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Meisgeier A, Pienkohs S, Dürrschnabel F, Neff A, Halling F. Rising incidence of severe maxillofacial space infections in Germany. Clin Oral Investig 2024; 28:264. [PMID: 38644434 PMCID: PMC11033243 DOI: 10.1007/s00784-024-05663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. MATERIALS AND METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. RESULTS The total standardized incidence rate of MSI-associated procedures in the observational period 2005-2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI - related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. CONCLUSIONS Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. CLINICAL RELEVANCE Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Frank Halling
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
- Gesundheitszentrum Fulda, Praxis für MKG-Chirurgie, Gerloser Weg 23a, D-36039, Fulda, Germany
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Gadicherla S, Manglani K, Pentapati KC, Kudva A, Aramanadka C, Chandravel R. Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors. ScientificWorldJournal 2024; 2024:9304671. [PMID: 38633105 PMCID: PMC11022519 DOI: 10.1155/2024/9304671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
Objective To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
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Affiliation(s)
- Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kirti Manglani
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kalyana C. Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Chithra Aramanadka
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Bigus S, Russmüller G, Starzengruber P, Reitter H, Sacher CL. Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery - a retrospective study. Clin Oral Investig 2023; 27:4687-4693. [PMID: 37294354 DOI: 10.1007/s00784-023-05095-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the current resistance situation concerning routinely used antibiotics for treatment in odontogenic abscesses. MATERIALS AND METHODS This retrospective study assessed patients with deep space head and neck infections who were treated by surgical intervention under general anesthesia at our department. The target parameter was the ascertainment of the resistance rates in order to identify the bacterial spectrum, sites in the body, length of inpatient stay, and the age and sex of the patients. RESULTS A total of 539 patients, 268 (49.7%) males and 271 (50.3%) females were included in the study. The mean age was 36.5 ± 22.1 years. There was no significant difference between the two sexes with regard to the mean duration of hospitalization (p = 0.574). The predominant bacteria in the aerobic spectrum were streptococci of the viridans group and staphylococci, in the anaerobic spectrum Prevotella and Propionibacteria spp. Rates of resistance to clindamycin were between 34 and 47% in both the facultative and obligate anaerobic spectrum. Increased resistance was likewise found in the facultative anaerobic spectrum, with 94% resistance to ampicillin and 45% to erythromycin. CONCLUSION Due to the increasing levels of resistance to clindamycin, their use in empiric antibiotic treatment for deep space head and neck infections should be viewed critically. CLINICAL RELEVANCE Resistance rates continue to increase compared to previous studies. The use of these antibiotic groups in patients with a penicillin allergy needs to be called into question and alternative medications sought.
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Affiliation(s)
- Simon Bigus
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Günter Russmüller
- Department of Oral and Maxillofacial Surgery, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannah Reitter
- Austrian Public Health Insurance, Wienerbergstrasse 13, 1100, Vienna, Austria
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Demian N, Pearl C, Woernley T, Dallaire-Giroux C. Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum. J Oral Maxillofac Surg 2023; 81:337-343. [PMID: 36581313 DOI: 10.1016/j.joms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). METHODS This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set at P < .05. RESULTS Fifty-one patients (17 female and 34 male) aged 18 to 65 years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3 ± 0.8 days (P-value = .0001), number of days intubated 3 ± 0.3 (P-value = .0001), and number of required washouts 2 ± 0.2 (P-value = .004) were statistically lower in the VAC group compared to the Conventional group. CONCLUSIONS There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.
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Affiliation(s)
- Nagi Demian
- Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Craig Pearl
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Timothy Woernley
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Cyndie Dallaire-Giroux
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX.
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Caruso SR, Yamaguchi E, Portnof JE. Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2021; 34:169-177. [PMID: 34728145 DOI: 10.1016/j.coms.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.
