The impact of diabetes mellitus on the risk of severe dental infection complications
Näytönastekatsaukset
22.10.2025
Level of evidence: C
Diabetes may increase the risk of severe infection complications of dental origin, and the length of hospital stay.
The evidence is based on mainly case-control and retrospective cohort studies including one large cohort study from Asia. The certainty of evidence is not upgraded or downgraded because of factors having effect on both directions. Downgrading could be done due to inconsistency and indirectness (studies conducted in very different circumstances show different results, e.g variability in the access to dental care in Asia compared to Nordic countries may explain these differences). Upgrading of the evidence would be possible based on strong effect size (> 3) and based on studies suggesting that poor control of diabetes treatment may be involved in impaired outcome.
| Reference | Study type | Population | Exposure and comparison or cases | Outcomes | Risk of bias «Additional comments for included studies»2 |
|---|---|---|---|---|---|
| SR=systematic review; MA=meta-analysis | |||||
| «Dou K, Shi Y, Yang B, et al. Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2024;125(4S):1019»1 | SR, MA with 7 case-control studies | Study populations from Italy, India, and China. | Patients with DM and multiple space involvement or high temperature (≥ 39 °C) or sepsis | Life-threatening complications of head and neck space infections (LCHNSI) | Moderate |
| «Ko HH, Chien WC, Lin YH, et al. Examining the correlation between diabetes and odontogenic infection: A nationwide, retrospective, matched-cohort study in Taiwan. PLoS One 2017;12(6):e0178941 »2 | Cohort study | 1 million randomly selected patients from Taiwan National Health Insurance Database, included in the register in 2005; the cohort was 21 510 newly diagnosed diabetes mellitus and 43 020 matched non-DM patients | Patients with and without DM | Acquiring of odontogenic facial cellulitis or odontogenic infection, long hospitalization | Moderate |
| «Yew CC, Ng MP, Khoo SE, et al. Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia. J Oral Maxillofac Surg 2022;80(4):736-743 »3 | Retrospective study | Patients with orofacial odontogenic infection. A cross-sectional 2-center study in Malaysia. | Patients with and without DM | Long hospitalization (> 5 d) | |
| «Rahimi-Nedjat RK, Sagheb K, Sagheb K, et al. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021;25(11):6279-6285 »4 | Retrospective study | Patients with severe odontogenic abscesses or other patients who received inpatient treatment for any diagnosis other than an abscess (general maxillofacial group) at department of Oral and Maxillofacial Surgery of the Medical Center of the Johannes Gutenberg-University, Mainz, Germany. | Patients with and without: Type I DM; type II DM; abnormal maximum blood sugar count (MBSC) and abnormal fasting blood sugar count (FBSC) | Long hospitalization, prevalence of severe odontogenic abscesses | |
| «Furuholm J, Rautaporras N, Uittamo J, et al. Health status in patients hospitalised for severe odontogenic infections. Acta Odontol Scand 2021;79(6):436-442 »5 | Retrospective study | Patients aged ≥ 18 years and who required treatment and hospital stay for acute odontogenic infection, OI (i.e. abscess, or cellulitis of facial or neck region of dental origin) (Helsinki university hospital, emergency department, Finland) | Predictor variables were history of recent dental procedure, preceding antibiotic medication localization of the infection focus. Explanatory variables were sex, age, body mass index, smoking, excess consumption of alcohol or regular use of drugs, and history of immunocompromised condition by disease (incl DM), medications, or both | Need for treatment in intensive care unit (ICU) or infection complications such as pneumonia or distant infection | |
Results
| Reference | Number of studies and number of patients (E/C) | Follow-up time | Absolute number of events (%) E | Absolute number of events (%) C | Relative effect (95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: moderate/low The quality of evidence is downgraded due to inconsistency, indirectness. The quality of evidence in upgraded due to large effect E=exposure; C=comparison; CI=confidence interval | |||||
