A New Type of Chronic Wound Infection after Wisdom Tooth Extraction: A Diagnostic Approach with 16S-rRNA Gene Analysis, Next-Generation Sequencing, and Bioinformatics
Sebastian Böttger,
Silke Zechel-Gran,
Philipp Streckbein,
Michael Knitschke,
Torsten Hain,
Markus Weigel,
Jan-Falco Wilbrand,
Eugen Domann,
Hans-Peter Howaldt,
Sameh Attia
Affiliations
Sebastian Böttger
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg, Location Giessen, Klinikstrasse 33, D-35392 Giessen, Germany
Silke Zechel-Gran
Institute of Medical Microbiology, Justus-Liebig-University Giessen, Biomedical Research Facility Seltersberg (BFS), Schubertstrasse 81, D-35392 Giessen, Germany
Philipp Streckbein
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg, Location Giessen, Klinikstrasse 33, D-35392 Giessen, Germany
Michael Knitschke
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg, Location Giessen, Klinikstrasse 33, D-35392 Giessen, Germany
Torsten Hain
Institute of Medical Microbiology, Justus-Liebig-University Giessen, Biomedical Research Facility Seltersberg (BFS), Schubertstrasse 81, D-35392 Giessen, Germany
Markus Weigel
Institute of Medical Microbiology, Justus-Liebig-University Giessen, Biomedical Research Facility Seltersberg (BFS), Schubertstrasse 81, D-35392 Giessen, Germany
Jan-Falco Wilbrand
Department for Cranio-Maxillofacial Surgery-Plastic Surgery, Diakonie Klinikum Jung-Stilling, Wichernstr. 40, D-57074 Siegen, Germany
Eugen Domann
Institute of Medical Microbiology, Justus-Liebig-University Giessen, Biomedical Research Facility Seltersberg (BFS), Schubertstrasse 81, D-35392 Giessen, Germany
Hans-Peter Howaldt
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg, Location Giessen, Klinikstrasse 33, D-35392 Giessen, Germany
Sameh Attia
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg, Location Giessen, Klinikstrasse 33, D-35392 Giessen, Germany
Delayed-onset infections are rare postoperative complications of lower third molar extractions. This article presents a case of a chronic combined hard and soft tissue infection after the extraction of a third molar, where the causative organisms could only be elucidated by molecular methods. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the bacterial spectrum of the infection. 16S-rRNA gene analysis delivered the microbiome of the abscessing inflammation while standard culture and laboratory examinations were all sterile. The microbiome showed a mixed bacterial infection with a dominance of Delftia and Alcanivorax (spp.) besides other bacteria of the normal oral flora. Using 16S-rRNA-gene analysis, next-generation sequencing, and bioinformatics, a new type of chronic wound infection after wisdom tooth extraction was found. The property of Delftia and Alcanivorax (spp.) as water-affine environmental bacteria raises suspicion of infection from contaminated water from a dental unit. Thus, osteotomies of teeth should only be done with sterile cooling water. The 16S-rRNA gene analysis should become a part of the routine diagnostics in medical microbiology.
