Accepted Manuscript

Incidence and management of severe odontogenic infections—a retrospective

analysis from 2004 to 2011

Daniel Opitz , DMD, Assistant physician, Dr. med. Christian Camerer , MD, DMD, Dr.
med. Doris-Maria Camerer , MD, DMD, Dr. med. Dr. med. dent. Jan-Dirk Raguse ,
MD, MD, Dr. med. Dr. med. dent. Horst Menneking , MD, MD, Prof. Dr. med. Dr. med.
dent. Bodo Hoffmeister , Phd., MD, DMD, Dr. med. Dr. med. dent. Nicolai Adolphs ,
MD, DMD, FEBOMFS

PII: S1010-5182(14)00349-7
DOI: 10.1016/j.jcms.2014.12.002
Reference: YJCMS 1935

To appear in: Journal of Cranio-Maxillo-Facial Surgery

Received Date: 29 July 2014

Revised Date: 13 November 2014
Accepted Date: 1 December 2014

Please cite this article as: Opitz D, Camerer C, Camerer D-M, Raguse J-D, Menneking H, Hoffmeister B,
Adolphs N, Incidence and management of severe odontogenic infections—a retrospective analysis from
2004 to 2011, Journal of Cranio-Maxillofacial Surgery (2015), doi: 10.1016/j.jcms.2014.12.002.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to
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Title Page:

Incidence and management of severe odontogenic infections—a retrospective analysis

from 2004 to 2011

Daniel Opitz, DMD

Dr. med. Camerer, Christian, MD, DMD
Dr. med. Camerer, Doris-Maria, MD, DMD

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Dr. med. Dr. med. dent. Raguse, Jan-Dirk, MD, MD
Dr. med. Dr. med. dent. Horst Menneking, MD, MD
Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister, Phd., MD, DMD

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Dr. med. Dr. med. dent. Nicolai Adolphs, MD, DMD, FEBOMFS

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Dept. of Craniomaxillofacial Surgery, Clinical Navigation
University Hospital Charité, Campus Virchow-Klinikum
Augustenburger Platz 1, 13353 Berlin

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Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister
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Correspondance to
Daniel Opitz
daniel.opitz77@web.de
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Assistant physician
Department of Craniomaxillofacial Surgery
Charité - Universitätsmedizin Berlin
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Campus Virchow
Head of department: Prof. Dr. Dr. Hoffmeister
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Augustenburger Platz 1
D-13353 Berlin
Germany
Phone: +49.(0)30.450.655195
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Fax: +49.(0)30.450.555901
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Abstract:
The management of odontogenic infections is a typical part of the spectrum of maxillofacial

surgery. Normally these infections can be managed in a straight forward way however under

certain conditions severe and complicated courses can arise which require interdisciplinary

treatment including intensive care.

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A retrospective analysis of all patients affected by an odontogenic infection that received

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surgical therapy from 2004 to 2011 under stationary conditions was performed. Surgical

treatment consisted in incision and drainage of the abscess supported by additional i.v.

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antibiotic medication in all patients. Detailed analysis of all patients that required

postoperative intensive medical care was additionally performed with respect to special risk

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factors.

During 8 years 814 patients affected by odontogenic infections received surgical treatment
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under stationary conditions representing 4% of all patients that have been treated during

that period (n = 18981). In 14 patients (1,7%) intensive medical therapy after surgery was
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required, one lethal outcome was documented (0,12%). In all of these 14 patients a history
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of typical risk factors was present.

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According to these results two patients per week affected by an odontogenic infection

required stationary surgical treatment, about two patients per year were likely to require
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additional intensive medical care. If well known risk factors are present in patients affected
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by odontogenic infection appropriate interdisciplinary management should be considered as

early as possible.
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Title

Incidence and management of severe odontogenic infections—a retrospective analysis

from 2004 to 2011

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Introduction

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The majority of infections of the head and neck region arise from odontogenic origin

(Uluibau, Jaunay et al., 2005; Zheng, Yang et al., 2013; Igoumenakis, Gkinis et al., 2014).