| «Dou K, Shi Y, Yang B, et al. Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2024;125(4S):1019»1 | DM: 7 studies | Not specified | Not specified | Increased risk of LCHNSI DM: OR = 3.31, 95 % CI: 2.49−4.40, P < 0.00001 | |
| «Ko HH, Chien WC, Lin YH, et al. Examining the correlation between diabetes and odontogenic infection: A nationwide, retrospective, matched-cohort study in Taiwan. PLoS One 2017;12(6):e0178941 »2 | 21 510 patients with newly diagnosed DM, 43 020 patients without DM | mean 5 years | Incidence of odontogenic facial cellulitis:110; | Incidence of odontogenic facial cellulitis: 100 | Odontogenic facial cellulitis HR 1.409 (95 % CI: 1.071–1.854, p= 0.014) |
| «Rahimi-Nedjat RK, Sagheb K, Sagheb K, et al. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021;25(11):6279-6285 »4 | 977 patients with severe odontogenic abscesses. Abscess patients n = 977 were compared to general patients n = 2 258. | Abscess patients: DM 71/977 type I DM 6/977 type II DM 65/977 abnormal MBSC 56/977 (32/56 with diagnosed DM) abnormal FBSC 39/977 General patients: DM 121/2 258 abnormal MBSC 242/2 258 impaired FBSC 185/2 258 | Abscess patients: no DM 906/977 General patients no DM 2 137/2 255 | Among all patients n = 3 235 Higher number of abscesses among patients with DM (p = 0.025), patients with abnormal MBSC and FBSC (p < 0.001). | |
| «Furuholm J, Rautaporras N, Uittamo J, et al. Health status in patients hospitalised for severe odontogenic infections. Acta Odontol Scand 2021;79(6):436-442 »5 | 303 acute OI patients in need for hospital treatment, of which 71 in need for ICU, 23 infection complication patients | Severe odontogenic infection 27 DM/303 immunocompromised in ICU 10/71 of which DM 7/71 | Severe odontogenic infection 246 healthy /303 in ICU 61/71 | No significant difference between previously healthy and immunocompromised patients (incl DM) for treatment in ICU, | |
| Reference | Number of studies and number of patients (E/C) | Follow-up time | Absolute number of events (%) E | Absolute number of events (%) C | Relative effect (95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: low E=intervention; C=comparison; CI=confidence interval | |||||
| «Yew CC, Ng MP, Khoo SE, et al. Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia. J Oral Maxillofac Surg 2022;80(4):736-743 »3 | 355 patients with orofacial odontogenic infection. 69/355 patients with DM. | 18/69 patients with > 5 d hospitalization | 34/284 patients with > 5 d hospitalization | DM: long hospitalization (> 5 d) OR = 4.387, 95% CI = 1.453-13.241, P = 0.009 | |
| «Rahimi-Nedjat RK, Sagheb K, Sagheb K, et al. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021;25(11):6279-6285 »4 | 2 258 general patients, 977 patients with severe odontogenic abscesses. Patients with: type I DM 6/977; type II DM 71/977; abnormal maximum blood sugar count (MBSC) 56/977 (32/56 with diagnosed DM), abnormal FBSC 39/977. | Significantly longer hospitalization for patients with abnormal MBSC (7.5 d, p = 0.046) and FBSC (9.2 d p 0 = 0.008) but not for DM patients (6.4 d) compared to 6 d in no DM patients. | |||
Comment:
Some studies «Stathopoulos P, Rallis G. Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin. Oral Surg Oral Med Oral Pathol Oral Radiol 2024;13»6, «Rahimi-Nedjat RK, Sagheb K, Sagheb K, et al. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021;25(11):6279-6285 »4 suggest that severe odontogenic infection complications (descending necrotizing mediastinitis, longer hospitalization stay) in DM patients are associated with poorly controlled diabetes
References
- Dou K, Shi Y, Yang B, et al. Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2024;125(4S):101954 «PMID: 38908479»PubMed
- Ko HH, Chien WC, Lin YH, et al. Examining the correlation between diabetes and odontogenic infection: A nationwide, retrospective, matched-cohort study in Taiwan. PLoS One 2017;12(6):e0178941 «PMID: 28594848»PubMed
- Yew CC, Ng MP, Khoo SE, et al. Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia. J Oral Maxillofac Surg 2022;80(4):736-743 «PMID: 34863695»PubMed
- Rahimi-Nedjat RK, Sagheb K, Sagheb K, et al. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021;25(11):6279-6285 «PMID: 33982168»PubMed
- Furuholm J, Rautaporras N, Uittamo J, et al. Health status in patients hospitalised for severe odontogenic infections. Acta Odontol Scand 2021;79(6):436-442 «PMID: 33502919»PubMed
- