‏A Silent Storm: A Narrative Review of Systemic Manifestations of Odontogenic Infections and a Framework for Interdisciplinary Recognition from Pre-Hospital Care to Rehabilitation

Ehsan Ali Mohammed Hakami (1), Nisrin Ali Mohammed Hakami , Afnan Hadi Kuriri (2), Ghaliah Hadi Mohammed Makin (3), Fahad Mohammed Bereik Aldosari (4), Ashwaq Jaloud Alanazi (5), Amer Mohamed Abdollah Aldosari (6), Safi Saad Abdullah Aldosari (6), Mohammed Mubarak Abdullah Aldawsari (6), Saeed Abdullah Aldawsari (7), Hanaa Ibrahim Essa Alkhebri (8), Obaid Abdulaziz Saeed Aldawsari (7), Meshael falah Mohammed (9)
(1) King Fahad Central Hospital, Ministry of Health, Saudi Arabia,
(2) ‏Employer Samtah General Hospital, Ministry of Health., Saudi Arabia,
(3) ‏King Fahad Hospital, Ministry of Health., Saudi Arabia,
(4) Wadi Al-Dawasir General Hospital – Riyadh First Health Cluster, Ministry of Health., Saudi Arabia,
(5) Jubail General Hospital – Jubail, Eastern Health Cluster, Ministry of Health., Saudi Arabia,
(6) Wadi Al-Dawasir General Hospital, Ministry of Health., Saudi Arabia,
(7) Wadi Al-Dawasir Hospital, Ministry of Health., Saudi Arabia,
(8) Quba Primary Health Care Center – Al-Madinah, Ministry of Health., Saudi Arabia,
(9) Suhaymiyah Health Center, Riyadh Health Cluster1, Ministry of Health., Saudi Arabia

Abstract

Background: Odontogenic infections can progress from dental structures to cause severe, life-threatening systemic complications. These conditions represent a critical intersection of dental, emergency, critical care, and rehabilitation medicine, yet physical therapists' role in this continuum remains underrecognized. Aim: This narrative review synthesizes evidence on the pathophysiology, recognition, and interdisciplinary management of severe systemic complications from oral infections, proposing an integrated framework for early detection and rehabilitation from paramedic contact through ICU to physical therapy. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and CINAHL (2010-2024). Included studies focused on epidemiology, management, and rehabilitation of severe odontogenic infections with systemic spread. Results: The review delineates infection pathways, identifies clinical red flags, and highlights rehabilitation needs. Two original frameworks are presented: a pre-hospital screening tool for paramedics/nurses and an integrated rehabilitation protocol incorporating physical therapy. Conclusion: Effective management demands seamless collaboration between all involved professions, including physical therapy for functional recovery. Standardized interdisciplinary protocols can significantly reduce morbidity and mortality while optimizing long-term outcomes.

Full text article

Generated from XML file

References

1. Alves, N., & Deana, N. F. (2016). Cavernous sinus thrombosis of odontogenic origin. Int J Clin Exp Med, 9(3), 5301-5307. www.ijcem.com

2. Barlow, C. (2019). Managing minor injuries in the pre-hospital setting. Fundamentals of Paramedic Practice: A Systems Approach.

3. Bridwell, R., Gottlieb, M., Koyfman, A., & Long, B. (2021). Diagnosis and management of Ludwig's angina: An evidence-based review. The American journal of emergency medicine, 41, 1-5. https://doi.org/10.1016/j.ajem.2020.12.030

4. Brooks, L., Narvekar, U., McDonald, A., & Mullany, P. (2022). Prevalence of antibiotic resistance genes in the oral cavity and mobile genetic elements that disseminate antimicrobial resistance: A systematic review. Molecular Oral Microbiology, 37(4), 133-153. https://doi.org/10.1111/omi.12375

5. Caruso, S. R., Yamaguchi, E., & Portnof, J. E. (2022). Update on antimicrobial therapy in management of acute odontogenic infection in oral and maxillofacial surgery. Oral and Maxillofacial Surgery Clinics, 34(1), 169-177. https://doi.org/10.1016/j.coms.2021.08.005

6. Craig, J. R., Cheema, A. J., Dunn, R. T., Vemuri, S., & Peterson, E. L. (2022). Extrasinus complications from odontogenic sinusitis: a systematic review. Otolaryngology–Head and Neck Surgery, 166(4), 623-632. https://doi.org/10.1177/01945998211026268

