Serious consequences of endodontics phlegmons and abscesses of the neck: A retrospective study

OBJECTIVES In the last years there has been an alarming increase in number of patients admitted to the emergency room (E.R.) with the diagnosis of neck abscesses and phlegmons of odontogenic origin requiring surgery and long hospitalization periods. The increase in cases led the authors to analyze the casuistry to understand from which structures the inflammation originated and the consequences to which it led. MATERIALS AND METHODS This retrospective longitudinal study includes patients admitted to the emergency room in the ENT department of sensory organs of the Policlinico Umberto I hospital (Director prof. Marco De Vincentiis), Rome, Italy, with a diagnosis of “odontogenic abscess” or “abscess of the neck with odontogenic origin” or “phlegmon of the neck with odontogenic origin”. The time interval analyzed goes from January 2013 to December 2019. The patients involved in this study have been admitted in the department exclusively through the emergency room due to their severe clinical conditions: Tumefaction in the site of the infectious process (often diffused at the level of the neck, mono- and bi-laterally to the infection site), pain, feverishness, trismus, dysphagia and in more severe cases dyspnea. Patients affected by abscesses and/or phlegmons that are not of odontogenic origin and/or immunodepressed patients have been excluded from this study. Also patients whose complete medical records weren’t found were excluded from this study. The total group of patients considered was of 121, 16 of which were excluded because they didn’t meet the inclusion criteria. RESULTS A total of 105 patients were admitted in this study. The incidence in relation to gender is of 61 males (58%) and 44 females (42%). The average age is of 46 years. The majority of patients are between 40 and 50 years of age. All patients have undergone a pharmacological therapy at home that lasted from 3 to 6 days. An average of two teeth per patients were extracted. The teeth that were most frequently extracted were 4.7, 4.8, 3.7, 3.8. Only 8 patients have manifested abscesses from teeth in the upper quadrants. In two patients the phlogistic process has originated from endosseous implants, in 12 patients from pericoronitis due to dysodontiasis of the third molars, in 91 patients the origin was endodontic; of these patients in 7 cases the phlogosis originated from an element previously treated and in 25 patients the phlogosis then involved a follicular sac of contiguous dental elements in dysodontiasis. CONCLUSIONS Nowadays, even though Italy is a first world country where prevention has a relevant role, the infection of odontogenic origin represents the first cause of severe neck infections that lead patients to long hospitalization periods and often to surgical treatments that could have been avoided with simple dental treatments. CLINICAL SIGNIFICANCE Data collected demonstrate that the abscesses of dental origin are in most cases responsible for severe neck infections. These patients underwent invasive surgical treatments that could have been avoided by adopting preventive measures and prompt basic care like caries treatments, endodontic treatments or extractions.