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Typically they are attributable to decayed or non-vital teeth, postoperative infections,

periodontal disease, and inflammation of the pericoronal tissues (Ylijoki, Suuronen et al.,

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2001; Uluibau et al., 2005; Flynn, Shanti et al., 2006; Sanchez, Mirada et al., 2011). In
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general, odontogenic infections remain localised and heal without complications if
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appropriate therapy is administered and physiologic immunocompetence is present. However,

under certain conditions, odontogenic infections can spread and cause systemic inflammatory
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reactions (Igoumenakis et al., 2014). Among the known predisposing factors are long-term
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diabetes mellitus, a history of immunosuppression after transplant surgery, radiation therapy,

chemotherapy, HIV infection, and chronic alcohol abuse (Seppanen, Lauhio et al., 2008;
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Lorenzini, Picciotti et al., 2011; Sandner and Borgermann, 2011; Juncar, Popa et al., 2014).

Indolent behaviour of affected patients can also contribute to severe courses after odontogenic
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infections (Uluibau et al., 2005; Jundt and Gutta, 2012). In the pre-antibiotic era, a mortality

rate ranging from 10% to 40% after odontogenic infection was reported (Uluibau et al., 2005;

Jundt and Gutta, 2012). Since the introduction of antibiotics, the prognosis of odontogenic

infections has significantly improved. However, surgical incision and drainage in combination

with the immediate or secondary removal of the odontogenic focus remain the basis of the

therapy (Jundt and Gutta, 2012).

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The incidence of severe odontogenic infection requiring additional intensive care after initial

surgery should be evaluated. In this study the corresponding patient profiles were analysed.

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Materials and Methods

In 2004, the DRG-System was introduced in Germany. A retrospective analysis was

performed of all patients who underwent surgical therapy under stationary conditions due to

odontogenic infection at the Department of Craniomaxillofacial Surgery at the Campus

Virchow Klinikum in Berlin, Germany, between January 2004 and December 2011. Surgical

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therapy consisted in extraoral incision and drainage under general anaesthesia. Typically,

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perioperative i.v. antibiotic treatment was also administered. If feasible, the odontogenic focus

was removed within the same surgical setting, and intraoperative swabs were taken routinely

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in each patient case.

The patients were selected from the department´s database. According to the International

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Classification of Diseases (ICD), the codes J32.9, K04.6-04.8, K10.20, K10.21, K10.28,
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K10.3, and K12.20-12.29 were used to select patients affected by odontogenic infections.
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Patients who received surgical therapy as described above were identified by the

corresponding procedure codes (OPS-Codes 5-270.0 to 5-270.y and 5-280.0 to 5-280.x). All
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patients who required postoperative respirator therapy and or additional intensive medical
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treatment could be isolated subsequently according to the ICD-Codes J96 (respiratory

distress) and/or J98.5 (mediastinitis). These patients subsequently underwent a more detailed
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analysis with respect to their risk profiles.

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Results

According to these criteria, a total of 814 patients affected by odontogenic infections were

treated under stationary conditions during 8 years, corresponding to approximately 4% of all

18,981 patients who received maxillofacial treatment during the observation period.

Emergency admission of these patients was due to typical acute symptoms of odontogenic

infection: clinical signs as pain, swelling of the affected region, difficulty of swallowing,

trismus, or impaired breathing. In all 814 patientsm i.v. antibiotics were administered initially
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in a calculated manner and adapted later according to the antibiogram. In the calculated

antibiotic therapy, mostly penicillin (Penicillin G) and its derivatives (Augmentan, Unacid)

and Lincosamide (Clindamycin) were used.

