Death from overwhelming odontogenic sepsis: a case report

Dental Complications and Reasons for Delayed Clearance Before Hematopoietic Stem Cell Transplant

AIM

Dental evaluation before hematological stem-cell transplant (HSCT) is considered a standard of care. Data on the complications of dental treatment before HSCT are scarce. The aim was to analyze the data on dental treatment in patients undergoing HSCT with an emphasis on complications and reasons for delayed dental clearance.

MATERIALS AND METHODS

Retrospective chart review of 125 patients referred for dental evaluation before HSCT was performed. Demographic, medical, dental data, and complications were registered. Number of appointments and days required to obtain a dental clearance for HSCT were registered, as well as reasons for delayed (i.e., > 21 days) dental clearance.

RESULTS

The most common procedure was tooth extraction, performed in 48 (38.4%) patients. Complications, that is, local infection and delayed healing, occurred in 2 (1.6%) patients. Most patients (104; 83.2%) obtained dental clearance for HSCT in 1-2 appointments (median 1 day). No patient experienced dental complications during the early (≤ 30 days) post-transplant period. Seven (5.6%) patients had their dental clearance delayed for more than 21 days due to increased treatment needs and complex medical conditions.

CONCLUSIONS

Dental treatment before HSCT can be performed with an acceptable safety rate. Delayed dental clearance occurs in complex, high-risk patients with significantly increased treatment needs.

A Nomogram to Predict Mortality in Patients With Severe Oral and Maxillofacial Space Infections

OBJECTIVE

This study aimed to explore the risk factors for death in extremely severe oral and maxillofacial space infection (OMSI) patients and to use these findings to establish a nomogram model that can be used to predict individual patient prognosis.

METHODS

Patients with extremely severe OMSI seen between 2020 and 2024 were enrolled (N = 102). Univariate and multivariate logistic regression were used to analyse the associations between clinical factors and the risk of death, and a nomogram was developed to visualise the model. Model accuracy and clinical utility of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curve and decision curve analysis (DCA).

RESULTS

Six variables were associated with death. Three independent risk factors for death were identified by multivariate logistic regression: history of rheumatoid arthritis (RA) (OR: 7.716; 95% CI: 0.988-52.122; p = 0.050), D-dimer (OR: 1.162; 95% CI: 1.048-1.28; p = 0.004), and serum creatinine level (OR: 1.011; 95% CI: 1.002-1.020; p = 0.018). The nomogram had an area under the receiver operating characteristic curve (AUC) of 0.819.

CONCLUSION

A history of RA, D-dimer and serum creatinine are independent prognostic factors for overall survival in OMSI patients. The nomogram model showed good concordance and accuracy.

A global science mapping analysis on odontogenic infections

OBJECTIVES

Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends.

METHODS

Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers.

RESULTS

A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management.

CONCLUSIONS

Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.

The association of travel distance and severity of odontogenic infections

BACKGROUND

Odontogenic infections (OI) are a preventable disease commonly managed in a tertiary hospital setting. Prevention of severe infections and hospitalisation relies on timely access to primary dental care. This study outlines the pre-hospital treatment of patients presenting to hospital with OIs and the association between travel distance from the patients' residence to a tertiary hospital oral and maxillofacial surgical (OMS) unit.

METHODS

This study analysed patients who initially presented hospital with an OI. Patient demographics, pre-hospital treatment, and clinical markers of severity were recorded. The travel distance from the patient's residence to the hospital was recorded in kilometers, along with any inter-hospital transfer via road/air ambulance.

RESULTS

Two hundred twenty-seven patients were included in this study, 17.2% required an inter-hospital transfer. Of these patients, 70.3% had prior treatment before hospitalisation, and antibiotics without source control was the most frequent treatment (83.1%). The mean travel distance for patients with more severe markers of infection significantly greater than patients with minor infections (p = < .001). Patients who required an inter-hospital transfer accounted for most cases with airway compromise requiring ICU admission.

CONCLUSION

This study found that most patients presenting to hospital with an OI had received antibiotics alone as treatment before hospitalisation. The travel distance from a tertiary hospital with OMS services had a significant correlation to more severe infections. This has important public health implications for the allocation of preventative dental services, and patient access to OMS services.

Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 10⁹/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.

Evaluation of sepsis teaching for medical and dental students at a British University

INTRODUCTION

The aim of this study was to evaluate sepsis on undergraduate programmes in medicine (BMBS), dentistry (BDS) and dental therapy (BScDTH) at a university in England.

