Severe odontogenic infections, part 1: prospective report.
OBJECTIVE
The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI).


METHODS
In this study, 37 consecutive hospitalized patients with odontogenic infection were treated with intravenous penicillin (PCN) (unless allergic), and prompt incision and drainage. Standardized data collection included demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications information. Appropriate descriptive statistics were computed.


RESULTS
The sample consisted of 37 subjects (38% female) with a mean age of 34.9 years. Three subjects (8%) had immunocompromising diseases. Caries was the most frequent dental disease (65%) and the lower third molar was the most frequently involved tooth (68%). Trismus and dysphagia were present on admission in over 70% of cases. The masticator, perimandibular (submandibular, submental, and/or sublingual), and peripharyngeal (lateral pharyngeal, retropharyngeal, and/or pretracheal) spaces were infected in 78%, 60%, and 43% of cases, respectively. Abscess was found in 76% of cases. PCN-resistant organisms were identified in 19% of all strains isolated and in 54% of patients with sensitivity data. PCN therapeutic failure occurred in 21% of cases and reoperation was required in 8%. Length of hospital stay was 5.1 +/- 3.0 days. No deaths occurred.


CONCLUSIONS
This study indicated that PCN resistance, resulting in PCN therapeutic failure, was unacceptably high in this sample. Alternative antibiotics, such as clindamycin, should be considered in hospitalized patients with OI. Masticator space infection occurred much more frequently than previously reported. Trismus and dysphagia should be appreciated as significant indicators of severe OI.
Flynn
Thomas R
TR
Harvard School of Dental Medicine, Boston, MA 02115, USA. thomas_flynn@hsdm.harvard.edu
Shanti
Rabie M
RM
Levi
Michael H
MH
Adamo
Arthur K
AK
Kraut
Richard A
RA
Trieger
Norman
N
D000038:Abscess / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D003731:Dental Caries / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D004351:Drug Resistance; D005260:Female; D005882:Gingival Diseases / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000382:microbiology / Q000473:pathology; D010406:Penicillins / Q000008:administration & dosage*; D010497:Pericoronitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D010510:Periodontal Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D014076:Tooth Diseases / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins