Non-odontogenic maxillofacial infections - a 17-years retrospective cohort study.

PURPOSE: A retrospective 17-year review of the epidemiology, microbiological aspects, and treatment of patients hospitalized for non-odontogenic maxillofacial infections. METHODS: A retrospective study reviewed 4040 medical records of patients hospitalized at Vilnius University Hospital Zalgiris Clinic during the period of 2003 to 2019. The following data were collected: patient sociodemographic characteristics, length of hospitalization, sources of infection, affected anatomical regions, treatment modalities, microbiological findings, and sensitivity to antibiotics. RESULTS: The mean (sd) annual incidence of non-odontogenic maxillofacial infections over the past 17 years was 237 (49) cases, and the mean (sd) hospital stay was 7.3 (4.5) days. The male-to-female ratio was 1.9:1, while the mean (sd) patient age was 42.1 (19.0) years. The need for an additional incision and the involvement of multiple anatomical regions were the strongest predictors of longer hospitalization. A total of 139 microorganism species were identified, with Bacteroides, Prevotella, and Staphylococcus showing the highest resistance to penicillin. CONCLUSIONS: Longer hospital stays were associated with older age (≥ 65 years), smoking, systemic diseases, type of treatment, involvement of multiple anatomical regions, and the need for additional surgery. Most of the cultured microorganisms were Staphylococcus species.

Mucosa-Associated Lymphoid Tissue Lymphoma of the Sublingual Salivary Gland: A Case Report.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of B-cell lineage lymphoma that can affect the head and neck region. This report presents a rare case of an extra-nodal marginal zone B-cell MALT lymphoma of a sublingual gland, diagnosed in an 18-year-old male patient. The patient had a history of ranula surgical removal on the right side of the mouth. One year after surgery, the patient presented with complaints of swelling of the left parotid gland, with no significant changes found during the examination and a self-resolving outcome. Subsequently, two years later, the patient began to complain of a fast-growing cyst under the tongue. A surgical excision of the left sublingual gland and the ranula was performed, and a final diagnosis of MALT lymphoma was rendered. The patient was referred to the department of hematology for further treatment planning and follow-up.

Self-determination theory guided oral self-care training for adolescents-A cluster randomised controlled trial.

Quality oral self-care is a key element in maintaining oral health, which is important for students' general health, their overall well-being and learning. The cluster randomised controlled trial tested the following hypotheses: (1) self-determination theory (SDT)-guided dental education is superior to conventional dental instruction in modifying oral self-care in adolescents; (2) after the discontinued dental education, improved oral self-care is only maintained for short rather than long term and (3) multiple predictors explain variations in adolescents' oral self-care at different observation periods. The intervention group (N = 97) received three face-to-face educational sessions to facilitate adolescents' intrinsic motivation, while the control group (N = 99) had one conventional dental instruction session. Dental plaque scores (% of tooth area covered by dental plaque) indicated a lack of oral self-care. Linear multivariable models tested the following predictors of oral self-care at different observation periods: socio-demographics (sex, socio-economic status, school) and self-determination attributes (autonomy, relatedness, competence). Results indicated that from baseline to the 6-month follow-up, dental plaque scores decreased (oral self-care improved) in the intervention group but not in the control group. At the 12-month follow-up point, there were no significant differences in mean plaque scores between the study groups. Baseline plaque levels (ß = 0.807), the type of dental instruction (theory guided vs. conventional) (ß = 0.208), relatedness (ß = 0.106) and competence (ß = 0.102) were significant predictors that explained 67.6% of the variance in dental plaque scores at the 12-month follow-up point. The theory-guided education was superior to conventional verbal instruction in improving adolescent oral self-care; however, this improvement was only maintained short term. Variations in adolescent oral self-care at short- and long-term observation points were explained by baseline oral self-care levels and two SDT components: relatedness and competence.

Predictors of longer hospitalization of maxillofacial infections-a 17-year retrospective study.

OBJECTIVES: To evaluate treatment outcomes in patients with severe maxillofacial infections requiring hospital care during a 17-year period. METHODS: A retrospective cohort study reviewed 5,465 medical records, and the following data were collected: the reason for infection, locations of inflamed regions, treatment provided, bacteriological findings, and treatment outcomes. Other information included sociodemographic characteristics (age, gender), presence of systemic diseases, and smoking history. RESULTS: The annual incidence rate of patients with acute maxillofacial infections was 206 ± 19 cases with a male to female ratio 1.4:1.0, a mean hospital stay of 7.9 ± 4.9 days. Older age (>65 years), smoking and systemic diseases (diabetes), the causative tooth (molar), and need for extraoral incision predicted longer hospitalization. Intravenous penicillin was the most common drug prescribed in 50.5% of cases. A total of 132 different microorganisms were identified. The highest microorganism resistance occurred for metronidazole and the highest sensitivity was to clindamycin. CONCLUSIONS: Increased age, smoking, diabetes, causative tooth, and the occurrence of several infected spaces were associated with a longer hospital stay. Streptococcus α haemolyticus was the most common microorganism found in more than 70.0% of cases that were sensitive to intravenous penicillin.

Tongue function characteristics in infants experiencing breastfeeding difficulties and changes in breastfeeding after frenotomy procedures.

