The impact of COVID-19 on cervicofacial infection of dental aetiology

Cervicofacial infections of dental aetiology can be life-threatening and with the closure of dental practices following the onset of the COVID-19, it would be anticipated that their prevalence presenting to maxillofacial surgery would increase and services may be overwhelmed, with patients presenting later with a potential subsequent increase in morbidity. A retrospective analysis of patients with cervicofacial infection of dental aetiology referred to maxillofacial surgery during the initial six weeks of COVID-19 lockdown in 2020 was carried out and compared with the equivalent period in the two preceding years. Unexpectedly, during COVID-19 lockdown, there was a reduction in patients seen with cervicofacial infection of dental aetiology. This may have resulted from patient adherence to government guidelines “Stay at home”, successful triaging of patients in primary care and emergency treatment provided by urgent dental care centres. Proportionally more patients who presented to hospital had received prior antibiotic therapy and required in-patient admission. All patients admitted received incision and drainage, with an increase extraoral drainage and an associated reduction in length of stay. During COVID-19 lockdown, maxillofacial managed a reduced number of patients with cervicofacial infection, likely resulting from primary and secondary dental care working together. The rate of incision and drainage of patients not admitted increased under local anaesthesia with increase of extraoral drainage and reduced length of stay for those admitted.     

Odontogenic infections: An 8-year epidemiologic analysis in a dental emergency outpatient care unit

Abstract

Objectives. The purpose of this investigation was to analyze epidemiological patterns, clinical features and the management of odontogenic infections in patients undergoing treatment in a dental emergency outpatient care unit. Study design. A retrospective analysis of 58 161 case records of patients presenting to an emergency outpatient unit in Hamburg, Germany between 2000–2007 was performed. From this pool, patients with odontogenic infections were identified using an ICD-10 code, analyzing age, gender, medical co-morbidities, duration of pain, ratio of infiltrates/abscesses, affected teeth, management of infection and administered antibiotics. Results. Of the 58 161 patients, 5357 (9.2%) were identified as having odontogenic infections, with 2689 (50.2%) inflammatory infiltrates and 2668 (49.8%) abscesses. Mean age was 34.8 ± 16.8 years. As the primary site of odontogenic infection, the most significantly affected teeth were the maxillary and mandibular first molars. Patients in age-group 20–29 years (25.1%) utilized the emergency care unit more frequently than other age groups. Clindamycin was the most frequently administered antibiotic. Conclusions. Early recognition, diagnosis and management of odontogenic infections are requisite for avoiding or minimizing the development of potential complications. Strategies and evidence-based protocols should be developed within the dental ambulatory care sector, advancing interdisciplinary cooperation between general dentists and oral or maxillofacial surgeons.     

Management of severe odontogenic infections in pregnancy

Background: The objective of this study was to review the management of patients presenting with severe odontogenic infections and who are also pregnant. Methods: A retrospective clinical audit was conducted of all female patients admitted to the Royal Adelaide Hospital by the Oral and Maxillofacial Surgery Unit from 1999 to 2009 with severe odontogenic infections. Pregnant patients were identified and their age, medical history, previous obstetric and gynaecological history, stage of current pregnancy, presenting infection, diagnosis and management were recorded, as well as the outcome of the pregnancy. Results: A total of 346 female patients were admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with an admission diagnosis of severe odontogenic infection and five were pregnant. Besides surgical and anaesthetic assessment, mother and foetus were assessed by the Obstetric and Gynaecology Unit. In all, five with severe infection were successfully resolved and four proceeded to a normal delivery with a healthy child. The remaining patient had an already planned therapeutic abortion. Conclusions: Pregnant patients with severe odontogenic infections require urgent referral to a tertiary hospital with full surgical, anaesthetic and obstetric services. This allows appropriate management of the complex requirements of mother and foetus.     

Atypical fulminating dental nfections

Dental surgeons are faced with treating dental infections on a daily basis and the cases discussed in this paper highlight the potential outcome of such infections, especially in immunocompromised patients. Fulminating infection in the head and neck may present as a rapidly progressive, potentially fatal condition characterized by extensive necrosis of the subcutaneous tissues. One form of such infection is necrotizing fasciitis. Although first described in 1793 by Pouteau, the term necrotizing fasciitis was first coined in 1952 by Wilson who noted that facial necrosis was the most consistent feature of this disease. When necrotizing fasciitis occurs in the head and neck region it is usually odontogenic in origin. This paper reviews the cases of four patients presenting with atypical fulminating dental infection who presented to the oral and maxillofacial department at Guy's and St Thomas's Hospital, London, resulting in cellulitis and necrotizing fasciitis. Aggressive management is critical for patient survival and time wasted is tissue lost. CLINICAL RELEVANCE: Early diagnosis and aggressive treatment of dental infections, especially in patients with altered immune status, is critical. There should be a high index of suspicion in patients with dental infections not responding to treatment and maxillary dental infections with sinus symptoms.     

Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

Antibiotic prophylaxis in pediatric odontology. An update

Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes.     

西北地区颌面部间隙感染65例临床总结

目的:回顾性研究颌面部间隙感染(MSI)的临床特征和诊治要点,以及MSI的危险因素。方法:收集2004-06—2011-12在甘肃省兰州大学第二医院口腔颌面外科就诊的65例MSI患者的临床资料,要求有详细的病历记录。分析其病因、手术方式、术后效果及并发症的发生情况。结果:65例患者年龄2～86岁(平均年龄44.4岁),男34例,女31例;牙源性颌面部间隙感染是主要原因;下颌下间隙是最容易发生感染的颌面部间隙;6例患者出现严重的并发症,其中3例死亡(病死率4.6%);糖尿病患者有14例(21.53%)。结论:早期的牙病治疗、脓肿切开引流协同使用抗生素是治疗MSI的有效措施。尤其对西北地区农牧民患者,需要重视口腔卫生宣教;针对糖尿病患者,控制血糖非常重要。     

Characteristics,length of stay,and hospital bills associated with severe odontogenic infections in Houston,TX

Background

There were 2 main purposes of this retrospective chart review study. The first was to describe the demographic, social, and financial characteristics of patients with severe odontogenic infections. The second was to assess the relationships among several demographic, social, and treatment variables and length of stay (LOS) in the hospital and hospital bill (charges).

An epidemiologic and anatomic survey of odontogenic infections

An 81-month review of patients with infections of odontogenic origin admitted to the oral and maxillofacial surgery service at a county hospital and teaching facility in northeast Ohio is presented. Age, sex, race, etiology, pathogens isolated, admission temperature, and admission white blood cell count were identified and related to the anatomic space(s) encountered. Multispace and single-space infections occurred with equal distribution. In both the multispace and single-space infections, the submandibular and buccal spaces were most frequently involved. Males were affected with single-space infections twice as often as females. An equal distribution among sexes was found in multispace infections. The most common age range for all infections was 25 to 30 years. alpha-Hemolytic streptococci, Bacteroides melaninogenicus, and beta-hemolytic streptococci were the most frequently isolated pathogens. Third molars were the prevalent cause in both multispace and single-space infections that required hospital admission.     

Severe odontogenic infections: focus on more effective early treatment

Our aim was to investigate delay in the treatment of patients with acute odontogenic infections. A prospective clinical study and a questionnaire survey were designed and implemented in the emergency maxillofacial surgical patients of Helsinki University Hospital, Finland, over a one-year period. Altogether 88 adult patients with odontogenic infections confirmed by hospital examination were included in the analysis. The outcome variable was admission to hospital. Two-thirds of the patients had had previous visits for health care for their current infection. Treatment was started in nearly half the patients before hospital admission, and half of the treatment provided was exclusively antibiotics. The focus of infection was detected in half the patients before admission. Patients who were required further hospitalisation were younger than who were discharged (p = 0.021). Less well-educated patients were more likely to be hospitalised than patients in other education groups (p = 0.033). Leucocytosis was more prevalent in patients with a mandibular focus (p = 0.008), non-identified focus (p = 0.010), and infection as a result of elective tooth extraction (p = 0.026). The number of previous health care visits for the acute infection was notably high. Early treatment of infection may be overlooked, particularly in younger age groups and less well-educated patients. Challenges in making the correct diagnosis and prescribing effective treatment for such infections cause additional health care visits and unnecessary delay in care. More attention should be paid to the early detection and comprehensive primary treatment of odontogenic infections.     

Diagnosis and treatment of the retropharyngeal abscess in adults

While the retropharyngeal space abscess is an extremely rare entity that may arise from odontogenic infections, its potential complications may be fatal. When infection of the retropharyngeal space occurs, urgent surgical and antibiotic therapy is required. A review of the anatomy, symptoms, treatment, diagnostic methods and complications is provided. As well, the successful treatment of a multispace odontogenic infection is discussed as a reminder that the retropharyngeal abscess does exist.     

The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care

Objectives

The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care.

Materials and methods

In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n?=?60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis.

Results

Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20–88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p?=?.0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate.

Conclusions

The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered.

Clinical relevance

Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.     

