{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:17:31Z","timestamp":1790155051614,"version":"4.0.1"},"reference-count":34,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p &lt; 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.<\/jats:p>","DOI":"10.3390\/ijerph17238917","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T20:10:22Z","timestamp":1606767022000},"page":"8917","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0385-1981","authenticated-orcid":false,"given":"Nathalie","family":"Pham Dang","sequence":"first","affiliation":[{"name":"CHU Clermont-Ferrand, Inserm, Neuro-Dol, Universit\u00e9 Clermont Auvergne, F-63000 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Delbet-Dupas","sequence":"additional","affiliation":[{"name":"CHU Clermont-Ferrand, Inserm, Neuro-Dol, Universit\u00e9 Clermont Auvergne, F-63000 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9080-0444","authenticated-orcid":false,"given":"Aur\u00e9lien","family":"Mulliez","sequence":"additional","affiliation":[{"name":"CHU Clermont-Ferrand, D\u00e9l\u00e9gation Recherche Clinique &amp; Innovation, 63003 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Devoize","sequence":"additional","affiliation":[{"name":"CHU Clermont-Ferrand, Inserm, Neuro-Dol, Universit\u00e9 Clermont Auvergne, F-63000 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7494-116X","authenticated-orcid":false,"given":"Radhouane","family":"Dallel","sequence":"additional","affiliation":[{"name":"CHU Clermont-Ferrand, Inserm, Neuro-Dol, Universit\u00e9 Clermont Auvergne, F-63000 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-4231","authenticated-orcid":false,"given":"Isabelle","family":"Barth\u00e9l\u00e9my","sequence":"additional","affiliation":[{"name":"CHU Clermont-Ferrand, Inserm, Neuro-Dol, Universit\u00e9 Clermont Auvergne, F-63000 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1053\/joms.2001.25017","article-title":"Differences between patients with or without the need for intensive care due to severe odontogenic infections","volume":"59","author":"Ylijoki","year":"2001","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1111\/j.1834-7819.2005.tb00390.x","article-title":"Severe odontogenic infections","volume":"50","author":"Uluibau","year":"2005","journal-title":"Aust. Dent. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1016\/j.joms.2006.03.015","article-title":"Severe odontogenic infections, part 1: Prospective report","volume":"64","author":"Flynn","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","first-page":"e670","article-title":"Severe odontogenic infections: Epidemiological, microbiological and therapeutic factors","volume":"16","author":"Mirada","year":"2011","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.oooo.2011.10.044","article-title":"Characteristics and cost impact of severe odontogenic infections","volume":"114","author":"Jundt","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.joms.2006.03.031","article-title":"Severe Odontogenic Infections, Part 2: Prospective Outcomes Study","volume":"64","author":"Flynn","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jcms.2014.12.002","article-title":"Incidence and management of severe odontogenic infections\u2014A retrospective analysis from 2004 to 2011","volume":"43","author":"Opitz","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jinf.2008.06.002","article-title":"Analysis of systemic and local odontogenic infection complications requiring hospital care","volume":"57","author":"Lauhio","year":"2008","journal-title":"J. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"French Health Products Safety Agency (2003). Prescribing antibiotics in odontology and stomatology. Fundam. Clin. Pharmacol., 17, 725\u2013729.","DOI":"10.1046\/j.0767-3981.2003.00205.x"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4103\/0975-5950.183867","article-title":"A review of complications of odontogenic infections","volume":"6","author":"Bali","year":"2015","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/sim.4780030207","article-title":"Regression modelling strategies for improved prognostic prediction","volume":"3","author":"Harrell","year":"1984","journal-title":"Stat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jcms.2019.05.002","article-title":"Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department","volume":"47","author":"Katoumas","year":"2019","journal-title":"J. Cranio Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1053\/joms.2001.24285","article-title":"The changing face of odontogenic infections","volume":"59","author":"Storoe","year":"2001","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.ijom.2005.03.001","article-title":"A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital","volume":"34","author":"Wang","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4103\/0976-237X.137921","article-title":"Odontogenic infections: Microbiology and management","volume":"5","author":"Bahl","year":"2014","journal-title":"Contemp. Clin. Dent."