Of this group, 14 patients (1.7%; six male and eight female, aging from 26 to 77 years, with

an average age of 53.4 years) required postoperative intensive medical treatment due to

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various complications. One patient died (0.1%). The ratio of men to women was almost

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balanced at 1:1, 3. In all 14 patients affected by severe odontogenic infections typical risk

factors contributing to a compromised immunocompetence were present. Comorbidity

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consisted in diabetes mellitus, obesity, immunosuppression, and hypertension as well as

additional long-term alcohol and nicotine abuse. Poor oral hygiene was documented in these

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patients as well. Fig. 1 gives an overview of the patients who were affected by complications
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after surgical treatment of odontogenic infections.
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Five patients (numbers 1, 2, 5, 6, and 14) had pulmonary complications (pneumonia,

atelectasis, pleural effusion, and pleural empyema) and/or septic circulatory situations
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(numbers 1, 3, 5, 8, and 14). Airway management required a temporary tracheotomy in five

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patients (numbers 1-3, 5, and 14). One patient (number 5) developed mediastinitis, requiring a

sternotomy for further intrathoracic management. Three patients (numbers 8, 11, and 14) had
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to be treated also for acute renal failure. In one patient (number 1), cardiopulmonary

resuscitation was required after swelling of the soft tissues of the neck had caused hypoxia
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and cardiac arrest. Due to underlying cardiac disease, in one patient (number 12), cardiac

arrest and subsequent lethal outcome occurred as a result of the odontogenic infection. All 14

patients with complications underwent incision and drainage of the affected area initially;

however, for eight patients of this group (57%) (numbers 1-3, 5, 10-12, and 14), at least one

surgical revision was required.

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The average length of the hospital stay for patients affected by severe odontogenic infections

was 19.9 days (ranging from 3 to 66 days). The average length of intensive medical care was

13.2 days (ranging from 1 to 60 days).

In 78.6% of the cases, the submandibular region was involved in the inflammatory process.

Decayed mandibular molars were predominantly the focus. A smaller part of infections

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started from endodontically and periodontally compromised teeth. The swabs that were taken

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intraoperatively demonstrated the typical aerobic and anaerobic spectra of oral pathogens. In

eight cases, there was a polymicrobial infection, with a total of six different bacterial species.

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The most frequently isolated bacteria were Streptococcus, followed by Prevotella and

Enterococcus.

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In summary, it can be concluded from the data that approximately 100 patients per year (814
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patients in 8 years) required in-patient surgical treatment for odontogenic infections
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corresponding to approximately two patients per week. In about two patients per year,

decompensation after odontogenic infections was observed, which required interdisciplinary

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treatment and intensive medical care. In all of these patients, well-known risk factors reducing
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regular immunocompetence were present (Fig. 1).

As an example, the following case report (Fig. 2a–j) elucidates the interdisciplinary
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management that was required to manage mediastinitis of odontogenic origin.

A 35-year-old man presented to the emergency room in reduced general condition.

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Progredient perimandibular swelling of the left side and trismus were evolving during the

preceding days. The orthopantomogram showed multiple decayed teeth, the left second molar

being the dental focus (Fig. 2a). Medical history revealed arterial hypertension, alcohol and

nicotine abuse, and depressive disorders.

Initial i.v. antibiotic administration was followed by surgical incision and drainage under

general anaesthesia. Both left second molars were removed within the same operative setting.

However, the postoperative situation was complicated by septic conditions, and postoperative
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ventilation was required. Therefore a CT scan of the neck and thorax was performed, which

revealed both drainage of the abscess (Fig. 2b) and already-descending inflammatory lesions.

Pretracheal and mediastinal gas formation suggested that incipient mediastinitis was present

(Fig. 2c and 2d). Despite combined antibiotic treatment against multi-infection

(Staphylococcus aureus/epidermidis, Streptococcus aureus, Prevotella buccae, Lactococcus

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lactis, and Enterococcus faecium), the general condition of the patient further deteriorated.