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Affiliation(s)
- Sam R Caruso
- Department of Oral & Maxillofacial Surgery, Broward Health Medical Center, Nova Southeastern University College of Dental Medicine, 1600 S. Andrews Avenue, Fort Lauderdale, FL 33301, USA.
| | - Elena Yamaguchi
- Private Practice, Infectious Diseases, 13550 South Jog Rd, Suite 202A, Delray, FL 33446, USA
| | - Jason E Portnof
- Department of Oral & Maxillofacial Surgery, Nova Southeastern University College of Dental Medicine, 3200 S. University Dr., Davie, FL 33314, USA; Private Practice, Oral & Maxillofacial Surgery, Surgical Arts of Boca Raton, 9980 North Central Park Bvld, Suite #113, Boca Raton, FL 33428, USA
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Bègue L, Schlund M, Raoul G, Ferri J, Lauwers L, Nicot R. Biological factors predicting the length of hospital stay in odontogenic cellulitis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:303-308. [PMID: 34260983 DOI: 10.1016/j.jormas.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether common biological factors are correlated with a longer hospital stay. STUDY DESIGN All patients having odontogenic cellulitis, treated from January 2019 to December 2019 at Lille University Hospital, and requiring surgical drainage under general anesthesia, were included, retrospectively. Data, such as length of hospital stay and biological factors, namely, C-reactive protein (CRP) level, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, and bacterial samples were collected. RESULTS Significant moderate-strong correlations were found between postoperative length of stay and patients' LRINEC score (rs = 0.556) and presurgical CRP level (rs = 0.579). There was a significant moderate correlation between postoperative length of stay and presurgical procalcitonin level (rs = 0.451), and a weak correlation between postoperative length of stay and presurgical white blood cell count (rs = 0.282). Linear regression verified CRP as an independent predictor of length of hospital stay, showing a significant linear relationship between them (p < 0.0001). A significant regression equation was found (F(1,65) = 27.089; p = 0.0001), with an R2 of 0.294. CONCLUSION In this study, CRP was the key biological predictor of length of hospital stay. STATEMENT OF CLINICAL RELEVANCE The ability to predict length of hospital stay and identify patients requiring intensive care management, using simple and inexpensive biological parameters (such as CRP), will enable more cost-effective care and efficient hospital bed management.
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Affiliation(s)
- Louis Bègue
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, F-59000 Lille, France
| | - Matthias Schlund
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Gwénaël Raoul
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Joël Ferri
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Ludovic Lauwers
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, F-59000 Lille, France
| | - Romain Nicot
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
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Kim HW, Kim CH. Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center. J Korean Assoc Oral Maxillofac Surg 2021; 47:197-208. [PMID: 34187960 PMCID: PMC8249195 DOI: 10.5125/jkaoms.2021.47.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.
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Affiliation(s)
- Hye-Won Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| | - Chul-Hwan Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
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Lee KC, Halepas S, Chuang SK, Ferneini EM. Is Weekend Presentation Associated With Odontogenic Infection Severity? J Oral Maxillofac Surg 2021; 79:2280-2284. [PMID: 34245702 DOI: 10.1016/j.joms.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Many dental infections that otherwise could be treated in-office are directly referred to emergency departments (ED) outside of normal business hours. This study sought to determine if odontogenic infections presenting to EDs were less severe on the weekends. MATERIALS AND METHODS This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of an oral soft tissue infection were included in the study sample. The primary study predictor was day of presentation. The study outcome was inpatient admission from the ED. A multivariate regression model was created for ED admission rate to identify independent predictors. RESULTS A total of 6,560 records were included in the final sample. Overall, 34.8% of encounters occurred on the weekend, and these patients were more likely to have private insurance and reside in higher income locations. The unadjusted ED admission rate (9.4 vs 13.4%, P < .01) was lower for patients evaluated on the weekend. The multiple regression model confirmed that weekend presentation was associated with a significantly lower odds of admission (OR = 0.69, P < .01). CONCLUSIONS Weekend odontogenic infections were less severe than those presenting on the weekdays. Off-hour dental emergencies remain a potential source of ED waste and should be scrutinized in any reforms seeking to reduce unnecessary emergency room encounters.