OBJECTIVES: The aims of the study were to describe tongue function in infants experiencing breastfeeding difficulties and to examine changes in breastfeeding after frenotomy procedures. MATERIALS AND METHODS: Mothers, and their infants, facing difficulties in breastfeeding were referred to the Vilnius University hospital Zalgirio clinic after assessment of breastfeeding quality by a lactation specialist. Anatomy evaluations included the type of ankyloglossia, tongue function, and the need for a frenotomy. All mothers completed the breastfeeding questionnaire twice, once during the referral consultation and 1 month later. The total breastfeeding hindrance score was calculated before and after the frenotomy. RESULTS: Fifty infants were included in the study and their mean age was 29.6 days (min age 1 day and max 78 days). The male to female ratio was 1.8:1.0. Of all infants, 70% had severe lingual function alterations and their mothers were facing issues in breastfeeding. After the frenotomy, there was a significant reduction in breastfeeding hindrance in infants who had disturbed function and aberrant anatomic characteristics. It was found that for type II ankyloglossia, the frenotomy procedure was significant more (p = 0.002) beneficial, than for type I ankyloglossia. After the frenotomy, there was a significant improvement in nine out of 14 criteria of breastfeeding (p = 0.001). CONCLUSIONS: Frenotomy procedures had a positive effect on improving breastfeeding. CLINICAL RELEVANCE: Current study analyses issues with breastfeeding. Dental practitioners and pediatricians should be familiar with this topic, as early and timely minimal invasive surgical intervention has a significant impact for better comfort of the mothers and continuation of breastfeeding.

Oral lichen planus: a 4-year clinical follow-up study.

BACKGROUND/AIM: This study aimed to examine oral lichen planus (OLP) cases histopathologically and cytologically, describe different clinical aspects of OLP manifestations, and associate different OLP clinical forms with self-reported oral health and with local and systemic risk factors. MATERIALS AND METHODS: All patients with a referral diagnosis of OLP received biopsies. The histological evaluation assessed infiltration with lymphocytes, epithelial hyperplasia, and hyperkeratosis. Histology was used to validate the OLP diagnosis and to evaluate the malignant transformation of OLP lesions. Clinical manifestations of OLP and potential local oral environment-related risks were clinically assessed. Systemic risks were evaluated by a structured questionnaire. RESULTS: A total of 133 patients with a histologically confirmed OLP diagnosis were followed. There were more females (N = 109) than males (N = 24) and the majority of patients were older than 50 years. The reticular form (45.1%) was the most prevalent clinical form followed by the erosive-ulcerative form (33.8%). The histological characteristics were most pronounced in the erosive-ulcerative form. Of the OLP cases, 2.3% had a malignant transformation. CONCLUSION: Reticular and erosive-ulcerative were the most prevalent OLP forms. There were more female than male OLP patients. Except for medication use, there were no statistically significant differences among different clinical OLP forms in either local or systemic risk factor distributions.

Odontogenic Maxillofacial Infections: A Ten-Year Retrospective Analysis.

BACKGROUND: To analyze treatment modalities and results in patients with severe odontogenic maxillofacial infections during a 10-y period. METHODS: Medical records of 1,077 patients hospitalized because of severe odontogenic maxillofacial infections during 2003-2012 were reviewed. The sample consisted of the records that matched inclusion criteria. For each patient the following data were collected: Age, gender, presence of systemic diseases, length of hospital stay, causal tooth, location of inflammation, treatment, results of bacteriologic sampling, and anti-bacterial susceptibility. RESULTS: Male to female ratio was 1.4:1. Two or more anatomic spaces were involved in 42.9% of cases, 37.3% of which involved the floor of the mouth. Penicillin in combination with gentamicin or metronidazole was prescribed in 69% of cases. Sixty-two different micro-organism species were identified with predominance of Streptococcus haemolyticus (42.9%). The microbial analysis showed the highest susceptibility of predominant micro-organisms to penicillin was 76.9% and the highest resistance was to metronidazole (27.9%). CONCLUSIONS: The frequency of odontogenic maxillofacial infection remained almost unchanged during a 10-y period. Single-space infections were more common (57.1%) than infections involving two or more spaces. Susceptibility to penicillin remains relatively high; therefore, penicillin can remain part of the armamentarium for treatment of odontogenic maxillofacial infections.

Dental treatment needs and health care-seeking behaviours of patients with acute odontogenic infections in Lithuania.

AIMS: To assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes. METHODS: During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains. RESULTS: Patients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help. CONCLUSIONS: Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment.

Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis.

OBJECTIVES: To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013. MATERIALS AND METHODS: Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius University's dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis. RESULTS: A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs. CONCLUSION: The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.

Retrospective analysis of cellulitis of the floor of the mouth.

OBJECTIVES: To analyze clinical data of patients treated for mouth floor cellulitis during 2003-2006 years at the Department of Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic and to compare the results with existing data. MATERIAL AND METHODS: Patient's gender, age, social insurance, demographic profile, preference of first visit, previous treatment, origin of inflammation, symptoms of disease, treatment protocol and outcomes were evaluated from 240 clinical records. RESULTS: The male-female ratio was 1.3:1. The mean age of patients was 43.18+/-7.56 years. 65% of patients were from urban. 47% of patients were employed, 15% retirees, 22% unemployed, 10% children, 2% students and 4% handicapped people. In 65% of cases primary diagnosis was incorrect. Majority of patients appealed to doctor on the first five days from the beginning of the disease. 93.7% of mouth floor cellulites were odontogenic origin. In 32.9% of the patients at the time of first examination the extension of inflammation into parapharyngeal, pterygomandibular spaces or neck together with mouth floor cellulitis was diagnosed. In 1.7% (in 4 out of 240) of cases infection extended into the neck and parapharyngeal spaces despite treatment. In 2% (in 5 out of 240) of cases infection extended to mediastinum. CONCLUSIONS: Despite the aggressive treatment serious complications still are possible. Delayed treatment procedures might determine poor prognosis.