Undetected permanent dental inflammation as a possible trigger for brain abscesses? A retrospective analysis over the last 2 decades.

BACKGROUND: Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting. METHODS: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin. RESULTS: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal. CONCLUSION: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.

Pattern Of The Oro-Facial Infections In Patients Presenting To Ayub Medical Institute, Abbottabad.

BACKGROUND: Orofacial space infections are commonly odontogenic in origin and the anatomical locations along with mode of spread to critical areas (e.g., orbit, brain, mediastinum) can result in morbidly and mortality if not diagnosed and treated well in time. This study was aimed to analyzing the incidence and pattern of oro-facial infections. METHODS: This Descriptive case series was carried out at Oral Surgery unit (Ayub Medical College) Abbottabad from January 2016 - May 2017. The sample was collected using purposive, consecutive non-probability sampling. The demographic data, infection site and clinical features were recorded. The data was analyzed by using SPSS version 21. All the descriptive variables were analyzed for percentages & frequencies. RESULTS: Thirty-six patients were included in the study. The male (23) to female (13) ratio was (1.7:1). Right Submandibular space was most common site. In one case each, there was involvement of retropharyngeal and retromandibular space. Majority of the patients presented with swelling (88.89%). Diabetes mellitus was the most commonly found systemic disorder in the patients affecting aggressiveness of infection. Conclusion: The most common source of odontogenic facial space infections is mandibular molars resulting spread to submandibular space. Diabetes Mellitus was the most common systemic disorder affecting host immunity. The proximity of oro-facial spaces with the critical areas makes it crucial for clinicians to identify the condition promptly and provide pertinent treatment in order to avoid the fatal complications as the rate of spread of facial space infection is very rapid.

Necesidad y tipo de tratamiento en cirugía bucomaxilofacial durante la pandemia por COVID-19 en un servicio de urgencias odontológicas del AMBA / Need and type of treatment in maxillofacial surgery during the COVID-19 pandemic in a dental emergency department in the AMBA

Objetivo: Analizar y describir los requerimientos de atención quirúrgica bucomaxilofacial de urgencia en el Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires durante el aislamiento social preventivo y obligatorio por la pandemia de COVID-19. Materiales y métodos: Se realizó un estudio observacional descriptivo de análisis retrospectivo durante el período de aislamiento social preventivo y obligatorio inicial de 93 días, comprendido entre el 20 de marzo y el 20 de junio de 2020. Se evaluó la totalidad de historias clínicas de los pacientes que acudieron al Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires y se caracterizó a aquellos que requerían distintos tipos de tratamiento quirúrgico bucal y maxilofacial. Resultados: Durante el período estudiado, se atendieron 4564 pacientes, de los cuales 1337 (29,3%) requirieron tratamientos quirúrgicos como terapéutica para la resolución de la urgencia. De estos, el 93,2% fueron exodoncias de piezas erupcionadas o retenidas; el 1,7%, biopsias quirúrgicas; el 2,4%, tratamientos agudos de infecciones que involucran espacios anatómicos vecinos; el 0,8%, resolución de traumatismos en los maxilares, y el 1,9%, tratamientos de complicaciones posquirúrgicas. Conclusión: Los resultados ponen de relieve la necesidad de disponer de servicios de guardia odontológica en el ámbito del AMBA que cuenten con recursos humanos calificados y entrenados para resolver urgencias de tipo quirúrgico

Aim: The objective of this study was to analyze and describe the requirements for the emergency care of oral and maxillofacial surgical treatment in the emergency dental department of the School of Dentistry of the University of Buenos Aires during the Preventive and Mandatory Social Isolation. Materials and methods: We conducted a retrospective analysis of a descriptive observational study during the initial period of 93 days of Preventive and Compulsory Social Isolation, from March 20, 2020 to June 20, 2020. All the medical records of the patients who attended the emergency dental department of the School of Dentistry of the University of Buenos Aires were evaluated and those who required different types of oral and maxillofacial surgical treatment were characterized. Results: A total of 4564 patients were attended during the period studied, of which 1337 (29.3%) required surgical treatment as a therapy for the resolution of their emergencies. Of these, 93.2% were exodontia of erupted or retained teeth, 1.7% surgical biopsies, 2.4% acute treatment of infections involving neighboring anatomical spaces, 0.8% resolution of maxillary alveolar trauma and 1.9% treatment of post-surgical complications. Conclusion: The results highlight the need to have dental emergency services in the AMBA area that have qualified and trained human resources to solve the surgical type emergencies that may arise (AU)

Odontogenic Head and Neck Region Infections Requiring Hospitalization: An 18-Month Retrospective Analysis.

