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Objectives: Aim of this study was to analyse causal microbiological agents and their bacterial resistance in orofacial infections requiring hospital admission. Materials and methods: Presented is a 10-year retrospective study of patients hospitalised at a single department in 2014–2023. 744 patients were involved. In the statistical analysis, following data was evaluated: causal microbes and their resistance to Penicillin, Amoxicillin-Clavulanate, Clindamycin and Metronidazole. Results: Most frequent aetiology was odontogenic with causal tooth in socket (n = 468; 62,9%), followed by odontogenic – post extraction (n = 152; 20.4%), jaw fracture (n = 41; 5.5%), sialadenitis n = 31 (4.2%), osteonecrosis n = 22 (3.0%), oncological diagnosis in head and neck (n = 17; 2.3%), unknown (n = 10; 1.3%) and multiple factors (n = 3; 0.4%). 408 patients (54.8%) underwent extraoral abscess revision, 336 patients (45.2%) patients were treated locally without extraoral revision. In odontogenic group with tooth still present, superior CRP (m = 145.8 mg/l; SD = 117.7) and leukocyte values (m = 13.6*109l; SD = 6.6) were observed in comparison to other groups. There were 698 cultivated bacteria in 362 patients. Most frequent bacteria were Streptococci (n = 162; 23.2%), Prevotella (n = 83; 11.2%) and Parvimonas (n = 65; 9.3%). Clindamycin resistance was highest (n = 180 resistant bacteria; 25.8%), followed by Metronidazole (n = 178; 25.5%), Penicillin (n = 107; 15.3%) and Amoxicillin-Clavulanate (n = 34; 4.9%). Conclusions: Orofacial infections in head and neck region are mostly of odontogenic origin with causal tooth still in socket. Causal bacteria show a high antibiotic resistance rate, especially to Clindamycin and Metronidazole. Clinical Relevance: Acquired data will be used to determine guidelines for empirical antibiotic prescription in cases of orofacial infections. [ABSTRACT FROM AUTHOR]

Objectives: Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. Results: The total standardized incidence rate of MSI-associated procedures in the observational period 2005—2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI – related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. Conclusions: Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. Clinical relevance: Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support. [ABSTRACT FROM AUTHOR]

Most odontogenic and intraoral abscesses can be treated on an outpatient basis with local anesthesia. However, severe disease progression may require an incision under general anesthesia (GA) with postoperative inpatient treatment. This study aimed to evaluate the first "COVID-19 year" in Germany and compare the first "COVID-19 year" with the two previous years. All consecutive cases with odontogenic or intraoral abscesses treated in an outpatient or inpatient setting between 2018 and 2021 were included in this study. Data were collected, including the type of anesthesia, length of hospital stay, and healthcare costs. Despite the lower total number of abscess treatments in the first year of COVID-19 (n = 298 patients) than that in the two previous years (n = 663 patients), the number of advanced abscesses requiring intervention under GA was significantly higher (p < 0.001). This increased burden of care was also reflected in increased healthcare costs. The measures taken against the COVID-19 pandemic had an impact on the course of other diseases, for example, odontogenic and intraoral abscesses. The results showed an emerging conflict in patient care during the pandemic crisis that should be considered in possible future pandemics. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack–Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack–Lehane grade were reliable predictors of difficult intubation. [ABSTRACT FROM AUTHOR]

Infection of an injectable soft tissue filler may involve fascial spaces and appears similar to an odontogenic abscess. This case report addresses a 32‐year‐old female patient with facial swelling who was referred to the department of endodontics for the treatment of a suspected odontogenic infection. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy. Materials and methods: A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab. Results: Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%). Conclusion: Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy. Clinical relevance: Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment. [ABSTRACT FROM AUTHOR]

Objectives: Although many physicians in daily practice assume a connection between odontogenic infections and meteorological parameters, this has not yet been scientifically proven. Therefore, the aim of the present study was to evaluate the incidence of odontogenic abscess (OA) in relation to outdoor temperature and atmospheric pressure. Patients and methods: An analysis of patients with an odontogenic abscess who presented at the emergency department within a period of 24 months was performed. Only patients who had not received surgical or antibiotic treatment prior to presentation and who lived in Berlin/Brandenburg were included. The OA incidence was correlated with the mean/maximum outdoor temperature and atmospheric pressure starting from 14 days before presentation. The statistical analysis was carried out using Poisson regression models with OA incidence as dependent and meteorological parameters as independent variables. Results: A total of 535 patients (mean age 39.4 years; range 1 to 95 years) with 538 cases were included. Of these, 227 were hospitalized. The most frequent diagnosis was a canine fossa abscess. A significant association between mean (p = 0.0153) and maximum temperature (p = 0.008) on the day of the presentation and abscess incidence was observed. Furthermore, a significant correlation between OA incidence and maximum temperature 2 days before presentation was found (p = 0.034). The deviation of the mean temperature on the day of the presentation from the monthly mean temperature had a significant influence (p = 0.021) on the incidence of OA. In contrast to temperature, atmospheric pressure had no significant influence on the incidence of OA. Conclusion: This study supports a relationship between the incidence of odontogenic abscess and outdoor temperature, but not atmospheric pressure. A significantly higher frequency of patients with an OA presented at our emergency department on days with (comparably) low and high outdoor temperatures. Furthermore, a significant correlation between incidence and maximum temperature 2 days before presentation was found. Clinical relevance: The treatment of odontogenic infections has become a significant economic burden to public health care facilities. The results of this study may help to adapt the numbers of doctors/dentists on duty in relation to different weather conditions. In any case, it is an impetus to think outside the box. [ABSTRACT FROM AUTHOR]

Background:Clostridium difficile (CD) is the major cause of nosocomial antibiotic-associated infections, having as main manifestation diarrhea and life-threatening inflammation of the colon. Surgery may be necessary in up to 80% of patients due to the frequent complications associated with this condition. The mortality rate of this devastating disease could reach 50% even after proper treatment. Case report: We report a case of a 24-year-old female who was admitted with clinical signs of an odontal inflammatory process. After repeated surgical treatments and antibiotic therapy, she presented acute abdominal pain on the 14th postoperative day. The explorative laparotomy was negative. Clostridium difficile was isolated from her stool, and she was transferred to the Department of Infectious Diseases. After a few days without any favorable clinical outcome, she was transferred to the intensive care unit (ICU), where she developed acute respiratory distress syndrome. Despite the immediate surgical intervention and ICU care, she died within 15 days after admission. Conclusions: CD infection is considered a complication of antibiotic treatment, having as main cause the combination of fluoroquinolones with antisecretory drugs. In the first phase, the changes of the colon can be minimal with the manifestation of a false acute surgical abdomen, but toxic colon can develop in evolution, leading to multi-system organ failure and death. [ABSTRACT FROM AUTHOR]

Objectives: Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus. Material and methods: A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction. Results: Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS. Conclusion: Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage. Clinical relevance: Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended. [ABSTRACT FROM AUTHOR]

Introduction: Intraoral abscesses are mainly odontogenic abscesses which need ambulatory treatment, which often involves the extraction of the causal tooth.///This is a clinical analysis of occurrence and treatment of an odontogenic abscess in patients of The Department Oral Surgery at the Pomeranian Medical University in Szczecin treated between 2010-2016.///Material/Methods: The estimate made was based on medical records between the years 2010-2016. Research applied to 327 patients, comprising 183 males and 144 females. The age of the patients ranged from 3 to 87. In the data analysis the patients' demographic data, treatment, location and causes of abscess were taken into account.///Results: The largest age group in which abscesses occurred was comprised of people between the ages of 21-30. Abscess occurrence was more common in males. The molar was the most common causal tooth in permanent as well as primary dentition. The most common abscess location was vestibule of the oral cavity.///Conclusions: Due to hygiene negligence, a large amount of odontogenic tissue inflammation and intraoral abscesses have been found to require surgical intervention despite widespread access to dental care. The most important in abscess treatment is surgical incision; pharmacotherapy should be additional treatment. The most common antibiotic used for inflammation treatment was clindamycin. [ABSTRACT FROM AUTHOR]