MATERIALS AND METHODS

The study was carried out at the Faculty of Health, University of Plymouth. Questionnaires consisting of a series of closed and open-ended items were designed for students and faculty by a group of academics. Following a pilot, participants were invited to complete the questionnaires online. Data collection and analyses were completed over a period of 3 months.

RESULTS

A total of 71 students responded, including 43 were on the BDS programme, 21 on BMBS and 7 on BScDTH. The vast majority were aged between 18-24 years old (n = 61), with 9 reporting being between 25-44 years old. Of the 14 staff who responded, 13 were aged between 35 and 54 years old, with one respondent reporting being aged 25-34. The participants reported their perceptions regarding the teaching and clinical exposure of students to sepsis patients; availability of resources for students and patients to raise sepsis awareness. Students across all programmes reported limited clinical exposure to management of sepsis and lack of confidence in recognising early signs of sepsis in patients. The agreement profile between programmes only differed significantly for recognition of sepsis risk item (χ(6, n = 71) = 26.187, p < 0.001), with BDS students disagreeing with the item to a larger extent than BMBS and BScDTH students. Students and staff reported similar perceptions regarding information available to students and patients. Responses to open-ended items provided several suggestions for improvements in the teaching of students and raising public awareness on sepsis.

CONCLUSION

This study identified several areas related to sepsis teaching which require improvements across all programmes. The key issues highlighted by the students included limited clinical exposure to sepsis patients and lack of confidence in recognising early signs of sepsis.

Multifunctional Irrigation-Assisted Vacuum Drainage versus Traditional Drainage in the Treatment of Odontogenic Deep Fascial Infection: A Retrospective Cohort Study

Purpose

Odontogenic deep fascial space infection in the head and neck is a common potentially fatal clinical problem. Traditional drainage method is considered laborious and gravity-dependent. In this study, we aimed to evaluate the clinical effect of a modified multifunctional irrigation-assisted vacuum drainage (MIVD) by comparing it with the traditional drainage method in the treatment of odontogenic deep fascial infection.

Patients and Methods

Patients diagnosed with odontogenic deep fascial space infection in the Second Affiliated Hospital, Zhejiang University School of Medicine, China between March 2018 and March 2021 were studied. We divided the patients into two groups based on the drainage method they received: patients with the MIVD device were included in the MIVD group, patients with traditional drainage were included in the traditional group. Data were collected retrospectively including baseline characteristics and treatment outcome variables.

Results

A total of 65 patients were included. All the patients were eventually cured. There were no significant differences in age, gender, diabetes, end stage renal disease, autoimmune diseases, other systemic diseases, tobacco use, number of the infected spaces, preoperative white blood cell count and C-reactive protein between the two groups. The number and frequency of manual irrigation by clinicians (MIC), time required for white blood cell count to return to normal levels (TWBC), time required for C-reactive protein to return to normal levels (TCRP), the length of hospitalization and the length and total cost of antibiotics use were significantly less in the MIVD group. There was no significant difference in the cost of hospitalization between the 2 groups.

Conclusion

The MIVD device significantly reduced the number and frequency of MIC, TWBC, TCRP, the length of hospitalization and the length and total cost of antibiotics use in comparison with the traditional drainage method. It provided a favorable treatment method for patients with odontogenic deep fascial space infection in the head and neck.

Redrainage in odontogenic orofacial infections: Risk factors and analysis

OBJECTIVES

The objective of this study was to determine the incidence of redrainage in odontogenic orofacial infections and evaluate possible risk factors. The investigators hypothesized that wait times to first surgery >48 hours and clinical risk factors may predispose patients to higher rates of redrainage.

STUDY DESIGN

Two hundred nineteen patients who underwent surgical drainage for odontogenic orofacial infections over an 8-year period were identified through Western Health electronic medical records. The primary outcome measure was the rate of redrainage. Secondary outcomes included total length of hospital stay and intensive care unit admission and length of stay. Stratified risk factors were analyzed using the Cochran-Mantel-Haenszel test to produce a total overall estimate risk ratio (forest plot).

RESULTS

Of 219 patients, 16 (7.3%) required at least 1 return to theater for redrainage. First surgery wait times >48 hours, multispace infection, C-reactive protein ≥150, trismus, and immunosuppression were associated with a significantly increased risk of redrainage (88%; combined risk ratio = 1.88; 95% confidence interval, 1.31-2.69; P = .001).

CONCLUSIONS

To minimize the risk of redrainage, patients with orofacial infections requiring surgery should undergo surgery within 48 hours of presentation to hospital, particularly when presenting with an elevated C-reactive protein ≥150, trismus, immunosuppression, or multispace involvement.

Risk Perception of Septic Shock with Multiple Organ Failure Due to Acute Exacerbation of an Infectious Dental Disease

In general dental conditions such as dental caries and periodontal disease, a combination of adverse conditions can cause potentially life-threatening periodontal abscess. We treated a patient in whom an oral infection developed into septic shock, resulting in patient death. A 78-year-old woman experienced spontaneous pain around a moving tooth. Pus discharge was observed, the area was sterilized, and an analgesic was prescribed. A few days later, the swelling spread to the buccal region leading to difficulty while eating. Upon systemic status and blood examination at our dental hospital, depressed consciousness due to dehydration and septic shock were suspected. Oxygenation and infusion of acetate linger with antibiotics were immediately performed. Furthermore, a blood examination revealed malnutrition and a severe infection; therefore, the patient was transferred to a nearby general hospital. However, the patient died the next day because of advanced disseminated intravascular coagulation and multiple organ failure. When an oral infection is suspected in an elderly patient, antibiotics should be quickly administered, the patient’s local and systemic state should be confirmed, and sterilization should be performed daily. If no improvement is observed, medical attention should be quickly sought.

An evaluation of sepsis in dentistry

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major health concern and causes substantial morbidity and mortality. It is imperative that the signs of sepsis are identified early in both adult and paediatric patients and appropriately escalated to initiate early treatment and improve prognosis. This paper aims to discuss the change in classification from the previous systemic inflammatory response syndrome (SIRS) criteria to the current definition in adults and also the unchanged definition in children. The hallmark signs of sepsis (both red and amber flags) are discussed in relation to their underlying cellular mechanisms to provide a comprehensive overview for clinicians in primary care, hospital and community settings. The rise of antimicrobial resistance is also an increasing global health concern with resistant bacteria from common infections likely to result in greater patient morbidity and worse outcomes.A literature search identified reported sepsis cases in dentistry through searches in Ovid Medline and Embase from January 1990 to December 2019. Only primary studies were included with no restrictions on languages. Four articles were identified which reported sepsis associated with tooth extractions, dental abscess and submental/submandibular cellulitis. It is well known that locoregional infections of dental origin have the potential to cause sepsis. Therefore, dental healthcare professionals need to be vigilant and understand the specific signs and escalation protocols to ensure patient safety.

Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management, and clinical features of patients hospitalised with CFI. Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis, and presenting clinical features. One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median (range) age was 34 (1-94) years. The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%). Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team, and members of the OMFS team.

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 2: consequences of withholding dental care

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm.

In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care.

The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses.

Natural history of oral disease progression if not managed is described.

Concerns about the medico-legal consequences of reduced access to dental care are discussed.

The economic repercussions of the COVID-19 need for suspension of routine care and the future increased costs of practice are presented.

Management of odontogenic infections and sepsis: an update

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.

Knowledge of sepsis risk and management among dental professionals in Wales: a service evaluation

Aims Sepsis is a significant medical condition. This service evaluation aimed to investigate the current level of knowledge, confidence and educational requirements regarding sepsis among dental professionals in Wales.Design A convenience-sampled, self-administered electronic questionnaire.Setting All chairside dental professionals registered with Health Education and Improvement Wales, all Local Dental Committees, district general hospitals, Cardiff University Dental Hospital and Community Dental Services throughout Wales.Materials and methods A questionnaire was distributed electronically to an estimated 3,716 dental professionals working in Wales in late 2019. Responses were descriptively and statistically analysed.Results In total, 357 responses were received (9.6%), which achieves a 95% confidence interval (CI) with a 5% margin of error. The majority of respondents reported lack of knowledge or confidence in sepsis recognition and management. Approximately two-fifths of respondents did not access equipment to measure oximetry, temperature or blood pressure. More than three-quarters of respondents had not been trained in sepsis recognition and management. The majority of respondents requested online/distance training (42%), local/national conferences (27%) and local study days (16%) as postgraduate educational format.Conclusion There is a clear need for postgraduate education for dental teams regarding the identification and management of individuals with potential sepsis in Wales.Introduction.