The aim of this study was to comprehensively review our experience with odontogenic infections in the head and neck region requiring treatment at a national referral center. We retrospectively reviewed 85 patients treated at the Chair and Clinic of Maxillofacial Surgery of the University Hospital in Wroclaw between January 2018 and June 2019. We excluded patients with nonondontogenic infections or other than purulent clinical forms of dentivitis in the head and neck region. Several demographic, clinicopathological, and treatment variables were assessed. The majority of patients were men who were referred for inpatient treatment by a dentist or family doctor, presented to the Hospital Emergency Ward (SOR) by themselves, or transported to the SOR by paramedics SOR from their home or another hospital. All patients were treated in accordance with the current guidelines for head and neck region odontogenic infections. An incision was made and the abscess was drained. The odontogenic cause was removed followed by the collection of tissue for microbiological examination. The course of infection was monitored by means of laboratory parameters such as leukocyte counts and c-reactive protein levels. Odontogenic infections in the head and neck region are a persistent and common problem. Rapid, accurate diagnosis and treatment minimizes the risk of life-threatening complications, shortens the hospitalization period, and lowers treatment costs.

Screening of dental and sinus infections in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased risk of infections. Screening for oral (dental and/or sinus) infection could be proposed before biologic disease-modifying antirheumatic drugs (bDMARDs) initiation but is not systematically recommended. The aim of our study was to assess the prevalence of oral infection in RA patients requiring bDMARDs. MATERIALS AND METHODS: This was a monocentric retrospective study. We included patients with RA and active disease requiring bDMARDs. Dental infection and sinusitis were assessed by a stomatologist and otorhinolaryngologist after clinical, panoramic dental X-ray and sinus CT evaluation. Factors associated with oral infections were analysed in uni- and multivariate models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included 223 RA patients (79.4% women, mean disease duration 8.9 ± 8.6 years). The mean age was 54.4 ± 10.9 years and mean Disease Activity Score in 28 joints 5.5 ± 2.6. Systematic dental screening revealed infection requiring treatment before bDMARDs initiation in 46 (20.9%) patients. Sinusitis was diagnosed by the otorhinolaryngologist in 33 (14.8%) patients. Among the 223 patients, 69 (30.9%) had dental and/or sinus infection. On univariate analysis, active smoking was associated with increased probability of oral infection (OR = 2.16 [95% CI 1.02-4.57], P = .038) and methotrexate with reduced probability (OR = 0.43 [95% CI 0.23-0.81], P = .006). On multivariate analysis, no RA variables were associated with oral infection. CONCLUSION: In our study, asymptomatic oral infection was confirmed in one third of RA patients.

Necesidad y tratamiento en la población infantil y juvenil durante la pandemia COVID-19 / Needs and treatment in children and youths population during the COVID-19 pandemic

Objetivos: analizar y describir los requerimientos de atención quirúrgica y no quirúrgica de urgencia en la población infantil y juvenil en un servicio de urgencias de Argentina durante el aislamiento social preventivo y obligatorio (ASPO). Materiales y métodos: se realizó un estudio observacional y descriptivo de análisis retrospectivo durante el período inicial de 93 días de ASPO, comprendido entre 20 de marzo de 2020 hasta el 20 de junio de 2020. Se registraron los pacientes menores de 17 años que acudieron al servicio de urgencias del Hospital Odontológico de la Universidad de Buenos Aires y se caracterizó aquellos que requerían distintos tipos de tratamientos. Resultados: se atendieron 4654 pacientes durante el periodo estudiado, de los cuales 116 eran menores de 17 años. Se realizaron 142 prestaciones. A 63 piezas dentarias se les realizó la exodoncia. A otras 63, algún tipo de tratamiento endodóntico. 11 piezas requirieron de restauraciones directas, y en 5 se realizaron otros tipos de tratamientos. Conclusión: fue importante la presencia de recurso humano calificado en el área de la cirugía bucal y pediátrica en los servicios de guardia, considerando el incremento sustancial de necesidad de tratamiento suscitado durante el ASPO (AU)

Objective: to analyse and describe the requirements for emergency surgical and non-surgical care in the paediatric population in an emergency department in Argentina during Preventive and Mandatory Social Isolation. Materials and Methods: an observational, descriptive, retrospective study was conducted during the initial period of 93 days of Preventive and Mandatory Social Isolation, from March 20, 2020 to June 20, 2020. Patients under 17 years of age who attended the emergency department of the Dental Hospital of the University of Buenos Aires were registered and those requiring different types of treatment were characterised. Results: 4654 patients were seen during the period studied, 116 of whom were under 17 years of age. A total of 142 services were performed. Sixty-three teeth were exodontically extracted. A further 63 underwent some form of endodontic treatment. 11 teeth required direct restorations and 5 required other types of treatment. Conclusion: the presence of qualified human resources in oral and paediatric surgery in the on-call services was important, considering the substantial increase in the need for treatment during the ASPO (AU)

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.