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Affiliation(s)
- Kevin C Lee
- Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Steven Halepas
- Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Sung-Kiang Chuang
- Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA; Private Practice, Brockton Oral and Maxillofacial Surgery Inc.; Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA; Visiting Professor, Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, School of Dentistry, Kaohsiung, Taiwan
| | - Elie M Ferneini
- Director, Beau Visage Med Spa and Greater Waterbury OMS, Cheshire, CT; Associate Clinical Professor, Division of Oral and Maxillofacial Surgery, University of Connecticut, Farmington, CT.
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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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Ritwik P, Fallahi S, Yu Q. Management of facial cellulitis of odontogenic origin in a paediatric hospital. Int J Paediatr Dent 2020; 30:483-488. [PMID: 31894605 DOI: 10.1111/ipd.12613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Facial cellulitis of odontogenic origin (FCOO) can lead to systemic complications in children. Research on factors leading to improvement of outcomes is limited. AIM The aim of this study was to investigate patient characteristics, treatment modalities (antibiotics and route of administration), length of stay in the hospital, time till definitive treatment, and factors related to early treatment of FCOO. DESIGN A retrospective review was performed to identify children presenting to the emergency department of a paediatric hospital with FCOO over a 5-year period. Data were extracted from records of included patients. RESULTS Sixty-four records were included for analysis with mean age of 8.19 ± 4.5 years. Significantly more patients received clindamycin (79.7%) than penicillin-based antibiotic (18.8%) with P < .0001. Forty-four (68.8%) children were admitted to the hospital and received parenteral clindamycin. The average hospital stay was 2.5 ± 1.2 days, and average days till dental treatment was 5.2 ± 8.9 days. Children who received intravenous antibiotic or had a primary tooth involved received dental treatment sooner, with P = .0036 and P = .03, respectively. CONCLUSIONS Oral antibiotics were prescribed for children who were discharged from the emergency department. Children who received intravenous antibiotics or had an infected primary tooth received early definitive treatment.
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Affiliation(s)
- Priyanshi Ritwik
- Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, TX, USA
| | - Susan Fallahi
- Department of Pediatric Dentistry, LSUHSC School of Dentistry, New Orleans, LA, USA
| | - Qingzhao Yu
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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What Is the Health Care Burden of Treating Pediatric Dental Infections on an Inpatient Basis? J Oral Maxillofac Surg 2020; 78:343-349. [DOI: 10.1016/j.joms.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 12/28/2022]
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Fu B, McGowan K, Sun JH, Batstone M. Increasing frequency and severity of odontogenic infection requiring hospital admission and surgical management. Br J Oral Maxillofac Surg 2020; 58:409-415. [PMID: 31987682 DOI: 10.1016/j.bjoms.2020.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
Odontogenic infections can become life-threatening if not managed in a timely manner, and they increase the physical cost of treatment to the patient and the financial cost to the public health system. We investigated the number of admissions to a Queensland tertiary hospital within a decade, and differences in the patients' characteristics, severity at presentation, and clinical outcomes. We compared patients with odontogenic infections who were taken to theatre at the Royal Brisbane & Women's Hospital (RBWH) between January 2003 and December 2004 with those treated between January 2013 and December 2014, a total of 292. Data on demographics, presentation, previous history, antimicrobial treatment, and admissions, were collated and analysed. There were no significant differences in demographics. In the 2013/2014 group there was a two-fold increase in infections related to lower third molars (p=0.001), a 50% increase in trismus (p=0.001), and a 20% increase in submandibular swelling (p=0.010). The percentage of patients admitted to the intensive care unit (ICU) was three and a half times higher in the 2013/2014 group (p=0.001). The presentation of odontogenic infections has increased in the decade from 2003/2004 to 2013/2014. Measures of the severity of disease have increased, while the basic characteristics of the patients have remained constant. Improved primary preventative measures and early interventions are therefore needed to alleviate the burden that these infections place on the public health system.
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Affiliation(s)
- B Fu
- School of Medicine, University of Queensland, Herston, Queensland 4029, Australia.
| | - K McGowan
- School of Dentistry & Oral Health, Gold Coast Campus, Griffith University, Queensland 4222, Australia
| | - J H Sun
- School of Public Health and Social Work, Queensland Univeristy of Technology, Brisbane, Queensland 4000, Australia
| | - M Batstone
- Oral & Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia
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Park J, Lee JY, Hwang DS, Kim YD, Shin SH, Kim UK, Song JM. A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward. Maxillofac Plast Reconstr Surg 2019; 41:49. [PMID: 31815113 PMCID: PMC6872703 DOI: 10.1186/s40902-019-0238-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/25/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay.
