The surgical management of severe dentofacial infections (DFI)-a prospective study.

Dentofacial infections (DFI) lead to morbidity and rarely, mortality. We hypothesised that certain clinical and laboratory parameter factors may be associated with a more severe course and an increased length of stay. We designed a prospective study that included all patients admitted with a DFI to the Oral and Maxillofacial Department between July 2014 and July 2015. A total of 125 were enrolled. We found that serum concentration of CRP on admission and increasing number of fascial spaces involved by the infection were significant predictors of hospital stay (p = 0.02 and p = 0.01, respectively). The average length of stay for a dentofacial infection requiring admission was 4.5 days. Most patients require surgical intervention in combination with intravenous antibiotics for successful resolution. Improved and timely access to primary dental care is likely to reduce the burden for patients their families and the acute hospital service as a consequence of advanced DFI.

The role of C-reactive protein and white blood cell count in the prediction of length of stay in hospital and severity of odontogenic abscess.

INTRODUCTION: Odontogenic infections and subsequent developing abscess remain to be a potentially life-threatening event, due to septicemia, airway compression and spreading into sensitive anatomic tissues. C-reactive proten (CRP) and white blood cell (WBC) count are routinely blood-measured indicators for inflammation. Are CRP-levels and WBC-count predictive factors of the developement of odontogenic abscess? METHODS: A 4-year retrospective study evaluated hospital records of 218 patients, diagnosed and inpatiently treated for acute odontogenic abscess. They received surgical incision, drainage and intravenous antibiotics. CRP-levels and WBC-counts were measured preoperativly. RESULTS: 218 subjects were enrolled in this study. Patients hospitalized 10 days or more showed significantly higher CRP-levels (p = < 0.001) and WBC-counts (p = 0.006) on admission day than patients with lower LOS. CRP-levels of patients with LOS from 7-9 days were significantly lower (p = 0.47) than in people hospitalized 10 days or more. Abscess focus in the mandible shows significantly higher WBC-counts (p = 0.014). Multiple space infections present a significantly higher CRP (p = 0.003) and WBC (p < 0.001) on admission day. DISCUSSION: According to the presented data, CRP-levels and WBC-count can be regarded as predictive factors for LOS (length of stay in hospital) in patients with long term hospitalization (CRP:7-9 days and > 10 days; WBC: > 10 days). Further WBC and CRP are suitable to predict multiple space infections and localisation of the abscess (WBC) in certain limits. CONCLUSION: In predicting the developement of odontogenic abscess, CRP is more capable in providing exact statements regarding the LOS. However, WBC-counts are more suitable in predicting multiple space infections and localization of infection.

Predictive factors of hospital stay in patients with odontogenic maxillofacial infections: the role of C-reactive protein.

To investigate whether clinical or laboratory variables on admission of patients with odontogenic infections are associated with a severe clinical course and a prolonged hospital stay, we hypothesised that specific factors such as the serum concentration of C-reactive protein (CRP) may act as predictors of the duration of stay. We designed a prospective patient-oriented study that included all those treated for maxillofacial infections of odontogenic origin in the Oral and Maxillofacial Surgery Department of Northampton General Hospital between November 2013 and December 2014. A total of 71 were enrolled. We found that the concentration of CRP was a significant predictor of hospital stay (p=0.01). Its measurement on admission can predict the likely duration of stay of these patients and enable beds to be managed more efficiently.

Non-surgical periodontal therapy improves serum levels of C-reactive protein and edematous states in female patients with idiopathic edema.

BACKGROUND: The relationship between periodontal disease and systemic disease is revealing new and exciting associations. Idiopathic edema presents a clinical syndrome with obscure pathophysiology. The present study investigates whether non-surgical periodontal therapy is beneficial in patients who are not responding to conventional treatment of idiopathic edema. METHODS: Thirty patients with idiopathic edema were allocated to intervention and control groups. All the subjects were assessed for systemic (body weight, body mass index, visual scale of edema, serum C-reactive protein, and serum albumin) and periodontal (plaque index, calculus index, and gingival index) parameters. Non-surgical periodontal therapy, including oral hygiene instructions, scaling and root planing, and systemic antibiotic therapy, was provided in the intervention group. Both groups were reevaluated after 4 weeks. RESULTS: Both groups were comparable at baseline. All parameters, except serum albumin, showed significant improvement after periodontal therapy. The control group showed further worsening of these parameters. CONCLUSIONS: This study shows that sources for systemic inflammation, such as periodontal disease, could affect the pathogenesis of idiopathic edema. Successful elimination of such covert sources of inflammation leads to a clinical benefit in patients who are distressed by this condition.

[Diagnostic and prognostic value of determination of the endogenic intoxication and functional activity of neutrophils indices in odontogenic phlegmon].

There were studied up the peripheral blood indices in 109 patients, suffering odontogenic phlegmon (OPH), coexistant with severe and of medium severity systemic inflammatory response syndrome (SIRS). In the patients with OPH and severe SIRS (with the complicated course), the blood neutrophils indices, concerning endogenic intoxication and functional activity, differ essentially from those parameters, present in patients, suffering noncomplicated course of the disease.

Isolation of Staphylococcus aureus and black-pigmented bacteroides indicate a high risk for the development of Ludwig's angina.

OBJECTIVE: The aim of this study was to compare clinical, microbiological, enzymatic, and host immune response variables between subjects hospitalized with facial cellulitis, with Ludwig's angina (LA) and without Ludwig's angina (WOLA). STUDY DESIGN: Microbiological and enzymatic tests on pus, and hematological and immunological assessments on blood samples of 15 patients with LA and 42 patients with WOLA were performed. Laboratory findings of both groups were compared using the Student t test. Multiple logistic regression analysis was performed and significant differences identified by univariate analysis. RESULTS: Patients with LA demonstrated increased levels of white blood cell counts, urea, and CRP levels, and decreased levels of CIC compared with patients WOLA. However, only CRP and urea were found to be significantly raised in the LA group. A greater population of Staphylococcus aureus and black-pigmented bacteroides were isolated from patients with LA. CONCLUSION: Elevated levels of CRP and urea could indicate the severity of infection in patients with LA. This could be because of the highly virulent and fast-spreading organisms, S. aureus and black-pigmented bacteroides, which may be a factor indicative of LA.

[Preparation glycosaminosulphate efficacy in comprehensive treatment of patients with odontogenic phlegmon of maxillofacial region].

The results of 20 patients (with odontogenic phlegmon of maxillofacial region) treatment by glycosaminosulphate were compared with the results of patients received traditional treatment. Significant speeding-up of the blood indices normalization terms, humoral immunity factors and postoperative wound regeneration after odontogenic phlegmon of maxillofacial region lancing was determined.

Differences between patients with or without the need for intensive care due to severe odontogenic infections.

PURPOSE: Despite greatly improved dental health in industrialized countries, severe odontogenic infections still occasionally lead to hospitalization. The aim of the present study was to determine whether what symptoms, signs, or laboratory parameters on hospital admission were associated with the need for treatment in the intensive care unit (ICU). PATIENTS AND METHODS: Over an 18-month period, 100 consecutive patients (59 male, 41 female) were included in the study. Twenty percent of the patients required ICU treatment because of cardiorespiratory problems or severe complications of their infection. Both ICU and non-ICU patients were examined clinically and blood samples were taken and studied in respect to several parameters associated with infection, including C-reactive protein (CRP) levels. The findings were analyzed statistically for differences between the groups. RESULTS: No particular anamnestic background variable was associated with the need for intensive care. However, a particularly high CRP level on admission was found to be associated with a more severe course of the infection. CONCLUSIONS: This study showed that determination of CRP levels may be useful in clinical decision-making in patients with severe odontogenic infections.

Odontogenic bacteremia following tooth cleaning procedures in children.

PURPOSE: This study was designed to investigate the prevalence and intensity of odontogenic bacteremia from tooth cleaning procedures in children and adolescents. METHODS: One hundred and fifty five children receiving dental treatment under general anesthesia at The Great Ormond Street Hospital for Children and Guy's Hospital were recruited. Each child was randomly allocated to one of three tooth cleaning groups. These were (1) toothbrushing, (2) professional cleaning with a rubber cup and (3) scaling. RESULTS: There was no significant difference in the prevalence of positive blood cultures or intensity of bacteremia between the three groups. The bacterial species isolated were similar to those reported by other workers. These were S. mitis, S. sanguis and Coagulase--negative staphylococci, all of which are implicated in the pathogenesis of Bacterial Endocarditis. CONCLUSIONS: Patients at risk are as likely to develop odontogenic bacteremia from toothbrushing at home as from professional scaling and polishing of the teeth at dental surgery.

Strength of evidence linking oral conditions and systemic disease.

