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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]

Odontogenic infections have a high prevalence and can lead to severe complications. Due to demographic changes, the number of geriatric patients has increased in recent years. The aim of this study was to analyse odontogenic abscesses in elderly patients and to differentiate them from non–elderly patients regarding clinical presentation, bacterial analysis and therapy. We retrospectively reviewed 1,173 inpatients with odontogenic abscesses from 2014 to 2020. Patients were divided into elderly patients (≥70 years, n = 240) and non-elderly patients (

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]

Background: Odontogenic abscesses are the most common pathology in maxillofacial surgery. Their frequency is significantly higher in people with poor social status. Materials and methods: The study retrospectively included 81 patients with odontogenic abscesses and phlegmons of the head and neck, hospitalized and operated on as an emergency case. Incision wound secretion for microbiological examination and preparation of an antibiogram were taken from each of them as a standard routine procedure. Results and discussion: The most affected are young patients (till 44 years), followed by patients in middle age (45-59 years). The reason for this is that with age, teeth gradually fall out of the dentition of mature individuals, and with this, the possibility of the occurrence of odontogenic infections decreases. The lower jaw is more affected. A mixed resident microflora comprising more than one bacterial species is isolated in 62% of all patients. Gram-positive bacteria isolated in the samples of the studied patients were coagulase-negative staphylococci (Staphylococcus coagulase negative, CNS), Staphylococcus aureus, Streptococcus anginosus and Streptococcus viridans. Gram-negative bacteria were Escherichia coli, Enterobacter cloacae and Stenotrophomonas maltophilia. Obligate anaerobes were found in only one sample. The isolated fungi were Candida albicans and Candidanonalbicans. Conclusion: In the studied group of patients with odontogenic abscesses, Gram-positive bacteria In the studied group of patients with odontogenic abscesses, Gram-positive bacteria were 2.5 times more than Gram-negative. Single antibacterial therapy is preferable for patients with small-area odontogenic abscesses, while triple antibacterial therapy is recommended for large-area odontogenic abscesses and their phlegmonous forms.

Abstract 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

Background: Clarifying the bacterial causes of inflammatory diseases has a major role in the treatment of this type of pathology. Materials and methods: In a retrospective study of 138 adult patients with abscesses and phlegmons of the head and neck, hospitalized and operated on urgently in the Clinic for Maxillofacial Surgery at University Multispecialty Hospital for Active Treatment "Sveta Marina" EAD – city of Varna, Bulgaria. Depending on their origin, the patients were divided into two groups - with odontogenic and non-odontogenic abscesses. Results: The study group consists of 73 men (52.9%) and 65 women (47.1%) with a mean age of 43 (18-84) years. The mixed resident microflora, including more than one bacterial species, is isolated in the largest number of cultures – 64.2%. The total number of cultures with Gram-positive bacteria isolated in the samples of the studied 92 patients with isolates is 20,33%. Representatives of Gram-negative bacteria are isolated in 7.49% of all. Obligate anaerobes are found in 2.14% of the isolates. Microorganism fungi are encountered in 3.21% of the crops. In patients with phlegmons of odontogenic origin the ratio between Gram-positive and Gram-negative bacteria is 3:1. In phlegmons of non-odontogenic origin, they are entirely of the Gram-negative spectrum. Conclusion: Microorganisms are not isolated in a third of the examined patients, which are most likely long errors in taking material for microbiological examination or in its improper storage and transportation. Of the other crops, the share of resident microorganisms as opportunistic pathogens is the largest. Of the conditionally pathogenic microorganisms, Gram-positive ones predominate.