Methods
A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression.
Results
A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age.
Conclusions
The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.
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14
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A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. J Craniomaxillofac Surg 2019; 47:334-340. [DOI: 10.1016/j.jcms.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
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Rajendra Santosh AB, Ogle OE, Williams D, Woodbine EF. Epidemiology of Oral and Maxillofacial Infections. Dent Clin North Am 2017; 61:217-233. [PMID: 28317563 DOI: 10.1016/j.cden.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dental caries and periodontal disease are the most common dental infections and are constantly increasing worldwide. Distribution, occurrence of dental caries, gingivitis, periodontitis, odontogenic infections, antibiotic resistance, oral mucosal infections, and microbe-related oral cancer are important to understand the public impact and methods of controlling such disease. Distribution of human papilloma virus and human immunodeficiency virus -related oral cancers in the US population is presented.
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Affiliation(s)
- Arvind Babu Rajendra Santosh
- Dentistry Programme, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston 7, Jamaica, West Indies.
| | - Orrett E Ogle
- Atlanta, GA, USA; Dentistry Program, The University of the West Indies, Mona, Jamaica, West Indies; Oral and Maxillofacial Surgery, Woodhull Hospital, Brooklyn, NY, USA
| | - Dwight Williams
- Oral and Maxillofacial Surgery, Woodhull Hospital, Brooklyn, NY, USA
| | - Edward F Woodbine
- Department of Dentistry/Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA
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16
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Guzmán-Letelier M, Crisosto-Jara C, Diaz-Ricouz C, Peñarrocha-Diago M, Peñarrocha-Oltra D. Severe odontogenic infection: An emergency. Case report. J Clin Exp Dent 2017; 9:e319-e324. [PMID: 28210456 PMCID: PMC5303338 DOI: 10.4317/jced.53308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Abstract
Odontogenic infections (OI) are a major reason for consultation in dental practice. They affect people of all ages, and most of them respond well to current medical and surgical treatments. However, some OI can spread to vital and deep structures, overcome the host immune system - especially in diabetic, immunocompromised or weakened patients - and even prove fatal. Ludwig’s angina is a severe form of diffuse cellulitis that can have an acute onset and spread very rapidly, bilaterally affecting areas of the head and neck, and may prove life threatening. A case of severe dental infection is presented in which emphasis is placed on the importance of airway maintenance, followed by surgical decompression under adequate antibiotic coverage.
Key words:Ludwig’s angina, severe odontogenic infection, surgical decompression, dental infection.
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Affiliation(s)
- Marcelo Guzmán-Letelier
- DDS, Maxillofacial Surgeon, Associate Professor, San Sebastián University Dental School. Valdivia, Chile Maxillofacial Surgeon, Hospital Base Valdivia, Chile
| | - Claudia Crisosto-Jara
- DDS, Dental surgeon. Associate Professor, San Sebastián University Dental School. Valdivia, Chile
| | - Camilo Diaz-Ricouz
- DDS, Oral Surgery Collaborator, San Sebastián University Dental School. Valdivia, Chile
| | - Miguel Peñarrocha-Diago
- MD, PhD, DDS, Chairman of Oral Surgery, Valencia University Medical and Dental School, Valencia, Spain
| | - David Peñarrocha-Oltra
- PhD, DDS, Associate Professor Department of Stomatology, Valencia University Medical and Dental School. Valencia, Spain
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17
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Abramowicz S, Rampa S, Allareddy V, Lee MK. The Burden of Facial Cellulitis Leading to Inpatient Hospitalization. J Oral Maxillofac Surg 2017; 75:1656-1667. [PMID: 28242238 DOI: 10.1016/j.joms.2017.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the present study was to present nationally representative estimates of hospitalizations primarily attributed to facial cellulitis and to conduct an exploratory analysis on identifying factors associated with outcomes, such as hospital charges, length of stay (LOS), disposition status, and occurrence of infectious complications. MATERIALS AND METHODS The present study is a retrospective analysis of the Nationwide Inpatient Sample (NIS) for 2012 and 2013. