Severe Odontogenic Infections Research Articles

Indication for an additional postoperative antibiotic treatment after surgical incision of serious odontogenic abscesses

IntroductionSerious abscesses of an odontogenic origin occur frequently in the oral and maxillofacial surgery departments. Rapid surgical incision and drainage constitutes the most important therapeutic action. However, additional surgical therapy and supplementary administration of antibiotics is often carried out, such that the efficiency of this supplementary therapeutic option has been questioned. MethodsAll patients with severe odontogenic infections who received surgical treatment under general anaesthesia were recruited to this retrospective study. We determined whether they received additional antibiotic therapy on the ward and if it was possible to improve therapeutic outcomes using this option. ResultsA total of 258 patients with a severe odontogenic infection between January 2008 and August 2014 were included. The most frequent infection observed was a submandibular abscess (56%), followed by a perimandibular abscess (18%) and a submental abscess (9%). About 65% of the patients were treated with antibiotics in addition to surgery. The median CRP level prior to surgical treatment was 87.8 mg/l (Q1: 40.3 mg/l; Q3: 143.5 mg/l) in patients who were administered an additional antibiotic and 83.8 mg/l (Q1: 37.3 mg/l; Q3: 135.0 mg/l) in those who received no antibiotic treatment after surgery. The postoperative median CRP levels were 116.5 mg/l (Q1: 52.1 mg/l; Q3: 159.3 mg/l) and 106.5 mg/l (Q1: 40.6 mg/l; Q3: 152.6 mg/l), respectively. Neither the preoperative CRP level (p = 0.546) nor the postoperative CRP level (p = 0.450) differed significantly between the groups. But patients who received additional antibiotic therapy had a significantly longer hospital stay (median: 6 days; range: 1–22 days) than patients who had no additional antibiotic therapy (median: 4 days; range: 1–19 days) (p = 0.002). ConclusionsThis study did not show an improvement in the therapeutic outcome with administration of supplementary antibiotics in addition to surgery. Thus, surgically incising an abscess is the most important therapeutic action and administration of antibiotics must be critically scrutinised.

Severe Odontogenic Infection Associated with Septic Shock and Acute Respiratory Distress Syndrome： A Case Study

Severe Odontogenic Infection Associated with Septic Shock and Acute Respiratory Distress Syndrome： A Case Study

ODONTOGENIC INFECTIONS: WHAT THE PRACTITIONER NEEDS TO KNOW AND WHAT TO DO

Odontogenic infections that take place within the clinical experience of dental professionals are nowadays considered to be a major public health problem. They are responsible for the growth of morbidity and mortality, even though this occurrence has decreased over the years. It is a disease of an urgent nature that requires immediate care in order to avoid possible systemic involvement. Nevertheless, the general state of the patient's systemic health can influence the spread and worsening of the disease, making its treatment more difficult. For this reason, this work aims to: (1) emphasize the importance of knowledge of severe oral and maxillofacial infections; (2) recognize the importance of dental surgeons in the morbidity and mortality of the patient; and (3) evaluate the characteristics, causes, classifications, clinical manifestations and treatment of severe odontogenic infections, using as reference cases of celebrities who have gone through this experience.

Severe odontogenic infections with septic progress \u2013 a constant and increasing challenge: a retrospective analysis

BackgroundMore than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development.MethodsAll patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day.ResultsSixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans.ConclusionOdontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.

FACTORS INflUENCING ODONTOGENIC MAXILLOFACIAL INFECTIONS AND THE ECONOMIC IMPACT AT A UK HOSPITAL

Objectives To describe the presentation, management, and demographics of 100 consecutive patients with odontogenic infection managed at the Royal Surrey County Hospital, UK. To identify factors influencing Length of Stay (LOS) with the resulting economic impact. Findings Male: female ratio was 54:46 with a mean age of 36 years and mean LOS of 2.38 nights. 29% had not received treatment prior to admission. Age, White cell count, male gender, and multiple space infection were associated with a significantly greater LOS. The most commonly involved fascial spaces were the submandibular (39%) and buccal (39%) spaces. 10% of patients experienced complications as a result of infection. Diabetes, smoking and treatment prior to admission were found not to significantly affect LOS. A total of 238 nights in hospital were spent by these patients in this study. Assuming an average cost of £400 ($ 560) per night, and OR cost of £1200/hour this cost the national health system an estimated £133,600 ($186,600) for an often preventable disease. Conclusions Severe odontogenic infection are preventable by regular dental attendance, and represent a significant morbidity and economic cost to patients and limited health resources that are under financial constraints. Aggressive management of odontogenic infections should be considered for older, male patients with multiple space involvement and a high White Cell Count.

Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions.

The purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections. Perioperative risk factors were retrospectively analyzed in 499 cases. Fisher's exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysis. Area-under-the-curve (AUC) was calculated by receiver-operating-characteristic (ROC) curve. Airway securing in patients with restricted mouth opening led to significant use of the video laryngoscope (p < 0.001) or fiberoptic bronchoscope (p < 0.001). The use of fiberoptic bronchoscopy was significantly increased in patients with dysphagia (p = 0.005) and dyspnea (p = 0.04). Four patients (0.8%) needed primary tracheostomy. ICU admission was significantly associated with higher levels of C-reactive protein (CRP, p = 2.78 × 10-5), white blood cell count (WBC, p = 0.003), dyspnea (p = 9.95 × 10-6), and higher body mass index (BMI, p = 0.0003). American Society of Anesthesiologists physical status (ASA PS) class III patients (p = 0.04) and the need for the use of a video laryngoscopy (p = 0.003) or fiberoptic bronchoscopy (p = 6.58 × 10-5) resulted in a more frequent ICU admission. The AUC of the model was 0.897. Difficult airway management was mainly dependent on limited mouth opening and elevated CRP. Elevated CRP, BMI, ASA PS III, and dyspnea were important risk factors for ICU admission. These predictors should be considered preoperatively for proper planning and preparation.

Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department

PurposeThe aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). MethodsA retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. ResultsDuring the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. ConclusionThe data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.

Treatment of severe odontogenic infection: antibiotic management preferences of oral surgeons

Background: Severe odontogenic infections are defined as fascial space infections that require incision and drainage in an operating room setting. Appropriate antimicrobial therapy is crucial in the treatment of severe OIs. Although there is a data published on the appropriate use of antibiotics to treat these infections, prescriptions patterns seem to vary widely.

Delay in the Referral of Pregnant Patients with Fascial Spaces Infection: A Cross-Sectional Observational Study from Khartoum Teaching Dental Hospital, Sudan.

Odontogenic infections have the potential to develop rapidly into deep-space infections and compromise the airway. This problem is aggravated by pregnancy because of the physiological changes. This study aimed to determine the causes of referral delay for pregnant patients presenting with fascial space infections. Ten pregnant patients with severe odontogenic infections reported to the outpatient clinic at Khartoum Teaching Dental Hospital included in the study during the study period included in the study. Patients with any systemic disease excluded. Demographic data were taken followed by history and then extraoral and intraoral examinations. A predesigned case report form was completed for each patient including the cause of referral delay, the offending teeth, space involved, and trimester at the time of presentation. The age range was from 18 to 35years, and the mean age was 26.5years SD ± 6.3. The odontogenic infections were most common in the last trimester (60%), followed by the late second trimester (40%).The most common tooth involved was the mandibular wisdom tooth (50%), and the submandibular space was the most frequently involved fascial space (70%). All patients were admitted and treated with incision and drainage under local anesthesia; the offending tooth was extracted and intravenous antibiotic and fluids were administered. Patients were on daily dressing until they were discharged on oral antibiotics. Two patients with Ludwig's angina progressed to necrotizing fasciitis. Misconceptions among women regarding dental treatment during pregnancy were the most common cause of the delay. The myths and misconceptions should be addressed by dentists and prenatal care providers about oral health during pregnancy, and obstetricians' awareness increased that oral health needs special attention during pregnancy.

Are routine microbiological samplings in acute dental infections justified? Our 10-year real-life experience

PurposeMost patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections. 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. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results. ResultsThe sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18–88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 – 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients. ConclusionThe results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.

The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients.

Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus. A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction. Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS. Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage. Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.

Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana.

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.

A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients

PurposeIncreasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants. Materials and methodsA 5-year retrospective study investigated records of 303 in-hospital patients with abscess of odontogenic origin. Time-to-event models were used to analyse data where the outcome variable is the time to the occurrence of a specific event. Here, the focus is on a statistical model for the prediction of LOS of patients. ResultsThe group of all patients (n = 303) was analysed by considering seven characteristics of the patients (age, gender, spreading of infection, localization of infection focus, type of administered antibiotics, diagnosed diabetes mellitus, and existence of a remaining infection focus). Age (p = 0.049; rc = −0.007) and spreading of infection (p < 0.001; rc = −0.965) showed a significant impact on the LOS. Subjects were divided into two groups. Group A (n = 185) consisted of patients who presented with a severe odontogenic infection and not yet removed infection focus; group B were patients having undergone outpatient operative tooth removal (n = 118). To group A patients’ data, two new risk factors (“days between abscess incision and removal of infection focus” = dbir and “removal of infection focus during the same stay as abscess incision” = riss) replaced the risk factors “remaining infection focus.” A significant impact on the LOS was detected for dbir (p < 0.001; rc = −0.15) and riss (p < 0.001; rc = −1.76). Our statistical model explicitly describes how the probability for discharge depends on the time and how specific characteristics affect the LOS. We observed a significantly higher LOS in older patients and subjects with infection spreading. In group A patients, dbir and riss had a highly significant impact on the LOS. ConclusionPredicting the LOS may promote transparency to costs and management of patients under inpatient treatment. Our statistical model describes the probability of a discharge at time t compared to a discharge later than t (a LOS longer than t). Furthermore, the model enables a prediction of the LOS of each patient for practitioners in an easy way.

Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9-year retrospective audit.

The aims of this study were to evaluate the microbiological trends in severe odontogenic infections requiring hospital admission in the South Australian Oral and Maxillofacial Surgery Unit. Rates of antibiotic resistance to empirical antibiotic regimens were determined to quantify the clinical implications of antibiotic-resistant odontogenic infections. A retrospective case audit was performed on all odontogenic infections admitted to the Royal Adelaide Hospital over a 9-year period. Data was collected regarding demographics, microbiological culture and sensitivity results, and clinical outcome variables. Of a total of 672 patients, microbiology data was available for 447 cases. Penicillin-resistant organisms were identified in 10.8% of patients, who required a significantly longer length of hospital admission (mean, 9.93days) and higher rates of non-response to initial surgical therapy (40%). There were moderate rates of antibiotic-resistant odontogenic infections within the South Australian population. Patients within this subgroup demonstrate markedly poorer clinical outcomes. Effective treatment of odontogenic infections involves early operative intervention, with adjunctive use of appropriate antibiotic therapy that involves close monitoring of response to removal of the cause and use of first-line antibiotic agents. Cases that fail to respond require urgent specialist review in order to reduce morbidity and mortality outcomes.

Treatment of odontogenic infections: An analysis of two antibiotic regimens

PurposeRetrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. Patients and MethodsEvaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. Results78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. ConclusionClindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

Management of a Severe Cervicofacial Odontogenic Infection

Odontogenic infections originate from a tooth or from its supporting structures, generally secondary to a pulp necrosis, periodontal disease, pericoronitis, apical lesions, or complications of dental procedures, which can be restricted to the alveolus or can reach the jaws and face through maxillofacial spaces. These are the most common conditions which affect the head and neck regions. The aim of this study is to report a severe case of a cervicofacial odontogenic infection while discussing the most relevant aspects. A 47-year-old female patient with a background of diabetes mellitus (DM) had a cervicofacial infection presenting edema and erythema in the left hemiface extending from the frontoparietal to cervical region and was submitted to extensive surgical treatment combined with antibiotic therapy. Although the prevalence and complication rates of odontogenic infections had decreased with the advancement of diagnostic techniques, availability of effective antibiotics, and improvement in oral hygiene, still there are conditions that require attention and accurate treatment to prevent the progression of the pathology to deeper fascial spaces. Odontogenic infections can be treated with fewer complications if approached earlier when diagnosed while their premature clinical manifestations. However, if the treatment is postponed and the infection spreads into deeper fascial spaces, it can damage vital structures, and, consequently, threaten the patient's life. In these cases, extensive and aggressive therapy should be performed.

Clinical oral microbiology and antimicrobial susceptibility – does it matter?

ABSTRACTLittle surveillance data is undertaken on the antimicrobial susceptibility of isolates from acute dento-alveolar infections. We present data collated from routine diagnostic microbiology specimens submitted over a 27 year period in Glasgow, UK. Over the study period isolates were identified using the API system, VITEK 2 and MALDI-TOF. Antimicrobial susceptibility tests were undertaken using combinations of Stokes method and/or E-tests. Baseline data based on Lewis et al., (JAC 23,69-77 1989) and compared to isolates from 1998-2015. From 621 specimens, we isolated Anginosus group streptococci (n = 196), Mitis group Streptococci (n = 448), anaerobic streptococci (n = 116), Fusobacteria (n = 121) and Prevotella (n = 140) species. No discernable increase in resistance patterns over the 27 year time period of analysis was observed. A 6 month audit (May-Oct 2016) in Glasgow recorded 37 patients hospital admissions for 142 bed days (mean 3.5 days) to incise and drain severe odontogenic infections. But, dental practitioners in England (2015) prescribed 10,717 items of cephalosporins and 18, 630 items of augmentin (Source: Health and Social Care Information Centre) – why?Diagnostic oral microbiology matters in guiding antimicrobial stewardship programs but more collaborative working on processing methods and routine susceptibility data would help overcome limited data from single centers.

