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Teal L, Sheller B, Susarla HK. Pediatric Odontogenic Infections. Oral Maxillofac Surg Clin North Am 2024; 36:391-399. [PMID: 38777729 DOI: 10.1016/j.coms.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.
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Affiliation(s)
- Lindsey Teal
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, 325 9th Avenue, Seattle, WA 98013, USA
| | - Barbara Sheller
- Department of Dentistry, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Harlyn K Susarla
- Department of Dentistry, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Dentoalveolar Surgery. J Oral Maxillofac Surg 2023; 81:E51-E74. [PMID: 37833029 DOI: 10.1016/j.joms.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Chadha S, Troost JP, Shivers PL. Does thePenicillin Allergy Label Affect Outcomes of Complicated Odontogenic Infections? J Oral Maxillofac Surg 2023; 81:1301-1310. [PMID: 37507104 DOI: 10.1016/j.joms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/31/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Penicillins are a potent antibiotic in managing odontogenic infections, but 10% of the population is labelled as allergic to these drugs. This has limited their use and resulted in increased utilization of health care resources as well as complications associated with alternative antibiotics. The purpose of the study was to measure the association between patients labeled as penicillin allergic and treatment outcomes in a sample of patients treated for complicated odontogenic infections. Additionally, we sought to investigate antibiotic resistance patterns in these patients. MATERIALS AND METHODS A retrospective cohort study was performed at the Michigan Medicine health care system to include patients who were treated for complicated odontogenic infections by oral and maxillofacial surgery between 2016 and 2020. Complicated odontogenic infection was defined as any odontogenic infection requiring admission and surgical management in the operating room. The primary predictor variable was the penicillin allergy label, which was determined by chart review and not confirmed with formal testing. Outcomes were measures of disease severity. The primary outcome variable was hospital length of stay. Secondary outcome variables were ICU admission (yes/no), repeat computed tomography scan(s), repeat surgery (yes/no), and re-admission (yes/no). Co-variates included were age, sex (male/female), tobacco use status, diabetes, immunocompromised state, number of spaces involved, white blood cell count upon admission and insurance status. For our secondary aim, the primary predictor variable was again penicillin allergy and outcome variable was antibiotic resistance as determined by wound culture results following surgical intervention. Negative binomial regression and logistic regression analyses were performed. P < .05 was considered significant. RESULTS A total of 150 patients met the inclusion criteria and of those 17.3% reported as penicillin allergic. Patients labelled as penicillin allergic did not differ significantly from patients without penicillin allergy label in terms of treatment outcomes. Age, diabetes, and immunosuppression were associated with an increased length of stay. Patients labelled as penicillin allergic were at significantly higher risk for antibiotic resistance (relative risk = 2.34; 95% confidence interval, 1.66 to 3.32; P < .001), specifically clindamycin resistance (relative risk = 3.17; 95% confidence interval, 1.93 to 5.18; P < .001). CONCLUSIONS Penicillin allergy was significantly associated with clindamycin resistance. There were similar outcomes amongst patients with and without a penicillin allergy label despite antibiotic differences. Delabeling efforts for patients with a reported penicillin allergy must be considered and local nomograms for antibiotic selection should be used by providers when seeking alternative antibiotics.
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Affiliation(s)
- Sagar Chadha
- Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Jonathan P Troost
- Lead Statistician, Michigan Institute for Clinical Health and Research, Ann Arbor, MI
| | - Paul L Shivers
- Clinical Instructor, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
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Słotwińska-Pawlaczyk A, Orzechowska-Wylęgała B, Latusek K, Roszkowska AM. Analysis of the Clinical Status and Treatment of Facial Cellulitis of Odontogenic Origin in Pediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4874. [PMID: 36981782 PMCID: PMC10049628 DOI: 10.3390/ijerph20064874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The most common cause of the development of odontogenic infection is untreated dental caries, which initially leads to pulpitis. If an odontogenic infection is left untreated, it will pass through the limiting bone plate and will infiltrate deeper structures. Odontogenic infections are different in adults and children. The study was conducted at the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of Upper Silesian Children's Health Center in Katowice in the 2020-2022. We included 27 patients aged 2-16 in the study. Patients were diagnosed with an active, acute odontogenic inflammatory process in the head and neck area. We assessed pain, trismus, extraoral and intraoral swelling and the level of CRP [C Reactive Protein], WBC [White Blood Cells], NLR [Neutrophil Lymphocyte Ratio], D-dimers and Prealbumins. The results were analyzed in terms of the location of the source of inflammation: maxilla or mandible and the type of source of infection: deciduous tooth or permanent tooth. Deciduous teeth are more often the cause of odontogenic infection in the maxilla, while permanent teeth in the mandible. Trismus, extraoral, and intraoral swelling occurred in all infections caused by permanent teeth. The CRP and NLR ratio is statistically higher in infection, which originates from permanent teeth. The mean hospitalization time was also longer for infections from permanent teeth 3.42 days than for deciduous teeth 2.2 days. The varied clinical picture of odontogenic infections in children requires periodic analyzes of statistical data related to epidemiology, etiology, and symptomatology in order to update diagnostic and therapeutic procedures.
