic Review: Bisphospho-nates and Osteonecrosis of the jaws. Ann Intern Med 2006;144:753-761

Migliorati CA, Casiglia J, Epstein J, et al; Managing the care ofpatients with bisphosphonate-associated osteonecrosis. JADA 2005;136:1658-1668

Kishi N, Adachi T, Koizumi H, et al; A case of osteonecrosis of themandible caused by bisphosphonates. Jpn J Oral Maxillofac Surg 2007;53:28-32

POSTER 023A Case of Bisphosphonate-InducedOsteonecrosis in the MaxillaAtsushi Nakamura, DDS, PhD, 4-4-12 Chuo, Yamato,Kanagawa, 242-0021, Japan (Arai T; Sumitani K)

Statement of the Problem: We report a case ofBisphosphonate-induced osteonecrosis which wasfound by severe pain 8 months after extraction of theupper left second molar.

Materials and Methods: The patient is a 61-year-oldwoman who had breast cancer in 1992, and had beengiven 30 times of 10mg of incadoronate for 29 monthsand 18 times of 90 mg of pamidronate for 18 months and9 times of 4 mg of zoledronate for 5 months as support-ive treatment of the lung metastasis. The painful upperleft second molar was extracted by the reason of poorprognosis on February in 2006, although the pain disap-peared after extraction, severe pain occurred in thesame portion from October in 2006. She was referred toour department with a diagnosis of non-healing bone.The histopatholological diagnosis was of chronic osteo-myelitis with osteonecrosis without evidence of meta-static disease.

Method of Data Analysis: The management of thepatient included more than 3 months of drug cessation,sequestrectomy with viable bleeding bone and then 10times of hyperbaric oxygen therapy. The antibiotic ad-ministration included 2 g per day of cephazolin for thefirst 7 days and then 400 mg per day of clarithromycinfor more than 1 month.

Results: The severe pain disappeared and the woundhealed by this treatment.

Conclusion: It is considered that administration ofnitrogen-containing bisphosphonates induces refractoryosteomyelitis; even in maxilla with high incident andprevious teeth extraction is commonly performed. Be-

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43.e12 AAOMS • 2007

cause these drugs deposit almost without metabolizationfor a long term in bone and these antiresorptive effectsare so powerful, some recurrent cases were reportedafter the treatment with the drug cessation. Furthercareful observation is necessary.

References

Dimitrakopoulos I, Magopoulos C, Karakasis D. Bisphosphonate-induced avascular osteonecrosis of the jaws: a clinical report of 11cases. Int J Oral Maxillofac Surg 2006: 35: 588-593

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis ofthe jaws associated with the use of bisphosphonates: a review of 63cases. J Oral Maxillofac Surg 2004: 62: 527-534

POSTER 024Cervical Necrotizing Fascitis &Mediastinitis Caused OdontogenicInfection: Cases ReportYong-Kwan Choi, Korea (Han SJ; Kim CH; Lee JH; KimKW)

Statement of the Problem: An odontogenic infection isoften the result of periapical or periodontal problems.The mild form of infection can be treated with antibiot-ics and surgical intervention. Cervical necrotizing fasci-tis, which is the cause of an odontogenic infection, is arare disease but can be life-threatening when it is rapidlytransmitted though a non-specific anatomic barrierspace. The infection includes high fever and cervicalswelling, and spreads rapidly through thorax and causessevere complications such as pneumonia, lung abscess,internal jugular vein thrombosis, meningitis, multipleorgans damage, mandible necrosis. For this reason, mor-tality rate of cervical neck fascitis is higher than an upperface infection. An odontogenic infection is sometimesself-limiting. However, if the infection extends to theretropharyngeal, prevertebral space, it may spread to thethorax, causing mediastinitis.

Mediastinitis can have a fatal result from causes suchas sepsis, mediastinal abscess, pleural effusion, emphy-sema, aspiration pneumonia, and pericarditis. The dis-ease eventually kills the victim by reducing the venusreturn to the heart as a result of compression to themediastinal vein. The key to the successful treatment ofcervical necritizing fascitis and mediastinitis is early di-agnosis, which includes incision and surgical cervicaland thoracic drainage with a debriment of the necrotictissue and the aggressive administration of antibiotics.We encountered a 51-year-old male patient diagnosedwith cervical necrotizing fascitis with a history of non-controlled diabetes mellitus and 20-year-old male patientdiagnosed with mediastinitis. We report these cases witha review of the relevant literature.

References

Rapoport Y, Himelfarb MZ, Zikk D, Bloom J. Cervical necrotizingfasciitis of odontogenic origin. Oral Surg Oral Med Oral Pathol. 1991Jul; 72(1):15-8.

Whitesides L, Cotto-Cumba C, Myers RA. Cervical necrotizing fasci-itis of odontogenic origin: a case report and review of 12 cases.J OralMaxillofac Surg. 2000 Feb;58(2):144-51; discussion 152. Review.

Biasotto M, Pellis T, Cadenaro M, Bevilacqua L, Berlot G, Di LenardaR. Odontogenic infections and descending necrotising mediastinitis:case report and review of the literature. Int Dent J. 2004 Apr;54(2):97-102. Review.

POSTER 025Survey of Preventive AntimicrobialChemotherapy for Dental Minor SurgerySatoshi Kinoshita, DDS, PhD, Japan (Iwai R; Yamada K;Matsumoto K; Tabushi M; Iseki T; Morita S)

Statement of the Problem: We designed the question-naire survey to study the present state of medication ofantimicrobial chemotherapy for the purpose of preven-tion of postoperative infection after dental surgery.

Materials and Methods: We divided into two groups oforal surgeon group that belongs to our oral surgery depart-ment and general dentist group that works at the dentalclinics. Twenty-five oral surgeons and 25 general dentistswere registered in 2003, and 25 oral surgeons in 2006.

Method of Data Analysis: We surveyed the followingitems concerning to the antimicrobial medication orally;initial administration time, kind of drugs, directions foruse, period of medication and reason for drug choice.

Results: In both groups, same responds that initialadministration time was postoperation (almost at com-ing home), kind of drugs cephems, giving direction threetimes daily, and reason for drug choice coworker usingwere obtained. Three days in general dentists group, and4 or 5 days in oral surgeon group. Almost same answersfrom oral surgeon group were obtained in 2003 and2006.

Conclusion: These results suggest that we have toimprove more effective method based on the truthwor-thy scientific information in using the antimicrobialagents for prevention of postoperative infection afterdental surgery.

References

Nagao Shinagawa, et.al.: The strategy of selection of antimicrobialprophylactic agents - a survey of the prophylaxis of postoperativeinfection -. Jpn. J. Chemoter. 49: 551-556, 2001

Takashi Yoshii, et.al.: Relationship between the duration of antibi-otic administration and the clinical course after mandibular third molarextraction - comparison between 1-day and 3-day therapy with lenam-picillin -. Oral Therap. Pharumacol.(Jpn) 19: 118

Alicia J. Mangram, et.al.: Guideline for prevention of surgical siteinfection, 1999. Infection Control and Hospital Epidemiology 20: 247-278, 1999

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