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]

Objectives: To determine the diagnostic accuracy of emergency magnetic resonance imaging (MRI) in odontogenic maxillofacial infections, the clinical and surgical significance of MRI findings, and whether MRI can identify the tooth responsible for the infection. Methods: A retrospective cohort study reviewed 106 emergency neck MRI scans of patients with neck infections of odontogenic origin. The diagnostic accuracy of MRI in identifying abscesses was studied relative to surgical findings. Correlations were analyzed between various MRI findings and clinical results and outcomes, such as the surgical approach (intraoral vs. extraoral). The ability of MRI findings to predict the causative tooth was assessed in a blinded multi-reader setting. Results: Of the 106 patients with odontogenic infections, 77 (73%) had one or more abscesses. Imaging showed a sensitivity, specificity, and accuracy of 0.95, 0.84, and 0.92, respectively, for MRI diagnosis of an odontogenic abscess. Among the imaging findings, mediastinal edema was the strongest predictor of extraoral surgery. MRI showed bone marrow edema in the majority of patients, and multi-reader assessment showed good reliability. MRI was also able to predict the causative tooth accurately. Conclusions: Emergency neck MRI can accurately detect odontogenic abscesses and reliably point to the causative tooth. These results can increase the utility and reliance on emergency MRI in clinical decision-making. [ABSTRACT FROM AUTHOR]

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes. [ABSTRACT FROM AUTHOR]

Odontogenic infections have a high prevalence and can lead to severe complications. Due to demographic changes, the number of geriatric patients has increased in recent years. The aim of this study was to analyse odontogenic abscesses in elderly patients and to differentiate them from non-elderly patients regarding clinical presentation, bacterial analysis and therapy. We retrospectively reviewed 1,173 inpatients with odontogenic abscesses from 2014 to 2020. Patients were divided into elderly patients (≥70 years, n  = 240) and non-elderly patients (<70 years, n  = 933). Demographics, clinical parameters, laboratory values and treatment parameters were analysed. Overall, elderly patients had a longer hospital stay (LOS) (median 4 [range 28] vs. 3 [range 22] days) and more complications (9.6% vs. 7.9%) than non-elderly patients, although these differences were not statistically significant. Peri-/submandibular ( p  = 0.015), parapharyngeal ( p  < 0.001) and oral base infections ( p  = 0.036) were associated with significantly longer LOS in the elderly. Chronic renal failure (CRF) was associated with LOS ( p  = 0.010) and complications ( p  = 0.006). In the elderly, c-reactive protein (CRP) correlated significantly with LOS ( p  < 0.001) and more complications ( p  = 0.036). This study identifies anatomical spaces and CRF as outcome predictors of odontogenic abscesses in the elderly. In addition, CRP level may serve as a predictor of complicated course in elderly patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships cthat could be construed as a potential conflict of interest., (© 2024 Kärcher, Thelen, Ruettermann, Li and Hamprecht.)