Update on antibiotics used to treat orofacial infections

Odontogenic infections are most often composed of many different bacteria. The pathogenesis of odontogenic infections depends on the relationship between anaerobic and aerobic bacteria within the infection. Historically, penicillins have been used to treat odontogenic infections. With the ever-increasing bacterial resistance to penicillin-based antibiotics with dental pathogens and concurrent clinical failures with penicillins, other agents have become increasingly attractive. Clindamycin has more recently become a drug of choice for the management of odontogenic infections because of the bacterial susceptibility to this drug, great oral absorption, low emergence of bacterial resistance and good antibiotic levels in bone. Newer macrolides, such as azithromycin, also have significant clinical efficacy for the management of dental infections and have additional benefits of reduced dosing, which increases patient compliance. Tables 1 and 2 provide additional information for a summary of antibiotics discussed in this article and general oral prescribing information for the adult patient. The general dentist should consider these additional choices of antibiotics to successfully manage odontogenic infections. [table: see text]     

Hospital course of HIV-positive patients with odontogenic infections

OBJECTIVE: The study purpose was to compare and contrast the hospital course of patients who are human immunodeficiency virus-positive (HIV+) and human immunodeficiency virus-negative (HIV-) who were admitted to manage their odontogenic infection. STUDY DESIGN: We used a retrospective case-control study design and a sample derived from patients admitted for management of their odontogenic infections. Cases and controls were defined as patients who were HIV+ or HIV-, respectively. HIV status was determined by patient self-report. Outcome variables included admission temperature (degrees Celsius) and white blood cell count, number of fascial spaces infected, days with temperature >38 degrees C, need for intensive care, and length of hospital stay. RESULTS: The study sample consisted of 60 patients (10 HIV+ cases and 50 HIV- controls matched for age and sex) with a mean age of 32.8 +/- 6.6 years and was predominantly male (78%). Significant differences existed between patients who were HIV+ and those who were HIV- for the following variables: admission white blood cell count, number of days with maximum temperature >38.0 degrees C, and use of the intensive care unit. CONCLUSIONS: The study results suggest that patients who are HIV+ who are admitted for management of odontogenic infection have a significantly more intense hospital course than those who are HIV-. However, the overall length of hospital stay is not significantly different.     

Management of odontogenic cervicofacial infections presenting to oral and maxillofacial units during the first wave of the COVID-19 pandemic in the United Kingdom

On 25 March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to oral and maxillofacial surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom.From 1 April 2020 until 31 July 2020 a database was used to prospectively collect records for all patients with CFI who presented to oral and maxillofacial teams. Information gathered included clinical presentation, location/origin of infection, and how this was managed. The OMFS units were asked to compare the patient’s care with the treatment that would usually have been given prior to the crisis. A total of 32 OMFS units recorded 1381 cases of CFI in the UK. Most of the infections were referred via the emergency department (74%). Lower first or second molars were the most common origin, contributing 40% of CFI. Collaborators reported that patients' treatments were modified as a response to COVID in 20% of cases, the most frequently cited reason being the application of COVID-19 hospital policy (85%). The impact of the first wave of COVID modified the management of a significant number of patients presenting with CFI, and there was a proactive move to avoid general anaesthetics where possible. Some patients who presented to secondary care were given no treatment, suggesting they could have been managed in primary dental care if this had been available. We recommend that OMFS units and urgent dental care centres (UDCCs) build strong communication links not only to provide the best possible patient care, but to minimise COVID exposure and the strain on emergency departments during the pandemic.     

西藏日喀则地区口腔颌面间隙感染90例临床分析

目的 探讨西藏日喀则地区口腔颌面间隙感染患者的发病特点。方法 回顾2015年1月—2018年2月在日喀则市人民医院口腔科住院的90例颌面间隙感染患者的病例资料,分析发病年龄、职业、感染原因、好发部位等。结果 90例患者中,儿童、学生及农牧民为好发人群;牙源性感染为首要致病原因,以第一、二恒磨牙为主要病灶牙;单间隙感染71例,占78.89%;多间隙感染19例,占21.11%;下颌下间隙受累最多。结论 日喀则地区口腔颌面间隙感染发病年龄较早,应及早对儿童及父母开展口腔卫生宣教,提高医疗保健意识,并加强基层医疗队伍建设。     

Occurrence of odontogenic infections in patients treated in a postgraduation program on maxillofacial surgery and traumatology

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Ara?atuba Dental School, S?o Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. Of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.     

Risk factors affecting hospital length of stay in patients with odontogenic maxillofacial infections

This study identified potential risk factors associated with increasing hospital length of stay (LOS) in patients with odontogenic maxillofacial infections. One hundred twenty-eight patients admitted to Brigham and Women's Hospital by the Division of Oral Surgery between October 1, 1984 and March 31, 1995 with a maxillofacial infection of dental origin were retrospectively identified by a medical chart review. Linear regression techniques were used to explain the relationship between patient admission characteristics and LOS. Variables considered included age, gender, infection location, admission white blood count (WBC), admission temperature, antibiotic treatment during hospitalization, attending surgeon, insurance class, operating room use (ORU), and preexisting medical conditions associated with chronic immunosuppression. The following variables were found to significantly increase LOS: ORU (P = .007), preexisting medical conditions (P < .0001), admission temperature (P = .022), and deep infection (P = .063). LOS is best predicted on the basis of underlying medical conditions and location of the infection.     

Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department

PurposeThe aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED).MethodsA retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED.ResultsDuring the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made.ConclusionThe data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.