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Affiliation(s)
- Adrianna Słotwińska-Pawlaczyk
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Chairs of Pediatric Surgery, Medical University of Silesia, 40-055 Katowice, Poland
| | - Bogusława Orzechowska-Wylęgała
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Chairs of Pediatric Surgery, Medical University of Silesia, 40-055 Katowice, Poland
| | - Katarzyna Latusek
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Chairs of Pediatric Surgery, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98122 Messina, Italy
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Judith MJ, Aswath N, Padmavathy K. Microbiota of Dental Abscess and their Susceptibility to Empirical Antibiotic Therapy. Contemp Clin Dent 2022; 13:369-374. [PMID: 36687001 PMCID: PMC9855256 DOI: 10.4103/ccd.ccd_782_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
Context Resistant pathogens to purulent odontogenic infections have evolved due to misuse of antibiotics. Hence, it is important to use a suitable antibacterial agent. Aim This study aimed to identify the common bacterial species causing odontogenic infections and to determine their antibiotic susceptibility profile to amoxicillin, amoxicillin and clavulanic acid, azithromycin, and linezolid. Settings and Design This was an in vitro cross-sectional study. Material and Methods Fifty pus samples from odontogenic abscess were cultured and antibiotic susceptibility tests were performed as per the standard microbiological procedures. Statistical Analysis Used Binomial test and Pearson's Chi-square test were used for statistical analysis. Results Out of the 50 samples cultured, 30 samples showed growth. The distribution of growth among the 30 samples was Gram-positive cocci (n = 23, 67.65%) and Gram-negative bacilli (n = 11, 32.35%). Gram-positive isolates that were grown were Enterococcus faecalis (38.24%) followed by Staphylococcus aureus (29.41%) and Gram-negative bacilli that were isolated were Klebsiella pneumoniae (14.71%), Pseudomonas aeruginosa (8.82%), Escherichia coli (5.88%), and Enterobacter (2.94%). Enterococcus isolates were highly susceptible to amoxicillin (76.92%). An increase in the zone of inhibition to amoxicillin-clavulanic acid was appreciated more for Staphylococcus (50%) than Enterococcus (30.76%). Enterococcus and Staphylococcus showed high susceptibility of 92.31% and 90% to linezolid, respectively. E. coli and Enterobacter were 100% susceptible to amoxicillin. All the Gram-negative bacteria except for P. aeruginosa were 100% highly susceptible to amoxicillin-clavulanic acid. Conclusions Culture-guided antibiotic prescriptions are necessary to prevent the emergence of antibiotic-resistant bacteria.
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Affiliation(s)
- M Jemima Judith
- Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital, BIHER, Chennai, Tamil Nadu, India
| | - Nalini Aswath
- Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital, BIHER, Chennai, Tamil Nadu, India
| | - Kesavaram Padmavathy
- Department of Microbiology, Research Laboratory for Oral Systemic Health, Sree Balaji Dental College and Hospital, BIHER, Chennai, Tamil Nadu, India
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Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections-A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10030240. [PMID: 33670844 PMCID: PMC7997333 DOI: 10.3390/antibiotics10030240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.
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Christensen BJ, Racha D, Hinkle R, Sahebi M. Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections. J Oral Maxillofac Surg 2020; 79:141-151. [PMID: 32717213 DOI: 10.1016/j.joms.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections. PATIENTS AND METHODS We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ2 test and logistic regression, and from these results, a multiple logistic regression model was created. RESULTS A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation. CONCLUSIONS Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.
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Affiliation(s)
- Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Dylan Racha
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Ryan Hinkle
- Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Mishaun Sahebi
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Gómez-Sandoval JR, Robles-Cervantes JA, Hernández-González SO, Espinel-Bermudez MC, Mariaud-Schmidt R, Martínez-Rodríguez V, Morgado-Castillo KC, Mercado-Sesma AR. Efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen in the treatment of periodontitis in patients with diabetes: a randomized clinical trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e000665. [PMID: 31958293 PMCID: PMC6954743 DOI: 10.1136/bmjdrc-2019-000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/11/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen during nonsurgical treatment of periodontitis in patients with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS In this double-blind, randomized clinical trial, a total of 42 patients with chronic periodontitis and type 2 diabetes were included. Patients were randomly assigned to treatment with either clindamycin or amoxicillin-metronidazole three times a day during 7 days. Clinical determinations (probing depth, bleeding on probe, and plaque index) were performed to determine the extent and severity of periodontitis before and after the pharmacological treatment. RESULTS After 7 days of administration of clindamycin or amoxicillin-metronidazole, no differences were observed between the clinical determinations, probing depth (0.44 vs 0.50 mm, p=0.624), plaque index (17.62 vs 15.88%, p=0.910), and bleeding on probing (16.12 vs 22.17%, p=0.163), respectively. There were no adverse events in either group. CONCLUSION The administration during 7 days of clindamycin or amoxicillin/metronidazole showed the same efficacy for the reduction of probing depth, plaque index, and bleeding on probing in patients with periodontitis and type 2 diabetes.
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Affiliation(s)
- Juan Ramón Gómez-Sandoval
- Departamento de Clínicas Odontológicas Integrales, Instituto de Invesigación en Odontología, Especialidad en Periodoncia, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico
| | - José Antonio Robles-Cervantes
- Servicio de Medicina Interna, Instituto Jalisciense de Cirugía Reconstructiva, Secretaría de Salud Jalisco, Guadalajara, Jalisco, Mexico
| | - Sandra Ofelia Hernández-González
- Unidad de Investigación Biomédica 02 y División de Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - María Claudia Espinel-Bermudez
- Unidad de Investigación Biomédica 02 y División de Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Rocío Mariaud-Schmidt
- Departamento de Clínicas Odontológicas Integrales, Instituto de Invesigación en Odontología, Especialidad en Periodoncia, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico
| | - Vianeth Martínez-Rodríguez
- Departamento de Clínicas Odontológicas Integrales, Instituto de Invesigación en Odontología, Especialidad en Periodoncia, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico
| | - Karina Celia Morgado-Castillo
- Unidad de Investigación Biomédica 02 y División de Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
- Diabetes sin Complicaciones S.A de C.V, Zapopan, Jalisco, México
| | - Arieh Roldán Mercado-Sesma
- Departamento de Salud enfermedad como proceso individual and Centro de Investigación Multidisciplinaria en Salud, Universidad de Guadalajara, Centro Universitario de Tonalá, Tonalá, Jalisco, Mexico
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Management of odontogenic infection in paediatric patients: a retrospective clinical study. Eur Arch Paediatr Dent 2019; 21:145-154. [PMID: 31332632 DOI: 10.1007/s40368-019-00466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the outpatient and inpatient management of odontogenic infections among paediatric patients attending a university hospital. METHODS A retrospective study (2013-2015) was carried out which involved retrieving relevant data from past records (manual/electronic) of paediatric patients (under 18-years-old) who presented with odontogenic infections to the Paediatric Dentistry and Oral and Maxillofacial clinic. Data collected was organised using descriptive statistics with SPSS version 12.0.1. RESULTS A total of 153 patients were identified, of which 83.7% were managed as outpatients. Odontogenic infections were more common in females (52.9%) and preschool children (58.2%). The most cases were seen in 2014 and maximum number of cases per month was 12. Common presentations were pain (62.1%), intraoral swelling (37.9%) and spontaneous pus discharge from the tooth and/or surrounding tissues (67.3%) with higher involvement of primary right molars. Dental panoramic tomograph was the most common radiographic investigation done. Outpatients were commonly managed chairside with pulpal opening (46.1%) at the paediatric dental clinic and 7% underwent extraction under general anaesthesia in day-care setting. Inpatients were admitted for 3 days on average and most commonly definitive care was extraction under local/general anaesthesia (68%). There were 22.7% outpatients and 72.0% inpatients who were prescribed antibiotics. CONCLUSIONS Overall, treatment and medications prescribed adhered to current guidelines. There was a tendency to solely prescribe antibiotics in 8.6% of outpatients which is contrary to recommendations.