Associations between dental diseases and systemic outcomes are potentially important because of the high occurrence of dental diseases. If this extremely common source of chronic infection (dental disease) leads to an increased morbidity and mortality rate, the public health impact of oral disease on millions of Americans would be substantial. Recent studies demonstrate an association between dental and systemic diseases, including systemic infections, cardiovascular disease, pregnancy outcomes, respiratory diseases, and increased all-cause mortality rate. Because there are several common risk factors for oral and systemic diseases, and limitations in published studies, a careful interpretation is needed. Confounding (shared risk factors for both systemic and dental disease) may explain part of the reported associations. It is also plausible that there may be a causal link. It is likely that if there is a causal link, several pathways and mediators coexist, linking oral and systemic disease. Bacteremia, bacterial endotoxins, cytokines, and other inflammatory mediators could conceivably be playing a direct or indirect role. Missing teeth are a surrogate marker for previous dental infection, and may also lead to altered dietary intake. Hence, diet may be an additional mediator for several of these outcomes. We caution clinicians not to recommend extracting infected teeth, based on the periodontal-systemic disease associations, if the teeth do not warrant extraction otherwise, because loss of teeth and edentulousness are associated with increased risk of systemic diseases. When assessed against causal-defined criteria, the evidence suggests possible causal associations between chronic periodontal disease and tooth loss with cardiovascular disease, bacterial endocarditis, pregnancy outcomes, and all-cause overall mortality. Further studies are needed to show consistency, to corroborate that the associations are independent of common risk factors for both systemic and dental disease, including healthy lifestyle factors, and to evaluate different biological pathways.

Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an overview.

Oral focal infection, a concept neglected for several decades, is a subject of controversy. Recent progress in classification and identification of oral microorganisms has renewed interest in focal infection. The aim of this study was to use phenotypic and genetic methods to trace microorganisms released into the bloodstream during and after endodontic treatment back to their presumed source--the root canal. Microbiological samples were taken from the root canals of 26 patients with asymptomatic apical periodontitis of single-rooted teeth. The blood of the patients was drawn during and 10 minutes after endodontic therapy. Microorganisms in blood were collected after anaerobic lysis filtration and cultured anaerobically on blood agar plates. The phenotypic methods used for characterization and tracing of microorganisms in blood and root canals were: biochemical and antimicrobial susceptibility test, SDS-PAGE of whole-cell soluble proteins, and gas chromatography of cellular fatty acids. Phenotypic data were verified by DNA restriction patterns and corresponding ribotypes of the root canal and blood isolates by using a computer-assisted system fro gel analysis. All root canals contained anaerobic bacteria. The frequency of bacteremia varied from 31% to 54%. The microorganisms from the root canal and blood presented identical phenotype and genetic characteristics within the patients examined. These characteristics differed between patients. The present study demonstrated that endodontic treatment can be the cause of anaerobic bacteremia and fungemia. The phenotypic and genetic methods used appeared valuable for tracing microorganisms in the blood back to their origin.

[The clinico-laboratory characteristics of the forms of suppurative infection in dental patients]. / Kliniko-laboratornaia kharakteristika form gnoinoi infektsii u stomatologicheskikh bol'nykh.

Odontogenic anaerobic sepsis was diagnosed using vapor-phase gas chromatographic analysis (VPGCA) for detecting volatile fatty acids--metabolites of anaerobic bacteria. The method is rapid and therefore diagnostically valuable. Rapid diagnosis of anaerobic odontogenic sepsis is to include detection of the clinical signs of anaerobic inflammation of the primary purulent focus and the clinical laboratory symptom complex of generalized infection and VPGCA of volatile fatty acids in the blood.

Oral infections in home-living elderly patients admitted to an acute geriatric ward.

Little is known about the oral health of the frail and home-living elderly. The effects of dentogenic infections on the general condition of the elderly are also unknown. We therefore set out to investigate 191 elderly patients referred to an acute geriatric hospital due to sudden worsening of their general health. The patients' mean age was 81.2 +/- 6.4 years (range, 67 to 96 years), and they had lived at home before hospitalization. The patients were examined and their diagnoses set by a team of physicians. The dentist's examination was also made bedside. Panoramic x-rays were taken for those who were able to stand (n = 148). Particular attention was paid to the occurrence of dental infection foci and systemic infection parameters of blood. Only patients free from other than dental infections were included in the statistical analyses (n = 184). Panoramic x-rays revealed dentogenic infection foci in 71.1% of the dentate patients. Periodontal condition was poor in 96.2% of the patients (CPI score, 2 to 4). All infection parameters were high in patients with high periodontal treatment need, but the differences were not statistically significant. Neither were there statistically significant correlations between the number of dentogenic infection foci recorded from the radiographs and infection parameters of blood. More of the edentulous patients had positive salivary yeast counts than did the dentate patients (84.4% vs. 66.1%; P < 0.05). No correlation was found between the main systemic diagnoses and dental infections. Since the prevalence of dentogenic infection foci in our subjects was high, and they did not cause marked increase in the hematological infection parameters investigated, it seems clear that geriatricians should refer their patients for dental examinations. Although our patients represent the home-living elderly population in a Nordic country with a high standard of living and good medical care, dental care had been neglected regardless of the patients' systemic disease.

