Orofacial viral infections--an update for clinicians

Postoperative Antibiotics May Be Unnecessary in Pediatric Patients Hospitalized With Minor Odontogenic Infections

BACKGROUND

Antibiotic overuse is a growing concern in health care. For pediatric odontogenic infections, the necessity of postoperative antibiotics lacks clear, evidence-based guidelines.

PURPOSE

The purpose of this study was to compare treatment outcomes between pediatric patients hospitalized with vestibular space odontogenic infections who received postoperative antibiotics and those who did not.

STUDY DESIGN, SETTING, SAMPLE

This ambispective cohort study was conducted at the Baruch Padeh "Tzafon" Medical Center, Poriya, Israel (January 2010-December 2015 for retrospective and November 2018-December 2019 for prospective). The sample included 522 pediatric patients (<15 years) hospitalized for odontogenic infections requiring surgical intervention. Patients with nonodontogenic infections, compromised immune systems, or infections involving deeper spaces were excluded.

PREDICTOR/INDEPENDENT VARIABLE

The primary predictor was postoperative antibiotic management (administration vs no administration), decided at hospital admission.

MAIN OUTCOME VARIABLE(S)

The primary outcome variable was hospital length of stay (LOS), categorized as short (1 to 2 days) or extended (≥3 days). LOS was chosen as a proxy for recovery time and symptom resolution, reflecting the overall efficacy of the treatment approach.

COVARIATES

Demographic, clinical, and laboratory data were collected.

ANALYSES

Descriptive statistics, Student t-tests, χ2 tests, and multivariable logistic regression were used (P < .05).

RESULTS

Of 522 patients (411 control, 111 study), mean LOS was similar between groups: 1.7 ± 0.91 days (control) versus 1.67 ± 0.9 days (study) (P = .76). Short stays were not significantly different (90.99 vs 87.10%, P = .32). Multivariable analysis showed no association between withholding antibiotics and extended stay (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.45 to 1.89, P = .82), but identified age (OR = 1.11, 95% CI: 1.02 to 1.21, P = .02) and initial white blood cell count (OR = 1.08, 95% CI: 1.01 to 1.15, P = .03) as predictors of extended stay.

CONCLUSION AND RELEVANCE

Withholding routine postoperative antibiotics in pediatric patients with odontogenic infections does not significantly impact length of hospital stay. While length of stay is not a direct measure of clinical outcome, it serves as a proxy for recovery. This approach may contribute to antibiotic stewardship efforts without compromising patient care, though future studies with direct clinical outcome measures are needed to confirm these findings.

Pattern of management of oro-facial infection in children: A retrospective

BACKGROUND

The purpose of this study was to determine the distribution and management of orofacial infection in children treated at one of the major hospitals in Jeddah City, Saudi Arabia over a 12-month period during the year 2014.

METHODS

Data from the clinical records of 94 children (33 girls, 61 boys; aged 2-14 years) who presented for treatment of orofacial infection at the emergency dental department of the military hospital in Jeddah during a 12-month period. Patients were treated with antibiotic therapy. A favorable outcome was determined based on length of hospital stay.

RESULTS

The results indicated that the most common cause of odontogenic infection in Saudi children was dental caries (88%). The primary posterior teeth (84%) were considered to be a major source of infection. The most commonly affected teeth were the primary first molars (34%), followed by the primary second molars (31%). Six children were hospitalized; four of these stayed less than 4 days, which was considered a short hospital stay. The most common treatment was antibiotics as 93% received a type of antibiotic.

CONCLUSIONS

The most common cause of odontogenic infection was dental caries which has been treated with antibiotic prescription and dental procedures.

Emerging and changing viral diseases in the new millennium

Most viral infections encountered in resource‐rich countries are relatively trivial and transient with perhaps fever, malaise, myalgia, rash (exanthema) and sometimes mucosal manifestations (enanthema), including oral in some. However, the apparent benignity may be illusory as some viral infections have unexpected consequences – such as the oncogenicity of some herpesviruses and human papillomaviruses. Infections are transmitted from various human or animal vectors, especially by close proximity, and the increasing movements of peoples across the globe, mean that infections hitherto confined largely to the tropics now appear worldwide. Global warming also increases the range of movement of vectors such as mosquitoes. Thus recent decades have seen a most dramatic change with the emergence globally also of new viral infections – notably human immunodeficiency viruses (HIV) – and the appearance of some other dangerous and sometimes lethal infections formerly seen mainly in, and reported from, resource‐poor areas especially in parts of Asia, Latin America and Africa. This study offers a brief update of the most salient new aspects of the important viral infections, especially those with known orofacial manifestations or other implications for oral health care.