Severe Odontogenic Infections With Endodontic Origin: A Retrospective Cohort Study

AIM: Endodontic infections can spread, leading to life-threatening systemic infections. However, the available literature is limited concerning factors associated with a higher risk. This study aimed to characterize patients hospitalized with a severe endodontic infection spread and explore the course of endodontic infection and treatment prior to hospitalization. METHODOLOGY: This retrospective cohort study included patients hospitalized with a severe odontogenic infection (SOI) of endodontic origin at the Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, between the 1st of November 2012 and the 31st of December 2019. Hospital records (demographic, anamnestic, and radiographic data) and dental records (preoperative, intraoperative, and radiographic data) were analyzed with descriptive statistics, chi-square test of homogeneity, Fisher's exact test, independent sample t-test, Welch's ANOVA, and, if indicated, post hoc test (level of statistical significance: p < 0.05). RESULTS: Out of 384 patient cases hospitalized with SOI, 229 (59.6%) were considered to have endodontic aetiology. Among these, apical periodontitis (AP) was related to root-filled (RF) teeth in 44 cases (19.2%), teeth with ongoing endodontic treatment in 44 cases (19.2%), endodontically untreated teeth in 121 cases (52.8%), and unknown endodontic treatment status in 20 cases (8.7%). Men were more often hospitalized with endodontically untreated teeth (56.2%) compared to RF teeth (34.1%) (p = 0.023). Patients hospitalized with endodontically untreated teeth had a higher mean age (46.5 [±20.1] years), more diseases (48.7%), and consumed more medications (53.7%) compared to those with ongoing endodontic treatment (38.9 [±13.5] years, 19.5% and 27.3%, respectively) (p = 0.025, p = 0.005, and p = 0.011, respectively). In total, 85% of the root fillings were assessed as insufficient regarding length and seal. From dental records, it was documented that 34% received systemic antibiotics (ABs) for their AP without initiating operative endodontic treatment. CONCLUSIONS: Endodontic infections, especially from endodontically untreated teeth, were the most frequent cause of SOIs leading to hospitalization. The quality of root fillings was generally insufficient, and numerous patients were prescribed systemic ABs prior to hospitalization without concomitant operative endodontic treatment. This indicates the importance of well-performed operative dental treatments to decrease the risk of severe infection spread.