Severe Odontogenic Infections, Part 1: Prospective Report

Thomas R. Flynn, Rabie M. Shanti, Michael H. Levi, Arthur K. Adamo, Richard A. Kraut, Norman Trieger

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI). Patients and 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.

Original languageEnglish (US)
Pages (from-to)1093-1103
Number of pages11
JournalJournal of Oral and Maxillofacial Surgery
Volume64
Issue number7
DOIs
StatePublished - Jul 2006

Fingerprint

Penicillins
Trismus
Infection
Deglutition Disorders
Length of Stay
Penicillin Resistance
Stomatognathic Diseases
Third Molar
Clindamycin
Reoperation
Abscess
Drainage
Tooth
Therapeutics
Demography
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Dentistry(all)
  • Surgery

Cite this

Severe Odontogenic Infections, Part 1 : Prospective Report. / Flynn, Thomas R.; Shanti, Rabie M.; Levi, Michael H.; Adamo, Arthur K.; Kraut, Richard A.; Trieger, Norman.

In: Journal of Oral and Maxillofacial Surgery, Vol. 64, No. 7, 07.2006, p. 1093-1103.

Research output: Contribution to journalArticle

Flynn, Thomas R. ; Shanti, Rabie M. ; Levi, Michael H. ; Adamo, Arthur K. ; Kraut, Richard A. ; Trieger, Norman. / Severe Odontogenic Infections, Part 1 : Prospective Report. In: Journal of Oral and Maxillofacial Surgery. 2006 ; Vol. 64, No. 7. pp. 1093-1103.
@article{e8e7eee170f4406b839d21a748e78016,
title = "Severe Odontogenic Infections, Part 1: Prospective Report",
abstract = "Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI). Patients and 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.",
author = "Flynn, {Thomas R.} and Shanti, {Rabie M.} and Levi, {Michael H.} and Adamo, {Arthur K.} and Kraut, {Richard A.} and Norman Trieger",
year = "2006",
month = "7",
doi = "10.1016/j.joms.2006.03.015",
language = "English (US)",
volume = "64",
pages = "1093--1103",
journal = "Journal of Oral and Maxillofacial Surgery",
issn = "0278-2391",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Severe Odontogenic Infections, Part 1

T2 - Prospective Report

AU - Flynn, Thomas R.

AU - Shanti, Rabie M.

AU - Levi, Michael H.

AU - Adamo, Arthur K.

AU - Kraut, Richard A.

AU - Trieger, Norman

PY - 2006/7

Y1 - 2006/7

N2 - Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI). Patients and 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.

AB - Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic infections (OI). Patients and 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.

UR - http://www.scopus.com/inward/record.url?scp=33744981401&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744981401&partnerID=8YFLogxK

U2 - 10.1016/j.joms.2006.03.015

DO - 10.1016/j.joms.2006.03.015

M3 - Article

C2 - 16781343

AN - SCOPUS:33744981401

VL - 64

SP - 1093

EP - 1103

JO - Journal of Oral and Maxillofacial Surgery

JF - Journal of Oral and Maxillofacial Surgery

SN - 0278-2391

IS - 7

ER -