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Tender, rupturing pustule on the chin
The Clinical Advisor, 07/31/09
Burkhart CG – A healthy 35–year–old white man complained of mild–to–moderate sensitivity in his lower incisor whenever he chewed for the past year. Four months ago, a painful tender swelling developed on his chin. The lesion began as a small pustule that subsequently ruptured. Culture revealed Staphylococcus aureus with sensitivity to ampicillin and tetracycline. Treatment with both antibiotics, in addition to local soaks, topical antibiotics, and heat, yielded no benefit...Cutaneous dental (or odontogenic) sinus tracts are uncommon occurrences in which a channel forms from a dental focus of infection to a drainage site on the skin of the face or neck. Odontogenic sinus tracts occur most frequently during middle age, but they can be seen in a broad range of age groups. This patient's intraoral examination revealed a lower incisor that was sensitive to percussion and mastication but insensitive to heat or cold. An electric pulp test revealed a nonvital tooth. Radiographs showed a periapical radiolucency. The diagnosis of pulpal necrosis with an associated extraoral sinus tract was confirmed. Extraction of the infected tooth resulted in resolution of the skin lesion without the need for further surgery.
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