Clinical and laboratory indicators as determinants of a pattern in the evolution of serious oral infections - A 3-year retrospective study

Authors

DOI:

https://doi.org/10.33448/rsd-v11i12.34564

Keywords:

Abscess; Oral Diagnosis; Angina Ludwing.

Abstract

Objective: To evaluate possible clinical and laboratory indicators that could determine a pattern in the evolution of infections and guide professionals to take a better approach, avoiding further complications and bad results. Material and Methods: Data from 440 patients were collected during 3 years at Hospital Alípio Corrêa Netto. The data collection period was from July 2018 to July 2021. We analyzed whether the presence of underlying diseases, trismus, oral spaces and whether or not changes in laboratory tests could determine a pattern in the course of treatment of infections. Results: Mean age was 26.5 years. The main signs and symptoms were: Pain, Prostration, Trismus, Fever, Odynophagia and dyspnea. In 65% of cases, multiple spaces were involved in the infection. The underlying disease showed greater statistical significance. Patients with underlying disease needed to be treated with general anesthesia due to the greater degree of severity. The mean length of hospital stay was 8.1 days for systemically compromised patients versus 4.2 for healthy patients. The CRP value was strongly influenced by the underlying disease, with an average of 45 mg/L for compromised patients versus less than 20 mg/L for healthy patients. Conclusion: Systemic patients should be treated with greater attention, because they tend to have higher trismus, CRP values, need for treatment in the operating room and length of stay, especially in the ICU, which demonstrates a greater severity of cases. 

Author Biographies

Marcelo Teruyoshi Saizaki, Universidades Estadual Paulista

Departamento de Diagnóstico e Cirurgia da Faculdade de Odontologia da Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brasil.

Fernando Vagner Raldi, Universidade Estadual Paulista

Departmento de Diagnóstico e cirurgia da Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brasil.

Michelle Bianchi de Moraes, Universidades Estadual Paulista

Departamento de Diagnóstico e Cirurgia da Universidade Estadual Paulista

Rodrigo Dias Nascimento, Universidades Estadual Paulista

Departamento de Diagnóstico e Cirurgia da Universidade Estadual Paulista

References

Alotaibi, N., Cloutier, L., Khaldoun, E., Bois, E., Chirat, M., & Salvan, D. (2015). Criteria for admission of odontogenic infections at high risk of deep neck space infection. European Annals of Otorhinolaryngology, Head and Neck Diseases, 132(5), 261–264. https://doi.org/10.1016/j.anorl.2015.08.007

Atamna, H., Tenore, A., Lui, F., & Dhahbi, J. M. (2018). Organ Reserve, Excess Metabolic Capacity, and Aging. Biogerontology, 19(2), 171. https://doi.org/10.1007/S10522-018-9746-8

Bali, R. K., Sharma, P., Gaba, S., Kaur, A., & Ghanghas, P. (2015). A review of complications of odontogenic infections. National Journal of Maxillofacial Surgery, 6(2), 136. https://doi.org/10.4103/0975-5950.183867

Boffano, P., Roccia, F., Pittoni, D., di Dio, D., Forni, P., & Gallesio, C. (2012). Management of 112 hospitalized patients with spreading odontogenic infections: Correlation with DMFT and Oral Health Impact Profile 14 indexes. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 113(2), 207–213. https://doi.org/10.1016/j.tripleo.2011.02.006

Boscolo-Rizzo, P., Marchiori, C., Montolli, F., Vaglia, A., & da Mosto, M. C. (2006). Deep neck infections: A constant challenge. In ORL (Vol. 68, Issue 5, pp. 259–265). ORL J Otorhinolaryngol Relat Spec. https://doi.org/10.1159/000093095

Christensen, B. J., Park, E. P., Suau, S., Beran, D., & King, B. J. (2019a). Evidence-Based Clinical Criteria for Computed Tomography Imaging in Odontogenic Infections. Journal of Oral and Maxillofacial Surgery, 77(2), 299–306. https://doi.org/10.1016/j.joms.2018.09.022

Christensen, B. J., Racha, D., Hinkle, R., & Sahebi, M. (2020). Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections. Journal of Oral and Maxillofacial Surgery. https://doi.org/10.1016/j.joms.2020.06.032

Delbet-Dupas, C., Devoize, L., Mulliez, A., Barthélémy, I., & Dang, N. P. (2021). Does anti-inflammatory drugs modify the severe odontogenic infection prognosis? A 10-year’s experience. Medicina Oral, Patología Oral y Cirugía Bucal, 26(1), e28. https://doi.org/10.4317/MEDORAL.23926

Dowdy, R. A. E., Emam, H. A., & Cornelius, B. W. (2019). Ludwig’s Angina: Anesthetic Management. Anesthesia Progress, 66(2), 103. https://doi.org/10.2344/ANPR-66-01-13

Edwards, J. D., Sadeghi, N., Najam, F., & Margolis, M. (2004). Craniocervical necrotizing fasciitis of odontogenic origin with mediastinal extension. In Ear, Nose and Throat Journal (Vol. 83, Issue 8 SUPPL. 3, pp. 579–582). Medquest Communications LLC. https://doi.org/10.1177/014556130408300819

el Chakhtoura, N. G., Bonomo, R. A., & Jump, R. L. P. (2017). Influence of Aging and Environment on Presentation of Infection in Older Adults. Infectious Disease Clinics of North America, 31(4), 593. https://doi.org/10.1016/J.IDC.2017.07.017

Farmahan, S., Tuopar, D., Ameerally, P. J., Kotecha, R., & Sisodia, B. (2014). Microbiological examination and antibiotic sensitivity of infections in the head and neck. Has anything changed? British Journal of Oral and Maxillofacial Surgery, 52(7), 632–635. https://doi.org/10.1016/j.bjoms.2014.02.028

Flynn, T. R. (2001). The changing face of odontogenic infections. Journal of Oral and Maxillofacial Surgery, 59(7). https://doi.org/10.1053/joms.2001.24287

Flynn, T. R., Paster, B. J., Stokes, L. N., Susarla, S. M., & Shanti, R. M. (2012). Molecular methods for diagnosis of odontogenic infections. Journal of Oral and Maxillofacial Surgery, 70(8), 1854–1859. https://doi.org/10.1016/j.joms.2011.09.009

Flynn, T. R., Shanti, R. M., & Hayes, C. (2006). Severe Odontogenic Infections, Part 2: Prospective Outcomes Study. Journal of Oral and Maxillofacial Surgery, 64(7). https://doi.org/10.1016/j.joms.2006.03.031

Fu, B., McGowan, K., Sun, J. H., & Batstone, M. (2020). Increasing frequency and severity of odontogenic infection requiring hospital admission and surgical management. The British Journal of Oral & Maxillofacial Surgery, 58(4), 409–415. https://doi.org/10.1016/J.BJOMS.2020.01.011

Ghali, S., Katti, G., Shahbaz, S., Chitroda, P. K., Anukriti, V., Divakar, D. D., Khan, A. A., Naik, S., Al-Kheraif, A. A., & Jhugroo, C. (2021). Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging. World Journal of Clinical Cases, 9(3), 573. https://doi.org/10.12998/WJCC.V9.I3.573

Gordon, N. C., & Connelly, S. (2003). Management of head and neck infections in the immunocompromised patient. Oral and Maxillofacial Surgery Clinics of North America, 15(1), 103–110. https://doi.org/10.1016/S1042-3699(02)00079-1

Heim, N., Berger, M., Wiedemeyer, V., Reich, R., & Martini, M. (2019). A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. Journal of Cranio-Maxillofacial Surgery, 47(2), 334–340. https://doi.org/10.1016/j.jcms.2018.12.002

Heim, N., Wiedemeyer, V., Reich, R. H., & Martini, M. (2018). 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. Journal of Cranio-Maxillofacial Surgery, 46(12), 2220–2226. https://doi.org/10.1016/j.jcms.2018.10.013

Huang, T. T., Tseng, F. Y., Liu, T. C., Hsu, C. J., & Chen, Y. S. (2005a). Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngology - Head and Neck Surgery, 132(6), 943–947. https://doi.org/10.1016/j.otohns.2005.01.035

Inaco, C. L., F.M., E., & de, A. J. (2006). Descending mediastinitis: A review. Sao Paulo Medical Journal, 124(5).

