Changing clinical features of severe odontogenic infections

Abstract number: 1733_966

Seppänen L., Lauhio A., Lindqvist C., Rautemaa-Richardson R.

Objectives: The number of patients requiring hospital care due to odontogenic infection has increased in the Helsinki and Uusimaa Hospital District, Finland. Our aim was to evaluate the clinical features of the patients hospitalised due to an odontogenic infection.

Methods: In this retrospective study two patient cohorts (years 1994–1996 and 2004) admitted to the Helsinki University Central Hospital due to an odontogenic infection were analysed. This patient series covers all cases of severe odontogenic infections in the region of Helsinki University Central Hospital (1.4 million inhabitants in year 2004). 99 (1994–1996) and 102 (2004) consecutive patients were included. Age, gender, fever at admission, WBC counts, CRP levels, focus, fascial spaces involved, need for re-operation and length of hospital stay were reviewed.

Results: The incidence of these severe infections increased from 5.3 to 7.2 per 100,000 inhabitants since 1994 to 2004. The two patient cohorts (1994–96 and 2004) did not differ in age (mean 40 and 43 years, respectively), gender (60.6% and 63.7% males, respectively), WBC count on admission (mean 12.4 and 12.5×10³/mL, respectively), focus (mandibular molar 76.8% and 81.4%, respectively) or fascial spaces (submandibular space involvement 46.5% and 49.0%, respectively). However, the proportion of patients with WBC greater than 11×10³/mL (49.5% and 53.9%, respectively) and CRP levels greater than 90 mg/L (36.3% and 54.9%, respectively), CRP level on admission (mean 89.2 and 112.0 mg/L, respectively) and maximal CRP levels (mean 93.4 and 153.7 mg/L, respectively), fever on admission (37.4% and 43.1%, respectively), need for re-operation (8% and 16.7%, respectively) and intensive care (18.2% and 31.4%, respectively) were markedly higher in 2004. In addition, the proportion of patients with mental disorders, cardiovascular diseases and diabetes had also increased.

Conclusion: This study shows that in the Hospital District of Helsinki and Uusimaa odontogenic infections require hospital care more often although the admission criteria have not changed. The increase in the need for intensive care implicates that the infections have become potentially more severe. The incidence of underlying systemic diseases has also increased.