The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections.

Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.

Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis.

BACKGROUND: More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. METHODS: All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. RESULTS: Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. CONCLUSION: Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.

MODERN TREATMENT METHODS OF PHLEGMON IN THE MAXILLO-FACIAL AREA AND NECK.

Objective of the investigation - to increase the effectiveness of treatment of phlegmon of the maxillo-facial area and neck with the influence onto the pathogenic factors, complementing the main treatment plan with the injection of a second antibiotic in a regionary lymphatic way. 100 patients with acute inflammatory odontogenic diseases of the maxillofacial area were examined. Patients received both traditional medical treatment and regional lymphotropic antibiotic therapy added to the main method of treatment as well. Regionarnl lymphotropic antibiotic injection in the treatment of phlegmon of the maxillofacial area and neck leads to an accelerated onset of the second phase of the development of the wound process, more rapid detoxification of the body. Key words: acute inflammatory odontogenic diseases, maxillofacial area, lymphatic system.

Management of a Severe Cervicofacial Odontogenic Infection.

INTRODUCTION: Odontogenic infections originate from a tooth or from its supporting structures, generally secondary to a pulp necrosis, periodontal disease, pericoronitis, apical lesions, or complications of dental procedures, which can be restricted to the alveolus or can reach the jaws and face through maxillofacial spaces. These are the most common conditions which affect the head and neck regions. AIM: The aim of this study is to report a severe case of a cervicofacial odontogenic infection while discussing the most relevant aspects. CASE REPORT: A 47-year-old female patient with a background of diabetes mellitus (DM) had a cervicofacial infection presenting edema and erythema in the left hemiface extending from the frontoparietal to cervical region and was submitted to extensive surgical treatment combined with antibiotic therapy. CONCLUSION: Although the prevalence and complication rates of odontogenic infections had decreased with the advancement of diagnostic techniques, availability of effective antibiotics, and improvement in oral hygiene, still there are conditions that require attention and accurate treatment to prevent the progression of the pathology to deeper fascial spaces. CLINICAL SIGNIFICANCE: Odontogenic infections can be treated with fewer complications if approached earlier when diagnosed while their premature clinical manifestations. However, if the treatment is postponed and the infection spreads into deeper fascial spaces, it can damage vital structures, and, consequently, threaten the patient's life. In these cases, extensive and aggressive therapy should be performed.

Antibiotics in Endodontics: a review.

The overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad-spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.

Antibiotic Therapy in the Treatment of Odontogenic Infections-An Evolving Landscape.

Odontogenic infections continue to be the most common reason for people to seek dental care. Antibiotic therapy, combined with appropriate surgical intervention has been the mainstay in treating dental infections for many years. Availability of new antimicrobial agents and reports of decreased efficacy in commonly used antibiotics warrant continued study to assure that the most effective agents are utilized. This paper presents a brief summary of the bacterial populations associated with odontogenic infection and their antibiotic resistance mechanisms. Information from a number of studies, including our own data, concerning antibiotic resistance and efficacy are presented. This paper may provide the practitioner with additional information as a guide for appropriate antibiotic use in odontogenic infections.

Prognostic determinants in severe odontogenic space infections: a single-center retrospective analysis.

BACKGROUND: Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. METHODS: Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). RESULTS: The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. CONCLUSIONS: Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.

Determinant of antibacterial failure in patients with head and neck infections with odontogenic source.

INTRODUCTION: Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections with odontogenic sources. MATERIAL AND METHOD: This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections with an odontogenic source who had been operated on in Shahid Rajaee hospital from March 2014 to December 2019. RESULTS: 123 (53.7%) patients were female and there were106 (46.3%) males. The mean age ± SD was 33.01±13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (p=0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared with 57.6% in patients without failure of treatment (p=0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender and history of chemotherapy, hypertension, smoking, pregnancy, alcohol usage, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, and surgical approach. CONCLUSION: Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

To-Go medications for decreasing ED return visits.

