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Ullah M, Irshad M, Yaacoub A, Carter E, Cox S. Hospitalisations Due to Dental Infection: A Retrospective Clinical Audit from an Australian Public Hospital. Dent J (Basel) 2024; 12:173. [PMID: 38920874 PMCID: PMC11203205 DOI: 10.3390/dj12060173] [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: 04/16/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of this clinical audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. This study retrospectively evaluated the records of patients admitted to the Nepean hospital, Kingswood, New South Wales, Australia, due to dental infections between 2018 and 2019. A total of 102 patients, mostly in their thirties with equal gender distribution, were admitted with dental infections, presenting with pain (100%), swelling (99%), trismus (40.2%), dysphagia (27.4%), fever (21%) [>37 °C], tachycardia (24.8%) and tachypnoea (9.3%). Most patients (68%) presented on weekends, outside regular working hours, and public holidays. A total of 52.5% of patients had taken prior antibiotics. Dental caries, smoking, mental health issues, and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.7, SD 1.6). Augmentin was the most prescribed antibiotic. Complications were reported in 8.8% of the patients, primarily due to airway compromise. Dental infections leading to hospitalisations continue to be a burden on the healthcare system. A notable finding was that the presentations were primarily on weekends, outside regular working hours, and public holidays, and the majority required dental interventions under local anaesthesia. The provision of on-call emergency dental services may reduce potentially preventable hospitalisations and the length of hospital stay.
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Affiliation(s)
- Mafaz Ullah
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
- Khyber College of Dentistry, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Irshad
- Specialised Dental Center, Ministry of Health, Sakaka Aljouf 72345, Saudi Arabia
| | - Albert Yaacoub
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia
| | - Eric Carter
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
| | - Stephen Cox
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
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Garola F, Cores B, Santalla Claros E, Botta M, Pigazzini P, Piemonte E, Garzón JC. Management of cervicofacial infection: a 7-year retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:19-29. [PMID: 37880047 DOI: 10.1016/j.oooo.2023.07.011] [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: 05/30/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE We aimed to describe and analyze the epidemiologic and clinical variables associated with, treatment for, and development of cervicofacial infection (CFI). STUDY DESIGN We retrospectively examined 201 patients older than 14 years who had met the CFI diagnostic criteria and whose treatment required hospitalization and intervention under general anesthesia at our hospital. We performed chi-square tests to compare proportions in categorical variables and either the Student t test or the Wilcoxon signed-rank test to compare quantitative variables. We performed an analysis of variance to compare 3 or more categories and either Pearson or Spearman correlation coefficient analysis to examine the correlations between quantitative variables. RESULTS The majority (85.07%) of the CFIs were of odontogenic origin. The mean hospitalization length was 4.58 days. Patients with diabetes who used tobacco and/or alcohol had a significantly longer length of hospitalization and several postoperative complications.The most common symptoms were pain, trismus and toothache. Symptoms of fever and nausea were associated with longer hospitalization. The most affected anatomic spaces were submandibular and pterygomandibular. Buccal and infraorbital, temporal, and parotid spaces were associated with longer hospitalization. CONCLUSIONS Most CFIs are of odontogenic origin. Diabetes and tobacco and alcohol use are important risk factors. Treatment should be surgical and target the cause of infection. Timely referrals are important when patients present symptoms compatible with CFI for immediate treatment.