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Sternotomy with multiple surgical revisions of the thoracic cavity with drainage of

peritracheal, pericardial, and pleura abscess formations was required to manage this

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decompensation (Fig. 2e–g). Additional sternal wound complications occurred contributing to

an overall in-patient stay of 66 days, 60 of them under ICU conditions.

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Clinical follow-up 7 years later demonstrated the actual intraoral situation (Fig. 2h) with
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persistent poor oral hygiene (Fig. 2i) and residual damage after the interdisciplinary treatment
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(Fig. 2j).
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Discussion
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Because of modern diagnostics and therapy, severe complications after odontogenic infection

have a small incidence and predominantly occur when predisposing factors are present
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(Seppanen et al., 2008; Lorenzini et al., 2011). Most patients recover completely after
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adequate surgical treatment in combination with administration of appropriate antibiotics and

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the removal of the odontogenic focus (Poeschl, Spusta et al., 2010). Generalisation of the

infection can be facilitated by a persistent odontogenic focus or inadequate initial treatment.

Self medication or frequently administered antibiotics without focus removal may contribute

to protracted symptoms (Igoumenakis et al., 2014). Patients initially feel pain relief, however

without focus, removal exacerbation of symptoms may reoccur, thus necessitating secondary

clinical admission (Jundt and Gutta, 2012). Severe complications of odontogenic infections

occur rarely: fasciitis, mediastinitis, sepsis, and multiple organ failure as life-threatening
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conditions have been described. Appropriate management of such complications requires

interdisciplinary approaches (Tung-Yiu, Jehn-Shyun et al., 2000; Sarna, Sengupta et al.,

2012). Reduced immunocompetence of the patient as well as specific virulence and the

synergistic effect of aerobic and anaerobic microorganisms can be responsible for the

spreading of an odontogenic infection (Tung-Yiu et al., 2000; Leyva, Herrero et al., 2013).

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The patient´s indolence can contribute to severe manifestations of odontogenic infections, as

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decompensation of the underlying pathology may already have occurred at the time of

presentation, as in the case report presented.

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All 14 patients affected by severe complications after odontogenic infections had typical

predisposing factors such as diabetes mellitus, obesity, immunosuppression, and arterial

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hypertension with its systemic consequences. In addition, long-term alcohol and nicotine
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abuse and inadequate oral hygiene were noted. Patients with relevant comorbidities are known
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to have a worse prognosis and longer hospitalisation compared to patients without

concomitant diseases (Tung-Yiu et al., 2000; Seppanen et al., 2008). Longer hospitalisation
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might increase the risk of acquiring a nosocomial infection as well (Sarna et al., 2012). The
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postoperative period of all 14 patients was characterised by multidisciplinary intensive care

and a prolonged hospital stay.

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With respect to the infective agent, certain factors can contribute to a more aggressive course
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of an odontogenic infection. Certain metabolites of anaerobic bacteria may support the

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virulence of aerobic bacteria, which in turn create favourable surroundings for the anaerobic

bacteria by removing oxygen from the environment (Lorenzini et al., 2011; Sandner and

Borgermann, 2011). Specific exotoxins can cause tissue necrosis contributing to the

separation of fascia, a mechanism that supports further spreading of the inflammation (Shand,

Breidahl et al., 2001; Edwards, Sadeghi et al., 2004; Roccia, Pecorari et al., 2007).

Anaerobic bacteria in particular are known to produce endotoxins that inhibit phagocytosis, an

integral part of cell immunology (Biasotto, Pellis et al., 2004). The most frequently isolated
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anaerobic microorganisms in odontogenic infections include Prevotella, Bacteroides, and

Peptostreptococcus. Typical aerobic bacteria are Streptococcus and Neisseria ssp.. This is in

accordance with our own results, as intraoperative swabs demonstrated predominantly the

presence of a multi-flora with a prevalence of different species of Streptococci and Prevotella.