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of "682.0" in the primary diagnosis field of NIS (reason for hospitalization) was used to identify cases with facial cellulitis. All patients at least 18 years old who were hospitalized for facial cellulitis were included. Outcome variables examined in the present study were hospital charges, LOS, disposition status, and occurrence of infectious complications. Descriptive statistics and a multivariable linear regression model were used to examine association between independent variables and patient disposition and infectious complications. RESULTS In 2012 and 2013, 74,480 hospitalizations involved facial cellulitis in adults at least 18 years old in the United States. Most were women (mean age, 47.5 yr). Most patients were routinely discharged home. Age was associated with an increase in odds of discharge to another facility. Variables associated with decreased odds of bacterial infections were age and black or Hispanic race. Women with at least 1 comorbidity had higher odds of mycoses. Statistically relevant predictors of longer than average LOS were age, race, insurance, presence of sepsis, and location. CONCLUSIONS This study presented nationally representative estimates of hospitalizations attributed primarily to facial cellulitis in the adult population in the United States in 2012 and 2013. The presence of a comorbid condition predicted worse outcomes. Public health efforts should focus on targeting high-risk patients and providing monitoring or early treatment of face cellulitis.
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Affiliation(s)
- Shelly Abramowicz
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta; Associate Chief, Section of Dentistry, Division of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Sankeerth Rampa
- Graduate Student, University of Nebraska Medical Center, Omaha, NE
| | - Veerasathpurush Allareddy
- Associate Professor, Department of Orthodontics, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA
| | - Min Kyeong Lee
- Assistant Professor, Children's Hospital of Los Angeles, Los Angeles, CA
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18
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Terapia delle infezioni odontogene. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rastenienė R, Aleksejūnienė J, Pūrienė A. Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis. Med Princ Pract 2015; 24:129-35. [PMID: 25592626 PMCID: PMC5588211 DOI: 10.1159/000370073] [Citation(s) in RCA: 12] [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: 06/16/2014] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013. MATERIALS AND METHODS Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius University's dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis. RESULTS A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs. CONCLUSION The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.
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Affiliation(s)
- Rūta Rastenienė
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
- * Rūta Rastenienė, Institute of Odontology, Faculty of Medicine, University of Vilnius, Žalgirio 115, LT-08217 Vilnius (Lithuania), E-Mail
| | - Jolanta Aleksejūnienė
- Division of Preventive and Community Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, B.C., Canada
| | - Alina Pūrienė
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
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Allareddy V, Rampa S, Nalliah RP, Allareddy V. Longitudinal discharge trends and outcomes after hospitalization for mouth cellulitis and Ludwig angina. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:524-31. [PMID: 25216950 DOI: 10.1016/j.oooo.2014.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective is to provide longitudinal discharge trends and hospitalization outcomes in patients hospitalized because of mouth cellulitis or Ludwig angina. METHODS Nationwide Inpatient Sample for years 2004 to 2010 was used. All hospitalizations with primary diagnosis of cellulitis or Ludwig angina were selected. Discharge trends were examined. RESULTS A total of 29,228 hospitalizations occurred as a result of mouth cellulitis/Ludwig angina; 55% of all hospitalizations were male patients; 68% were aged 21 to 60 years. Non-whites comprised close to 40%. The uninsured comprised 22.3%. Ninety-nine patients died in hospitals. The total hospitalization charges across the entire United States over the study period was $772.57 million. Factors associated with increased hospitalization charges included, age, co-morbid burden, insurance status, race, teaching status of hospital, and geographic location. CONCLUSIONS Uninsured non-whites, those with high co-morbid burden, and those aged 21 to 60 years tended to be hospitalized consistently over the study period.