Jevon, P., Abdelrahman, A., & Pigadas, N. (2020). Management of odontogenic infections and sepsis: an update. British Dental Journal, 229(6), 363–370. https://doi.org/10.1038/s41415-020-2114-5

Juncar, M., Popa, A. R., Baciuţ, M. F., Juncar, R. I., Onisor-Gligor, F., Bran, S., & Bǎciuţ, G. (2014). Evolution assessment of head and neck infections in diabetic patients - A case control study. Journal of Cranio-Maxillofacial Surgery, 42(5), 498–502. https://doi.org/10.1016/j.jcms.2013.06.009

Jundt, J. S., & Gutta, R. (2012). Characteristics and cost impact of severe odontogenic infections. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 114(5), 558–566. https://doi.org/10.1016/j.oooo.2011.10.044

Kang, S. H., & Kim, M. K. (2019). Antibiotic sensitivity and resistance of bacteria from odontogenic maxillofacial abscesses. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 45(6), 324–331. https://doi.org/10.5125/jkaoms.2019.45.6.324

Keswani, E. S., & Venkateshwar, G. (2019). Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai. In Journal of Maxillofacial and Oral Surgery (Vol. 18, Issue 3, pp. 345–353). Springer. https://doi.org/10.1007/s12663-018-1152-x

Kim, M. K., Nalliah, R. P., Lee, M. K., & Allareddy, V. (2012a). Factors associated with length of stay and hospital charges for patients hospitalized with mouth cellulitis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 113(1). https://doi.org/10.1016/j.tripleo.2011.01.012

Kristensen, M. S. (2010). Airway management and morbid obesity. In European Journal of Anaesthesiology (Vol. 27, Issue 11, pp. 923–927). https://doi.org/10.1097/EJA.0b013e32833d91aa

L., S., A., L., C., L., R., S., & R., R. (2008). Analysis of systemic and local odontogenic infection complications requiring hospital care. Journal of Infection, 57(2).

Mahmoodi, B., Weusmann, J., Azaripour, A., Braun, B., Walter, C., & Willershausen, B. (2015). Odontogenic Infections: A 1-year Retrospective Study. The Journal of Contemporary Dental Practice, 16(4), 253–258. https://doi.org/10.5005/jp-journals-10024-1671

Mirochnik, R., Araidy, S., Yaffe, V., & El-Naaj, I. A. (2017). Severity Score as a Prognostic Factor for Management of Infections of Odontogenic Origin, a Study of 100 Cases. Open Journal of Stomatology, 07(01), 25–34. https://doi.org/10.4236/ojst.2017.71002

Neff, S. P. W., Merry, A. F., & Anderson, B. (1999). Airway management in Ludwig’s angina. Anaesthesia and Intensive Care, 27(6), 659–661. https://doi.org/10.1177/0310057x9902700323

Poeschl, P. W., Spusta, L., Russmueller, G., Seemann, R., Hirschl, A., Poeschl, E., Klug, C., & Ewers, R. (2010). Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 110(2), 151–156. https://doi.org/10.1016/J.TRIPLEO.2009.12.039

Pynn, B. R., Sands, T., & Pharoah, M. J. (1995). Odontogenic infections: Part one. Anatomy and radiology. In Oral health (Vol. 85, Issue 5).

Quinn, F. B. (1999). Ludwig angina. Archives of Otolaryngology--Head & Neck Surgery, 125(5), 599. https://doi.org/10.1001/ARCHOTOL.125.5.599

Rao, D. D., Desai, A., Kulkarni, R. D., Gopalkrishnan, K., & Rao, C. B. (2010). Comparison of maxillofacial space infection in diabetic and nondiabetic patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 110(4), e7–e12. https://doi.org/10.1016/j.tripleo.2010.04.016

Riekert, M., Kreppel, M., Zöller, J. E., Zirk, M., Annecke, T., & Schick, V. C. (2019). Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions. Oral and Maxillofacial Surgery, 23(3), 331–336. https://doi.org/10.1007/s10006-019-00770-5

Saifeldeen, K., & Evans, R. (2004). Ludwig’s angina. In Emergency Medicine Journal (Vol. 21, Issue 2, pp. 242–243). British Association for Accident and Emergency Medicine. https://doi.org/10.1136/emj.2003.012336