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Affiliation(s)
- Federico Garola
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Bárbara Cores
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ezequiel Santalla Claros
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Botta
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Paola Pigazzini
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Piemonte
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina
| | - Julio César Garzón
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
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Mahran H, Hassanein AG, Rizq M. Trends and Outcome of Aggressive Fascial Space Infections. Surg Infect (Larchmt) 2023; 24:475-481. [PMID: 37279453 DOI: 10.1089/sur.2023.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Background: Odontogenic infections are common and self-limiting in most cases; however, they can lead to severe consequences, considerable morbidity and can even be fatal despite modern medical therapy. Patients and Methods: This retrospective study included patients with severe deep fascial space infections treated in the Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag Governorate, Egypt, and the Department of Oral and Maxillofacial Surgery, King Fahd Specialist Hospital (tertiary referral center), Burayda City, Qassim Province, Saudi Arabia, from June 2017 to June 2022. Results: This study included 296 patients, 161 (54.4%) males, 135 (45.6%) females. The fifth decade of life was the most common vulnerable age group. Forty-three percent of patients had diabetes mellitus, 26.6% were hypertensive, and 13.3% were on long-term steroid therapy. In 83% of patients, the offending tooth was identified but in 17% of patients no dental cause was identified. The lower third molar tooth was most commonly involved. Sixty-nine (23.3%) patients had submandibular space infections. Fifty-three (17.9%) patients had canine space infections. Thirty (10.1%) patients had submasseteric space infection. Twenty-eight (9.5%) patients had submental space infections. Twenty-three (7.8%) patients had combined infection of the submasseteric, submandibular, and pterygomandibular spaces, whereas 19 (6.4%) patients presented with Ludwig's angina. Conclusions: Odontogenic infections are common. The submandibular space is the most commonly affected single space. These infections could lead to lethal complications in immunocompromised patients, especially patients with diabetes mellitus. These infections require urgent surgical intervention to decrease hospital stays and avoid potentially lethal complications.
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Affiliation(s)
- Hamada Mahran
- Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Assiut University, Asyut, Egypt
- King Fahd Specialist Hospital, Burayda, Qassim Province, Saudi Arabia
| | - Ahmed Gaber Hassanein
- Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Akhmim, Sohag Governorate, Egypt
| | - Moataz Rizq
- Oral and Maxillofacial Surgeon, Alexandria, Egypt
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Sommacal A, Bingisser R, Filippi A, Bethke M, Thieringer FM, Jaquiéry C, Berg BI. Dental and Maxillofacial Emergency Algorithms in Swiss Emergency Departments. J Clin Med 2023; 12:jcm12082952. [PMID: 37109288 PMCID: PMC10144593 DOI: 10.3390/jcm12082952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to evaluate the availability and use of dental and maxillofacial emergency algorithms in Swiss hospitals. A survey was performed among physicians at Swiss emergency departments (ED) and participants of the "36th Annual Meeting of the Society for Oral and Cranio-Maxillofacial Surgery". Eighty-nine EDs in Switzerland were questioned about the availability and use of electronic algorithms in their hospitals. Eighty-one (91%) participated in the study. In 75 (93%) of the EDs, electronic algorithms are used, mainly "medStandards". Six have no available algorithms. Fifty-two (64%) use algorithms daily. Eight (10%) Swiss EDs have maxillofacial and dental algorithms, and 73 (90%) have no access to or do not know about them. For dental algorithms, 28 (38%) of the respondents would like to have access, and 16 (22%) do not desire access. For maxillofacial algorithms, 23 (32%) want to have access and 21 (29%) do not want it. Most (74%) of the participating maxillofacial surgeons did not know about the existence of ED algorithms regarding their specialty. Our study shows that the existence of specific algorithms is often not known. Furthermore, there is a demand for dental and maxillofacial algorithms in Swiss EDs.
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Affiliation(s)
- Adelita Sommacal
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Roland Bingisser
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
| | - Andreas Filippi
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Clinic of Oral Surgery and Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland
| | - Mascha Bethke
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Swiss MAM Research Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Claude Jaquiéry
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Britt-Isabelle Berg
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
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Da J, Li Y, Zhang K, Ren J, Wang J, Liu X, Liu X, Zhang J, Liu L, Zhang W, Zhang S, Guo Y, Zhang B, Jin H. Functionalized Prussian Blue Nanozyme as Dual-Responsive Drug Therapeutic Nanoplatform Against Maxillofacial Infection via Macrophage Polarization. Int J Nanomedicine 2022; 17:5851-5868. [PMCID: PMC9719692 DOI: 10.2147/ijn.s385899] [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: 08/12/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Maxillofacial infection is a common disease in stomatology and is difficult to treat owing to its high potential to spread to vital anatomical structures. Excessive levels of reactive oxygen species (ROS) in infected tissues lead to cellular damage and impede tissue regeneration. However, uncontrollable strategies to remove ROS have limited therapeutic efficacy. Nanoparticle systems for scavenging ROS and remodeling the inflammatory microenvironment offer much promise in the treatment of maxillofacial inflammation. Methods Here, a novel microenvironment-stimuli-responsive drug delivery nanoplatform (HMPB@Cur@PDA) based on a polydopamine (PDA)-functionalized hollow mesoporous Prussian blue (HMPB) nanozyme was developed for the delivery of curcumin (Cur) in the treatment of maxillofacial infection. Low pH and excess ROS in the inflammatory microenvironment cause degradation of the outer PDA layer of the nanocomplex, exposing the HMPB nanozyme and loaded Cur, which synergistically act as a ROS scavenger and anti-inflammatory agent, respectively, and induce macrophage polarization from the pro-inflammatory M1 to the anti-inflammatory M2 phenotype. Results Experiments in vitro provided strong evidence for the application of novel nanocomplexes in scavenging multiple ROS and inhibiting lipopolysaccharide-induced inflammation. In addition, in vivo results obtained using a mouse maxillofacial infection model demonstrated that HMPB@Cur@PDA had excellent biocompatibility, significantly attenuated the inflammatory response in periodontal tissue, and improved the repair of damaged tissue. Conclusion Our results indicate that HMPB@Cur@PDA nanocomposites have great potential for ROS regulation as well as having anti-inflammatory effects, providing new insights for the development of dual-response maxillofacial infection treatments.
