Is Dental Treatment of an Infected Tooth a Risk Factor for Locally Invasive Spread of Infection?

doi:10.1016/j.joms.2010.05.015

Journal of Oral and Maxillofacial Surgery

Volume 69, Issue 4, April 2011, Pages 986-993

https://doi.org/10.1016/j.joms.2010.05.015 Get rights and content

Purpose

To determine the impact of antecedent dental procedures and dental health on the course of odontogenic maxillofacial infections requiring hospital care.

Patients and Methods

In this retrospective cohort study in a referral center, we evaluated medical records and panoramic radiographs of all patients admitted because of odontogenic maxillofacial infection (n = 84). The predictor variables were preceding dental treatment, antimicrobial therapy, and dental health. The outcome variables comprised infection parameters, length of stay, need for intensive care, and management during hospitalization.

Results

The mean age of the patients was 43.2 ± 16.5 years and 60% were men. Dental procedure preceded the spread of the infection in 49 cases (58%): endodontic treatment (n = 22), tooth extraction (n = 19), and minor first aid (n = 8). Twenty-seven patients had not received any dental or antimicrobial treatment in the recent past. Antimicrobial treatment alone had been given to 8 patients. Patients without preceding treatment had the highest C-reactive protein levels on admission and at maximum (P = .020 and P = .011) and the highest white blood cell counts on admission (P = .011). Their length of stay was also longer, and they needed intensive care more often than the other patients. Maximum C-reactive protein levels and white blood cell counts between treatment groups did not significantly differ from each other.

Conclusions

The systemic response to the infection was strongest and the course of the infection most severe in the absence of preceding dental treatment and in patients with poor dental health. All types of dental treatment contributed to a less severe course of infection.

Section snippets

Study Design

To address the research purpose, the investigators designed and implemented a retrospective cohort study. The study population was comprised of all patients presenting for evaluation and management of odontogenic facial infections requiring hospital admission. Hospital admission criteria were threat to airways or other vital structures, need for general anesthesia, septic fever, marked swelling, need for inpatient control of a concomitant systemic disease, and need for intravenous antimicrobial

Results

In 2004, 101 patients were admitted to Helsinki University Central Hospital for at least 1 day because of an emerging odontogenic maxillofacial infection. Panoramic radiographs were available for 84 patients and these patients comprised the study material. Of the patients, 34 (40%) were women and 50 (60%) were men. Spread of the infection without any preceding dental or antimicrobial treatment was found in 27 cases (32%). A dental procedure preceded the spread of infection in 49 patients (58%):

Discussion

The aim of this study was to determine the impact of antecedent dental procedure and the overall dental health on the course of odontogenic maxillofacial infections requiring hospital care. In the present study, locally invasive odontogenic infections were mainly complications developing after dental treatment. However, one-third of patients had no preceding dental or antimicrobial treatment in the recent past before hospitalization. These patients had significantly poorer dental health based

Acknowledgments

This study project was supported by grants from the Finnish Dental Society, Apollonia, the Research Foundation of Orion Corporation, and Helsinki University Central Hospital Research Funds (EVO). We thank Professor Seppo Sarna (Department of Public Health, University of Helsinki, Finland) for statistical advice.

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In the same way, the service could contribute to avoiding severe cellulitis by allowing earlier surgical drainage of non-severe infections. Seppänen et al. [18] supported this hypothesis, concluding that systemic response to the infection was strongest and the course of the infection was most severe in the absence of preceding dental treatment and in patients with poor dental health. They also highlighted that all types of dental treatment contribute to a less severe course of infection.
Introduction: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay. Material & Methods: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected. Results: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]. Conclusion: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.
Severe odontogenic infections: focus on more effective early treatment
2020, British Journal of Oral and Maxillofacial Surgery
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A previous retrospective study from Greece showed corresponding results in early treatment of these infections; only 19 of their 102 patients admitted to hospital had received treatment of the infective focus.17 The small proportion of local treatment of infection is remarkable, particularly when noting that any dental treatment has been shown to reduce the risk of severe odontogenic infection.10,20 The large number of patients treated exclusively with antibiotics before admission should be addressed, and corresponding observations have been made in other studies that have focused on severe infections.5,16,17
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.
Fungal periapical abscess and the burn patient: A report of two cases of an unreported source for systemic infection
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Admissions to the hospital and intensive care unit for management of dental infections and abscesses appear to be increasing and is reflected in analysis of national data sets over the last several decades. These infections are not without consequence, as observed in our patients, and in others, endodontic infections have been shown to result in significant morbidity with invasive spread, as well as systemic disease leading to death [12]. These infections have traditionally been known to have multiple causative organisms, typically flora of the oropharynx [10,11].
Fungal infections in the intensive care unit are becoming a more common occurrence, especially in the care of the burn patient. Fungal infections in the critically burned patient, who by nature have a heightened inflammatory state and impaired immune response, have been found to carry a profound degree of morbidity and mortality. We present our experience in the care of severe thermal injuries; a series of patients with endodontic fungal infection which, as we found, pose a significant risk for the development of systemic infection and sepsis. Fungal periapical abscesses are a rare and, yet undescribed, potential source of systemic sepsis in the burn intensive care unit.
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To identify the predisposing factors related to maxillofacial space infection treatment outcomes.
A retrospective study was performed. Our sample comprised 112 patients admitted to the hospital with fascial space infections. The study variables were classified. Descriptive statistics were computed. The chi-squared test, t test, ANOVA, multivariate linear regression, and logistic regression were used to analyze statistical differences between the groups.
One hundred and twelve patients (65 males, 47 females) with a mean age of 33.29 ± 19.68 years were admitted to the hospital with infections, mostly due to odontogenic causes. The mean time from the first onset of symptoms to admission was 6.22 ± 4.94 days. Patients often presented with more than one infected space (68.7%). The submandibular space was most commonly involved (46.4%), followed by the pterygomandibular space (28.6%). The white blood cell count at admission ranged from 10,000 to 15,000 cell/mm³. The length of hospital stay averaged 5.93 ± 5.39 days. The multiple linear regression showed (statistical significance p = 0.002 and p = 0.003, respectively) that patients aged 41–60 years or who had at least four involved spaces were positively involved with having longer hospitalizations. The logistic regression showed that patients aged more than 40 years (p = 0.021) or who had at least four involved spaces (p = 0.001) were more likely to develop complications.
The factors that are related significantly to the treatment outcome of maxillofacial infection are increasing age, more than four involved fascial space infection, and immune compromised conditions. The better understanding of these factors and close monitoring of the patients will prevent serious complications.
Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial
2015, Journal of Oral and Maxillofacial Surgery
To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction.
The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant.
One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006).
In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.

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Dentoalveolar surgeryIs Dental Treatment of an Infected Tooth a Risk Factor for Locally Invasive Spread of Infection?

Purpose

Patients and Methods

Results

Conclusions

Section snippets

Study Design

Results

Discussion

Acknowledgments

Infect Dis Clin North Am

J Infect

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Clin Microbiol Infect

J Dent

Int J Oral Maxillofac Surg

J Infect Chemother

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Am Dent Assoc

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Clin Microbiol Infect

Dentoalveolar surgery
Is Dental Treatment of an Infected Tooth a Risk Factor for Locally Invasive Spread of Infection?