The preoperative administration of antibiotics is intended to focus on these bacteria, to

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prevent the spreading of inflammation with subsequent serious complications (Warnke,

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Becker et al., 2008; Poeschl et al., 2010; Sanchez et al., 2011). For that reason, i.v. antibiotics

were administered to all patients in this series before surgery. It remains to be decided

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whether this represents a sort of overtreatment in the era of multi-resistant bacteria.

If a patient’s clinical condition deteriorates despite successful incision, drainage, and

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appropriate antibiotic treatment, a severe course of odontogenic infection must be assumed,
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and diagnostic imaging by means of computed tomography (CT) is recommended without
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latency. CT scans provide an exact overview of the extent of the infection, and subsequent

surgical revision can be scheduled accordingly (Kinzer, Pfeiffer et al., 2009; Gonzalez-
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Garcia, Risco-Rojas et al., 2011). This is in accordance with our findings. Nine of 14 patients
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affected by complications underwent a CT scan of the neck and thorax. Eight of 14 patients in

this series required surgical revision after initial incision. To assess inflammatory progress,
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examination of the effects of surgery with an interval of 48 hours between postoperative CT´s
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is favoured (Gonzalez-Garcia et al., 2011).

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Severe odontogenic infections are known to cause upper airway obstruction (Uluibau et al.,

2005; Zheng et al., 2013). Airway management can be performed by prolonged endotracheal

intubation or tracheotomy, which is discussed in the literature and is controversial (Sandner

and Borgermann, 2011). An early tracheotomy can be recommended when the inflammatory

process has already caused obstruction of the upper airway, tracheal injury, or complications

during in- or extubation must be expected (Biasotto et al., 2004; Kinzer et al., 2009).

Sakamoto et al., however, pointed out that tracheotomy should be avoided, as the surgical
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approach would result in the separation of the cervical fascia. Contamination of the

pretracheal area might be the consequence, thus facilitating a further spreading of the

infection caudally (Sakamoto, Aoki et al., 2000). In our series, in five patients, transient

tracheotomy was required based on individual needs, after an interdisciplinary decision was

made. Tracheoplasty was subsequently performed after ending of the respiratory treatment.

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Mandibular molars are a well-known dental focus for odontogenic infections. Inadequate oral

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hygiene is particularly observed in this area (Sanchez et al., 2011). The root tips of the second

and third mandibular molars reach the point of origin of the mylohyoid muscle, so periapical

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infections can spread into the submandibular or adjacent parapharyngeal space (Edwards et

al., 2004; Lorenzini et al., 2011). The parapharyngeal space is anatomically related to the

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major compartments of the neck. Consequently, if inflammation has already been established
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in that region, further spreading is likely to occur (Sakamoto et al., 2000). This is consistent
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with our own results. In more than 11 patients, the submandibular region was involved, and in

eight patients, the inflammatory process affected the parapharyngeal space. Lower molars
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were predominantly the focus.

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Overall, according to this retrospective evaluation of 8 years, the incidence of severe

odontogenic infections was low. Only 1.7% of all patients who underwent surgical therapy for
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odontogenic infections were affected by severe complications. In all of these patients, typical
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comorbidity reducing the patient’s immunocompetence was found. The decompensation of

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these patients, which was observed during odontogenic infection, is likely related to the

present comorbidity and risk factors. Interdisciplinary treatment was required for an

appropriate management of these patients after severe odontogenic infection.

Conclusion
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Today severe odontogenic infections are rare and predominantly occur in patients affected by

typical risk factors that reduce the immonocompetence of the patient. Adequate management

of severe odontogenic infections requires early diagnosis and an interdisciplinary treatment

approach. Residual damage may occur nevertheless. If well-known risk factors are present in

patients with odontogenic infections, a severe course of the infection should be considered

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early, to provide appropriate interdisciplinary treatment for this group of patients.

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Conflict of interest statement:

All authors disclose any financial interest and personal relationship to organisations and

companies that are mentioned in the article.

