Petroff Laura, Richardson Ruby, Jensen Emilija, Cheng Andrew, Sambrook Paul, Rossi-Fedele Giampiero
Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.
Int Endod J. 2025 May;58(5):727-735. doi: 10.1111/iej.14204. Epub 2025 Jan 31.
Endodontic conditions are associated with severe odontogenic infections. However, no studies have explicitly explored their role in the infectious process. This study aimed to assess associations between tooth-related and patient-related factors resulting in severe odontogenic infections and clinical care needs.
A retrospective audit was conducted of all records of patients who presented with severe odontogenic infections requiring admission between 2018 and 2023, at the largest public hospital in South Australia. Pericoronitis, postoperative, and non-odontogenic infections were excluded. Associations between tooth-related factors (type, location, presence/absence of caries, restorations, root canal filling, apical periodontitis, and space of infection), patients-related factors (diabetes and smoking statuses), clinical management (length of admission, intensive care unit admission number of days, and need for general anaesthesia) were explored. χ, Mann-Whitney's test and Fisher's exact test were used for statistical analysis, and the level of statistical significance was set at 5%.
Of 382 records identified, 189 met the inclusion criteria. Mandibular (95.8%) molars (92.1%) were the most commonly offending teeth. Eight (4.2%) were root canal filled, 27 (14.3%) restored, 166 carious (87.8%), and 181 (95.8%) were associated with an apical radiolucency. Over half the sample were smokers (56.9%) and 16.4% were diabetics. The most common infection involved the submandibular space (56.1%). Intensive care unit admission was required for 157 patients (83.1%), and stay depended on the space of infection, with buccal space having the shortest duration (median 1 day) compared with submandibular (median 4 days) (p < .001). Need for general anaesthesia was associated with Ludwig's angina (n = 3, 100%) (p = .04) and submandibular space infection (n = 104, 98.1%) (p < .001), plus intensive care unit admission (p < .001). Conversely, for buccal space infection, the need for general anaesthesia was lower (n = 5, 23.8%). No further significant differences were found.
Untreated mandibular molars with apical periodontitis were the most frequent tooth-related findings. Results from the present study suggest associations between the most severe clinical presentations (Ludwig's angina and submandibular infection) and complexity in clinical care. Buccal space infections required the least complex management.
牙髓疾病与严重的牙源性感染相关。然而，尚无研究明确探讨它们在感染过程中的作用。本研究旨在评估导致严重牙源性感染和临床护理需求的牙齿相关因素与患者相关因素之间的关联。
对2018年至2023年期间在南澳大利亚最大的公立医院因严重牙源性感染需要住院治疗的所有患者记录进行回顾性审核。排除冠周炎、术后感染和非牙源性感染。探讨牙齿相关因素（类型、位置、有无龋齿、修复体、根管充填、根尖周炎和感染间隙）、患者相关因素（糖尿病和吸烟状况）、临床管理（住院时间、重症监护病房住院天数和全身麻醉需求）之间的关联。采用χ检验、曼-惠特尼检验和费舍尔精确检验进行统计分析，统计显著性水平设定为5%。
在识别出的382份记录中，189份符合纳入标准。下颌磨牙（95.8%）和磨牙（92.1%）是最常受累的牙齿。8颗（4.2%）进行了根管充填，27颗（14.3%）有修复体，166颗（87.8%）有龋齿，181颗（95.8%）伴有根尖透射区。超过一半的样本为吸烟者（56.9%），16.4%为糖尿病患者。最常见的感染累及下颌下间隙（56.1%）。157例患者（83.1%）需要入住重症监护病房，住院时间取决于感染间隙，颊间隙的住院时间最短（中位数为1天），而下颌下间隙为（中位数为4天）（p<0.001）。全身麻醉需求与路德维希咽峡炎（n=3，100%）（p=0.04）、下颌下间隙感染（n=104，98.1%）（p<0.001）以及重症监护病房入住情况（p<0.001）相关。相反，对于颊间隙感染，全身麻醉需求较低（n=5，23.8%）。未发现进一步的显著差异。
未经治疗的伴有根尖周炎的下颌磨牙是最常见的牙齿相关发现。本研究结果表明，最严重的临床表现（路德维希咽峡炎和下颌下感染）与临床护理的复杂性之间存在关联。颊间隙感染所需的管理最为简单。