Key factors of odontogenic infections requiring hospitalization: A retrospective study of 102 cases

ObjectiveThis retrospective study describes the clinical and sociodemographic data collected from patients hospitalized due to odontogenic infections. Materials and MethodsA retrospective study was conducted in patients admitted presenting odontogenic infections at Besat Educational Hospital between 2010 and 2015. Treatmentconsisted of intravenous antibiotics, surgical incision and drainage, and extraction of involved teeth. The Study variables were categorized as demographic, preadmission, preoperative, anatomic, treatment, involved teeth and complications. Appropriate descriptive statistics were calculated. ResultsThe sample consisted of 102 patients (62 males, 40 females) with a mean age of 28.7±13.19years. Mandibular posterior teeth were the most frequently involved (72.4%). Moreover, trismus, fever, and dysphagia were the most frequent preadmission clinical variables; in 51%, 24.5%, and 22% of cases respectively. The perimandibular, masticator and peripharyngeal spaces were infected in 72%, 61%, and 3% of cases, respectively. The combination of intravenous penicillin and metronidazole were the most frequently prescribed antibiotics (73.5%). General anesthesia was needed in 89% and local anesthesia in 11% of patients before surgical treatment. In addition, 4 patients required urgent tracheostomy for airway management. The average number of drained anatomic spaces was 1.5 spaces per patient. Additionally, the average length of hospital stay was 6.8days and mortality recorded in this study was only one case. ConclusionUnderstanding of the key variables involved in severe odontogenic infections has been greatly improved by recent studies and reinforced by the present study. The authors concluded that the major criteria for hospital admission of patients with severe odontogenic infections are trismus, fever, and dysphagia.

Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX

BackgroundThere were 2 main purposes of this retrospective chart review study. The first was to describe the demographic, social, and financial characteristics of patients with severe odontogenic infections. The second was to assess the relationships among several demographic, social, and treatment variables and length of stay (LOS) in the hospital and hospital bill (charges). MethodsThe authors conducted a retrospective chart review for patients admitted to the hospital and taken to the operating room for treatment of severe odontogenic infections at 3 hospitals in Houston, TX (Ben Taub, Memorial Hermann Hospital, and Lyndon B. Johnson) from January 2010 through January 2015. ResultsThe authors included data from severe odontogenic infections in 298 patients (55% male; mean age, 38.9 years) in this study. In this population, 45% required admission to the intensive care unit, and the mean LOS was 5.5 days. Most patients (66.6%) were uninsured. The average cost of hospitalization for this patient population was $13,058, and the average hospital bill was $48,351. At multivariable analysis, age (P = .011), preadmission antibiotic use (P = .012), diabetes mellitus (P = .004), and higher odontogenic infection severity score (P < .001) were associated with increased LOS. Higher odontogenic infection severity score, diabetes mellitus, and an American Society of Anesthesiologists score of 3 or more were associated with an increased charge of hospitalization. ConclusionsSevere odontogenic infections were associated with substantial morbidity and cost in this largely unsponsored patient population. The authors identified variables associated with increased LOS and charge of hospitalization. Practical ImplicationsClinicians should consider these findings in their decision-making processes and prioritize early treatment of odontogenic infections potentially to decrease the number of patients admitted to the hospital, LOS, and overall costs of treatment for these infections.

The Neutrophil-to-Lymphocyte ratio as a marker of recovery status in patients with severe dental infection.

BackgroundThe aim of the study was to assess the value of pretreatment neutrophil/lymphocyte (N/L) ratio and mean platelet volume (MPV) and the correlation between these markers with progression in patients with severe odontogenic infection.Material and MethodsA cohort of 100 patients with severe odontogenic infection were divided into 2 groups according to their length of hospital stay. The N/L ratio and MPV was measured in all patients. The correlation in all patients between preoperative fever, preoperative antibiotic doses, postoperative antibiotic doses, total antibiotic doses and hospital stay with N/L ratio and MPV were analyzed. The Youden index was used to identify the optimal cut-off value.ResultsThere were positive and statistically significant correlations between N/L ratio and prolonged hospital stay and postoperative antibiotic doses and total antibiotic doses. The optimum cut –off level of N/L ratio was 5.19 according to ROC analysis. However, there was no correlation between MPV and any of these parameters.ConclusionsN/L ratio may be used as a prognostic marker for patients with odontogenic infections. These patients may need a higher dose of antibiotics and stay more than 1 day in hospital for the treatment of odontogenic infection when the N/L ratio is detected to be more than 5.19. Key words:Neutrophil/lymphocyte ratio, mean platelet volume, odontogenic infection.