Celulitis facial odontógena en pacientes del Hospital Lenin de Holguín / Odontogenic Facial Cellulitis in Patients from Lenin Hospital of Holguín

Introducción: la celulitis odontógena es una inflamación difusa del tejido celular subcutáneo que se extiende por los espacios entre el tejido celular a más de una región anatómica a causa de la infección de uno o varios dientes o de enfermedades asociadas al tejido dentario o de sostén. Es una de las infecciones más frecuente y la urgencia más grave que puede presentarse en la práctica esto­matológica.Objetivo: caracterizar el comportamiento de la celulitis facial odontógena en los pacientes atendidos en el Hospital Vladímir Ilich Lenin, Holguín.Métodos: se realizó un estudio descriptivo de serie de casos durante los años 2014 y 2015. El universo estuvo constituido por 54 pacientes con celulitis facial odontógena, la muestra quedó conformada por 51 pacientes. Las variables estudiadas fueron: sexo, grupos de edad, etiología, grupo dentario, regiones anatómicas y clasificación clínica.Resultados: existió un predominio del sexo masculino y el grupo de edad de 35-59 años representado por el 62,75 por ciento y el 60,78 por ciento respectivamente. La principal etiología fue la caries dental con el 68,63 por ciento. El grupo dentario de los molares inferiores fue el más afectado con un 41,18 por ciento. La región submandibular fue la más afectada en el 25,49 por ciento. La celulitis moderada resultó ser la más frecuente representando el 74,51 por ciento.Conclusiones: la etiología de la infección fue variada al igual que las regiones anatómicas afectadas.(AU)

Introduction: odontogenic cellulitis is an undefined inflammation of the subcutaneous cell tissue that spreads over the spaces between the cell tissue in addition to an anatomic region because of the infection of one or several teeth or of correlated conditions of the dental and support tissues. It is one of the most frequent infections and the most serious urgency that can be presented in stomatological practice.Objective: to characterize the odontogenic facial cellulitis incidence in the patients attended at Vladímir Ilich Lenin Hospital, Holguín.Method: a descriptive study of series of cases was performed during the years 2014 and 2015. The universe was composed of 54 patients with odontogenic facial cellulitis. The sample comprised 51 patients. The studied variables were: sex, age bracket, etiology, dental group, anatomic regions and clinical classification.Results: the male sex was the most frequently affected and the age group between 35-59 representing 62.75 percent and 60.78 percent respectively. The main etiology was the dental cavity with 68.63 percent. The dental group of the inferior molars was the most affected one (41.18 percent). The region submandibular was the most affected one in 25.49 percent of patients. The moderate cellulitis turned out to be the most frequent, representing 74.51 percent.Conclusions: the etiology of infection was varied just like the anatomic affected regions.(AU)

Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX.

BACKGROUND: There were 2 main purposes of this retrospective chart review study. The first was to describe the demographic, social, and financial characteristics of patients with severe odontogenic infections. The second was to assess the relationships among several demographic, social, and treatment variables and length of stay (LOS) in the hospital and hospital bill (charges). METHODS: The authors conducted a retrospective chart review for patients admitted to the hospital and taken to the operating room for treatment of severe odontogenic infections at 3 hospitals in Houston, TX (Ben Taub, Memorial Hermann Hospital, and Lyndon B. Johnson) from January 2010 through January 2015. RESULTS: The authors included data from severe odontogenic infections in 298 patients (55% male; mean age, 38.9 years) in this study. In this population, 45% required admission to the intensive care unit, and the mean LOS was 5.5 days. Most patients (66.6%) were uninsured. The average cost of hospitalization for this patient population was $13,058, and the average hospital bill was $48,351. At multivariable analysis, age (P = .011), preadmission antibiotic use (P = .012), diabetes mellitus (P = .004), and higher odontogenic infection severity score (P < .001) were associated with increased LOS. Higher odontogenic infection severity score, diabetes mellitus, and an American Society of Anesthesiologists score of 3 or more were associated with an increased charge of hospitalization. CONCLUSIONS: Severe odontogenic infections were associated with substantial morbidity and cost in this largely unsponsored patient population. The authors identified variables associated with increased LOS and charge of hospitalization. PRACTICAL IMPLICATIONS: Clinicians should consider these findings in their decision-making processes and prioritize early treatment of odontogenic infections potentially to decrease the number of patients admitted to the hospital, LOS, and overall costs of treatment for these infections.

Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?

PURPOSE: On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS: A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS: Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION: After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN).

OBJECTIVES: This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany. METHODS: From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models. RESULTS: Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities. CONCLUSION: This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities. CLINICAL RELEVANCE: Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

Odontogenic infections in a dental emergency care unit: Eleven-year epidemiological analysis

Aim: To evaluate medical records from patients who underwent abscess drainage due to odontogenic infections in a public hospital in the city of Belo Horizonte (Minas Gerais, Brazil) during the period of 2003 and 2013. Methods: A retrospective analysis of cases which required drainage of abscesses due to dental infections. The types of therapeutic procedures analyzed were endodontic drainage, intraoral mucosa drainage, periodontal drainage, and extraoral drainage. Results: 162,902 cases required dental assistance, and 32,352 cases required drainage of abscesses due to dental infections. The most frequent approach was endodontic drainage (21,313 procedures); the least frequent procedure was extraoral drainage (922 procedures). Conclusions: Odontogenic infection is a common clinical condition in dental clinics. It should be diagnosed and treated as quickly as possible to avoid or minimize progression to more severe cases. (AU)

Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery.

OBJECTIVE: To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. STUDY DESIGN: This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value < .05 was considered to be statistically significant. RESULTS: One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides. CONCLUSIONS: MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery.

Odontogenic cervical necrotizing fasciitis, etiological aspects.

INTRODUCTION: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. MATERIALS AND METHODS: In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. RESULTS: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). CONCLUSION: The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.

Risk Factors for Life-Threatening Complications of Maxillofacial Space Infection.

The purpose of this study was to review the clinical features of maxillofacial space infection (MSI), and to identify the potential risk factors predisposing to life-threatening complications. A retrospective review of the medical charts of patients with MSI treated at Peking University School and Hospital of Stomatology from August 2008 to September 2013 was conducted. A total of 127 patients [75 men (59.1%) and 52 women (40.9%); mean age, 45.39 ± 21.18 years, with a range of 1-85 years] formed the study cohort. The most common cause of MSI was odontogenic infection (57.5%). The most common space involved was the submandibular space. All patients were treated by antibiotics as well as surgical incision and drainage. Sixteen patients developed life-threatening complications, and the dominant complication was respiratory obstruction. Multivariate logistic regression analysis revealed the percentage of neutrophils (NEUT%) upon hospital admission ≥ 85.0% to be associated with life-threatening complications (P < 0.05). Even though adequate antibiotic therapy and incision and drainage of abscess were given, MSI patients with NEUT% upon hospital admission ≥ 85.0% carry a higher risk of life-threatening complications. In these patients, an aggressive treatment strategy is mandatory.

Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?

AIM: This is a retrospective study to review the treatment and management of patients presenting with odontogenic infections in a large urban teaching hospital over a four-year period, comparing the number and complexity of odontogenic infections presenting to an acute general hospital in two periods, as follows: Group A (January 2008 to March 2010) versus Group B (April 2010 to December 2011). The background to the study is 'An alteration in patient access to primary dental care instituted by the Department of Health in April 2010'. OBJECTIVES: a) to identify any alteration in the pattern and complexity of patients' presentation with odontogenic infections following recent changes in access to treatment via the Dental Treatment Services Scheme (DTSS) and the Dental Treatment Benefit Scheme (DTBS) in April 2010; and, b) to evaluate the management of severe odontogenic infections. METHOD: Data was collated by a combination of a comprehensive chart review and electronic patient record analysis based on the primary discharge diagnosis as recorded in the Hospital In-Patient Enquiry (HIPE) system. RESULTS: Fifty patients were admitted to the National Maxillofacial Unit, St James's Hospital, under the oral and maxillofacial service over a four-year period, with an odontogenic infection as the primary diagnosis. There was an increased number of patients presenting with odontogenic infections during Group B of the study. These patients showed an increased complexity and severity of infection. Although there was an upward trend in the numbers and complexity of infections, this trending did not reach statistical significance. CONCLUSIONS: The primary cause of infection was dental caries in all patients. Dental caries is a preventable and treatable disease. Increased resources should be made available to support access to dental care, and thereby lessen the potential for the morbidity and mortality associated with serious odontogenic infections. The study at present continues as a prospective study.