7. de Almeida, A. C. P. B., da Silva Coelho, A., de Faria Castro, D. P., da Silva Sperandio, D. M., Segal, I. C., & Prado, R. (2022). Cavernous Sinus Thrombosis focusing on odontogenic causes: a narrative review. Journal of Oral Diagnosis, 7, 1-6. https://doi.org/10.5935/2525-5711.20220200

8. Fitzpatrick, D., Maxwell, D., & Craigie, A. (2018). The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department. BMC emergency medicine, 18(1), 16. https://doi.org/10.1186/s12873-018-0168-3

9. Flynn, T. R. (2011). What are the antibiotics of choice for odontogenic infections, and how long should the treatment course last?. Oral and Maxillofacial Surgery Clinics, 23(4), 519-536. https://doi.org/10.1016/j.coms.2011.07.005

10. Flynn, D., Francis, R., Robalino, S., Lally, J., Snooks, H., Rodgers, H., ... & Price, C. (2016). A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC emergency medicine, 17(1), 5. https://doi.org/10.1186/s12873-017-0118-5

11. Goodacre, S., Fuller, G., Conroy, S., & Hendrikse, C. (2023). Diagnosis and management of sepsis in the older adult. bmj, 382. https://doi.org/10.1136/bmj-2023-075585

12. Harley, A., Johnston, A. N. B., Denny, K. J., Keijzers, G., Crilly, J., & Massey, D. (2019). Emergency nurses’ knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study. International emergency nursing, 43, 106-112. https://doi.org/10.1016/j.ienj.2019.01.005

13. Hayek, G., Goldberg, M. H., & Ferneini, E. M. (2019). Odontogenic Infections. In Evidence-Based Oral Surgery: A Clinical Guide for the General Dental Practitioner (pp. 239-262). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-91361-2_13

14. Heim, N., Berger, M., Wiedemeyer, V., Reich, R., & Martini, M. (2019). A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. Journal of Cranio-Maxillofacial Surgery, 47(2), 334-340. https://doi.org/10.1016/j.jcms.2018.12.002

15. Kabil, G., Hatcher, D., Alexandrou, E., & McNally, S. (2021). Emergency nurses’ experiences of the implementation of early goal directed fluid resuscitation therapy in the management of sepsis: a qualitative study. Australasian emergency care, 24(1), 67-72. https://doi.org/10.1016/j.auec.2020.07.002

16. Kumar, S., & Ambikavathy, M. (2012). Ludwig's angina: Report of 40 cases and review of current concepts in emergency management in a rural tertiary facility teaching hospital. International Journal of Head and Neck Surgery, 8(1), 11-14. DOI: 10.5005/jp-journals-10001-1298

17. McDonnough, J. A., Ladzekpo, D. A., Yi, I., Bond Jr, W. R., Ortega, G., & Kalejaiye, A. O. (2019). Epidemiology and resource utilization of Ludwig's angina ED visits in the United States 2006–2014. The Laryngoscope, 129(9), 2041-2044. https://doi.org/10.1002/lary.27734

18. Morton, B., Stolbrink, M., Kagima, W., Rylance, J., & Mortimer, K. (2018). The early recognition and management of sepsis in sub-saharan african adults: A systematic review and meta-analysis. International journal of environmental research and public health, 15(9), 2017. https://doi.org/10.3390/ijerph15092017

19. Mukherji, A., Singh, M. P., Nahar, P., Bhuvaneshwari, S., Goel, S., & Mathur, H. (2019). Competence of handling medical emergencies among dental graduates and post-graduate students–A cross-sectional questionnaire study. Journal of Indian Academy of Oral Medicine and Radiology, 31(2), 107-116. DOI: 10.4103/jiaomr.jiaomr_24_19

20. Pham Dang, N., Delbet-Dupas, C., Mulliez, A., Devoize, L., Dallel, R., & Barthélémy, I. (2020). Five predictors affecting the prognosis of patients with severe odontogenic infections. International Journal of Environmental Research and Public Health, 17(23), 8917. https://doi.org/10.3390/ijerph17238917

21. Qu, L., Liang, X., Jiang, B., Qian, W., Zhang, W., & Cai, X. (2018). Risk factors affecting the prognosis of descending necrotizing mediastinitis from odontogenic infection. Journal of Oral and Maxillofacial Surgery, 76(6), 1207-1215. https://doi.org/10.1016/j.joms.2017.12.007

