Clinical Paper
Oral Medicine
A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital

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Abstract

The aim of this study was to analyze the etiology, presentation, management and outcome of odontogenic maxillofacial infections seen in an urban population that has only one major public hospital, which is also the only level I trauma center. All patients admitted to the Oral and Maxillofacial Surgery Service of San Francisco General Hospital with odontogenic infections over a 5-year period were included. Age, gender, site of infection, investigations performed, treatment carried out and outcomes were studied. Length of hospital stay and any readmissions were also noted. A total of 250 patients were admitted with maxillofacial infections, and in 157 cases the infection was odontogenic in origin. Males outnumbered females (102:55). Children had a preponderance of maxillary buccal infections whilst adults had more mandibular infections. Hospital stays ranged from 1 to 23 days, and only one patient required re-admission. A wide range of antibiotics were prescribed and 122 patients required dental extractions. Odontogenic maxillofacial infections are a public and personal health issue with potential life-threatening complications. This study identifies potential risk factors and suggests that early dental extraction, incision and drainage, coupled with intravenous antibiotic therapy, is the most effective treatment. Antibiotic therapy can be empirical since in no case where cultures were performed did this alter the antibiotic management.

Section snippets

Materials and methods

All patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital (the only public hospital for the City and County of San Francisco, and the only level I trauma center), were studied for a 5-year period. The population served by San Francisco General Hospital is approximately 780,000. It is estimated that of these approximately 155,000 are uninsured. Characteristics studied included age, gender, number of admissions, white blood cell (WBC) count on

Results

Over the study period, 250 patients were admitted to hospital and treated for maxillofacial infections (50 per year). Of these, in 157 cases the infection was considered odontogenic in origin. In 90 patients the infection was considered to be non-odontogenic in origin, and included infected fractures, infected lacerations, infected sebaceous cyst and folliculitis. Additionally, the records of two patients were lost, and one patient left against medical advice and was subsequently treated at a

Discussion

The majority of the 157 patients were adults over the age of 18. Approximately 15% were children under the age of 12, but only 2% were teenage children. This confirms previous studies showing that young children may get maxillofacial infections, but the majority occur in adults, and they are relatively rare in young adults.3 The site of infection again confirms previous studies showing that young children are more likely to have a maxillary buccal infection, whereas adults have more (>18 group

Acknowledgment

We are indebted to Peter Bacchetti, Ph.D., Department of Epidemiology and Biostatistics at the University of California, San Francisco, for statistical assistance.

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Copyright © 2005 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.