Incidence and management of severe odontogenic infections-a retrospective analysis from 2004 to 2011.

The management of odontogenic infections is a typical part of the spectrum of maxillofacial surgery. Normally these infections can be managed in a straight forward way however under certain conditions severe and complicated courses can arise which require interdisciplinary treatment including intensive care. A retrospective analysis of all patients affected by an odontogenic infection that received surgical therapy from 2004 to 2011 under stationary conditions was performed. Surgical treatment consisted in incision and drainage of the abscess supported by additional i.v. antibiotic medication in all patients. Detailed analysis of all patients that required postoperative intensive medical care was additionally performed with respect to special risk factors. During 8 years 814 patients affected by odontogenic infections received surgical treatment under stationary conditions representing 4% of all patients that have been treated during that period (n = 18981). In 14 patients (1.7%) intensive medical therapy after surgery was required, one lethal outcome was documented (0.12%). In all of these 14 patients a history of typical risk factors was present. According to these results two patients per week affected by an odontogenic infection required stationary surgical treatment, about two patients per year were likely to require additional intensive medical care. If well-known risk factors are present in patients affected by odontogenic infection appropriate interdisciplinary management should be considered as early as possible.

Poor Oral Health Linked with Increased Risk of Infectious Complications in Adults with Leukemia.

OBJECTIVE: The objective of this study is to examine the impact of the presence of gingivitis/periodontitis on the occurrence of infectious complications (including septicemia, bacterial infections, and mycoses) in hospitalized leukemic adults in the United States. METHODS: A retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2004-2010 was performed. All hospitalized leukemic patients aged 18 to 65 years were selected. The association between occurrence of gingivitis/periodontitis and infectious complications was examined by multivariable logistic regression models. A total of 135,692 hospitalizations were due to leukemias during the study period. Among these, gingivitis/periodontitis was present in 0.6%. Septicemia occurred in 27.8% of those who had gingivitis/periodontitis (compared to 19.6% in those without gingivitis/periodontitis), bacterial infections occurred in 19.5% of those who had gingivitis/periodontitis (compared to 10.1% in those without gingivitis/periodontitis), and mycoses occurred in 20.7% of those who had gingivitis/periodontitis (compared to 10.7% in those without gingivitis/periodontitis). Patients who had gingivitis/periodontitis were associated with significantly higher odds for septicemia (OR = 1.58, 95% CI = 1.14-2.19, p = 0.01), bacterial infections (OR = 2.15, 95% CI = 1.51-3.07, p<0.01), mycoses (OR = 2.16, 95% CI = 1.43-3.28, p<0.01), or any infectious complication (OR = 2.15, 95% CI = 1.63-2.84, p<0.01) when compared to their counterparts following adjustment for multiple patient and hospital-level confounding factors. CONCLUSIONS: Poor oral health (as defined by the presence of gingivitis/periodontitis) is an independent predictor of increased risk of infectious complications in hospitalized leukemic adults in the United States.

Do anti-inflammatory drugs worsen odontogenic cervico-facial cellulitis?

OBJECTIVE: The aim of this prospective study was to determine the influence of anti-inflammatory drugs on the severity of odontogenic cellulitis in patients admitted to our hospital emergency unit. STUDY DESIGN: The study was made from April 30 to October 31 2006. The clinical and pharmacological data was prospectively collected at admission, during hospitalization, and during systematic follow-up. We first studied the whole population and then compared the 2 groups: patients having received anti-inflammatory drugs before admission or not. RESULTS: Two hundred and sixty-seven patients were included. The only severity criterion significantly different between the 2 groups was spreading of cervical lymphangitis (P=0.028). None of the 4 studied parameters was identified as a risk factor for spreading of cervical lymphangitis in multivariate analysis: anti-inflammatory use (OR=5.99, 95%CI [0.71-50.88]), alcohol abuse (OR=4.00, 95%CI [0.66-24.12]), dental hygiene (OR=1.53, 95%CI [0.36-6.56]), and tobacco use (OR=0.27, 95%CI [0.57-1.28]). DISCUSSION: The use of anti-inflammatory drugs during the initial phase of an odontogenic infection was not related to the severity of infection.