title: The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care.
abstract: OBJECTIVE
  The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care.
  
  
  METHODS
  In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n = 60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis.
  
  
  RESULTS
  Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20-88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p = .0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate.
  
  
  CONCLUSIONS
  The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered.
  
  
  CONCLUSIONS
  Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.
authors.affiliation: Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 HU, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Grönholm
authors.forename: K K
authors.initials: KK
authors.lastname: Lemberg
authors.forename: L
authors.initials: L
authors.lastname: Tjäderhane
authors.forename: A
authors.initials: A
authors.lastname: Lauhio
authors.forename: C
authors.initials: C
authors.lastname: Lindqvist
authors.forename: R
authors.initials: R
authors.lastname: Rautemaa-Richardson
mesh_terms: D000038:Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D004322:Drainage; D005260:Female; D005491:Focal Infection, Dental / Q000150:complications* / Q000382:microbiology; D005500:Follow-Up Studies; D005928:Glossitis / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000209:etiology; D010482:Periapical Abscess / Q000209:etiology; D010485:Periapical Periodontitis / Q000150:complications* / Q000382:microbiology; D011670:Pulpectomy; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012390:Root Canal Therapy / Q000009:adverse effects / Q000379:methods*; D014081:Tooth Extraction; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents