Is dental treatment of an infected tooth a risk factor for locally invasive spread of infection?
OBJECTIVE
To determine the impact of antecedent dental procedures and dental health on the course of odontogenic maxillofacial infections requiring hospital care.


METHODS
In this retrospective cohort study in a referral center, we evaluated medical records and panoramic radiographs of all patients admitted because of odontogenic maxillofacial infection (n = 84). The predictor variables were preceding dental treatment, antimicrobial therapy, and dental health. The outcome variables comprised infection parameters, length of stay, need for intensive care, and management during hospitalization.


RESULTS
The mean age of the patients was 43.2 ± 16.5 years and 60% were men. Dental procedure preceded the spread of the infection in 49 cases (58%): endodontic treatment (n = 22), tooth extraction (n = 19), and minor first aid (n = 8). Twenty-seven patients had not received any dental or antimicrobial treatment in the recent past. Antimicrobial treatment alone had been given to 8 patients. Patients without preceding treatment had the highest C-reactive protein levels on admission and at maximum (P = .020 and P = .011) and the highest white blood cell counts on admission (P = .011). Their length of stay was also longer, and they needed intensive care more often than the other patients. Maximum C-reactive protein levels and white blood cell counts between treatment groups did not significantly differ from each other.


CONCLUSIONS
The systemic response to the infection was strongest and the course of the infection most severe in the absence of preceding dental treatment and in patients with poor dental health. All types of dental treatment contributed to a less severe course of infection.
Seppänen
Lotta
L
Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Finland.
Lemberg
Kim K
KK
Lauhio
Anneli
A
Lindqvist
Christian
C
Rautemaa
Riina
R
D000328:Adult; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications*; D001831:Body Temperature / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D003422:Critical Care; D003729:Dental Care; D003793:Dental Restoration, Permanent; D005260:Female; D005491:Focal Infection, Dental / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019558:Occlusal Adjustment; D009909:Oral Health; D010343:Patient Admission; D010485:Periapical Periodontitis / Q000382:microbiology; D010497:Pericoronitis / Q000382:microbiology; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D012390:Root Canal Therapy; D014076:Tooth Diseases / Q000382:microbiology*; D014081:Tooth Extraction
D000890:Anti-Infective Agents; D002097:C-Reactive Protein