Level of plasma proteins in patients with severe odontogenic infection and fever.

Twenty patients complaining of acute dental infection were admitted to the hospital. Clinical examination, peak of daily temperature for every patient were recorded. Electrophoretic studies of plasma proteins of all patients revealed slight increase of mean value of some plasma proteins (albumin, and gamma globulins) and more pronounced increase of mean values of alpha 1, and alpha 2 and beta globulins. The temperature and plasma proteins returned to normal levels after antibiotics therapy and dental treatment.

[The diagnostic and prognostic significance of the degree of neutrophilic leukocyte activation in the peripheral blood of patients with odontogenic phlegmons]. / Diagnosticheskoe i prognosticheskoe znachenie stepeni aktivatsii neitrofil'nykh leikotsitov perifericheskoi krovi bol' nykh odontogennymi flegmonami.

Structural and morphologic changes in peripheral blood neutrophilic leukocytes were examined with the aim to diagnose and predict the clinical course of acute pyoinflammatory maxillofacial diseases. Classification of structural and morphologic signs of neutrophilic leukocyte activation levels during odontogenic pyoinflammatory diseases were studied using optic and electron microscopy. There degrees of neutrophilic leukocyte activation were distinguished: inactive, moderately active, and hyperactive. Inactive cells occurred in normal subjects and patients with mild forms of the disease, moderately active ones in patients with mild and medium-severe condition, hyperactive ones in those with medium-severe and grave disease. Increased count of hyperactive neutrophilic leukocytes in the peripheral blood was a sign predicting a grave clinical course of the disease with complications.

[The role of the genotype in the development of suppurative inflammatory complications in trauma to the facial bones]. / Rol' genotipa v razvitii gnoino-vospalitel'nykh oslozhnenii pri travme litsevykh kostei.

The distribution of the genetic markers of leukocytes (HLA I and II), serum proteins (allotypes Gm, transferrin, haptoglobin, group-specific component), red cell enzymes (acid phosphatase--AP, phosphoglucomutase--PGM, esterase D, adenosine deaminase) was found to be universal in patients suffering from various pyoinflammatory diseases. The incidence of HLA A10, Cw4, DR5 antigens, IgG allotype G1m (2) and phenotype G1m (+1+2) and AP (aa) and PGM (2-2) phenotypes was found increased in patients with maxillofacial suppuration and pyoinflammatory complications of maxillofacial injuries as against normal subjects and patients with maxillofacial injuries without such complications. Traumatic osteomyelitis much more often develops in the carriers of the before genetic markers than in those in whom these markers are absent (61.6 and 20.4%, respectively).

[Studies on the host factors in the outbreak of odontogenic infection--the background factors of patients and the effect of serum after sleep deprivation on PMN chemotaxis].

These studies were carried out to investigate the background factors in the outbreak of acute infection of odontogenic origin. In the clinical study, fifty patients who suffered from acute odontogenic infection were compared with fifty symptom free controls with chronic odontogenic inflammation. The subjects were asked whether they had basal disease or not, and were given a series of questionnaires about the episodes of recent life changes (f.e. busy, decrease of sleeping time, travel etc) to measure the incidence of these background factors. In the experimental study, the effect of serum after 24 hours sleep deprivation on PMN chemotaxis in vitro was studied in six young volunteers. Chemotactic assays were performed with the modified Boyden chamber method. Results obtained were as follows: 1) The basal diseases were observed in 16 cases (32%) with acute odontogenic infection, and in 14 cases (28%) of controls. The incidence was not different statistically between both groups. 2) The incidence of background episodes in the patients were noted in 39 cases (78%) of patients and 10 cases (20%) of the controls (p less than 0.01). The predominant factor in these episodes were busy (36%), and decrease of sleeping time (30%) in the patient group. 3) Serum of all 6 subjects obtained after sleep deprivation showed depressed effects on PMN chemotaxis to chemotactic factor. (P less than 0.05). 4) Pre-exposure levels were regained in five of the six subjects within seven days after terminating the visil. These results suggest that fatigue plays a major role in the susceptibility to acute odontogenic infection by the alternation of PMN chemotaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

[The possibilities of using clinical blood analysis for the prognosis of the course of acute suppurative inflammatory processes in the soft tissues of the maxillofacial area]. / Vozmozhnosti ispol'zovaniia klinicheskogo analiza krovi dlia prognozirovaniia techeniia ostrykh gnoinykh vospalitel'nykh protsessov miagkikh tkanei cheliustno-litsevoi oblasti.

The authors have attempted to mathematically predict the length of inpatient treatment of patients with maxillofacial acute pyoinflammatory processes basing on the regression analysis of the peripheral blood parameters. A number of mathematical formulae fit for wide clinical application were derived.