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Sykara M, Maniatakos P, Tentolouris A, Karoussis IK, Tentolouris N. The necessity of administrating antibiotic prophylaxis to patients with diabetes mellitus prior to oral surgical procedures-a systematic review. Diabetes Metab Syndr 2022; 16:102621. [PMID: 36183455 DOI: 10.1016/j.dsx.2022.102621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Μany studies suggest the use of antibiotic prophylaxis (AP) as an appropriate preventive measure for patients with diabetes mellitus (DM) due to the increased possibility of an impaired wound healing and infections after surgical procedures in the oral cavity. Existing recommendations regarding antibiotic prophylaxis before surgical procedures are not definitive and are based on expert opinions. The purpose of this study was to review the available scientific data about the necessity of administrating AP as a preventive measure prior to oral surgical procedures. METHOD PubMed®, Scopus® και Cochrane Central Register of Controlled Trials (CENTRAL) were used as databases to search for published research. All articles were initially identified and classified based on the title and subsequently on their abstract. For the next level the full scientific paper was read and evaluated. RESULTS Overall, 22 articles were included in the study, of which 2 were systematic reviews, 2 cohort studies, 2 case-control studies, 1 case series, 8 case reports and 7 professional association publications. CONCLUSIONS In the scientific literature, there is a wide range of recommendations and inconsistency regarding the need to administer AP prior to surgical dental operations in patients with DM, while there is no scientific evidence demonstrating its' effectiveness as a precautionary measure. Both blood glucose level measurements and recent HbA1c measurement should be evaluated before any dental procedure. Poor regulation may result to life-threatening infections after tooth extraction. AP is recommended prior to the placement of dental implant. Randomized, controlled, clinical trials with large number of participants and greater variety of surgical dental procedures are needed.
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Affiliation(s)
- Maria Sykara
- Department of Periodontology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Maniatakos
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Laiko General Hospital, Athens, Greece.
| | - Ioannis K Karoussis
- Department of Periodontology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Laiko General Hospital, Athens, Greece
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Abstract
ABSTRACT Necrotizing fasciitis of the face and scalp is a severe bacterial infection that can result in long-term morbidity or even mortality if not properly managed. In a third-world country like Ghana, where most of the population relies on daily income for livelihood, citizens with diseases that have long-term morbidity suffer financial difficulty, particularly when the patient is the breadwinner.This brief clinical study demonstrates the severity of necrotizing fasciitis of the face and scalp originated from oral infection, and its capability to affect any part of the body if proper treatment is not established at early onset of disease. Correct diagnosis, patient education, early antibiotic treatment, and timely surgery are crucial for controlling infection and for preventing irreparable damage. Therefore, public education is crucial in preventing such infection by discouraging use of over-the-counter medication in such situations.
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Hechler BL, Blakey GH. Necrotizing soft tissue infection following routine third molar extraction: report of two cases and review of the literature. Int J Oral Maxillofac Surg 2019; 48:1525-1529. [PMID: 31227274 DOI: 10.1016/j.ijom.2019.05.010] [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: 03/11/2019] [Revised: 03/18/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
Necrotizing cellulitis, necrotizing fasciitis, and necrotizing myositis are a constellation of severe soft tissue infections characterized by rapid progression, dusky soft tissue changes, and edema and induration expanding beyond the clinical wound edges. The cases of two female patients with type II necrotizing soft tissue infections occurring after routine third molar extraction are reported here. The patients were treated for the infections at the University of North Carolina Hospitals in 2016. Both were previously healthy. Of particular interest, recent inoculation of group A Streptococcus appears to have contributed to the infection in both cases.
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Affiliation(s)
- B L Hechler
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
| | - G H Blakey
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
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Gore MR. Odontogenic necrotizing fasciitis: a systematic review of the literature. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:14. [PMID: 30127662 PMCID: PMC6094465 DOI: 10.1186/s12901-018-0059-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/11/2018] [Indexed: 02/03/2023]
Abstract
Background While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death. Methods A PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher’s exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity. Results A total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1). Conclusions Necrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.
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Cariati P, Monsalve-Iglesias F, Cabello-Serrano A, Valencia-Laseca A, Garcia-Medina B. Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: A case series. J Clin Exp Dent 2017; 9:e150-e152. [PMID: 28149480 PMCID: PMC5268119 DOI: 10.4317/jced.53009] [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: 01/30/2016] [Accepted: 02/10/2016] [Indexed: 11/22/2022] Open
Abstract
Necrotising fasciitis (NF) is an uncommon infection. Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site. Moreover, fulminant evolution and high mortality rate are typical of this pathology. In the present report we describes three cases of cervical necrotizing fasciitis complicated by acute mediastinitis. All patients were apparently immunocompetent adults. The main aim of the present report is to show the serious consequences that a dental infection might trigger. Furthermore, we highlight the importance of a multidisciplinary approach in these cases. The constant interaction between different medical specialties is essential for ensuring a proper management of each case.
