Severe odontogenic infection in pregnancy: a timely reminder

Abstract

Dental practitioners often treat patients that are pregnant. Understanding the altered physiology in the pregnant patient, especially changes in immune function, is vital in effective management of orofacial infections. We present a case of rapidly spreading odontogenic infection in a pregnant patient requiring surgical management. We also discuss the physiological changes of pregnancy relevant to dentistry, and the principles of managing such infections in the gravid patient.

Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review

“…The most frequent odontogenic cause, when specified, was the carious process of the third molar (upper or lower) in 23% of cases, followed by caries of the first molar in 8.7%, and then second molars and premolars, both with 7.3%. Severe odontogenic complications occurred in this study were: cervicofacial cellulitis in 30% of cases [ 3 , 22 ], Ludwig’s angina in 27.5% [ 9 , 14 , 15 , 16 , 18 , 19 , 26 , 27 ], abscesses (submandibular and submental) in 23.2% [ 2 , 12 , 13 , 21 , 27 ], deep neck infection (DNI) in 21.7% [ 7 , 8 , 17 , 23 , 24 , 25 ], mediastinitis in 2.3% [ 7 , 23 ], and brain abscess in one case [ 20 ]. Sixty-nine patients were included; in one case drainage occurred spontaneously, and in two patients, medical therapy was sufficient to solve the clinical condition.…”

“…Before the case presented above, a total of 69 cases had been described in the literature since 1994. A total of 16 case reports [ 7 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] and 5 retrospective studies [ 2 , 3 , 8 , 9 , 27 ] were included in this analysis ( Table 1 and Table 2 ). The mean age of the sample was 27.72 years.…”

“…Adverse outcomes recorded were: 9 fetal deaths (13%) [ 7 , 8 , 9 , 22 ], 4 babies presented fetal distress (5.8%) [ 12 , 13 , 21 , 23 ], and 2 needed intensive care unit (ICU) (2.9%) [ 19 , 21 ]. Four mothers died (5.8%) [ 8 , 9 ], 6 needed postoperative ICU (8.7%) [ 2 , 14 , 15 , 19 , 24 ], and 3 cases developed sepsis (4.3%) [ 7 , 8 ]. Nine infectious-related cesarean sections were detected, and 3 patients showed necrotizing fasciitis of the submandibular region and neck [ 22 , 27 ].…”

Odontogenic cervico-facial cellulitis during pregnancy: about 3 cases

“…Odontogenic infection is the most prevalent disease worldwide and it´s known to be the main cause of facial space infections [ 1 ]. Without adequate treatment, the infection can spread along fascial planes caudally to the cranial base, and in a rostral direction to the mediastinum [ 2 ]. On the other hand, pregnancy is an altered physiological state with decreased immune functions that affects almost every system of the body [ 3 ], the implication of which is rapidly spreading cellulitis that can be life threatening for both the mother and the foetus.…”

“…Management plan should be such that it should maximize benefit to the mother and minimizing the risk to the developing fetus [ 6 ]. Consequently, treatment decision should be taken by a multidisciplinary team including the obstetrician, the oral and maxillofacial surgeon and the anesthesiologist [ 2 ]. The aim of this paper was to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis during pregnancy.…”