The changing face of odontogenic infections

The purpose of this investigation was to compare characteristics of patients hospitalized with odontogenic infections during the 1980s to those of the 1990s.

This study was a retrospective record review that compared 2 cohorts of patients admitted to the same institution during two 81-month periods, one decade apart. Admission criteria were face or neck swelling suggesting abscess or cellulitis and one or more of the following: temperature above 38 degrees C, white blood cell (WBC) count greater than 10.8 x 10(3)/microL, or concern about airway compromise. Characteristics reviewed were age, gender, race, admission temperature, admission WBC count, fascial space(s) involved, tooth of etiology, duration of hospitalization, and bacteria isolated. Data were compared for statistical significance (P <.05).

No significant differences were found between the 2 cohorts for age, gender, race, admission temperature, admission WBC count, space involvement, or length of stay (P <.05). One tooth (mandibular left first molar) of 52 was involved more frequently in the 1990 group (P <.03). Gram-positive cocci were isolated significantly more frequently from the 1990s patients than from the 1980s patients (P <.03). There were also significant differences (P <.02) between cohorts in the isolation frequency of individual genera, such as alpha-hemolytic Streptococci, coagulase negative staphylococci, Staphylococcus epidermidis, Bacteroides melanogenicus, beta-lactamase positive Bacteroides, Eikenella corrodens, and Neisseria species. Eighty-one percent of the bacteria cultured from the 1990s patients were resistant to one or more common antibiotics; 47% of these organisms were Staphylococcus aureus.

No clinically significant differences existed in the characteristics of patients hospitalized with odontogenic infections between the 1980s and the 1990s. Although there were differences in the type and prevalence of bacteria isolated, this was probably a result of changes in nomenclature, identification protocols, and isolation techniques.