Key words:Cervical necrotizing fasciitis, acute mediastinitis, odontogenic origin , multidisciplinary approach.
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Affiliation(s)
- Paolo Cariati
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | | | - Almudena Cabello-Serrano
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | | | - Blas Garcia-Medina
- Maxillofacial Surgeon. Hospital Universitario Virgen de las nieves, Granada, Spain
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Reuter NG, Westgate PM, Ingram M, Miller CS. Death related to dental treatment: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:194-204.e10. [PMID: 27989710 DOI: 10.1016/j.oooo.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with death in relation to dental care. STUDY DESIGN A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Dental and Oral Sciences Source, Web of Science, and the Cochrane database were searched, and the references of all retrieved articles were analyzed. Studies were included if death had occurred within 90 days of the dental appointment, and if the patient's age, procedure, and information regarding cause or time of death were provided. Factors associated with death were assessed by multivariate analyses and logistic regression. RESULTS Fifty-six publications, including retrospective studies and case reports/series that reported 148 fatalities, were analyzed. On average, 2.6 deaths were reported per year. The leading cause of deaths was anesthesia/sedation/medication-related complications (n = 70). Other causes were cardiovascular events (n = 31), infection (n = 19), airway-respiratory complications (n = 18), bleeding (n = 5), and others (n = 5). Age (P < .0001), disease severity (P < .02), disease stability (P < .006), dental provider characteristics (P < .05), level of consciousness/sedation (P < .02), and drug effects (P < .03) had significant associations with death. CONCLUSIONS Reports of death were rare; however, specific risk factors associated with dentistry were identified. A better understanding of these factors is important for the development of guidelines that help prevent fatalities in dentistry.
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Affiliation(s)
- Nathan G Reuter
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Mark Ingram
- Medical Library, University of Kentucky, Lexington, KY, USA
| | - Craig S Miller
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA; Center for Oral Health Research, College of Dentistry, and University of Kentucky, Lexington, KY, USA.
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Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty. J Craniofac Surg 2015; 25:e507-9. [PMID: 25148627 DOI: 10.1097/scs.0000000000001120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. Necrotizing fasciitis is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of serious cervical necrotizing fasciitis that developed after acupuncture and herbal injection treatment of fat accumulation of the submental area in a 32-year-old healthy woman. She presented with discharging wound over the submental area. The initial diagnosis was based on clinical information, in which localized necrosis areas in the cervical and chin regions were observed. Wide antibiotic therapy was applied, followed by surgical drainage, debridement, and negative pressure wound therapy. Culture was positive for Serratia liquefaciens and Staphylococcus intermedius. She made a good recovery.
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Özkan A, Şentürk S, Topkara A, Tosun Z. Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg 2014; 73:918-27. [PMID: 25795188 DOI: 10.1016/j.joms.2014.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
Necrotizing fasciitis (NF) is a serious clinical condition, which, if diagnosed late, invariably leads to a fatal outcome. A high index of suspicion of the presenting clinical signs and symptoms, supported by knowledge of the clinicopathologic processes that underlie its aggressive nature, should prompt early surgical intervention. Ultimately, the success of treatment requires a robust clinical pathway in which all members of the health care team are aligned by their skill sets and competencies to manage NF. This report describes the management of a case of a young man with aggressive NF of odontogenic origin affecting the neck and anterior mediastinum. A multidisciplinary approach brought about early recognition of the disease and surgical intervention, the use of frozen section biopsies to determine the extent of fascial spread, and aggressive debridement of the affected tissue. Teamwork, critical thinking, and situational awareness ensured that the patient received optimum care in a timely manner. The psychological, clinical, radiologic, pathologic, and microbiological aspects of the patient's care are presented with a literature review.
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Affiliation(s)
- Joseph Kamal Muhammad
- Consultant and Head, Maxillofacial Surgery Service, Al Rahba Hospital, Abu Dhabi, UAE; formerly at Mafraq Hospital, Abu Dhabi.
| | - Hana Almadani
- Consultant, Department of General Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Bader A Al Hashemi
- Consultant and Head, Department of Maxillofacial Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Muneezeh Liaqat
- Consultant, Department of Anatomic Pathology, Mafraq Hospital, Abu Dhabi, UAE
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