The role of C-reactive protein and white blood cell count in the prediction of length of stay in hospital and severity of odontogenic abscess

Introduction

Odontogenic infections and subsequent developing abscess remain to be a potentially life-threatening event, due to septicemia, airway compression and spreading into sensitive anatomic tissues. C-reactive proten (CRP) and white blood cell (WBC) count are routinely blood-measured indicators for inflammation. Are CRP-levels and WBC-count predictive factors of the developement of odontogenic abscess?

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).

A prospective double-blind evaluation of penicillin versus clindamycin in the treatment of odontogenic infections

In a prospective, double-blind trial, penicillin and clindamycin were compared in treatment of moderate to severe orofacial infections of odontogenic origin, which yielded pus on aspiration. Among 27 patients randomized to receive penicillin, 22 (81%) had a successful outcome, and five (19%) were improved. In the 28 clindamycin-treated patients, 23 (82%) had a successful outcome, and five (18%) were improved. No failures were noted in either group. One patient who was receiving penicillin and two who were receiving clindamycin developed diarrhea. Bacteriologic results showed an average of 6.1 organisms per culture (2.5 aerobes and 3.6 anaerobes). Resistance rates for anaerobic isolates were 8.9% to penicillin and 1.9% to clindamycin. It was concluded that penicillin and clindamycin produce similar good results in treating odontogenic infection when the rate of penicillin resistance among oral anaerobic bacteria is at a relatively low level.     

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.     

A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients

Purpose

Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants.

Detection of Bacterial Flora in Orofacial Space Infections and Their Antibiotic Sensitivity Profile

Introduction

Most odontogenic infections arise as a sequel of pulp necrosis caused by caries, trauma, periodontitis, etc. They range from periapical abscesses to superficial and deep infections in neck. Some resolve with little consequence and some lead to severe infections of head and neck region. The purpose of this study was to identify microbial flora present in orofacial space infection of odontogenic origin and thereby provide better perspective in management of odontogenic infection.

Materials and Methods

Twenty-six patients with space infection of odontogenic origin were selected irrespective of their age and gender. Pus samples were collected and processed in the microbiology laboratory for the growth of anaerobic and aerobic bacteria and antibiotic sensitivity profile.

Results

Demographic profile of the patients showed that male patients were more commonly involved and most patients fell in to the third and fourth decade of age groups. Most common site of involvement was submandibular space. Alpha hemolytic streptococci were the frequent aerobic bacterial isolate and among anaerobes, anaerobic streptococci followed by bacteroids were the major pathogens. Clindamycin, Gentamycin, Linezolid, Imipenam were the most effective antibiotics. 20 % of the aerobes were resistant to penicillin.

Conclusion

Streptococcus species are still the commonest pathogen in orofacial infections of odontogenic origin. Administration of amoxicillin clavulanic acid combination and metronidazole followed by surgical drainage of abscess and extraction of infected teeth, yielded satisfactory resolution of infection.     

Judicious use of antibiotics in dental practice

With the discovery of penicillin and entrance into the antibiotic era, the capability of dentists to treat dental infections have changed dramatically. Many antibacterial agents have developed since, but bacterial resistance using diverse mechanisms, have increased concomitantly. Since antimicrobial agents are frequently needed in dentistry, their judicious use is of prime importance. Dental infections can be divided to two main groups according to the origin of the infection. First, odontogenic infections (acute dento-alveolar abscess) originating from the dental pulp are most commonly caused by gram-positive anaerobic or facultative bacteria. Systemic antibiotic should be given concomitantly with drainage of the dento-alveolar abscess, debridment of the root canal of the infected tooth, and placement of inta-canal antimicrobial medication such as calcium hydroxide. Penicillin G, penicillin V (Rafapen) or amoxycillin (moxypen) are the first line systemic antimicrobial agents. In case of no improvement within 2-3 days, second line regimens such as amoxycillin-clavulanate (augmentin), cefuroxime (zinnat) or penicillin and metronidazole are recommended. In patients allergic to penicillin, clindamycinn (dalacin) is preferred over macrolides. The second group of infections originates from the periodontal apparatus, and is caused usually by gram-negative anaerobes bacilli, sometimes with Actinobacillus actinomycetemcomitance (Aa). Systemic antibiotics are only infrequently indicated in this situation, and always accompanied by scaling, root planning and curettage of the infected root and gingiva. In regenerative or post surgical periodontitis, augmentin, metronidazole or metronidazole in combination with penicillin or amoxycillin augmentin are recommended. In aggressive periodontitis the most common pathogen is Aa and therefore tetracycline, augmentin, or metronidazole and amoxicillin are recommended. In necrotizing ulcerative gingivitis, which is caused usually by fusiform bacilli and spirochetes, metronidazole or augmentin are appropriate. In patients with periodontal disease who are allergic to penicillin can be treated with a macrolides.     

