A European multicenter retrospective study of hospitalized patients with severe odontogenic infections

Introduction: Severe odontogenic infections have become a public health issue. Epidemiological data on severe odontogenic infections are limited, and protocols for their management are not standardized and remain debated. The objective of this European multicenter study is to present and discuss the epidemiology and management of severe odontogenic infections. Methods: All hospitalized and treated cases of severe odontogenic infections at the participating surgical units across Europe between January 1st, 2014, and December 31st, 2023, were recorded. The following data were collected: comorbidities, odontogenic etiology, spaces affected, isolated microorganisms, treatment, duration of hospital stay, and outcome. Results: A total of 6190 patients diagnosed with severe odontogenic infection were included. An older age (p < 0.0001) and the male gender (p = 0.0003) were statistically associated with a longer hospital stay. The presence of comorbidities was not associated with a longer hospital stay or a poorer outcome. Recorded infections originating in the lower premolars and lower molars were associated with a longer hospital stay (p < 0.0001). The most frequently observed microorganisms were Alfa-hemolytic streptococci. The presence of Gram + microorganisms was associated with a longer hospital stay (p < 0.05). Several treatments were administered, with most patients (36.7%) undergoing a course of antibiotics, dental extraction, and an incision and drainage of the abscess. Eleven out of the 6,190 patients (0.18%) died due to a severe odontogenic infection. Conclusions: Most hospitalized patients with dental infections are previously healthy individuals, predominantly young or middle-aged adults. Clinical significance: Mandibular molars are the most frequent infectious origin teeth. Despite the potential severity of these infections, mortality rates remain low in Europe.