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

Abstract

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.

Streptococcus anginosus: a stealthy villain in deep odontogenic abscesses

“…Currently, however, there are no reports showing that microbial findings would be altered in severe OIs compared to milder infections according to patients' systemic condition, although the proportion of patients with underlying systemic disease has been reported to have increased [2,41]. Our earlier studies have shown that severe OIs occur most often in previously healthy adults [11,42]. Dental procedures including extraction and root canal treatment disrupt the mucosal barrier allowing introduction of mucosal opportunistic bacteria to normally sterile tissue, are local oral risk factors for severe OIs [10,11].…”

“…Our earlier studies have shown that severe OIs occur most often in previously healthy adults [11,42]. Dental procedures including extraction and root canal treatment disrupt the mucosal barrier allowing introduction of mucosal opportunistic bacteria to normally sterile tissue, are local oral risk factors for severe OIs [10,11]. Furthermore, ineffective early treatment of OI may increase the risk of a severe OI [42].…”

“…Mandibular molars are the most common sources of severe OIs [8,9], and these arise from apical periodontitis in particular [10]. 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].…”