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Affiliation(s)
- Junlong Da
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Ying Li
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Kai Zhang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Junyu Ren
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jianqun Wang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xinpeng Liu
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xiaoyao Liu
- Department of Orthodontics, the First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jiahui Zhang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Lixue Liu
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Wenxuan Zhang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Shujian Zhang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Yuyao Guo
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Bin Zhang
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China,Heilongjiang Academy of Medical Sciences, Harbin, People’s Republic of China
| | - Han Jin
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China,Correspondence: Han Jin; Bin Zhang, Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China, Tel/Fax +86 0451-86297231, Email ;
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Akram ZM, Khalid KB, Oraibi QK, Nassar MF. Antimicrobial resistance of bacterial pathogens isolated from the infections of post maxillofacial surgery. J Med Life 2022; 15:944-950. [PMID: 36188658 PMCID: PMC9514827 DOI: 10.25122/jml-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Inappropriate antibiotic prescriptions contributed to a global issue of antimicrobial resistance. This study aimed to assess the prevalence of bacterial pathogens and antimicrobial resistance isolated from maxillofacial infections (MIs). Two hundred and twenty-two patients with different MIs were included in this study. Swab samples were taken from the site of infections. Samples were cultured, and isolated bacteria were identified using various biochemical tests. Antimicrobial resistance patterns of isolates were assessed by the disk diffusion method. The mean age of the patients was 50.8 years. The male-to-female ratio was 127/95 (P<0.05). Smoking and alcohol consumption were found in 60.36% and 37.38% of patients, respectively. Most patients had a ≤1-week infection duration (P<0.05). Abscess lesion was the most predominant infection type (P<0.05). The prevalence of aerobic bacteria among abscess, pus localization, and deep facial infections was 59.33%, 64.28%, and 46.66%, respectively. The prevalence of anaerobic bacteria among abscess, pus localization, and deep facial infections was 40.66%, 23.80%, and 53.33%, respectively. Staphylococcus aureus (10.36%) and Prevotella buccalis (8.55%) had the uppermost distribution amongst all examined samples. Isolated bacteria exhibited the uppermost resistance rate toward penicillin (65.76%), tetracycline (61.26%), gentamicin (58.10%), and ampicillin (57.65%) antimicrobials. The lowest resistance rate was obtained for linezolid (25.67%), ceftriaxone (31.08%), and azithromycin (31.08%) antimicrobials. Linezolid, ceftriaxone, and azithromycin had effective antimicrobial activities toward bacteria isolated from MIs. Therefore, cautious antibiotic prescription might decrease the prevalence of antimicrobial resistance in dental and maxillofacial infections.
