Severe odontogenic infections: focus on more effective early treatment

Our aim was to investigate delay in the treatment of patients with acute odontogenic infections. A prospective clinical study and a questionnaire survey were designed and implemented in the emergency maxillofacial surgical patients of Helsinki University Hospital, Finland, over a one-year period. Altogether 88 adult patients with odontogenic infections confirmed by hospital examination were included in the analysis. The outcome variable was admission to hospital. Two-thirds of the patients had had previous visits for health care for their current infection. Treatment was started in nearly half the patients before hospital admission, and half of the treatment provided was exclusively antibiotics. The focus of infection was detected in half the patients before admission. Patients who were required further hospitalisation were younger than who were discharged (p=0.021). Less well-educated patients were more likely to be hospitalised than patients in other education groups (p=0.033). Leucocytosis was more prevalent in patients with a mandibular focus (p=0.008), non-identified focus (p=0.010), and infection as a result of elective tooth extraction (p=0.026). The number of previous health care visits for the acute infection was notably high. Early treatment of infection may be overlooked, particularly in younger age groups and less well-educated patients. Challenges in making the correct diagnosis and prescribing effective treatment for such infections cause additional health care visits and unnecessary delay in care. More attention should be paid to the early detection and comprehensive primary treatment of odontogenic infections.