Medical emergencies in the dental practice poster: revised and updated

Medical emergencies can occur in the dental practice. The posters 'Medical Emergencies in the Dental Practice' and 'Emergency Drugs in the Dental Practice' have been designed to help dental care professionals to respond effectively and safely to a medical emergency. They have been updated and completely revised in line with current national guidelines and recommendations. The 'Medical Emergencies in the Dental Practice' poster is available as an insert in this issue of the British Dental Journal. Both posters are available to download from https://www.bda.org/advice/Pages/Patient-care.aspx .

Increasing Use of Intensive Care Unit for Odontogenic Infection Over One Decade: Incidence and Predictors

PURPOSE

To determine whether intensive care unit (ICU) admissions for odontogenic infections have increased during the past decade and whether certain clinical features are associated with a greater rate of ICU admission.

MATERIALS AND METHODS

The data from patients undergoing surgery for odontogenic infections at the Royal Brisbane and Women's Hospital in the 24 month from January 2003 to December 2004 were compared with those from patients treated from January 2013 to December 2014. A χ² analysis was used to compare the demographic, admission, and clinical patient data in each cohort. A multiple logistic regression model was used to determine which clinical features were associated with greater rates of ICU admission.

RESULTS

The rate of ICU admission increased significantly from 7 to 24% during the decade (χ² = 12.74; P = .000), although the clinical presentation of patients admitted to the ICU was similar in both cohorts. The mean number of days spent in the ICU increased significantly from 1.7 ± 0.5 to 3.24 ± 2.5 days (t = -3.63; P = .001), and the overall length of stay increased from 1.7 ± 0.5 to 3.5 ± 4.1 days (t = 2.99; P = .004). The use of preoperative computed tomography (CT) increased significantly from 42.9 to 93.3% (χ² = 13.25; P = .000). The most significant predictors of ICU admission were lower third molar involvement (P = .026), dysphagia (P = .020), and C-reactive protein (CRP) levels exceeding 150 mg/L (P = .039).

CONCLUSIONS

The use of the ICU in the management of odontogenic infection has increased significantly at the Royal Brisbane and Women's Hospital over 1 decade. The demographic data and clinical presentation of the patients admitted to the ICU did not change significantly. However, the length of ICU stay and the total length of stay have both increased. A significant increase in CT usage for odontogenic infections also occurred. Third molar infections, dysphagia, and elevated CRP might be relevant clinical predictors of a more complicated course of care requiring ICU admission. More judicious use of CT scanning, combined with prompt surgical consultation and intervention, might reduce the rate of ICU admissions for odontogenic infections.

The surgical management of severe dentofacial infections (DFI)-a prospective study

Dentofacial infections (DFI) lead to morbidity and rarely, mortality. We hypothesised that certain clinical and laboratory parameter factors may be associated with a more severe course and an increased length of stay. We designed a prospective study that included all patients admitted with a DFI to the Oral and Maxillofacial Department between July 2014 and July 2015. A total of 125 were enrolled. We found that serum concentration of CRP on admission and increasing number of fascial spaces involved by the infection were significant predictors of hospital stay (p = 0.02 and p = 0.01, respectively). The average length of stay for a dentofacial infection requiring admission was 4.5 days. Most patients require surgical intervention in combination with intravenous antibiotics for successful resolution. Improved and timely access to primary dental care is likely to reduce the burden for patients their families and the acute hospital service as a consequence of advanced DFI.

Oral health of adult patients undergoing hematopoietic cell transplantation. Pre-transplant assessment and care

Hematopoietic cell transplantation (HCT) is now one of the frequent procedures used for treatment of malignant and non-malignant blood diseases, autoimmune disorders, and certain solid tumors. Despite improvements of therapeutic protocols, HCT still carries a high risk of non-relapse mortality due to early and late complications. Side effects of the therapy regimen frequently occur in the oral cavity and often significantly decrease the patients' quality of life. The complications may result from or may be exacerbated by improper oral preparation of the patient before transplantation. Therefore, it is mandatory that all patients referred to HCT undergo thorough dental examination and receive appropriate treatment before the procedure. It is also very important to develop an individual post-transplantation oral care protocol with special concerns to oral hygiene before implementation of the conditioning. This paper presents a review of dental management methods intended for patients before HCT proposed in literature as well as recommendations based on the experience of the Department of Comprehensive Dental Care and the Department of Conservative Dentistry of Warsaw Medical University and the Warsaw Institute of Hematology and Blood Transfusion. The article pays special attention to the problem of potential foci of infection and bleeding. It also presents protocol of oral hygiene in post-transplantation period, used by patients of Warsaw Medical University and Institute of Hematology and Blood Transfusion.

