Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections

Nathalie Pham Dang, Candice Delbet-Dupas, Aurélien Mulliez, Laurent Devoize, Radhouane Dallel and Isabelle Barthélémy
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Nathalie Pham Dang: CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
Candice Delbet-Dupas: CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
Aurélien Mulliez: CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 63003 Clermont-Ferrand, France
Laurent Devoize: CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
Radhouane Dallel: CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
Isabelle Barthélémy: CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France

IJERPH, 2020, vol. 17, issue 23, 1-13

Abstract: Background : Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods : In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results : 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy ( p < 0.001), psychiatric disorders ( p = 0.005), oropharyngeal oedema ( p = 0.008), floor oedema ( p = 0.004), fever ( p = 0.04) and trismus ( p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions : Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.

Keywords: severe odontogenic infection; cellulitis; allergy; predictor (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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