Severe Odontogenic Infections, Part 1: Prospective Report

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

doi:10.1016/j.joms.2006.03.015

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 64, Issue 7 , Pages 1093-1103, July 2006

Severe Odontogenic Infections, Part 1: Prospective Report

Thomas R. Flynn, DMD
- Assistant Professor, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine; and Associate Visiting Surgeon, Massachusetts General Hospital, Boston, MA
- Address correspondence and reprint requests to Dr Flynn: Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115
Rabie M. Shanti
- Howard Hughes Medical Institute-National Institutes of Health Research Scholar, National Institutes of Health, Bethesda, MD; and Predoctoral Candidate, Harvard School of Dental Medicine, Boston, MA
Michael H. Levi, ScD
- Co-Director, Microbiology, Montefiore Medical Center; and Associate Professor of Pathology (Clinical), Albert Einstein College of Medicine, Bronx, NY
Arthur K. Adamo, DDS
- Director, Oral and Maxillofacial Surgery, North Bronx Healthcare Network; and Associate Clinical Professor of Oral and Maxillofacial Surgery, Albert Einstein College of Medicine, Bronx, NY
Richard A. Kraut, DDS
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
Norman Trieger, DMD, MD
- Chairman Emeritus and Professor, Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

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.