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.bjoms.2014.02.027","article-title":"The clinical relevance of microbiology specimens in head and neck space infections of odontogenic origin","volume":"52","author":"Farmahan","year":"2014","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1089\/sur.2013.264","article-title":"Odontogenic Maxillofacial Infections: A Ten-Year Retrospective Analysis","volume":"16","author":"Zaleckas","year":"2015","journal-title":"Surg. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.joms.2008.09.008","article-title":"Eight-Year Retrospective Study of Odontogenic Origin Infections in a Postgraduation Program on Oral and Maxillofacial Surgery","volume":"67","author":"Sato","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.jcms.2016.05.019","article-title":"Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections","volume":"44","author":"Zirk","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s12663-019-01232-x","article-title":"Outcome of Odontogenic Infections in Rural Setup: Our Experience in Management","volume":"19","author":"Uppada","year":"2020","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.anorl.2015.08.007","article-title":"Criteria for admission of odontogenic infections at high risk of deep neck space infection","volume":"132","author":"Alotaibi","year":"2015","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1007\/s001340050715","article-title":"C-reactive protein as an indicator of sepsis","volume":"24","author":"Almeida","year":"1998","journal-title":"Intensiv. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"R169","DOI":"10.1186\/cc10313","article-title":"C-reactive protein, an early marker of community-acquired sepsis resolution: A multi-center prospective observational study","volume":"15","author":"Carneiro","year":"2011","journal-title":"Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/S0736-4679(99)00135-3","article-title":"The C-reactive protein1","volume":"17","author":"Clyne","year":"1999","journal-title":"J. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s00134-009-1402-y","article-title":"Is C-reactive protein a good prognostic marker in septic patients?","volume":"35","author":"Silvestre","year":"2009","journal-title":"Intensiv. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Meili, M., Kutz, A., Briel, M., Christ-Crain, M., Bucher, H.C., Mueller, B., and Schuetz, P. (2016). Infection biomarkers in primary care patients with acute respiratory tract infections-comparison of Procalcitonin and C-reactive protein. BMC Pulm. Med., 16.","DOI":"10.1186\/s12890-016-0206-4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1053\/joms.2000.18259","article-title":"Cervical necrotizing fasciitis of odontogenic origin: A report of 11 cases","volume":"58","year":"2000","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.tripleo.2009.12.039","article-title":"Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections","volume":"110","author":"Poeschl","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1054\/ijom.2001.0190","article-title":"Odontogenic infection pathway to the submandibular space: Imaging assessment","volume":"31","author":"Ariji","year":"2002","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_30","first-page":"123","article-title":"Deep facial infections of odontogenic origin: CT assessment of pathways of space involvement","volume":"19","author":"Yonetsu","year":"1998","journal-title":"Am. J. Neuroradiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1177\/014556130408300819","article-title":"Craniocervical necrotizing fasciitis of odontogenic origin with mediastinal extension","volume":"83","author":"Edwards","year":"2004","journal-title":"Ear Nose Throat J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S1079-2104(00)70121-1","article-title":"Descending necrotizing mediastinitis due to odontogenic infections","volume":"89","author":"Sakamoto","year":"2000","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10597-009-9280-x","article-title":"Oral Health of Adults with Serious Mental Illnesses: A Review","volume":"46","author":"Matevosyan","year":"2009","journal-title":"Community Ment. Heal. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s12529-013-9298-x","article-title":"The Impact of Lifestyle Factors on the Physical Health of People with a Mental Illness: A Brief Review","volume":"21","author":"Stanley","year":"2013","journal-title":"Int. J. Behav. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/23\/8917\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:39:51Z","timestamp":1760179191000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/23\/8917"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":34,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["ijerph17238917"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17238917","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,30]]}}}