Introduction Head and neck abscesses are categorized as either odontogenic, originating from dental infections, or non-odontogenic, arising from soft tissue inflammation. This article aimed to investigate inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), and compare them against established diagnostic parameters such as white blood cell (WBC) count, neutrophil count (Neu), lymphocyte count (Ly), platelet count (PLT), C-reactive protein (CRP), and procalcitonin (PCT). Material and methods Our retrospective analysis of a prospective study involved 80 patients, including 50 individuals (56% men) with an average age of 41.6±18.18 years diagnosed with odontogenic abscesses and 30 patients (66.7% men) with an average age of 44.53±15.49 years diagnosed with non-odontogenic head and neck abscesses, during the period from July 2021 to June 2022. The complete blood count provided data on WBC, Neu, Ly counts, MPV, and PLT using a 5-diff hematological analyzer. The MPV to PLT index (MPI) was calculated by dividing MPV by PLT, neutrophil-to-lymphocyte ratio (NLR) by dividing Neu by Ly, and platelet-to-white blood cell ratio (PWR) by dividing PLT to WBC. A latex-enhanced immunoturbidimetric assay was used to determine CRP (mg/L) on Cobas 6000 and PCT (ng/mL) on Advia 1800. Results PLT, PCT, and Ly were lower in patients with odontogenic abscesses compared to those with non-odontogenic abscesses (p<0.05), while CRP and Neu were significantly elevated in the odontogenic abscess group (p<0.05). In the non-odontogenic abscess group, men presented higher CRP levels (50.39±64.99 ng/mL versus 9.77±8.36 mg/L), MPI (0.036±0.017 ng/mL versus 0.029±0.01 ng/mL), and NLR (5.6±5.66 versus 3.09±2.2) compared to women (p<0.05). In contrast, women exhibited higher PLT values (390.78±197.129x10 9 /L versus 220.33±55.153x10 9 /L) and PWR (43.88±32.72 versus 23.86±9.34) compared to men (p<0.05). A significant combination of Ly% and Neu% was identified for predicting the MPV value in the non-odontogenic abscess group (R²=0.126, p=0.042), NLR and PWR as a predictor of CRP in both study groups (p<0.05) (R²=0.3 for the non-odontogenic abscess group, R²=0.448 for the odontogenic abscess group), and NLR and PWR as predictors for PCT values in those with non-odontogenic abscesses (R²=0.239, p=0.025). Discussion Despite the expected association between elevated MPV and heightened inflammatory responses, our findings revealed an inverse correlation between MPV and Neu and Ly in patients with non-odontogenic abscesses. This indicates complex interactions in immune responses during inflammation and underscores the need for further investigation to clarify MPV's role across different abscess types. Integrating traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV can enhance our understanding of inflammatory responses and improve predictions regarding patient outcomes in head and neck abscesses. Conclusion Our study confirms the value of combining traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV to assess the severity of infections in head and neck abscesses. These biomarkers provide significant insights into inflammatory responses and may improve patient outcome predictions. However, further research with larger, diverse populations is needed to fully integrate these markers into routine clinical practice for better management of such infections., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Review Board of Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria, issued approval 101/2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chausheva et al.)

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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]

ABSTRACT: Oral diseases are limiting to health, welfare, and conservation practices, especially in the case of endangered animals. In this retrospective study, a survey on oral health-related conditions noted in the clinical records for 261 deer comprised in an ex situ population of the Marsh Deer Conservation Center (CCCP) over 30 years (1990-2020) was carried out. Of these, 49 (18.77%) marsh deer (31 females - 63.27% and 18 males - 36.73%) had clinical oral affections; the affected deer’s mean age was 8.9 years. Logistic regression analysis was performed, and the variable age was significantly associated with the presence of dental affections. Thus, with a change in the age category, a deer had eight times the chance of manifesting oral affections; therefore, age can be considered a risk factor for the manifestation of oral affections in the species. Increased facial volume (65.3%), accumulation of food in the mouth (36.7%), tooth loss (22.4%), fistulas (22.4%), mucosal or palatal lesions (22.4%), tooth wear (20.4%), and tooth root exposure (18.3%) were the most frequently recorded lesions. The relatively high occurrence of oral affections in Blastocerus dichotomus reiterates the importance of oral health care when deer are kept in human care.

Abstract 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.

Background: Brain abscess is a potentially fatal condition. Orbital fractures caused by penetrating injury may be associated with intracranial infection. Such complication associated with blunt trauma, orbital roof fractures, and odontogenic abscesses is exceedingly rare. Case Description: We report the case of a 40-year-old transgender female with a frontal abscess presenting several weeks following a motor vehicle crash from which she suffered multiple facial fractures and an odontogenic abscess. On computed tomography scan, the patient had multiple right-sided facial fractures, including a medial orbital wall fracture and a right sphenoid fracture extending into the superior orbital roof. There was hemorrhage notable in the right frontal lobe. Communication with the ethmoid sinuses likely provided a conduit for bacterial spread through the orbit and into the intracranial and subdural spaces. Conclusion: Skull base fractures that communicate with a sinus, whether it be frontal, ethmoid, or sphenoid may increase the risk of brain abscess, especially in patients who develop an odontogenic abscess. Surgical repair of the defect is essential, and treating patients prophylactically with antibiotics may be beneficial. [ABSTRACT FROM AUTHOR]

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.