OBJECTIVES: The primary objective was to determine if providing patients with a complete course of antibiotics for select conditions would decrease the rate of return to the emergency department (ED) within 7 days of the initial visit. METHODS: In an urban, academic medical center, we compared patients who received medications at discharge (To-Go medications) with patients who received standard care (a prescription at discharge). Emergency department patients were included if they were older than 18 years; had a discharge diagnosis International Classification of Diseases, Ninth Revision, code for urinary tract infection, pyelonephritis, cellulitis, or dental infection; and presented initially between January and December 2010. Candidates had limited health insurance or were discharged when nearby pharmacies were closed. Return visits were included if the condition was related to the initial diagnosis. Wound checks and scheduled revisits were excluded. Medications dispensed were penicillin, clindamycin, sulfamethoxazole-trimethoprim, and nitrofurantoin. RESULTS: A total of 4257 individuals were seen in initial ED visits for the included conditions. Comparing the 243 individuals given medications with the 4014 who were not given medications, the To-Go medications group was less likely to return than the comparison group (2.5% vs 5.9%; P = .026). The cellulitis subgroup also showed a significant reduction in return visits (1.6% vs 6.9%; P = .024). Three hundred eighteen courses of medication were given to the 243 individuals for a total cost of $1123. CONCLUSIONS: For a 1-year expense of $1123, we demonstrated a 50% reduction in ED return visits for patients who were given a free, complete course of antibiotics at discharge for select conditions.

Infection from an exfoliating primary tooth in a child with severe neutropenia: a case report.

In patients with deficient immune defenses, a localized oral infection can progress to a systemic infection. The purpose of this paper was to describe the case of a child with acute lymphoblastic leukemia who presented with fever, trismus, and submandibular swelling in the absence of the typical dental causes of infection such as deep dental caries or clinically significant periodontal disease. Treatment included an aggressive intravenous antibiotic regimen and extraction of the offending tooth after the recovery from bone marrow suppression.

Current approaches to the diagnosis and management of odontogenic abscesses / Odontogén tályogok diagnosztikája és kezelése a nemzetközi ajánlások tükrében

A wide scale of medical professionals including general practitioners, dentists, maxillofacial surgeons, otolaryngologists or even emergency physicians frequently encounter patients suffering from abscesses of odontogenic origin. These dental infections spreading along the fascial planes into the adjacent anatomical spaces or by the lymphatic vessels and veins may result in life-threatening situations. It is essential to prevent and - in the case of an evolved disease pattern - to treat them properly, since improper or delayed treatment may entail avoidable burdens on the healthcare system. Our aim was to review the current literature regarding the development, diagnostics and treatment of odontogenic infections. A review of the English and Hungarian literature was performed. Considerations regarding the surgical management of dental abscesses have well-tried, traditional routes. Prompt intervention is considered mandatory with surgical decompression of the swelling by performing incision and drainage. A rapid improvement of radiology has provided the possibility to realize and avoid fatal consequences of this disorder. The administration route, necessity and duration of empiric antibiotic therapy are still debated, protocols vary across studies. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, future research should evaluate evidence-based and effective management of dental abscesses.

Brain abscesses due to odontogenic infection: Case series.

Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of São Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus spp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.

Facial cellulitis secondary to dens invaginatus: a case report.

We describe a case of dens invaginatus in an unerupted permanent maxillary lateral incisor, which led to facial cellulitis in a 10-year-old girl. We review the importance of recognizing dens invaginatus and present strategies for preventing loss of vitality in the affected tooth.

Safety and Tolerability of Clofazimine in a Cohort of Children With Odontogenic Mycobacterium abscessus Infection.

Mycobacterium abscessus infections can be challenging to treat. Clofazimine has excellent in vitro activity against M abscessus, but reports of its use, particularly in children, have been limited. In this study, clofazimine was given to 27 children during an outbreak of odontogenic mycobacterial infections and seemed to be well tolerated as part of a multidrug regimen.

Clinical results of the application of perftoran for the treatment of odontogenous abcesses and phlegmons in the maxillofacial region.