Acknowledgements:

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Special thanks to all colleagues from ICU as well as anaesthesiology and surgical departments

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that had been involved in the interdisciplinary treatment of patients affected by odontogenic

infections during the reviewed period as mentioned in the article.

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Special thanks to Franz Hafner for his organizational skills in arranging the photo

documentation for this article. Credit is also due to the Klinik für Strahlenheilkunde, Charité -

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Universitätsmedizin Berlin (Chairman: Prof. Dr. Hamm) for providing CT scans and X-rays.
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Fig 1: Overview of 14 patients who required intensive medical care after initial surgical
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therapy for odontogenic infections.

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Fig. 2. (a) A 35-year-old male patient with OPTG at admittance and perimandibular abscess
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caused by massively decayed lower second molar of the left side. Note the multiple decayed

teeth requiring additional dental treatment (b–d). Postoperative CT series after surgical

incision and drainage: correct placement of drains at lingual and buccal sides of the mandible

(b), pretracheal (c), and mediastinal manifestation of gas (d) as a sign of already descending

infection. (e–g) Series of thoracic X-rays showing clinical situation before (e) and after

repeated thoracic surgery for the management of odontogenic mediastinitis. Note the sternal
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cerclages after open debridement and drainage of septic effusions of the pleura (f). Residual

thoracic situation 3 months after the beginning of interdisciplinary management of

odontogenic mediastinitis (g). (h) OPTG 7 years after severe odontogenic infection. (i)

Corresponding intraoral situation demonstrating persistently poor oral hygiene. (j) Clinical

situation demonstrating residual damage after interdisciplinary treatment of odontogenic

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mediastinitis in a 35-year-old man.