Sainuddin, S., Hague, R., Howson, K., & Clark, S. (2017). New admission scoring criteria for patients with odontogenic infections: a pilot study. British Journal of Oral and Maxillofacial Surgery, 55(1), 86–89. https://doi.org/10.1016/j.bjoms.2016.05.003

Sandner, A., & Börgermann, J. (2011). Update on necrotizing mediastinitis: Causes, approaches to management, and outcomes. Current Infectious Disease Reports, 13(3), 278–286. https://doi.org/10.1007/s11908-011-0174-z

Sharma, A., Giraddi, G., Krishnan, G., & Shahi, A. K. (2014). Efficacy of Serum Prealbumin and CRP Levels as Monitoring Tools for Patients with Fascial Space Infections of Odontogenic Origin: A Clinicobiochemical Study. Journal of Maxillofacial and Oral Surgery, 13(1). https://doi.org/10.1007/s12663-012-0376-4

Tan, F. Y., Selvaraju, K., Audimulam, H., Yong, Z. C., Adnan, T. H., & Balasundram, S. (2021). Length of hospital stay among oral and maxillofacial patients: a retrospective study. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 47(1), 25. https://doi.org/10.5125/JKAOMS.2021.47.1.25

Vytla, S., Gebauer, D., Perth Hospital, R., Australia, W., & Surgery, M. (2017). Clinical guideline for the management of odontogenic infections in the tertiary setting. Australian Dental Journal, 62(4), 464–470. https://doi.org/10.1111/ADJ.12538

Witherow, H., Swinson, B. D., Amin, M., Kalavrezos, N., & Newman, L. (2004). Management of oral and maxillofacial infection. In Hospital Medicine (Vol. 65, Issue 1). https://doi.org/10.12968/hosp.2004.65.1.2415

Yang, W., Hu, L., Wang, Z., Nie, G., Li, X., Lin, D., Luo, J., Qin, H., Wu, J., Wen, W., & Lei, W. (2015). Deep Neck Infection: A Review of 130 Cases in Southern China. Medicine, 94(27), e994. https://doi.org/10.1097/MD.0000000000000994

Yew, C. C., Sivamuni, S. S., Khoo, S. E., Yuen, K. M., & Tew, M. M. (2021a). Clinical Management of Orofacial Odontogenic Infection: A FourYear Retrospective Study. Archives of Orofacial Sciences, 16(1), 25–37. https://doi.org/10.21315/aos2021.16.1.3

Ylijoki, S., Suuronen, R., Jousimies-Somer, H., Meurman, J. H., & Lindqvist, C. (2001). Differences between patients with or without the need for intensive care due to severe odontogenic infections. Journal of Oral and Maxillofacial Surgery, 59(8). https://doi.org/10.1053/joms.2001.25017

Yuvaraj, V. (2016). Maxillofacial Infections of Odontogenic Origin: Epidemiological, Microbiological and Therapeutic Factors in an Indian Population. Indian Journal of Otolaryngology and Head and Neck Surgery, 68(4), 396–399. https://doi.org/10.1007/s12070-015-0823-x

Zeitoun, I. M., & Dhanarajani, P. J. (1995). Cervical cellulitis and mediastinitis caused by odontogenic infections. Report of two cases and review of literature. Journal of Oral and Maxillofacial Surgery, 53(2). https://doi.org/10.1016/0278-2391(95)90404-2

Zheng, L., Yang, C., Zhang, W., Cai, X., Jiang, B., Wang, B., Pu, Y., Jin, J., Kim, E., Wang, J., Zhang, Z., Zhou, L., Zhou, J., & Guan, X. (2013). Comparison of multi-space infections of the head and neck in the elderly and non-elderly: Part i the descriptive data. Journal of Cranio-Maxillofacial Surgery, 41(8), e208–e212. https://doi.org/10.1016/j.jcms.2013.01.020

Published

13/09/2022

How to Cite

SAIZAKI, M. T.; RALDI, F. V.; MORAES, M. B. de .; NASCIMENTO, R. D. Clinical and laboratory indicators as determinants of a pattern in the evolution of serious oral infections - A 3-year retrospective study. Research, Society and Development, [S. l.], v. 11, n. 12, p. e250111234564, 2022. DOI: 10.33448/rsd-v11i12.34564. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/34564. Acesso em: 26 nov. 2024.

Issue

Section

Health Sciences