Abstract
Background Numerous biochemical datas support the noxious role of anti-inflammatory drugs on immune response. Those observations are often put forward for unfavorable evolution of odontogenic infection but has never been really proven in clinic. The aim of this study is to try to clarify this role based on the collection of the clinical course of odontogenic infections over a 10-year analysis period. Material and Methods The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. Clinical and pharmacological data were collected at admission, during hospitalization until discharged home. The population was first separated into two groups patients with or without anti-inflammatory drugs on admission, then on four groups (non-steroidal anti-inflammatory drugs, corticosteroids drugs, both and none on admission). Analysis were performed each time by univariate analysis, multivariate analysis and propensity score matching. Results Six hundred and fifty-three patients were included in the study, 329 (50%) patients report orally anti-inflammatory treatment before presenting to hospital, 50 (7.6%) received corticosteroids, 242 (37%) received NSAIDs and 37 (5.6%) both. Evolution is worsening for patients under anti-inflammatory drugs in term of hospitalization in ICU (p=0.016), number of surgeries (p=0.003), risk of tracheotomy (p=0.036), duration of hospitalization (p=0.005) and spaces involved by the infection (p<0.001). When separating patients into 4 groups, dysphonia and odynophagia are more frequent for patients under corticosteroid and NSAID (35.14%, p<0.001), mediastinal erythema is more frequent for patients under corticosteroid (16%, p=0.004), fever is more frequent for patients under NSAID (35.5%, p=0.032), pain is higher for patients under corticosteroids (p=0.024). But, in order to reduce bias, linked to factors of gravity, a regression weighted by propensity scores was performed and any group of patients is different from the others. Conclusions Patients under anti-inflammatory drugs have more severe dental infection on admission and their complex evolution seems to be linked to the severity of infection on admission. Key words:Severe odontogenic infection, anti-inflammatory drugs, corticosteroids.
Highlights
When separating patients into 4 groups, dysphonia and odynophagia are more frequent for patients under corticosteroid and Non-steroidal anti-inflammatory drugs (NSAID) (35.14%, p
In most cases of severe odontogenic infection, the cellulo-adipose spaces of the head and neck are involved by pus but tooth extraction, drainage of the collections and systemic probabilistic antibiotic therapy rapidly resolves the infection [18]
This prospective observational study showed that patients managed in our Department of Oral and Maxillofacial surgery for acute dental infection have significantly more complex evolution especially when taken anti-inflammatory drugs
Summary
Non-steroidal anti-inflammatory drugs (NSAID) may inhibit neutrophil functions, either aggregation or degranulation, both in vitro and in vivo [7] and may inhibit prostaglandin synthesis [8] This effect may promote the onset or the aggravation of infectious processes normally controlled by an immune physiological response. Our clinical observation initiated this observational study to determine if glucocorticoids and/or NSAID therapy increase severity and complications of dental infection. Numerous biochemical datas support the noxious role of anti-inflammatory drugs on immune response Those observations are often put forward for unfavorable evolution of odontogenic infection but has never been really proven in clinic. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. Analysis were performed each time by univariate analysis, multivariate analysis and propensity score matching
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