22. Rababa, M., Bani Hamad, D., & Hayajneh, A. A. (2022). Sepsis assessment and management in critically Ill adults: A systematic review. PLoS One, 17(7), e0270711. https://doi.org/10.1371/journal.pone.0270711

23. Ramos-Zayas, A., Lopez-Medrano, F., Urquiza-Fornovi, I., Zubillaga, I., Gutiérrez, R., Sanchez-Aniceto, G., ... & Cebrián, J. L. (2021). The impact of healthcare-associated infections in patients undergoing oncological microvascular head and neck reconstruction: A prospective multicentre study. Cancers, 13(9), 2109. https://doi.org/10.3390/cancers13092109

24. Reuter, T. C., Korell, V., Pfeiffer, J., Ridder, G. J., Ketterer, M. C., & Becker, C. (2023). Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences—a retrospective follow-up study. European Archives of Oto-Rhino-Laryngology, 280(4), 1983-1990. https://doi.org/10.1007/s00405-022-07769-x

25. Riekert, M., Kreppel, M., Zöller, J. E., Zirk, M., Annecke, T., & Schick, V. C. (2019). Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions. Oral and maxillofacial surgery, 23(3), 331-336. https://doi.org/10.1007/s10006-019-00770-5

26. Sugio, K., Okamoto, T., Maniwa, Y., Toh, Y., Okada, M., Yamashita, T., ... & Society, J. B. E. (2021). Descending necrotizing mediastinitis and the proposal of a new classification. JTCVS open, 8, 633-647. https://doi.org/10.1016/j.xjon.2021.08.001

27. Thiele, H., Zeymer, U., Thelemann, N., Neumann, F. J., Hausleiter, J., Abdel-Wahab, M., ... & IABP-SHOCK II Trial (Intraaortic Balloon Pump in Cardiogenic Shock II) Investigators. (2019). Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction: long-term 6-year outcome of the randomized IABP-SHOCK II trial. Circulation, 139(3), 395-403. https://doi.org/10.1161/CIRCULATIONAHA.118.038201

28. Thompson, K., Venkatesh, B., & Finfer, S. (2019). Sepsis and septic shock: current approaches to management. Internal medicine journal, 49(2), 160-170. https://doi.org/10.1111/imj.14199

29. Valerio, L., Corsi, G., Sebastian, T., & Barco, S. (2020). Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry. Thrombosis research, 196, 494-499. https://doi.org/10.1016/j.thromres.2020.10.002

30. Wang, E. J., Berninger, L. E., Komargodski, O., & Smith, T. J. (2022). Painful diabetic neuropathy-spinal cord stimulation, peripheral nerve stimulation, transcutaneous electrical nerve stimulation, and scrambler therapy: a narrative review. Pain Physician, 25(8), E1161.

31. Weise, H., Naros, A., Weise, C., Reinert, S., & Hoefert, S. (2019). Severe odontogenic infections with septic progress–a constant and increasing challenge: a retrospective analysis. BMC oral health, 19(1), 173. https://doi.org/10.1186/s12903-019-0866-6

32. Wong, A. P., Duggins, M. L., & Neil, T. (2015). Internal jugular vein septic thrombophlebitis (lemierre syndrome) as a complication of pharyngitis. The Journal of the American Board of Family Medicine, 28(3), 425-430. https://doi.org/10.3122/jabfm.2015.03.140131

Authors

Ehsan Ali Mohammed Hakami
ehhakami@moh.gov.sa (Primary Contact)
Nisrin Ali Mohammed Hakami
Afnan Hadi Kuriri
Ghaliah Hadi Mohammed Makin
Fahad Mohammed Bereik Aldosari
Ashwaq Jaloud Alanazi
Amer Mohamed Abdollah Aldosari
Safi Saad Abdullah Aldosari
Mohammed Mubarak Abdullah Aldawsari
Saeed Abdullah Aldawsari
Hanaa Ibrahim Essa Alkhebri
Obaid Abdulaziz Saeed Aldawsari
Meshael falah Mohammed
Hakami, E. A. M., Hakami, N. A. M., Kuriri, A. H., Makin, G. H. M., Aldosari, F. M. B., Alanazi, A. J., … Mohammed, M. falah. (2024). ‏A Silent Storm: A Narrative Review of Systemic Manifestations of Odontogenic Infections and a Framework for Interdisciplinary Recognition from Pre-Hospital Care to Rehabilitation. Saudi Journal of Medicine and Public Health, 1(2), 2007–2013. https://doi.org/10.64483/202412564

Article Details