A RT I C L E A N A LY S I S & E VA LUAT I O N : H A R M & E T I O LO G Y
The number of odontogenic infections has not changed in the
past decade
Original Article:
• Level of Evidence:
• Purpose:
• Source of Funding:
• Type of Study/Design:
SUBJECTS
The dental records of 159
patients admitted to the
Cleveland MetroHealth Medical
Center—86 patients from March
1983 to November 1989 and 73
patients from July 1992 to March
1999—were assessed.
The inclusion criteria for accep-
tance into the study were swelling
of the face or neck suggesting
abscess or cellulitis and one or
more of the following: tempera-
ture above 38°C, white blood cell
count greater than 10.8 × 103/µL,
or concern about a compromised
airway.
162
Storoe W, Haug RH, Lillich TT. The changing face of odontogenic
infections. J Oral Maxillofac Surg 2001;59:739-48.
5
To compare characteristics of patients hospitalized with odontogenic infec-
tions during the 1980s with the characteristics of those hospitalized during
the 1990s
Not available
Retrospective record review
SUMMARY
EXPOSURE
sion temperature and white blood
Changes over time were com- cell count, fascial space involve-
pared. ment, or length of hospital stay.
Tooth #19 was found to be the
MAIN OUTCOME MEASURE most common etiology of the
Patient characteristics reviewed infection, and gram-positive cocci
were sex, age, race, admission were more often isolated in the
temperature, admission white 1990s cohort than in the 1980s
blood cell count, duration of cohort (Table 1).
hospitalization, fascial spaces
involved, tooth of origin, and
bacteria identified.
MAIN RESULTS
No significant differences were
found between the 2 cohorts with
regard to age, sex, race, admis-
J Evid Base Dent Pract 2002;2:162-3
© 2002 Mosby, Inc. All rights reserved.
doi:10.1067/med.2002.125679
 COMMENT ARY

CONCLUSIONS relate that the findings about the types of bacteria

No clinically significant differences were found in
the characteristics of patients hospitalized with
odontogenic infections in the 1980s and the 1990s.
Differences in the type and prevalence of bacteria
isolated in the infections from the 2 cohorts were
attributed to changes in nomenclature, identifica-
tion protocols, and isolation techniques.
ANALYSIS
This retrospective study was performed to deter-
mine whether there were any differences in the char-
acteristics of patients admitted with odontogenic
infections in the 1980s and those admitted in the
1990s. Overall, the results showed that the patients
admitted in the 1990s were essentially the same as
those who presented in the 1980s. Although the
authors discuss some trends found within the data
they collected, the only significant findings relate to
tooth #19 being more commonly involved and
gram-positive cocci being more commonly isolated
in the 1990s cohort of patients. The authors also
isolated from the infections and the antibiotics used
in the management of the infections are limited for 2
reasons: first, the difficulty in obtaining this infor-
mation from a retrospective review of records and,
second, by changes in the nomenclature and classifi-
cation of bacteria from the 1980s to the 1990s. What
is of interest is the finding that culture and sensi-
tivity data were only available in 10 (14%) of the
patients treated in the 1990s cohort.
In summary, although this study does an excellent
job in comparing patients admitted for treatment of
odontogenic infections in the 1980s and 1990s, it still
leaves unanswered questions pertaining to the
changes in flora of odontogenic infections, antibiotic
resistance, and antibiotics subsequently prescribed
from the 1980s to the 1990s. The authors do, however,
emphasize the need for prospective randomized clin-
ical trials to address these clinical questions. Finally, it
would also have been interesting to see if the overall
management of odontogenic infections had changed
from the 1980s to the 1990s.

Table 1. Patient characteristics

No. of 1980s Patients No. of 1990s Patients Statistic* P
Total patients identified 86 73 0.063 .8
Total patients with complete records 79 71 0.006 .9
Gender
Male 45 40 0.006 .9
Female 34 31
Race
White 44 44
African American 30 20 0.006 .6
Hispanic 4 6
Asian 1 1
Mean ± SD
Age (yr) 31.40 ± 17.97 32.58 ± 10.90 0.989 .6
Admission temperature (°C) 37.76 ± 0.76 37.62 ± 0.92 0.960 .4
Admission WBC count (WBC × 103/µL) 14.40 ± 5.36 13.93 ± 4.837 1.040 .3
Length of stay (d) 6.66 ± 6.20 8.27 ± 11.59 0.567 .6
*χ2 for total patients, gender, and race; t test for age, admission temperature, admission WBC, and length of stay.
Abbreviations: WBC, white blood cell.
(Reprinted from Storoe W, Haug RH, Lillich TT. J Oral Maxillofac Surg 2001;59:739-48. By permission).

• Content Reviewer: Jeffrey W. Hutter, DMD, MEd, Boston University, Massachusetts

Journal of Evidence-Based Dental Practice Storoe, Haug, and Lillich 163

Volume 2, Number 2