Severe infections after teeth removal – are we doing enough in preventing them?

BACKGROUND: The present study clarified features and prehospital care in patients with severe infection after teeth removal. MATERIAL AND METHODS: Patients who were hospitalized for infection following teeth removal were included in this study. Background variables and infection severity parameters were compared between patients who underwent elective and acute teeth removal prior to hospitalization. Additionally, associations of these variables with antibiotic use were evaluated. RESULTS: Of the 118 patients included in the study, teeth removal was due to acute infection in 64% and removal was elective in 36%. The time span from teeth removal to hospitalization varied considerably (from <1 day to 205 days). The variation was significantly greater in patients with preceding acute removal than those with elective removal (P=0.030). Smoking was significantly associated with acute teeth removal (P<0.001). Length of hospital stay (LOHS) was a day longer in the elective group (P=0.017). Overall, 70% of patients received antibiotics prior to hospitalization. There was a significant association between removal type and antibiotic use (P=0.005); antibiotic use was less common in elective teeth removal patients. Immunocompromised patients received antibiotic prophylaxis significantly more often than non-immunocompromised patients (P=0.003). LOHS was significantly associated with prehospital antibiotic use (P=0.035). LOHS was a day longer in patients who had not received antibiotics than in other patients. CONCLUSIONS: Severe infection can develop with a long delay after acute teeth removal. More attention should be paid to preceding symptoms and early effective treatment of these infections. A more precise timing of antibiotic use could reduce severe postoperative infections in elective teeth removal. Key words:Odontogenic infection, teeth removal, antibiotic use, prophylaxis, postoperative infection.