Gilardi,Leonardo

Brazilian Journal of Infectious Diseases

Leonardo Gilardi

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Odontogenic infections in the Internal Medicine Service

Gilardi, Leonardo

Elsevier - Publisher Connector 

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fbraz j infect d i s . 2012;16(6):605
The Brazilian Journal of
INFECTIOUS DISEASES
www.elsev ier .com/ locate /b j idetter to the editor
In
r
1
2
3
4dontogenic infections in the
ear Editor,
ost head and neck infections are due to odontogenic
thiologies.1 Complications may include locoregional collec-
ions and systemic dissemination, but scientiﬁc publications
oncerning the role of the Internal Medicine Service in diag-
osis and treatment are lacking.
We present a retrospective review of medical records from
une 2005 to May 2009 from a tertiary care hospital in Buenos
ires. The inclusion criterion was hospitalization for an odon-
ogenic infection in adult patients with normal immune
unction. In the study period, 18 patients (44% males) were
dentiﬁed, and represented 0.1% of all admissions during the
tudy period. Median age was 28 years and mean length of
tay (LOS) was 3.72± 1.74 days; both were signiﬁcantly lower
han the respective values for the entire admitted population.
ll patients were evaluated by a trained odontologist before
dmission. Trismus was the only symptom that was consis-
ently present in all patients.
Localized collections were diagnosed by computed tomo-
raphy in seven patients. In six cases, infection originated
n the lower third molars (17th or 32nd tooth in the Univer-
al Numbering System). Initial white blood cell (WBC) count
as signiﬁcantly correlated with LOS and need for surgical
rainage. Hemocultures and abscess cultures were negative.
ll patients were treated with systemic corticosteroids and
mpicillin-sulbactam, except for a subject with penicillin
llergy history, who received clindamycin. No other com-
lications or death were recorded. No tooth extraction was
erformed during hospitalization; all subjects underwent this
rocedure during outpatient follow-up.
An interdisciplinary approach should be considered
ecause odontogenic infections may be associated with
igh morbidity rates.2 Patients included in this study were
igniﬁcantly younger than the population admitted for all
auses, which is consistent with previous research.3 The
ost frequently involved teeth were the lower third molars,
s previously cited. LOS was shorter than in other similar
ase studies2,3 and correlated signiﬁcantly with total WBC
ount at admission. However, we could not exclude bias due
o corticoids administration before hospitalization, based on
ack of data.
Neither hemocultures nor abscess cultures were use-
ul tools for choosing or modifying antibiotic treatment.ternal Medicine Service
Aminopenicillins may be considered the gold standard of
treatment.4 Lack of utility of microbial cultures is a relevant
issue with potential impact in terms of healthcare resources.
Conclusions should be conﬁrmed in larger prospective studies
at the tertiary care level.
Conﬂict of interest
The author declares to have no conﬂict of interest.
e f e r e n c e s
. Chow A. Infections of the oral cavity, neck and head. In:
Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and
Bennett’s principles & practice of infectious diseases. 5th ed.
New York: Churchill Livingstone; 2000.
. Rodríguez Frausto M, Murillo Bravo LD, Solorio S, Hernández
González MA, Villa Barajas R. Frecuencia de infección
cervicofacial odontógena que requieren hospitalización. Rev
Med Inst Mex Seguro Soc. 2011;49:137–40.
. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, Trieger N.
Severe odontogenic infections, part 1: prospective report. J Oral
Maxillofac Surg. 2006;64:1093–103.
. Al-Qamachi LH, Aga H, McMahon J, Leanord A, Hammersley N.
Microbiology of odontogenic infections in deep neck spaces: a
retrospective study. Br J Oral Maxillofac Surg. 2010;48:37–9.
Leonardo Gilardi ∗
Programa de Guías de Práctica Clínica – Obra Social de Empleados
de Comercio y Actividades Civiles (OSECAC), Buenos Aires,
Argentina
∗ Corresponding author at: Santa Fe 4990, 7th Floor, Aprt “H”,
(C1425BHY) Ciudad Autónoma de Buenos Aires, Argentina.
E-mail address: revision guias@yahoo.com.ar
Received 25 May 2012
Accepted 10 July 2012
Available online 8 November 20121413-8670
© 2012 Elsevier Editora Ltda.
http://dx.doi.org/10.1016/j.bjid.2012.07.010
Este é um artigo Open Access sob a licença de CC BY-NC-ND
