Introduction Odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana. Methods A retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review. Results A total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection. Conclusion This study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management.

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Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t -test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

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