Odontogenic signs and symptoms as predictors of odontogenic infection: a clinical trial.
BACKGROUND
The authors conducted a study to determine if odontogenic signs and symptoms in the emergency department predicted the development of overt odontogenic infection at a follow-up dental visit.


METHODS
One hundred ninety-five patients with odontalgia, but without overt signs of infection, were enrolled in a prospective, double-blind, randomized clinical trial. Data included dental diagnosis, pain characteristics, presence of caries and restorations, presence and size of periapical radiolucencies and other diagnostic test results.


RESULTS
Thirteen of 134 subjects for whom data were available had signs of infection at the follow-up visit. Subjects in the follow-up infected (FU-I) group had larger baseline radiolucencies than did subjects in the follow-up noninfected (FU-NI) group, and restorations were more prevalent for involved teeth in the FU-I group than in the FU-NI group.


CONCLUSIONS
A relationship exists between radiolucency size and the presence of amalgam restorations in patients who develop clinical signs of infection. Penicillin did not appear to influence this progression.


CONCLUSIONS
Antibiotics are not effective in preventing the development of odontogenic infection when definitive dental therapy cannot be provided for acute pain in the absence of clinical signs of infection. Although the overall risk of developing infection is low, early treatment is indicated for teeth with larger periapical radiolucencies, amalgam restorations or both.
Brennan
Michael T
MT
Oral Medicine Residency, Carolinas Medical Center, Department of Oral Medicine, 1000 Blythe Blvd., MEB-409, Charlotte, NC 28232, USA. mike.brennan@carolinas.org
Runyon
Michael S
MS
Batts
Jayne J
JJ
Fox
Philip C
PC
Kent
M Louise
ML
Cox
Timothy L
TL
Norton
H James
HJ
Lockhart
Peter B
PB
D000038:Abscess / Q000000981:diagnostic imaging; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis*; D003731:Dental Caries / Q000145:classification; D003793:Dental Restoration, Permanent; D004311:Double-Blind Method; D004487:Edema / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010404:Penicillin V / Q000627:therapeutic use; D010483:Periapical Diseases / Q000000981:diagnostic imaging; D010919:Placebos; D011446:Prospective Studies; D011671:Pulpitis / Q000145:classification; D011859:Radiography; D013492:Suppuration; D014076:Tooth Diseases / Q000382:microbiology*; D014098:Toothache / Q000175:diagnosis*
D000900:Anti-Bacterial Agents; D010919:Placebos; D010404:Penicillin V