Oral and maxillofacial surgery
Management of 112 Hospitalized Patients with Spreading Odontogenic Infections: Correlation with DMFT and Oral Health Impact Profile 14 Indexes

https://doi.org/10.1016/j.tripleo.2011.02.006Get rights and content

Objective

The aim of this study was to report our experience in treating patients affected by spreading odontogenic infections and to discuss their management and outcome.

Study Design

Demographic and clinical information was collected from hospitalized patient records. Decayed, missing, and filled teeth (DMFT) index was calculated for 45 randomly selected patients. Statistical analysis was used to search for associations among multiple variables.

Results

Statistical analysis of the variance by univariate test found significant associations between a longer hospital stay and patients >30 years old (P < .05) and patients with the presenting symptoms of dysphagia and/or dyspnea (P < .05). Statistical analysis using Fisher exact test found significant associations between patients with a DMFT index >10 and female patients (P < .05), patients >30 years old (P < .005), and a hospital stay >4 days (P < .0005).

Conclusions

Rapid resolution of the infection was appreciated when removal of the cause, drainage of the infection, and intravenous antibiotics were performed.

Section snippets

Material and Methods

Between January 2003 and June 2010, 112 patients were admitted and hospitalized for SOIs at the Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Italy.

The criteria for hospital admission were swelling of the face or neck suggesting abscess or cellulitis, dysphagia, dyspnea, and/or trismus (maximum interincisal opening <10 mm). The following information was collected from patient records: age, gender, medical history, etiology of the infection (causative teeth),

Results

Of the 112 patients affected by SOIs, 57 were male and 55 female. Ages ranged from 13 to 82 years (mean 38.45, median 35, SD 16.6). SOIs occurred most commonly in patients aged 10-20 years (n = 31; 27.68%), followed by patients aged 20-30 years (n = 28; 25%; Fig. 1).

Fourteen patients (12.5%) reported comorbidities: 8 were allergic to penicillin, 2 had insulin-dependent diabetes, 2 were HIV-seropositive consumers of illicit drugs, 1 patient was hepatitis B virus positive, and 1 patient suffered

Discussion

Dental practitioners and oral and maxillofacial surgeons frequently encounter odontogenic infections in everyday practice. Most SOIs affect patients between the ages of 31 and 45 years20, 21, 22, 23 (21-40 years in the present study population; Fig. 1). Untreated or misdiagnosed odontogenic infections may spread rapidly and are potentially life-threatening, due to serious complications, such as descending necrotizing mediastinitis, necrotizing fasciitis, septic shock, and multiorgan failure.

Conclusions

We achieved rapid resolution of SOIs and dramatic improvement of clinical conditions when we removed the cause, drained the infection, and administered antibiotics intravenously. The prompt removal of involved teeth is mandatory; endodontic therapy should be reserved to limited periapical lesions. The empiric use of amoxicillin/clavulanate and ceftriaxone was effective for odontogenic infections and produced no noteworthy side effects. However, we believe that the drainage of abscesses is of

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