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Figure 1. Summary of the patients with severe complications after surgical treatment of odontogenic infections
Case Gender/ Clinical presentation
Age
1 XX, 68 Perimandibular abscess
Phlegmon of the neck
2 XY, 58 Dentogenic phleg of the
neck after tooth ex alio loco
3 XX, 47 Perimandibular abscess
4 XX, 26 Perimandibular abscess
after tooth ex alio loco
5 XY, 35 Dental abscess with spread
of infection into the peri-
mandibular/ retrosternal/
mediastinal space
6 XX, 73 Perimandibular abscess
7 XX, 53 Submental abscess
8 XY, 68 Submandibular abscess
after tooth ex alio loco
9 XY, 42 Perimandibular abscess
10 XY, 42 Injection abscess ptm and
phlegmon after tooth
extraction alio loco
11 XX, 65 Perimandibular abscess
with spread of infection
into the phar/media space
12 XX, 62 Perimandibular abscess bi
Phlegmon of the neck bi
13 XX, 32 Perimandibular abscess
Maxillary sinus empyema
14 XY, 77 Perimandibular abscess
with phlegmonous spread
Abbreviations: ab, abuse; adh, adhesion; ARI, acute respiratory insufficiency; AT, atelectasis; bi, bilateral; ca, cancer; CHD, coronary heart disease; CI, cardiac insufficiency; COPD, chronic obstructive pulmonary disease; DM,
diabetes mellitus; eff, effusion; ex, extraction; geri, geriatric; HIV, human immunodeficiency virus; HT, hypertension; ICU, intensive care unit; laryn, laryngeal; LOS, length of stay; LTI, long-term intubation; max, maxillary;
media, mediastinal; metast, metastatic; MS, multiple sclerosis; MI, myocardial infarction; outpat, outpatient; pall, palliative; PE, pleural effusions; phar, pharyngeal; phleg, phlegmon, PM, pneumonia; Postop, postoperative;
Prev, prevotella; ptm, pterygomandibular; Staph, staphylococcus; Strept, streptococcus; tracheo, tracheostomy
ACCEPTED MANUSCRIPT
Etiology Comorbidities Surgical therapy Postoperative Microbiology LOS/ICU Outcome
complications (days)
Untended dentition status DM, HT, Rheumatism Extra-/intraoral incision, Reanimation (Hypoxia) Group A ß-hemolytic Strept 42 / 40 Discharged
(Mandible) Adipositas tooth removal Sepsis, PE/AT right Enterococcus faecalis
Nephrolithiasis Tracheostomy Critical illness myopathy Escherichia coli
Lower left third molar Adipositas Extraoral incision ARI (Pseudomonas PM) Pseudomonas aeruginosa 24 / 11 Discharged
PT
Hyperuricemia Tracheostomy PE/ AT bilateral
Multiple decayed teeth Hypertension Extra-/transoral incision Septic shock Streptococcus constellatus 22 / 15 Discharged
(Maxilla/Mandible) Tracheo, tooth removal
RI
Lower left third molar Alcoholic disease Extraoral incision Laryngeal-/ pharyngeal Strept anginosus/constellatus 9/3 Discharged
edema Prevotella buccae
SC
Multiple decayed teeth Hypertension Extra-/intraoral incision Mediastinitis /Fasciitis Staph aureus/epidermidis 66 / 60
(Maxilla/Mandible) Alcoholic disease tooth removal Sepic shock/ ARI Strept anginosus, Prev buccae
Depression Tracheostomy/Sternotomy PE bilateral/ AT right Lactococcus lactis Rehab-
Nicotine abuse resection of parts of the Pleural adh ,Pericardial eff Enterococcus faecium Centre
U
sternocleidomastoideus Immune paralysis Suspected infection with
muscle Laryn swelling due to LTI Actinomycetes
AN
Decayed lower right second Hypertension Extraoral incision Hypertensive crisis and Strept anginosus/oralis 8/3 Discharged/
premolar MS, CHD with CI tooth removal pulmonary edema/PE bi Prevotella intermedia outpat care
Untended dentition status DM, Hypertension Abscess incision Acute respiratory Enterococcus faecalis 16 / 2 Discharged
M
(Maxilla/Mandible) Severe COPD Multiple tooth removal insufficiency Strept constellatus/intermedius
Upper left second molar HT, CHD with CI Extra-/intraoral incision Acute renal failure Lactococcus ssp. cremoris 10 / 4 Palliative
Prostatic. Ca Sepsis Prevotella intermedia Care
D
Decayed lower right first Diabetes Mellitus Extraoral incision Swelling of the oral floor Streptococcus anginosus 6/3 Discharged
TE
molar Tooth extraction
Lower left second molar Alcohol-/ Extraoral abscess incision Acute respiratory Lactococcus lactis ssp. cremoris 10 / 4 Discharged
Nicotine abuse insufficiency
EP
Decayed teeth/ dental HT, DM, COPD Extra-/intraoral incision Postop airway obstruction Escherichia coli 12 / 8 Discharged
implants (Mandible) Nicotine abuse Teeth extraction/ removal Renal failure Streptococcus australis
of dental implants
C
Residual roots of lower right Hypertension Extraoral incision Cardiac arrest 3/1 Lethal
AC
third molar Nicotine-/alcohol ab Tooth removal Suspected MI outcome
Untended dentition status HIV-positive Extraoral incision, Acute respiratory Streptococcus intermedius 5/2 Discharged
(Maxilla/Mandible) Nicotine-/Alcohol Revision of max sinus insufficiency
abuse tooth removal
Decayed lower right canine Hypertension Extraoral incision Pneumonia/atelectasis bi Enterococcus faecalis 45 / 29 Geriatric
and first premolar Diabetes Mellitus tooth removal Sepsis Streptococcus anginosus Care
Tracheostomy Acute renal failure Prevotella buccae/intermedia
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Highlights review „severe odontogenic infections“

• Retrospective analysis overlooking eight years of surgical therapy of

odontogenic infections

• Incidence and risk factors for severe odontogenic infection requiring

interdisciplinary treatment

• Focus on interdisciplinary management after severe odontogenic infection

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