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Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
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Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
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de Lima BR, Nicoloso GF, Fatturi-Parolo CC, Ferreira MBC, Montagner F, Casagrande L. Prevotella
strains and lactamic resistance gene distribution in different oral environments of children with pulp necrosis. Int Endod J 2018; 51:1196-1204. [DOI: 10.1111/iej.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- B. R. de Lima
- Post-Graduate Program in Dental Clinics; Division of Pediatric Dentistry; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
| | - G. F. Nicoloso
- Post-Graduate Program in Dental Clinics; Division of Pediatric Dentistry; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
| | - C. C. Fatturi-Parolo
- Division of Cariology; Department of Preventive and Social Dentistry; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
| | - M. B. C. Ferreira
- Department of Farmacology; Institute of Basic Health Sciences; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
| | - F. Montagner
- Post-Graduate Program in Dental Clinics; Division of Endodontics; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
| | - L. Casagrande
- Post-Graduate Program in Dental Clinics; Division of Pediatric Dentistry; Federal University of Rio Grande do Sul - UFRGS; Porto Alegre Brazil
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Kumari S, Mohanty S, Sharma P, Dabas J, Kohli S, Diana C. Is the routine practice of antibiotic prescription and microbial culture and antibiotic sensitivity testing justified in primary maxillofacial space infection patients? A prospective, randomized clinical study. J Craniomaxillofac Surg 2017; 46:446-452. [PMID: 29311020 DOI: 10.1016/j.jcms.2017.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/12/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The purpose of this prospective, randomized, comparative clinical study was to compare treatment outcome of removal of foci and incision and drainage, with or without oral antibiotic therapy, in the management of single primary maxillofacial space infection with a known focus. MATERIALS AND METHODS A total of 40 patients with single primary maxillofacial space infection with a known infectious focus were divided into two groups, one treated with incision and drainage only, and the other with incision and drainage along with oral antibiotics. The focus of infection was addressed in both groups. Parameters evaluated included pain score, maximum mouth opening, swelling, purulent discharge and return to normal life, which were assessed on days 1, 2, 3, 5 and 7. The patients were followed up until they reported return to normal life as assessed by a questionnaire. RESULTS All of the patients rapidly responded to treatment as observed by a reduction in pain, swelling, discharge, and improvement in mouth opening. Pus discharge stopped within first 3 days in 75% of patients. The patients who underwent immediate extraction showed a faster resolution of infection (mean return to normal life = 9 days) than others (mean = 11.2 days). There was no statistically significant difference between the two groups for the five study parameters (p < 0.05). Of the total pus specimens, 75% had no significant bacterial growth, or grew 'oral flora'/contaminants, while only 25% grew specific bacteria. CONCLUSION This study questions the conventional practice by dental practitioners and surgeons of prescribing antibiotics to all patients with odontogenic infection. Microbial culture and antibiotic sensitivity is of little therapeutic value in selected patient groups.
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Affiliation(s)
- Saroj Kumari
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sujata Mohanty
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Pankaj Sharma
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Jitender Dabas
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sanchaita Kohli
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Cathrine Diana
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
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Holmes CJ, Pellecchia R. Antimicrobial Therapy in Management of Odontogenic Infections in General Dentistry. Dent Clin North Am 2017; 60:497-507. [PMID: 27040298 DOI: 10.1016/j.cden.2015.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article focuses on the diagnosis and management of odontogenic infections. Current antibiotic regimens are reviewed and discussed including use of alternative antibiotics with patients known to have a penicillin allergy. Emphasis is made on proper examination of the patient with use of diagnostic aids to provide the correct treatment of choice.