The assessment of fangs is a fundamental part of clinical examination of viperid snakes. The long curved venom fang is carried by short, highly mobile maxilla. Short anaesthesia is advised for safe physical examination and radiography of the mouth cavity. The fangs are gently forced outside the fang pocket by passing the bar or forceps on the palato-maxillary arch, and rotating them rostrally shifting the mucosal fold. Functional fangs are periodically shed and several generations of replacement teeth lie behind and beneath each fang. In case of fang fracture, therapy should be limited to flushing with a solution of chlorhexidine or povidone iodine, and topical application of pro-coagulant and antibacterial cream. Therapy of chronic fang inflammation is based on removal of necrotized fang and repeated abundant irrigation of the fang pocket. Treatment of chronic stomatitis consists of flushing with chlorhexidine or povidone iodine, physical removal of the plaques, administration of analgesics and antibiotics (marbofloxacin, enrofloxacin or ceftazidime). Extra-oral surgical approach is the best method for odontogenic abscess removal. A vigorous flushing with sterile saline solution, chlorhexidine and povidone iodine and topical application of antibiotics (antibiotic embedded surgical sponge) is advised. Force feeding of the anorectic patient suffering from fang inflammation is a mandatory part of the standard treatment protocol. [ABSTRACT FROM AUTHOR]

Odontogenic abscesses are infections that usually develop secondary to dental caries and periodontal infections, and may have local and systemic effects. Complications of odontogenic abscess, which are commonly seen in the childhood period, are very important and may occur as hematogenous spread, infections of the oral and facial cavity, or osteomyelitis of the jaw bones. We report a 5.5-year-old male patient who presented with findings suggesting a malignancy on admission to emphasize the importance of dental abscesses and to draw attention to complications. [ABSTRACT FROM AUTHOR]

Principles for the treatment of odontogenic infections with different levels of complexity odontogenic infections are one of the main causes of consultation in dental practice. these, affect individuals of all ages and are responsible for the majority of antibiotic prescriptions in the field of dentistry. odontogenic infections are generally underestimated in terms of morbidity and mortality, although the incidence and severity have decreased dramatically over the past 70 years. However, odontogenic infections can have varying degrees of severity and even some can be quite complex and need emergency care in a hospital setting under a specialist in oral and Maxillofacial surgery. odontogenic infections are commonly the result of pericoronitis, caries with pulp exposure, periodontitis or complication of a dental procedure. the literature contains various principles and approaches for odontogenic infections therefore the objective of our review is to establish a simplified manner based on the current literature, the principles that the clinician should follow to face odontogenic infections with different levels of complexity. [ABSTRACT FROM AUTHOR]

Streptococcus anginosus, an anginosus group bacterium, is frequently isolated from odontogenic abscesses, and is the oral bacterium that is primarily responsible for producing hydrogen sulfide from -cysteine through the action of its -cysteine desulfhydrase (βC-S lyase) enzyme. However, the relationship between its production of hydrogen sulfide and abscess formation has not been investigated. To elucidate the etiological role of hydrogen sulfide in abscess formation, we initially measured, using specific primers, expression of the lcd gene, which encodes βC-S lyase, in the pus of abscesses that formed in BALB/c mice following subcutaneous injection of S. anginosus into the dorsa. Expression of lcd was >15-fold higher when -cysteine was present than when it was absent. A mouse virulence assay revealed that the mean diameter of abscesses caused by S. anginosus FW73 plus -cysteine was greater than that of abscesses caused by S. anginosus FW73 in the absence of -cysteine. These findings demonstrate that the lcd gene of S. anginosus is upregulated in mouse abscesses and that hydrogen sulfide, the product of a reaction catalyzed by βC-S lyase, plays an etiological role in odontogenic abscess formation. [ABSTRACT FROM AUTHOR]

Aim To investigate in individuals with symptomatic dental abscesses the occurrence of functional polymorphisms within five genes involved with the immune response. The functional gene polymorphisms analysed were CD14 (−260 C/T), IL1B (+3954 C/T), IL6 (−174 G/C,), IL10 (−1082 G/A) and TNFA (−308 G/A). Methodology Genomic DNA obtained from oral swabs from individuals with symptomatic dental abscesses and asymptomatic inflammatory periapical lesions, without previous exacerbation, was submitted to restriction fragment length polymorphism (RFLP) analyses to determine each individual genotype. The chi-square and principal components analysis tests were used for statistical analysis. Results A significant association was observed between the occurrence of the GG genotype or the G allele expression of the polymorphic locus−174 (G/C) of the IL6 gene, and the presence of the symptomatic dental abscesses in women and in individuals ≤35 years old. The principal components analysis suggested predominance of the symptomatic dental abscesses in individuals displaying: high-producer IL6 genotype; intermediate and high-producer IL1B genotypes and low-producer TNFA genotype. Conclusions The present study suggests that genetic factors are associated with susceptibility to develop symptomatic dental abscesses. [ABSTRACT FROM AUTHOR]