Analysis of the risk factors influencing complications in surgical treatment of mandibular fractures: A retrospective study

The study aim was to identify risk factors associated with complications following open reduction and internal fixation of mandibular fractures.A retrospective cohort study was conducted in patients who were treated for mandibular fractures in a single center between January 2010 and December 2020. Authors classified postoperative complications as overall complications, infections, and reoperations. Factors that may be associated with these complications were grouped as patient, wound, and management variables. Statistical analysis was performed to determine whether these factors influenced complications.Among 175 patients, 125 underwent open reduction and internal fixation. Among patient variables, alcohol consumption was a risk factor for overall complications (p = 0.03) and reoperation (p = 0.02). Among wound variables, the more severe the external wound, the greater the incidence of overall complications (p = 0.001) and infections (p < 0.001). Presence of two or more fracture sites was a risk factor for reoperation (p = 0.038). Among management variables, intraoral and extraoral approaches increased the rates of overall complications, infections, and reoperation. In the multivariate analysis, only intraoral and extraoral approaches were associated with significant risks for overall complications (OR = 5.63, p = 0.017) and infections (OR = 11.53, p = 0.005).Alcohol consumption, external wound severity, multiple fracture site, and incision approach were related to postoperative complications. These findings can help guide surgical decisions and manage patient expectations after surgery.     

影响口腔颌面部多间隙感染老年患者治疗结果的因素分析

目的：分析影响口腔颌面部多间隙感染老年患者的治疗结果的转归因素。方法：对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析,根据年龄分为老年组和中青年组。研究内容包括一般资料,临床指标（全身系统性疾病、病因、症状发作到人院治疗的时间、受累间隙的数量和分布）,实验室检查（细菌学、入院血糖水平、入院血白细胞总数和中性粒细胞百分比）和治疗结果（切口数量、住院天数和并发症）。对数据进行多元线性回归、logistic回归、t检验和x2检验分析。结果：在老年患者中,切口数量和并发症与受累间隙的数量有关。而在中青年患者中,切口数量和住院天数与受累间隙的数量有关,并发症与入院血糖浓度和人院白细胞总数。结论：分析阐明了影响口腔颌面部多间隙感染老年患者治疗转归的因素。其中,受累间隙的数量是一个重要的影响因素。     

Management of complex multi-space odontogenic infections

The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. Diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. Magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. Amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly Peptostreptococcus, Fusobacterium, or Bacteroides, that are resistant to penicillin. Clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (Ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for bacterial identification, timely and aggressive incision and drainage, and removal of the etiology. It is usually preferable to drain multi-space infections involving the submandibular, submental, masseteric, pterygomandibular, temporal, and/or lateral pharyngeal masticator spaces, as early as possible from an extraoral approach. Trismus and airway management are important considerations and may preclude the selection of other surgical approaches. The patients with multi-space infections should be hospitalized and patient care provided by experienced clinicians capable of management of airway problems, in administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging studies, and control of possible surgical complications.     

Pediatric maxillofacial infections: a retrospective study of 113 patients

This is a retrospective review of 113 hospitalized children with maxillofacial infections. The upper face (orbits, paranasal sinuses, maxillary teeth, and cheeks) was affected most frequently in younger children (mean age = 4.03 years), and the source of infection was often unknown. The patients were treated empirically with a second-generation cephalosporin. Lower-face infections (mandibular teeth, submental, sublingual, and submandibular structures) occurred more frequently in older children (mean age = 5.56 years) and were likely to be of odontogenic origin. Empiric therapy in lower face infections usually consisted of penicillin.     

