Immediate Versus Delayed Treatment of Odontogenic Infections
Study Details
Study Description
Brief Summary
The objective of this study is to compare the physiologic resolution of dental infections between immediate tooth extraction (control group) and administration of systemic antibiotics and delayed extraction (study groups 1 and 2). A secondary objective is two compare two different antibiotic regimens in the delayed extraction groups (study group 1 and 2).
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
This is a prospective partially randomized clinical trial. Patients 2-11 years old who have a vestibular swelling associated with an odontogenic infection are being studied. Subjects will self-select into the control or study group. All subjects will be offered to have the tooth extracted on the day of diagnosis, and if this treatment is chosen they will join the control group (group 1). Subjects who defer treatment will be placed on amoxicillin and will be placed into the study group. The study group will be randomized into two parallel study groups that either have average dose antibiotics for 10 days (group 2), or maximum dose antibiotics for 5 days (group 3).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Extraction Only Immediate extraction of infected tooth without antibiotic prescription. |
Procedure: Tooth extraction
Removal of infected tooth on first day of study, this approach does not require an antibiotic drug.
Other Names:
|
| Experimental: Average Dose Antibiotic Average dose antibiotic therapy(25 mg/kg/day in divided doses every 12 hours (maximum 875 mg/dose)) for 10 days and receive tooth extraction on day 10 (25 patients). (*given the average weight of a 12 year old is 45 kilos, we do not expect that we will reach the maximum dose in this group) |
Drug: Amoxicillin
Antibiotic given at different dosages and durations.
Other Names:
Procedure: Tooth extraction
Removal of infected tooth on first day of study, this approach does not require an antibiotic drug.
Other Names:
|
| Experimental: High Dose Antibiotic High dose antibiotic therapy (45 mg/kg/day in divided doses every 12 hours (maximum 875 mg/dose)) for 5 days and receive tooth extraction on day 10 (25 patients) |
Drug: Amoxicillin
Antibiotic given at different dosages and durations.
Other Names:
Procedure: Tooth extraction
Removal of infected tooth on first day of study, this approach does not require an antibiotic drug.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Change in diagnosis [Infection will be monitored at days 0, 5, 10 and 20.]
Tooth infection not clinically detectable
Secondary Outcome Measures
- Measure of pediatric oral health-related quality of life: the POQL [Survey of quality of life at days 0, 5, 10 and 20.]
Quality of life compared between arms. Pediatric Oral Health Quality of Life (PQOL) clustered into four dimensions - Physical Functioning, Role Functioning, Social Functioning and Emotional Functioning. It was designed to be used in high risk, low resource, populations with greater health disparities. Specifically we are looking significant difference between the study groups that is at least 2 standard errors from the control group. If there are not two deviations to discriminate between scales would indicate a non-significant finding.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients who present to the dental clinic or Boston Children's Hospital emergency room
-
Odontogenic origin associated with a primary tooth and limited to the buccal vestibule only
-
Ages of 2-11 years old
-
Primary Caregiver present
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English speaking
-
American Society of Anesthesiologists (ASA) classification of I
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None or current systemic antibiotic therapy regimen < 24 hours
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Able to take medication orally
-
Those patients who choose to participate in the study
Exclusion Criteria:
-
Infection that has spread beyond the buccal vestibule, or not detectable
-
Infection is associated with a permanent adult tooth
-
Ages of <2 years old or >11 years old
-
American Society of Anesthesiologists classification of II or greater or poor general health.
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Renal impairment
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Immunosuppressive disease
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Recent antibiotic therapy in the last 1 to 30 days
-
Allergy to penicillin
-
Unable to take oral medications
-
Decline participation
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Boston Children's Hospital
Investigators
- Principal Investigator: Keri Discepolo, DDS, Boston Children's Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
- Biederman GR, Dodson TB. Epidemiologic review of facial infections in hospitalized pediatric patients. J Oral Maxillofac Surg. 1994 Oct;52(10):1042-5.
- Dodson TB, Perrott DH, Kaban LB. Pediatric maxillofacial infections: a retrospective study of 113 patients. J Oral Maxillofac Surg. 1989 Apr;47(4):327-30.
- Huntington NL, Spetter D, Jones JA, Rich SE, Garcia RI, Spiro A 3rd. Development and validation of a measure of pediatric oral health-related quality of life: the POQL. J Public Health Dent. 2011 Summer;71(3):185-93.
- Kara A, Ozsurekci Y, Tekcicek M, Karadag Oncel E, Cengiz AB, Karahan S, Ceyhan M, Celik MO, Ozkaya-Parlakay A. Length of hospital stay and management of facial cellulitis of odontogenic origin in children. Pediatr Dent. 2014 Jan-Feb;36(1):18E-22E.
- Lin YT, Lu PW. Retrospective study of pediatric facial cellulitis of odontogenic origin. Pediatr Infect Dis J. 2006 Apr;25(4):339-42.
- Rush DE, Abdel-Haq N, Zhu JF, Aamar B, Malian M. Clindamycin versus Unasyn in the treatment of facial cellulitis of odontogenic origin in children. Clin Pediatr (Phila). 2007 Mar;46(2):154-9.
- Thikkurissy S, Rawlins JT, Kumar A, Evans E, Casamassimo PS. Rapid treatment reduces hospitalization for pediatric patients with odontogenic-based cellulitis. Am J Emerg Med. 2010 Jul;28(6):668-72. doi: 10.1016/j.ajem.2009.02.028. Epub 2010 Apr 2.
- Warnke PH, Becker ST, Springer IN, Haerle F, Ullmann U, Russo PA, Wiltfang J, Fickenscher H, Schubert S. Penicillin compared with other advanced broad spectrum antibiotics regarding antibacterial activity against oral pathogens isolated from odontogenic abscesses. J Craniomaxillofac Surg. 2008 Dec;36(8):462-7. doi: 10.1016/j.jcms.2008.07.001. Epub 2008 Aug 29.
- P00030880