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Affiliation(s)
- Curtis J Holmes
- Department of Dentistry and Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| | - Robert Pellecchia
- Department of Dentistry and Oral and Maxillofacial Surgery, Geisinger Medical Center, Danville, PA, USA
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The Use of Antibiotics in Odontogenic Infections: What Is the Best Choice? A Systematic Review. J Oral Maxillofac Surg 2017; 75:2606.e1-2606.e11. [PMID: 28893540 DOI: 10.1016/j.joms.2017.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Odontogenic infections are a common problem in dentistry, and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to make a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the Patient, Intervention, Comparison, Outcome (PICO) format: When should antibiotics be used in dental infections (DIs)? Which are the most effective drugs? How long should antibiotics be administered? MATERIALS AND METHODS This was a systematic review using the PubMed, Scopus, and Cochrane databases without restriction as to the period researched. The variables analyzed in each article were the number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotics administered, statistical differences between groups studied, and patients' evolution after treatment. RESULTS The search included 1,109 articles. After the full reading of 46 articles, 16 were included in the final review and 30 were excluded. A sample of 2,197 DI cases was obtained, in which 15 different antibiotics were used, with a 98.2% overall cure rate. CONCLUSIONS The studies showed that antibiotics were prescribed only in situations of regional and/or systemic body manifestations. In the case of DIs, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.
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AlRahabi MK, Abuong ZA. Antibiotic abuse during endodontic treatment in private dental centers. Saudi Med J 2017; 38:852-856. [PMID: 28762439 PMCID: PMC5556303 DOI: 10.15537/smj.2017.8.19373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/11/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES We evaluated antibiotic prescription practices during root canal treatments among general dentists in private dental clinics in Al-Madinah Al Munawarah, Saudi Arabia. Methods: A self-administered, questionnaire about antibiotic used during root canal treatment was distributed to 75 randomly selected general dental practitioners working in private dental clinics in Al-Madinah Al-Munawarah, Saudi Arabia, between March and April 2016. The questionnaires were collected one week later. To compare results of the collected data, Chi-square test was used. Results: The results revealed that 60% of the dentists prescribed amoxicillin with clavulanic acid as the first choice treatment for endodontic pathosis. Clindamycin (51.6%) was the first choice for patients who were allergic to penicillin. Forty-five percent of the general practitioners prescribed antibiotics for 5 days. Approximately 83.3% of general practitioners prescribed antibiotics for acute apical abscesses. Prophylactic antibiotics were prescribed for cases with a history of infective endocarditis (65.5%), non-controlled diabetes (60.3%), placement of a prosthetic joint in the previous 2 years (46.6%), congenital heart disease (36.2%), and kidney dialysis shunts (34.5%). Conclusion: This study reveals antibiotic abuse in endodontic treatment practice in private dental clinics in Al-Madinah Al Munawarah, Saudi Arabia. General dental practitioners are lacking knowledge regarding the prescription of antibiotics in endodontic treatment and situations requiring prophylactic antibiotics.
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Affiliation(s)
- Mothanna K AlRahabi
- Department of Restorative Dental Science, College of Dentistry, Taibah University, Al Madinah AlMunawwarah, Kingdom of Saudi Arabia. E-mail.
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Shakya N, Sharma D, Newaskar V, Agrawal D, Shrivastava S, Yadav R. Epidemiology, Microbiology and Antibiotic Sensitivity of Odontogenic Space Infections in Central India. J Maxillofac Oral Surg 2017; 17:324-331. [PMID: 30034150 DOI: 10.1007/s12663-017-1014-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/07/2017] [Indexed: 10/19/2022] Open
Abstract
Introduction Odontogenic infections are the most commonly encountered orofacial infections, which may spread into the adjacent anatomical spaces along the contiguous fascial planes, leading to involvement of multiple spaces which can progress to life-threatening situations. Materials and Methods A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 18 months by surgical intervention and intravenous antibiotics. Morphologic study of the isolates and antibiotic sensitivity testing was performed. Results Caries was the most frequent dental disease (53.27%), and the mandibular first molar was the most frequently involved tooth (41.9%) associated with the etiology of odontogenic infections. A total of 158 spaces were involved in 100 patients. In subjects with single space odontogenic infections (n = 61), submandibular space was most commonly affected (44.26%) followed by buccal space (27%). In subjects with multiple space infections (n = 39), submandibular space (30.19%) was most frequently involved followed by buccal space (17.92%). In the aerobic group/microaerophilic group, 17 different species were isolated in a total of 102 aerobic isolates. A total of 18 species were identified in 65 anaerobic isolates sampled. Conclusion Amoxicillin possess antimicrobial activity against major pathogens in orofacial odontogenic infections, but β-lactamase production has restricted the effectiveness of amoxicillin against the resistant strains of Staphylococcus aureus, Bacteroides, Prevotella and Porphyromonas. For the management of orofacial infections, the use of amoxicillin/clavulanate and clindamycin is recommended because of stability against β-lactamases.