Brain abscesses caused by oral infection

Abstract— Brain abscesses are rare but can be life-threatening infections. Recent progress in microbiological classification and identification has indicated that they are sometimes caused by oral infection and dental treatment. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. In the direct extension, oral infections spread along the fascial planes. Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack valves, through the cavernous sinus and into the cranium. Another hematogenous pathway is through the general circulation. Oral bacteria may cause systemic infections, e.g., endocarditis, and then indirectly initiate brain abscess. Microbiota, complications, and the prevention and management of odontogenic brain abscesses are also discussed in this review.     

Differences between patients with or without the need for intensive care due to severe odontogenic infections.

PURPOSE: Despite greatly improved dental health in industrialized countries, severe odontogenic infections still occasionally lead to hospitalization. The aim of the present study was to determine whether what symptoms, signs, or laboratory parameters on hospital admission were associated with the need for treatment in the intensive care unit (ICU). PATIENTS AND METHODS: Over an 18-month period, 100 consecutive patients (59 male, 41 female) were included in the study. Twenty percent of the patients required ICU treatment because of cardiorespiratory problems or severe complications of their infection. Both ICU and non-ICU patients were examined clinically and blood samples were taken and studied in respect to several parameters associated with infection, including C-reactive protein (CRP) levels. The findings were analyzed statistically for differences between the groups. RESULTS: No particular anamnestic background variable was associated with the need for intensive care. However, a particularly high CRP level on admission was found to be associated with a more severe course of the infection. CONCLUSIONS: This study showed that determination of CRP levels may be useful in clinical decision-making in patients with severe odontogenic infections.     

Descending necrotizing mediastinitis. Two cases consequent on odontogenic infections and a review of literature

Mediastinitis is a frequently-fatal infection of the connective tissue that surrounds the mediastinal organs. The principal causes are perforation of the oesophagus or infections following thoracic surgery with sternotomy, but it may also occur as a rare but dangerous complication of oropharyngeal or cephalic infections that, spreading through the fascias of the cervical spaces, reach and infect the connective tissue present in the mediastinum and between the pleura. The chief cause of the high rate of mortality still carried by this disease is the poor understanding of this possible complication of oro-facial infections (sometimes initially trivial) and the consequent delay in diagnosis and failure to provide adequate therapy. Mediastinal infections of odontogenic aetiology is a rare occurrence but its management requires an early diagnosis and an aggressive surgical treatment. So all the dentists and the oral surgeons should consider the possibility of onset of this dangerous complication also of banal infections of mandibular molars. The aim of this article is to review the literature, and to report two cases of patients whom, following on to odontogenic infections originating from molars in the mandibular arch, developed an odontogenic cervical abscess complicated by pleural effusion, mediastinal empyema and septic shock, with severe risk of a fatal outcome.     

Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections

OBJECTIVE: The aim of this study was to obtain information for an effective antimicrobial therapy against orofacial odontogenic infections; such information was obtained from recent bacteriologic features and antimicrobial susceptibility data. STUDY DESIGN: The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to 7 antibiotics was examined. RESULTS: Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis. Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against beta-lactamase-positive Prevotella. Cefmetazole was effective against all test pathogens. Erythromycin was ineffective against viridans streptococci and most Fusobacterium. Clindamycin exerted a strong antimicrobial activity on anaerobes. Minocycline was effective against almost all the test pathogens. The antimicrobial activity of levofloxacin against viridans streptococci was not strong. CONCLUSIONS: An antibiotic that carries out antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis. Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections. Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria.     

Metronidazole compared with penicillin in the treatment of acute dental infections.

The efficacy of metronidazole in the treatment of acute dental infections was investigated and compared with parenteral penicillin in a controlled trial. All 37 patients in the trial responded satisfactorily and metronidazole appeared to be as effective as parenteral penicillin. A further 24 patients treated with metronidazole also responded satisfactorily. Bacteriological studies of pus obtained from 25 patients revealed the presence of many species of obligate anaerobes. Since metronidazole is only active against obligate anaerobic bacteria it is concluded that these organisms are the important pathogens in acute dental infections.     

The odontogenic abscess. Aetiology, treatment and involvement in the orofacial region

Odontogenic infections are a common problem in daily practice. Occasionally, an odontogenic infection evolves an abscess. This article discusses the aetiology, the treatment and the involvement of odontogenic abscesses in the oro-facial region. Their occurrence, course and treatment are depending on the patient's immune response, and on microbial and environmental factors.     

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.     

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.