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Affiliation(s)
- Zaid Mustafa Akram
- Department of Dentistry, Al-Rafidain University College, Baghdad, Iraq,Corresponding Author: Zaid Mustafa Akram, Department of Dentistry, Al-Rafidain University College, Baghdad, lraq. E-mail:
| | | | | | - Maadh Fawzi Nassar
- Department of Chemistry, Faculty of Science, University Putra Malaysia, Selangor, Malaysia
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Wang P, Huang Y, Long J. A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China. Infect Drug Resist 2022; 15:5099-5110. [PMID: 36068836 PMCID: PMC9441175 DOI: 10.2147/idr.s377657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To grasp the current epidemiological situation of maxillofacial space infection and investigate the risk factors contributing to the longer hospitalization of odontogenic space infection in western China. Patients and Methods This retrospective study collected the clinical characteristics from 746 hospitalized patients with maxillofacial space infection and investigated the risk factors associated with longer hospitalization. Pearson’s chi-square test and multivariable binary logistic regression were performed for statistical analysis. Results A total of 438 males and 308 females were included in this study, aging from 1 to 90 years (mean age 48.6 years). 74.9% cases resulted from odontogenic infections, with the submandibular space being the most commonly involved space (53.7%). Advanced age (OR (>60 y:19–60 y:≤18 y) = 3.784:3.416:1, p < 0.05), treatment before admission (OR = 2.271, p < 0.05) and number of involved spaces (OR (≥4:2–3:1) = 3.204:1.931:1, p < 0.05) were closely related to longer hospitalization. Streptococcus being the most frequently found aerobic bacteria (268/615, 43.6%) of all the bacteria isolated was resistant to clarithromycin (91.5%) and erythromycin (92.8%). Conclusion Hospitalization time could be longer for patients with the identified risk factors. Streptococcus, as the most common type of aerobic flora, is highly resistant to clindamycin and erythromycin.
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Affiliation(s)
- Peihan Wang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yanling Huang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Correspondence: Jie Long, Tel +86 28 85503406, Fax +86 28 85501456, Email
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Martu C, Martu MA, Maftei GA, Diaconu-Popa DA, Radulescu L. Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities-A Narrative Review of Recent Data. Diagnostics (Basel) 2022; 12:1600. [PMID: 35885504 PMCID: PMC9319441 DOI: 10.3390/diagnostics12071600] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique.
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Affiliation(s)
- Cristian Martu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - George-Alexandru Maftei
- Department of Dento-Alveolar Surgery and Oral Pathology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Diana Antonela Diaconu-Popa
- Department of Oral Implantology, Removable Dentures and Technology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania;
| | - Luminita Radulescu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
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Kamiński B, Błochowiak K, Kołomański K, Sikora M, Karwan S, Chlubek D. Oral and Maxillofacial Infections—A Bacterial and Clinical Cross-Section. J Clin Med 2022; 11:jcm11102731. [PMID: 35628858 PMCID: PMC9145374 DOI: 10.3390/jcm11102731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
The treatment of oral and maxillofacial infections is based on a recognized algorithm that may require modification under the influence of various local and systemic factors. The aim of this study was to present a comprehensive and microbiological profile of oral and maxillofacial infections, and explore possible correlations between the course of an infection and selected systemic factors based on the medical records of 329 patients affected by the disease. We identified most common clinical, demographic, bacterial, and laboratory parameters specific for these infections. There were statistically significant differences in Erythrocyte Sedimentation Rate, number of accompanying diseases, otalgia, dyspnea, and speech difficulties occurrence and neck space involvement between diabetic and non-diabetic patients. The duration of hospitalization and accompanying diseases correlated positively with the patient age and white blood cell count, and C-reactive protein value negatively correlated with age. The primary cause of infections, age, and comorbid diseases can modify the infection course and increase the risk of developing serious complications. It confirms the need for effective and targeted bacterial treatment in the early stages of infections. Age and general diseases are the most important systemic factors determining the infection symptoms and laboratory parameters assessing the severity of the inflammatory process.
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Affiliation(s)
- Bartłomiej Kamiński
- Department of Otolaryngology, Maria Skłodowska-Curie District Hospital, 26-110 Skarżysko-Kamienna, Poland;
| | - Katarzyna Błochowiak
- Department of Oral Surgery and Periodontology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Konrad Kołomański
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sławomir Karwan
- Department of Maxillofacial Surgery, Regional Specialized Children’s Hospital, 10-561 Olsztyn, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
- Correspondence:
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Rasteniene R, Vitosyte M, Jankauskaite D, Aleksejuniene J. Predictors of longer hospitalization of maxillofacial infections-a 17-year retrospective study. Oral Dis 2021; 28:1979-1986. [PMID: 33915000 DOI: 10.1111/odi.13894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate treatment outcomes in patients with severe maxillofacial infections requiring hospital care during a 17-year period. METHODS A retrospective cohort study reviewed 5,465 medical records, and the following data were collected: the reason for infection, locations of inflamed regions, treatment provided, bacteriological findings, and treatment outcomes. Other information included sociodemographic characteristics (age, gender), presence of systemic diseases, and smoking history. RESULTS The annual incidence rate of patients with acute maxillofacial infections was 206 ± 19 cases with a male to female ratio 1.4:1.0, a mean hospital stay of 7.9 ± 4.9 days. Older age (>65 years), smoking and systemic diseases (diabetes), the causative tooth (molar), and need for extraoral incision predicted longer hospitalization. Intravenous penicillin was the most common drug prescribed in 50.5% of cases. A total of 132 different microorganisms were identified. The highest microorganism resistance occurred for metronidazole and the highest sensitivity was to clindamycin. CONCLUSIONS Increased age, smoking, diabetes, causative tooth, and the occurrence of several infected spaces were associated with a longer hospital stay. Streptococcus α haemolyticus was the most common microorganism found in more than 70.0% of cases that were sensitive to intravenous penicillin.
