Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

Rautaporras, Niina; Furuholm, Jussi; Uittamo, Johanna; Saloniemi, Mikko; Puolakka, Tuukka; Snäll, Johanna

doi:10.1007/s00784-020-03500-4

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…In the current study, smokers had teeth removal significantly more often at acute state (93%), whereas only 7% were hospitalized for a preceding elective procedure. In addition to known common surgical side effects ( 26 ) and local healing in oral cavity ( 27 - 29 ), smoking can alter the oral microbiome ( 30 ). Considering our finding, it is possible that smoking is common among patients who visit a dentist for teeth removal at the acute state.…”

Section: Discussionmentioning

confidence: 99%

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

Rautaporras¹,

Uittamo²,

Furuholm³

et al. 2022

J Clin Exp Dent

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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.

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Section: Discussionmentioning

confidence: 99%

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

Rautaporras¹,

Uittamo²,

Furuholm³

et al. 2022

J Clin Exp Dent

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“…Odontogenic infections have well-established management protocols involving antimicrobial drugs and incision and drainage of abscesses. Death from odontogenic infections is rare and is often associated with prolonged hospital care/mechanical ventilation and secondary pneumonia [4]; early diagnosis is the key to preventing severe complications.…”

Section: Introductionmentioning

confidence: 99%

“…Fig 4. Four patients with odontogenic deep neck infection, periapical infection on T1 fatsuppressed sagittal images with gadolinium (upper row), and corresponding X-ray findings (lower row).…”

mentioning

confidence: 99%

MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability

et al. 2022

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Objectives To determine the diagnostic accuracy of emergency magnetic resonance imaging (MRI) in odontogenic maxillofacial infections, the clinical and surgical significance of MRI findings, and whether MRI can identify the tooth responsible for the infection. Methods A retrospective cohort study reviewed 106 emergency neck MRI scans of patients with neck infections of odontogenic origin. The diagnostic accuracy of MRI in identifying abscesses was studied relative to surgical findings. Correlations were analyzed between various MRI findings and clinical results and outcomes, such as the surgical approach (intraoral vs. extraoral). The ability of MRI findings to predict the causative tooth was assessed in a blinded multi-reader setting. Results Of the 106 patients with odontogenic infections, 77 (73%) had one or more abscesses. Imaging showed a sensitivity, specificity, and accuracy of 0.95, 0.84, and 0.92, respectively, for MRI diagnosis of an odontogenic abscess. Among the imaging findings, mediastinal edema was the strongest predictor of extraoral surgery. MRI showed bone marrow edema in the majority of patients, and multi-reader assessment showed good reliability. MRI was also able to predict the causative tooth accurately. Conclusions Emergency neck MRI can accurately detect odontogenic abscesses and reliably point to the causative tooth. These results can increase the utility and reliance on emergency MRI in clinical decision-making.

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“…In addition, deep infection may occur after tooth removal to treat acute or subacute local infection symptoms [11]. Early management of the dental infection focus by tooth removal or root canal treatment effectively reduces dispersion of the infection, however, occasionally, the pathogenic microbes invade deeper spaces, causing infection complications such as pneumonia, septicaemia, and endocarditis [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Streptococcus anginosus: a stealthy villain in deep odontogenic abscesses

et al. 2022

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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.

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Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

Cited by 7 publications

References 38 publications

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

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

MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability

Streptococcus anginosus: a stealthy villain in deep odontogenic abscesses

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