Simple Summary: Odontogenic infections are very common. The course of disease ranges from mild to severe and sometimes even life-threatening infections. Optimal therapy is based on rapid abscess incision and, especially in severe cases, on adjuvant antibiotic therapy that ideally targets the culprit bacteria. In order to identify these bacteria, clinicians usually perform cultural analysis from smears of pus and aim for antibiotic susceptibility testing. In recent years, using new molecular methods, it has become possible to carry out a much more detailed analysis of the bacterial colonization of different parts of the human body by determining a microbiome. In our study, we have, for the first time, compared such a microbiome of odontogenic abscesses with cultural bacterial determination carried out in the clinical routine of a university hospital. The key finding of the study is not only that considerably more bacteria can be detected in the abscess in this way but also that easily cultivated bacteria dominate over the actual fastidious pathogenic bacteria. Thus, routine clinical culture probably only provides a distorted picture of reality and should be supplemented by molecular methods in the future. Odontogenic abscesses are usually caused by bacteria of the oral microbiome. However, the diagnostic culture of these bacteria is often prone to errors and sometimes fails completely due to the fastidiousness of the relevant bacterial species. The question arises whether additional pathogen diagnostics using molecular methods provide additional benefits for diagnostics and therapy. Experimental 16S rRNA gene analysis with next-generation sequencing (NGS) and bioinformatics was used to identify the microbiome of the pus in patients with severe odontogenic infections and was compared to the result of standard diagnostic culture. The pus microbiome was determined in 48 hospitalized patients with a severe odontogenic abscess in addition to standard cultural pathogen detection. Cultural detection was possible in 41 (85.42%) of 48 patients, while a pus-microbiome could be determined in all cases. The microbiomes showed polymicrobial infections in 46 (95.83%) cases, while the picture of a mono-infection occurred only twice (4.17%). In most cases, a predominantly anaerobic spectrum with an abundance of bacteria was found in the pus-microbiome, while culture detected mainly Streptococcus, Staphylococcus, and Prevotella spp. The determination of the microbiome of odontogenic abscesses clearly shows a higher number of bacteria and a significantly higher proportion of anaerobes than classical cultural methods. The 16S rRNA gene analysis detects considerably more bacteria than conventional cultural methods, even in culture-negative samples. Molecular methods should be implemented as standards in medical microbiology diagnostics, particularly for the detection of polymicrobial infections with a predominance of anaerobic bacteria. [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy. [ABSTRACT FROM AUTHOR]

Background: Oral Health-Related Quality of Life (OHRQoL) is an important aspect of quality of life. Acute illnesses, as well as chronic diseases, can have a strong, persisting impact on an individual's quality of life. This study evaluates OHRQoL of patients with odontogenic fascial space abscesses, the underlying conditions, and its consequences for clinical routines. Methods: The research group consisted of patients presenting themselves to the emergency room or elective clinic of the Department for Cranio-Maxillofacial and Plastic Surgery (n = 94). The validated German version of the Oral Health Impact Profile (OHIP-G) and additional questions (including habits and routines in oral hygiene) with an anamnestic recall period of 1 month was used to evaluate OHRQoL shortly after emergency treatment (baseline) and again after 3–6 months' follow-up. Ninety-four patients completed the questionnaire at baseline, 54 completed both questionnaires. Additionally, OHIP-G scores were compared to those of the non-impacted general German population. Results: Results showed a significant difference in OHIP-G scores from baseline to follow-up (p = 0.001). Overall a mean of 55.24 (±37.02) points was scored at baseline and a mean of 37.02 (±35.79) points was scored at follow-up. Patients scored higher than participants of a representative study of the general German population. Conclusion: Overall results suggest an increase in OHRQoL 3–6 months after acute treatment. Nevertheless, OHRQoL of patients suffering from odontogenic fascial space abscesses seems to remain generally lower than the OHRQoL of the general German population. Trial registration: Trial registration: Central Study Register of the University Hospital Duesseldorf, Registration-ID: 2016085405. Registered 24 August 2016. [ABSTRACT FROM AUTHOR]

Background: Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer.Case Presentation: A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae.Conclusions: Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment. [ABSTRACT FROM AUTHOR]