Deep odontogenic infections - Computed tomography imaging-based spreading routes and risk for airway obstruction.

PURPOSE: This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging. MATERIAL AND METHODS: Patients with acute DOI and preoperative contrast-enhanced CT-imaging were included in the study. Infection spaces, radiological features of these infections, CT imaging-based compromised airway and patients' background factors were evaluated and associations between these and need for postoperative mechanical ventilation (MV) were reported. RESULTS: Altogether 262 hospitalized patients were included in the final analysis. Typically affected spaces were submandibular (74%), mandibular buccal/vestibular (37%), and sublingual (26%). Retropharyngeal (1%), mediastinal (1%) and danger space (1%) involvements were unusual. The infections were quite evenly distributed between multispace abscesses (53%) and other infections (47%). In multivariate analysis, CT-based compromised airway (OR 5.6, CI 95%, 2.9-10.9, P <0.001), midline crossing (OR 3.3, CI 95%, 1.2-8.8, P = 0.018) and extension at the level or below hyoid body (OR 2.4, CI 95% 1.2-5.1, P = 0.016) predicted the need for MV. Other radiological findings and patients' background variables remained statistically non-significant for MV. CONCLUSION: Anterolateral and superior spread to the neck is typical in DOIs, whereas caudal progression is rare. Postoperative need for MV can be well recognized from CT.

Streptococcus anginosus: a stealthy villain in deep odontogenic abscesses.

Odontogenic infections (OIs) occasionally spread to deep facial and neck tissues. Our study aimed to explore the role of Streptococcus anginous group (SAG) in these severe OIs. A retrospective study of patients aged ≥ 18 years who required hospital care for acute OI was conducted. We analysed data of OI microbial samples and recorded findings of SAG and other pathogens. These findings were compared with data regarding patients' prehospital status and variables of infection severity. In total, 290 patients were included in the analyses. The most common (49%) bacterial finding was SAG. Other common findings were Streptococcus viridans and Prevotella species, Parvimonas micra, and Fusobacterium nucleatum. Infection severity variables were strongly associated with SAG occurrence. Treatment in an intensive care unit was significantly more common in patients with SAG than in patients without SAG (p < 0.001). In addition, SAG patients expressed higher levels of C-reactive protein (p = 0.001) and white blood cell counts (p < 0.001), and their hospital stays were longer than those of non-SAG patients (p = 0.001). SAG is a typical finding in severe OIs. Clinical features of SAG-related OIs are more challenging than in other OIs. Early detection of SAG, followed by comprehensive infection care with prompt and careful surgical treatment, is necessary due to the aggressive behaviour of this dangerous pathogen.

Are there differences between dental diseases leading to severe odontogenic infections requiring hospitalization? A retrospective study.

OBJECTIVES: Common dental diseases may develop into severe odontogenic infections (OIs). This study aimed to characterize the occurrence and nature of dental diseases in OIs requiring hospitalization. METHOD AND MATERIALS: Data of a total of 168 adult patients requiring hospital care for severe OI were retrospectively investigated. Study participants were grouped according to OI etiology: apical periodontitis, marginal periodontitis, combined infection (apical and marginal periodontitis) or vertical root fracture, pericoronitis, and root remnant. The categorization of the dental diseases was achieved by radiologic evaluation and supplemented with clinical findings from patient records. Differences in background variables and infection severity were statistically analyzed. RESULTS: Apical periodontitis was the most common dental infection disease leading to OI (n = 113; 67%). In 83 cases, no root canal treatment (RCT) was administered prior to hospital admission; in 30 cases, RCT had been commenced or completed. Between study groups, significant differences were observed in age (P < .001), immunocompromised status (P = .024), and pulse (P = .012). Patients with marginal periodontitis were older and more often immunocompromised; patients with pericoronitis were younger. Pulse was higher in patients with a severe OI originating from apical periodontitis than in patients with OI originating from other dental diseases. CONCLUSION: Apical periodontitis, specifically with no prior endodontic treatment, was observed in the majority of severe OIs. Additionally, when compared with other types of dental diseases, apical periodontitis was associated with features of more severe infections. This highlights the importance of periapical health.

Severe infections after teeth removal - are we doing enough in preventing them?

Background: The present study clarified features and prehospital care in patients with severe infection after teeth removal. Material and Methods: Patients who were hospitalized for infection following teeth removal were included in this study. Background variables and infection severity parameters were compared between patients who underwent elective and acute teeth removal prior to hospitalization. Additionally, associations of these variables with antibiotic use were evaluated. Results: Of the 118 patients included in the study, teeth removal was due to acute infection in 64% and removal was elective in 36%. The time span from teeth removal to hospitalization varied considerably (from <1 day to 205 days). The variation was significantly greater in patients with preceding acute removal than those with elective removal (P=0.030). Smoking was significantly associated with acute teeth removal (P<0.001). Length of hospital stay (LOHS) was a day longer in the elective group (P=0.017). Overall, 70% of patients received antibiotics prior to hospitalization. There was a significant association between removal type and antibiotic use (P=0.005); antibiotic use was less common in elective teeth removal patients. Immunocompromised patients received antibiotic prophylaxis significantly more often than non-immunocompromised patients (P=0.003). LOHS was significantly associated with prehospital antibiotic use (P=0.035). LOHS was a day longer in patients who had not received antibiotics than in other patients. Conclusions: Severe infection can develop with a long delay after acute teeth removal. More attention should be paid to preceding symptoms and early effective treatment of these infections. A more precise timing of antibiotic use could reduce severe postoperative infections in elective teeth removal. Key words:Odontogenic infection, teeth removal, antibiotic use, prophylaxis, postoperative infection.

Health status in patients hospitalised for severe odontogenic infections.

OBJECTIVE: Previous findings refer to certain predisposing medical conditions that compound the risk of developing severe and potentially lethal acute odontogenic infections (OI). The objective of this study was to clarify this rationale and infection severity in general. MATERIAL AND METHODS: Records of patients aged ≥18 years requiring hospital care for deep OI were retrospectively investigated. The main outcome variable was need for intensive care unit (ICU) treatment. Additional outcome variable was occurrence of infection complications and/or distant infections. Several parameters describing patients' prior health and recent dental treatment were set as independent variables. RESULTS: Of the 303 acute OI patients included, 71 patients (23%) required treatment in the ICU, with no significant difference between previously healthy and patients with disease history. OIs originating from teeth in the mandible compared with maxilla had 7.8-fold risk (p = .007) for ICU treatment in binary logistic regression analyses. Elevated levels of infection parameters at hospital admission predicted further ICU stay. Infection complications and/or distant infections occurred in 7.6% of patients, of which septicaemia and pneumonia were the most common. The mortality rate was 0.3%. Infection complications and/or distant infections occurred significantly more often in smokers (p = .001) and in patients with excessive consumption of alcohol or drugs (p = .025), however smoking showed 3.5-folded independent risk for infection complications and/or distant infections (p = .008) in logistic regression. CONCLUSIONS: Severe OIs often occur in previously healthy patients. Smokers in particular are prone to the most serious OIs.

Deep odontogenic infections-identifying risk factors for nosocomial pneumonia.

OBJECTIVES: To evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI). MATERIALS AND METHODS: All patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease. RESULTS: Ninety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011). CONCLUSION: Secondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia. CLINICAL RELEVANCE: Nosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.