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.

Abstract 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 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.

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]

Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. Case Description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic. [ABSTRACT FROM AUTHOR]

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.

Severe odontogenic abscesses are regularly caused by bacteria of the physiological oral microbiome. However, the culture of these bacteria is often prone to errors and sometimes does not result in any bacterial growth. Furthermore, various authors found completely different bacterial spectra in odontogenic abscesses. Experimental 16S rRNA gene next-generation sequencing analysis was used to identify the microbiome of the saliva and the pus in patients with a severe odontogenic infection. The microbiome of the saliva and the pus was determined for 50 patients with a severe odontogenic abscess. Perimandibular and submandibular abscesses were the most commonly observed diseases at 15 (30%) patients each. Polymicrobial infections were observed in 48 (96%) cases, while the picture of a mono-infection only occurred twice (4%). On average, 31.44 (±12.09) bacterial genera were detected in the pus and 41.32 (±9.00) in the saliva. In most cases, a predominantly anaerobic bacterial spectrum was found in the pus, while saliva showed a similar oral microbiome to healthy individuals. In the majority of cases, odontogenic infections are polymicrobial. Our results indicate that these are mainly caused by anaerobic bacterial strains and that aerobic and facultative anaerobe bacteria seem to play a more minor role than previously described by other authors. The 16S rRNA gene analysis detects significantly more bacteria than conventional methods and molecular methods should therefore become a part of routine diagnostics in medical microbiology.

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]

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]

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

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis. [ABSTRACT FROM AUTHOR]

Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers., (Copyright © 2023 Elsevier Inc. All rights reserved.)

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]

Introduction: The aim of this retrospective longitudinal research was to determine if there is correlation between meteorological parameters and occurrence of odontogenic abscesses requiring hospitalization. Materials and methods: In our research we collected data from patients that were admitted to the Department of Oral and Maxillofacial Surgery at Dubrava University Hospital in Zagreb from 1.1.2015. to 1.6.2021. Total of 292 patients' records were analysed. There was 168 male and 124 female patients. Patients were divided into adult and pediatric groups. We investigated following parameters: gender, seasonality, infected tooth, antibiogram, antibiotic therapy, antibiotic prophylaxis, bacterial group, comorbidities, complications, localization of abscess, laboratory results, period between symptoms onset and hospitalization, duration of hospital stay, period between dental procedure and hospitalization. Meteorological parameters were obtained from the Croatian Meteorological and Hydrological Service (https://meteo.hr/). Meteorological parameters on the day of acute symptoms of odontogenic abscess onset and two, five and seven days prior to onset of symptoms and hospitalization in each patient were recorded: daily mean temperatures, daily mean relative humidity, daily mean atmospheric pressure and precipitation. Data analysis was performed using the MedCalc Statistical Software version 12.5.0 (MedCalc Software, Ostend, Belgium; https://www.medcalc.org). Results: In adult group daily mean atmospheric pressure five days before hospitalization present a moderate positive association with odontogenic abscess incidence (r=0.48, p=0.05). Interestingly, changes more than 12 hPa five days prior hospitalization shows strong positive association with odontogenic abscess incidence (r=0.52, p=0.05). In 26.3% of cases clindamycin resistance was observed. Regarding the localization, perimandibular abscess (35.7%) was most common. Previous dental procedure was performed in 70.7% of patients. Conclusion: There is moderate correlation between daily mean pressure change five days prior to hospitalization and odontogenic abscess occurrence. Threshold value was 12 hPa. [ABSTRACT FROM AUTHOR]

