Abstract
IntroductionOdontogenic 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.MethodsA 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.ResultsA 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.ConclusionThis 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.
Highlights
Odontogenic infections are fairly common in healthcare settings
When not controlled, these could spread into anatomically associated spaces of the maxillofacial and cervical region, risking myriad possible complications including respiratory obstruction, Ludwig's angina, facial cellulitis, deep neck abscesses, necrotizing cervical fasciitis (NCF), aspiration pneumonia, septicaemia, descending mediastinitis, brain abscess, thoracic empyema, endocarditis, pericarditis, pleuropulmonary suppuration, pneumothorax, abscess of the carotid sheath and jugular thrombophlebitis, hematogenous dissemination to distant organs, and coagulation abnormalities ranging from thrombocytopenia to a fulminant state of disseminated intravascular coagulation (DIC), which could all eventually result in mortality [2, 3, 5, 6]
Most (52%) of the patients presented with bilateral cellulitis of the submandibular, sublingual and submental spaces, characteristic of Ludwig's angina, while a proportional 3%, Page number not for citation purposes 2 as shown in Figure 3, included other manifestations of odontogenic infections such as deep cervical and pharyngeal abscess, sepsis, intracranial abscess and infra orbital abscess
Summary
Odontogenic infections are fairly common in healthcare settings. late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. 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 Odontogenic infections, in their severe forms have generally been considered to be decreasing in occurrence [1, 2], with many attributed reasons such as availability of antimicrobials [1], advancements in healthcare delivery and general improvement in oral hygiene, with subsequent reduction in mortality [3]. Being the premier national referral centre in Ghana with a 2,000-bed capacity, the hospital attends to patients from its nearby communities as well as all over the country, especially the southern zone of the country The objective of this retrospective study was to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital.
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