J. Maxillofac. Oral Surg.
https://doi.org/10.1007/s12663-020-01343-w
LETTER TO THE EDITOR
Role of Occupation in the Presentation of Odontogenic Infection:
Two Interesting Case Scenarios
Charlene D’souza1 • Adarsh Kudva1 • Chithra Aramanadka1 • B. Vasantha Dhara1
Smriti Puri1
Received: 26 January 2020 / Accepted: 29 February 2020
Ó The Association of Oral and Maxillofacial Surgeons of India 2020
To the Editor,
The concept of external heat application to an existing
odontogenic infection has been a subject of controversy.
We present two cases of patients’ whose occupation reg-
ularly exposed them to increased concentrated tempera-
tures on the face and hypothesise the role of occupation in
the presentation of odontogenic infection.
The first patient, a 28-year-old male, presented with a
consolidated swelling in relation to his left submandibular
region. After a detailed case history, it was found that the
patient, a machine operator at a fish drying company, was
repeatedly exposed to steam vapours while evaluating the
fish drying process (the process involves converting the
final moisture content of fish to 6–8%) (Fig. 1a). In less
than a week, a simple periapical infection progressed
rapidly to a submandibular space abscess.
The second patient, a 19-year-old male, presented with a
swelling over one half of his face. His complaint of tooth
pain progressed to cellulitis of left buccal space in a matter
of 3 days. His case history revealed a daily 12-h shift that
involved the mass baking of bread in an open charcoal
oven (Fig. 1b).
Both patients continued to work until their reporting day
to our OPD and were on oral antibiotics. Neither patient
had any underlying medical conditions or contributory
factor other than their working environment that could
have been a factor in the exacerbation of the dental
infection.
& Adarsh Kudva
dradarshkudva@gmail.com
1
Department of Maxillofacial Surgery, MCODS, Mahe
University, Manipal, India
•
Thermal agents, known to be responsible for local
vasodilation combined with inflammation, increase the
influx of inflammatory mediators resulting in tissue
oedema.
Poultice is a soft moist mass, often heated and medi-
cated, that is spread on cloth over the skin to treat an
aching, inflamed or painful part of the body. In the pre-
antibiotic days, poultices were applied to extensive infec-
tions of the soft tissues, to induce local vasodilatation by
means of their heat and the rubefacient substances which
they contained [1]. Seward et al. [1] suggested that poul-
tices hasten suppuration, encourage the drainage of pus and
contribute to the spread of cellulitis. Furthermore, when
applied after the pus has formed beneath the deep fascia, it
induced increased oedema and exudate [1]. According to
Laskin, the factors affecting the ability of the infection to
spread depends on the type and virulence of the organism,
general health of the patient, the anatomical site of the
initial infection which decides the drainage of pus and the
effectiveness of the patient’s immune mechanism [2].
External heat application to ‘draw’ an abscess to the
surface has been regarded as a counterproductive measure.
In the cases described above, the occupation, like the
poultice, in the form of our patients’ working external
climate, for prolonged hours, most likely played a role in
the progression of the odontogenic infection in 2 otherwise
healthy individuals. The role of occupation, particularly in
the Indian subcontinent, where a majority of the population
comprises individuals working in the unorganised sector,
cannot be over-emphasised. Recognising this, as a possible
factor in the progression of space infections, can help guide
the treatment plan at an early stage with patient case his-
tory playing an omnipresent role.
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Fig. 1 a Diagrammatic representation of fish dryer with an inlet, outlet and valve for heat regulation. b Photograph of the open charcoal oven
(patient’s workstation)

Acknowledgements We would like to acknowledge Dr. Ridyumna References

for his artistic contributions to this article.
1. Seward GR, Harris M, McGowan DA, Killey HC, Kay LW (1987)
Compliance with ethical standards Killey and Kay’s outline of oral surgery. Wright, Bristol
2. Laskin DM, Laskin JL (1989) Odontogenic infections of the head
Conflict of interest The authors declare that they have no conflict of and neck. In: Laskin DM (ed) Oral and Maxillofacial Surgery, vol
interest. 2. CV Mosby Co, St Louis, pp 219–252

Publisher’s Note Springer Nature remains neutral with regard to

jurisdictional claims in published maps and institutional affiliations.

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