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Affiliation(s)
- Ruta Rasteniene
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Milda Vitosyte
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dainora Jankauskaite
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Eshghpour M, Sabouri M, Labafchi A, Shooshtari Z, Samieirad S. Maxillofacial Infections: A 5-Year Assessment of the Epidemiology and Etiology in an Iranian Population. J Maxillofac Oral Surg 2021. [DOI: 10.1007/s12663-021-01569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Pham Dang N, Delbet-Dupas C, Mulliez A, Devoize L, Dallel R, Barthélémy I. Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238917. [PMID: 33266250 PMCID: PMC7730806 DOI: 10.3390/ijerph17238917] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p < 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.
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Affiliation(s)
- Nathalie Pham Dang
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
- Correspondence: ; Tel.: +33-473-750-102; Fax: +33-473-750-103
| | - Candice Delbet-Dupas
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 63003 Clermont-Ferrand, France;
| | - Laurent Devoize
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Radhouane Dallel
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Isabelle Barthélémy
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
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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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Delbet-Dupas C, Devoize L, Depeyre A, Mulliez A, Barthélémy I, Pham Dang N. Are routine microbiological samplings in acute dental infections justified? Our 10-year real-life experience. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:397-401. [PMID: 30836194 DOI: 10.1016/j.jormas.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/26/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Most patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections. METHODS The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results. RESULTS The sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18-88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 - 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients. CONCLUSION The results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.
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Affiliation(s)
- C Delbet-Dupas
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - L Devoize
- UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France; Department of odontology, CHU de Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, 63003, France
| | - A Depeyre
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - A Mulliez
- Délégation recherche clinique and innovation, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - I Barthélémy
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - N Pham Dang
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France.
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Aksoy U, Orhan K. Risk Factor in Endodontic Treatment: Topographic Evaluation of Mandibular Posterior Teeth and Lingual Cortical Plate Using Cone Beam Computed Tomography (CT). Med Sci Monit 2018; 24:7508-7516. [PMID: 30343309 PMCID: PMC6206815 DOI: 10.12659/msm.908970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Topographic relationships of mandibular posterior teeth with mandibular cortical plate are extremely important both in terms of infection spread and endodontic and surgical procedures to be performed. The aim of this study was to determine the relationship between root apex of the mandibular posterior teeth and lingual plate of the mandible. Material/Methods CBCT data of 138 patients were retrospectively analyzed. The topographic relationship between root apex and lingual plate was classified as non-contact, contact, or perforation. Morphology of the mandibular lingual plate was classified into the 4 types (convex, parallel, undercut, slanted) and recorded for each tooth region. The prevalence of each group was calculated. Results In 6.2% of all mandibular posterior teeth, the lingual plate was perforated by at least 1 root of the corresponding tooth. The teeth with the highest perforation rate were the third molar tooth (31.6%) and the second molar tooth (14.7%). The most common mandibular lingual plate morphology type was “undercut type” (61.3%) in the molar teeth region, while “parallel type” (55.7%) was most common in the premolar teeth region. Conclusions In conclusion, a high percentage of mandibular second and third molars root apex have topographically close relationships to the lingual plate of the mandible. Hence, endodontic consultants must be aware by this anatomical relationship and be aware of possible complications during endodontic and surgical procedures using radiographical modalities.
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Affiliation(s)
- Umut Aksoy
- Department of Endodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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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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