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Affiliation(s)
- Neelam Shakya
- 1Department of Oral and Maxillofacial Surgery, Government College of Dentistry, N 210, Singapore Green View, Talawalichanda, Indore, 452001 M.P India
| | - Divashree Sharma
- 2Department of Dentistry, Shyam Shah Medical College, F -7/2, New Doctors' Colony, Arjun Nagar, Rewa, 486001 M.P India
| | - Vilas Newaskar
- 3Department of Oral and Maxillofacial Surgery, Government College of Dentistry, 301 Chanakya Apartment, Plot 59, Indore, 452001 M.P India
| | - Deepak Agrawal
- 4Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Room No 3, Opposite M.Y Hospital, Indore, 452001 M.P India
| | - Sanket Shrivastava
- Birla Institute of Medical Research Centre, E1, Site No: 1, City Centre Behind, Gwalior, 474001 M.P India
| | - Rashi Yadav
- 4Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Room No 3, Opposite M.Y Hospital, Indore, 452001 M.P India
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Zwetchkenbaum SR, Overbeck KJ, Pomerantz SC. Antibiotic-associated diarrhea and the older dental patient: how do dentists respond? SPECIAL CARE IN DENTISTRY 2015; 35:279-84. [DOI: 10.1111/scd.12130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel R. Zwetchkenbaum
- Previously; Geriatric Dentistry Fellow; New Jersey Institute for Successful Aging; Rowan University School of Osteopathic Medicine, Currently; Clinical Instructor; Rutgers School of Dental Medicine
| | - Kevin J. Overbeck
- Assistant Professor- Geriatric Medicine; New Jersey Institute for Successful Aging; Rowan University School of Osteopathic Medicine
| | - Sherry C. Pomerantz
- Assistant Professor- Medicine; New Jersey Institute for Successful Aging; Rowan University School of Osteopathic Medicine; Stratford New Jersey
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The value of early intraoral incisions in patients with perimandibular odontogenic maxillofacial abscesses. J Craniomaxillofac Surg 2014; 43:220-3. [PMID: 25523398 DOI: 10.1016/j.jcms.2014.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/21/2022] Open
Abstract
Perimandibular abscesses require drainage and removal of the underlying cause of infection. Traditionally drainage was established extraorally, but this can be associated with delay to treatment, because this is done under general anaesthesia. Between July 2008 and June 2013, 205 patients were initially either treated by immediate intraoral incision under local anaesthesia or extraoral incisions under general anaesthesia and prospectively evaluated. Predictors of treatment outcomes and complications were analysed. Fewer secondary procedures were needed for patients with primary treatment under general anaesthesia (p < 0.0001), but the overall stay in hospital was shorter after initial treatment under local anaesthesia (p < 0.0001, Odds Ratio (OR) 0.72, 95% CI 0.62-0.85). Postoperative complications occurred significantly more often under general anaesthesia (p < 0.0001, OR = 16.63, 95% CI 5.59-49.5). Significant prognostic variable was the administration of amoxicillin combined with clavulanic acid (p = 0.016, OR = 1.24, 95% CI 1.09-1.41) and adverse prognostic factors were infections with Human Immunodeficiency Virus (HIV) (p = 0.048, OR 17.45, 95% CI 1.02-298) or diabetes mellitus (p = 0.003, OR 10.39, 95% CI 2.23-48.41). Amoxicillin combined with clavulanic acid showed a significant impact on the treatment course of patients with perimandibular abscesses.
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Henslee AM, Shah SR, Wong ME, Mikos AG, Kasper FK. Degradable, antibiotic releasing poly(propylene fumarate)-based constructs for craniofacial space maintenance applications. J Biomed Mater Res A 2014; 103:1485-97. [DOI: 10.1002/jbm.a.35288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/15/2014] [Accepted: 07/18/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Sarita R. Shah
- Department of Bioengineering; Rice University; Houston Texas
| | - Mark E. Wong
- Department of Oral and Maxillofacial Surgery; The University of Texas Dental Branch; Houston Texas
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Abstract
Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema. Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease.
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