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Affiliation(s)
- Veerasathpurush Allareddy
- Associate Professor, Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
| | - Sankeerth Rampa
- Graduate student, Texas A and M University Health Science Center School of Rural Public Health, College Station, TX
| | - Romesh P Nalliah
- Instructor, Department of Global Health, Harvard School of Dental Medicine, Boston, MA
| | - Veerajalandhar Allareddy
- Assistant Professor, Department of Pediatric Critical Care, Case Western Reserve University School of Medicine, Cleveland, OH
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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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Ottaviani G, Costantinides F, Perinetti G, Luzzati R, Contardo L, Visintini E, Tirelli G, Di Lenarda R, Gobbo M, Biasotto M. Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste. Oral Dis 2013; 20:499-504. [PMID: 23879656 DOI: 10.1111/odi.12164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.
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Affiliation(s)
- G Ottaviani
- Department of Dental Science, University of Trieste, Trieste, Italy
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23
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The characteristics of hospital emergency department visits made by people with mental health conditions who had dental problems. J Am Dent Assoc 2013; 144:617-24. [DOI: 10.14219/jada.archive.2013.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chi DL, Masterson EE. A serial cross-sectional study of pediatric inpatient hospitalizations for non-traumatic dental conditions. J Dent Res 2013; 92:682-8. [PMID: 23694928 DOI: 10.1177/0022034513490733] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Investigators have examined children's dental utilization in various settings (e.g., dental offices, emergency departments, operating rooms), but no studies have examined inpatient hospitalizations for non-traumatic dental conditions (NTDCs). The authors examined NTDC-related hospitalization trends in the United States and identified the relationship between complex chronic condition (CCCs) and NTDC-related inpatient hospitalizations. We analyzed data from the U.S. Nationwide Inpatient Sample (2000-2010) for children ages 3 to 17 years (N = 3,030,970). The predictor variable was number of CCCs (0/1/2+). The outcome variable was whether the child had a NTDC-related hospitalization (no/yes). Covariate-adjusted multivariable logistic regression models were used to estimate prevalence odds ratios (PORs). From 2000 to 2010, there were 17,993 NTDC-related hospitalizations (0.59%) and a slight increase in NTDC-related hospitalizations (p = .049). This increase was not significant in the final regression model. There was no difference in odds of NTDCs for children with 0 or 1 CCCs (POR = 1.08; 95%CI = 0.99, 1.18), but children with 2+ CCCs had significantly greater odds (POR = 1.61; 95%CI = 1.42, 1.83), as did non-White, publicly insured, and lower income children. NTDC-related hospitalizations for children did not increase from 2000 to 2010. Children with 2+ CCCs had the greatest odds of being hospitalized for NTDCs, which highlights the need to develop preventive interventions targeting children with 2+ CCCs.
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Affiliation(s)
- D L Chi
- University of Washington, Seattle, WA, USA.
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25
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Bouloux GF, Wallace J, Xue W. Irrigating drains for severe odontogenic infections do not improve outcome. J Oral Maxillofac Surg 2012; 71:42-6. [PMID: 22726703 DOI: 10.1016/j.joms.2012.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/21/2012] [Accepted: 04/27/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The need to irrigate surgical drains in the postoperative period in patients with odontogenic infections is controversial. The purpose of this study was to evaluate the efficacy of irrigating surgical drains postoperatively in patients with severe odontogenic infections. MATERIALS AND METHODS Consecutive patients presenting with severe odontogenic infections who required incision and drainage were randomized to irrigating drains (red rubber catheters) or nonirrigating drains (Penrose drains). The primary predictor variable was the type of drain and the use of postoperative irrigation. The primary outcome variable was length of stay. Secondary outcomes included postoperative temperature, need for additional procedures, and complications. The t test was used for the primary outcome, and a P value lower than .05 was considered statistically significant. RESULTS Forty-six patients completed the study. There was no statistically significant difference in overall length of stay, length of stay after surgery, temperature, or need for additional procedures between the 2 treatment groups. CONCLUSIONS The use of nonirrigating drains appears to be equally efficacious as irrigating drains in the management of severe odontogenic infection.
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Affiliation(s)
- Gary F Bouloux
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA 30322, USA.
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