Paediatric brain abscesses and odontogenic infection: a critical analysis of the existing literature.

Purpose: Brain abscesses in children are an uncommon, but potentially severe condition requiring rapid diagnosis and treatment. The objectives of this article are (1) to present and discuss the currently available literature on prevalence, aetiology and management of dental brain abscesses in children; (2) to report a series of five clinical cases of intracranial abscesses due to dental pathogens; and (3) to highlight the importance of dental care in temporary and permanent dentition to prevent brain abscesses.

Methods: We report a series of five cases of brain abscesses secondary to dental infection in the paediatric population. Clinical signs, location of abscess, pathogens involved, type of surgical treatment, antibiotic therapy regimen, aetiology of the infection and sequelae are reported. Case descriptions are followed by a systematic review according to PRISMA criteria.

Results: Four patients had an infection on primary (n = 2) or permanent teeth (n = 2) and for all patients an oral commensal bacterium belonging to the Streptococci group was identified. The main location of the abscess was the frontal lobe. The treatment consisted of antibiotic therapy, surgical drainage and dental extraction. Our systematic review included 28 studies amongst 296 identified records. We analysed 20 case reports or case series and 8 retrospective studies.

Conclusion: It is imperative that paediatric dentists are informed about the risk of developing dental brain abscesses. This rare series of cases in children highlights the importance of systematically exploring the oral cavity in the presence of brain abscesses and radically eradicating the potential infectious foci.