INTRODUCTION: The study was carried out to ascertain the effects of perftoran in the treatment of facial and Dupuytren's phlegmons with simultaneous estimation of the general reaction in humans. MATERIAL AND METHODS: Seventy-six patients with facial or Dupuytren's phlegmons were divided into 2 groups, one with mild and the other with a severe course of the inflammatory process. Each group was subdivided into 2 subgroups: one control group with "traditional" treatment and one study group where the traditional treatment was supplemented with perftoran. Perftoran was given to both study groups (1-3 ml/kg body weight, single intravenous injection) immediately after surgery plus further daily local wound treatment with perftoran until the end of exudation. The condition of the purulent wound and its reparative processes, the state of free-radical oxidation processes, antihypoxia and effects of perftoran were evaluated at various treatment stages (the moment of surgically opening the phlegmon, on the 1st, 3rd and 7th postoperative days). RESULTS: Perftoran considerably decreased the tissue hypoxia as well as the transaminase and creatinine levels in blood serum. Perftoran helped to decrease the intoxication indices, hypoxaemia by 10-15%, to speed local wound healing by 2-5 days and to shorten the time of hospital treatment by 3-6 days on average. CONCLUSIONS: The many positive effects of perftoran on the clinical course of the disease and on a series of homeostatic parameters allow us to recommend that this drug to be added for treating patients having odontogenous phlegmons in the maxillofacial region.

Microbial flora and antibiotic resistance in odontogenic abscesses in Upstate New York.

Abscesses in the head and neck frequently have odontogenic sources. As bacterial pathogens and antibiotic resistance patterns may change over time and based on location, we describe the current common bacteria found in odontogenic abscesses, the prevalence of antibiotic resistance, and differences in each between pediatric and adult patients in Upstate New York. This is a retrospective review of patients who underwent drainage of odontogenic abscesses (n = 131) from 2002 to 2012 at an academic institution. The medical records were reviewed for results of abscess cultures, comorbidities, and drainage procedures. Polymicrobial sources were identified in 60.3% and monomicrobial in 33.6%. Overall, the most common bacteria were alpha hemolytic Streptococci (33.6%), Streptococcus milleri (32.1%), Prevotella (16.8%), and coagulase-negative Staphylococcus (14.5%). Candida and Morganella spp were more common in children than in adults. Overall, antibiotic resistance was observed in seven different pathogens. The most common antibiotic resistances were to clindamycin and erythromycin, which should be considered when deciding initial antibiotic therapy, especially in adult patients, who trended in this study toward having pathogens with higher rates of resistance.

[Diagnosing and treatment of dental foci in Dutch medical centres]. / Odontogeen focusonderzoek in een selectie van Nederlandse medische centra.

Although not scientifically proven, dental foci are believed to result in severe local or systemic disease. Eradicating dental foci in order to prevent possible interference with a medical treatment may be important in specific patient groups. To gain insight in the number of dental focus examinations, the medical evidence, the number of potential foci determined, as well as the treatment eradicating the focus, all dental focus examinations in 16 Dutch hospitals were registered during 3 months. A total number of 470 examinations were performed. Scheduled heart(valve)surgery and radiotherapy of the head and neck were the main reasons for a dental focus examination. Dental foci were found and treated in more than 50% of the patients examined. There was a significant difference between dentate and edentulous patients in the percentage of patients diagnosed and treated for a dental focus. More than 80% of dentate and less than 20% of edentulous patients were treated.

[Clinical results of perftorane use in comprehensive treatment of patients with odontogenic phlegmons].

Analysis of data collected during observation upon 76 patients with odontogenic phlegmon of maxillofacial region of different severity in complex treatment plan of whom preparation Perftorane was included according to the worked out method. Based upon received clinical, morphological, cytological and biochemical results the conclusion was derived that the application of the worked out method of perftorane use optimized traditional method of treatment of patients with odontogenic phlegmon of maxillofacial region exerting antihypoxic, desintoxicatic and antioxidant actions that led finally to speedy clearing of suppurative focus and to stimulation reparative processes in the wound.