Acute cervico-facial infection in Scotland 2010: patterns of presentation, patient demographics and recording of systemic involvement

Acute bacterial cervicofacial infection is a common problem that is most often secondary to dental infection. Most cases present as localised abscesses but some may be associated with serious morbidity including scarring, embarrassment of the airway, SIRS (systemic inflammatory response syndrome), and sepsis syndrome. Fourteen oral surgery or maxillofacial surgery units in Scotland took part in a clinical audit of acute infection during two four-week cycles (August and November) in 2010. Information regarding the patients, signs and symptoms, and management was recorded. Training material was distributed between cycles with information on SIRS, sepsis, and the prescription of antibiotics. Overall, 140 patients presented with acute infection. There was an equal sex distribution and ages ranged from 5 to 87 years. There was an association with deprivation and 36% of patients were from the lowest socioeconomic quintile. Most infections were dental (n=120, 86%), and patients presented with pain and swelling (n=120, 86% and n=134, 96%, respectively) Twenty-three patients (16%) met the criteria for SIRS. A further 23 (16%) had at least one positive SIRS marker with incomplete recording of the remaining markers. Twenty-six patients (19%) had no recorded SIRS markers. Cervicofacial infection can be associated with serious morbidity and mortality, which may be better managed if the systemic signs and symptoms of sepsis are recognised and recorded at presentation. This study showed that the recording of signs of sepsis was variable even with training. Further training of junior staff to recognise severe acute bacterial infection may improve management.

Is dental treatment of an infected tooth a risk factor for locally invasive spread of infection?

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.

Dental assessment prior to stem cell transplant: treatment need and barriers to care

OBJECTIVE

To assess the treatment needs of patients undergoing pre-haematopoietic stem cell transplant (HSCT) dental assessment, to collate the examination findings and treatment provided and to define the management issues impacting on care.

DESIGN

Single centre retrospective analysis.

SETTING

Salaried Primary Care Dental Service, Western General Hospital, Edinburgh, UK.

SUBJECTS AND METHODS

One hundred and sixteen available charts of patients who attended for pre-transplant dental assessment during April 2004-June 2007 were examined.

RESULTS

Ninety-four patients, 52 men (55.3%) and 42 women (43.6%), were included. Patients were referred a mean of 31.5 (SD 18.82) days before admission for transplant. Dental assessment occurred, on average, 7.88 days (SD 6.78) following referral. Eighty-eight (93.6%) patients were dentate, while six (6.3%) were edentulous. Eighty-eight (93.6%) patients presented with oral disease; 89 (94.7%) patients received dental care. Issues impacting on care were medical (n = 88, 93.6%), time constraints (n = 73, 77.7%), no GDP (n = 25, 26.7%), dental complexity (n = 5, 5.3%) and anxiety management (n = 1, 1.1%).

CONCLUSION

The majority of patients required dental care, most of which, for healthy adults, would normally be completed within a primary care setting. However, the issues surrounding the care of patients destined for HSCT indicate that there is a place for a dedicated dental service as part of the multidisciplinary team.

Analysis of systemic and local odontogenic infection complications requiring hospital care

OBJECTIVE

Analysis of systemic and local odontogenic infection complications requiring hospital care.

METHODS

All cases of odontogenic infections requiring hospital care, which were adjudicated in the Finnish Patient Insurance Centre during 2000-2003, were analysed. Patient characteristics, and the course and outcome of infection were reviewed.

RESULTS

The study material consisted of 35 patient cases; 15 male, 20 female; mean age 38.4 (16-67) years. The mean length of hospital stay was 14.8 (2-81) days. Nine patients required intensive care for mean 6.2 (2-19) days. Twenty-five (71%) patients developed local infection complications with cellulitis and abscess formation, and 10 (29%) patients a generalised or metastatic infection complication. The length of hospital stay among patients with systemic complications was longer than with local complications, 30.2 (2-81) days vs. 8.0 (2-34) days (p=0.0144). All patients with local complications survived but three of the 10 patients with systemic complications died. Medically compromised patients with underlying disease developed more often systemic infection complications than previously healthy patients (p=0.0028).

CONCLUSIONS

Medically compromised patients appear more susceptible to systemic rather than local infection complications with a need for significantly longer hospital stay and with an increased risk for fatal complications.