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Treatment of odontogenic abscesses: comparison of primary and secondary removal of the odontogenic focus and antibiotic therapy

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Abstract

Purpose

To examine the time of removal of the odontogenic focus, antibiotic therapy and risk factors in odontogenic abscesses.

Patients

From January 2012 to December 2015, inpatients undergoing incision due to odontogenic abscesses were identified in a retrospective study. All the patients were evaluated for time of removal of the odontogenic focus, antibiotic therapy, germ spectrum, complications and risk factors.

Results

Two hundred ten patients completed the study. In 89 cases (42.4%), the odontogenic focus was removed as part of the abscess treatment (group A). In 121 cases (57.6%), the focus was secondarily removed (group B). On average, 2 ± 4 teeth were removed in group A, and 6 ± 5 teeth in group B (p < 0.0001). An average of 1.2 ± 0.4 surgical interventions were performed in group A, and 2 ± 0.2 operations in group B (p < 0.0001). Microbiological examination was positive in one-third of the cases (70 cases). Most commonly, streptococci (27%) were isolated. A resistance screening was possible in 57 of the detected germs (68.7%). In 89% of these patients, the combination of ampicillin-sulbactam was effective. The hospital stay was 4.8 ± 2 days for group A and 7.6 ± 3 days for group B (p < 0.0001). The clinical evaluation revealed 12 intermediate (5.7%) and three long-term (1.4%) complications. The long-term complications included a recurrence in two cases (1%) and an osteomyelitis in one case (0.5%). A logistic regression analysis identified no significant risk factor in relation to these complications.

Conclusion

The study shows that a primary removal of the odontogenic focus may have advantages over a secondary removal: (1) fewer operations, (2) shorter hospital stay and (3) shorter antibiotic therapy. Broad-spectrum penicillins in combination with beta-lactamase inhibitors are a possible, sufficient antibiotic regimen. Long-term complications are rare. No risk factors are identified in relation to these complications.

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Acknowledgements

The second author won the poster award 2018 of the DGMKG (German Association of oral and maxillofacial surgeons). Subsequently, an abstract was published in “Der MKG-Chirurg 2018 (Springer)” due to the award.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany

    Sven Holger Baum, An-Khoa Ha-Phuoc & Christopher Mohr

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  1. Sven Holger Baum
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  2. An-Khoa Ha-Phuoc
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by An-Khoa Ha-Phuoc and Sven Holger Baum. The first draft of the manuscript was written by Sven Holger Baum and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sven Holger Baum.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Baum, S.H., Ha-Phuoc, AK. & Mohr, C. Treatment of odontogenic abscesses: comparison of primary and secondary removal of the odontogenic focus and antibiotic therapy. Oral Maxillofac Surg 24, 163–172 (2020). https://doi.org/10.1007/s10006-020-00835-w

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  • DOI: https://doi.org/10.1007/s10006-020-00835-w

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