The connection between brain abscess and odontogenic infections: A systematic review

The study performed a systematic review to understand better the pathogenesis, microbiology, and predisposing factors related to the association between cerebral abscess and odontogenic infections.

The review was performed according to the PRISMA guidelines and registered on PROSPERO. The search was carried out in PubMed electronic database for articles published until March 2020. Eligibility criteria were: case reports, case series, and retrospective studies. After the selection, independent evaluations of the studies' methodological quality were performed using two Joanna Briggs Institute Critical Appraisal Checklists.

A total of 648 articles were obtained, and later 81 articles were selected and had data extracted. The number of individual cases was 135. Cerebral abscesses were similarly distributed by both right and left sides. However, 26 (19.3%) affected both sides simultaneously. In 42 cases (31.1%), the brain-affected side coincided with the odontogenic infection side. Cerebral and odontogenic sites shared the same microorganism in 23 cases (17%). Although in most cases, only brain samples were microbiologically analyzed (88, 65%). Upper molars were the most associated teeth (n = 53, 23.7%). The majority of patients recovered their health without sequels after medical-dental intervention 96 (71.1%). However, 9 (6.6%) individuals died.

The association between brain abscess and odontogenic infection was confirmed by numerous articles reporting oral bacteria in samples collected directly from brain abscesses. Upper molars were the teeth most often associated with brain abscesses.