Background: Anecdotal reports assert a relationship between weather and lunar activity and the odontogenic abscess (OA) incidence, but this relationship has not been validated. Therefore, the present study investigated the relationship between oral pain caused by OA and a variety of meteorological parameters and cyclic lunar activity. Methods: The records of all dental emergency patients treated at the AllDent Zahnzentrum Emergency Unit in Munich, Germany during 2012 were retrospectively reviewed. Patients with oral pain who were diagnosed with OA and treated surgically (n = 1211) were included in the analysis. The OA incidence was correlated to daily meteorological data, biosynoptic weather analysis, and cyclic lunar activity. Results: There was no seasonal variation in the OA incidence. None of the meteorological parameters, lunar phase, or biosynoptic weather class were significantly correlated with the OA incidence, except the mean barometric pressure, which was weakly correlated (rho = -0.204). The OA incidence showed a decreasing trend as barometric pressure increased (p < 0.001). On multiple linear regression, the barometric pressure accounted for approximately 4% of the OA incidence. Conclusion: There is no evidence supporting a correlation between the incidence of odontogenic abscess and the weather and lunar activities. [ABSTRACT FROM AUTHOR]

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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.

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]

Purpose: The purpose of this study was to prospectively evaluate a series of patients with severe odontogenic abscess. Patients and Methods: In this study, we retrospectively evaluated patients with odontogenic abscess treated at the Oral and Maxillofacial Department of Dicle University during a ten-year period between 1998 and 2008. In this study 549 patients were included. Among the patients, 324 (59.0%) were males and 225 (41.0%) were females. Standardized data collection included surgical and medical treatment, complications and clinical features information. Appropriate descriptive statistics were computed. Results: In 10 years (from 1998 to 2008) 549 patients were treated. Among the patients, 324 (59.0%) were males and 225 (41.0%) were females. Patients were treated by 67% (368) extraoral drainage and 33% (181) intraoral drainage. The most common abscess formation sites were mandibular posterior (74.8%-441 case), maxillar posterior (9.6%-53 case); maxillar anterior (8.9%-49 case) and mandibular anterior (6.5%-36 case) regions. Conclusions: This study indicated that severe odontogenic abscess can be life threatening. Intra oral and extra oral drainage may be useful for successful treatment of extensive odontogenic infection, which can be life threatening when medical therapy is ineffective. [ABSTRACT FROM AUTHOR]

Summary: Objectives: We examined the spectrum of oral pathogens found in odontogenic abscesses and their susceptibility to penicillin as well as to amoxicillin with clavulanic acid, doxycycline, clindamycin and moxifloxacin. The in vitro results were compared with clinical observations. Patients and methods: One hundred and eighty eight swabs were obtained from 94 patients with odontogenic abscesses. Bacterial strains were isolated for susceptibility tests. The same patients were investigated for their clinical outcome after standard therapy. Results: A total of 517 bacterial strains were isolated from 94 patients. Ninety eight per cent of abscesses were polymicrobial. The most prevalent bacteria were Viridans streptococci representing 54% of the aerobic/facultative anaerobic bacteria. Prevotella spp. comprised 53% of the anaerobes. No multiresistant strains were detected. Susceptibility testing revealed a sensitivity of over 99% of aerobes/facultative aerobes and 96% of anaerobes sensitivity for moxifloxacin. The corresponding values for penicillin were lowest at 61% and 79%, respectively. In the clinical collective, patients with minor abscesses and no risk of further progression received surgical treatment without antibiotics (36%). Penicillin was administered additionally in 30%. Amoxicillin with clavulanic acid was given in 18% and clindamycin in 15%. Ninety two of the 94 patients showed significant recovery with the described treatment. Only in two cases was a change to the latest broader spectrum antibiotics necessary. Conclusion: In contrast to the moderate in vitro results, penicillin successfully treated the pathogens derived from odontogenic abscess sufficiently when adequate surgical treatment was provided. One third of the patients was treated successfully with incision and drainage only. We suggest that one good reason for its clinical efficacy is the susceptibility of the dominant aerobe/facultative aerobe and anaerobe strains to penicillin. [Copyright &y& Elsevier]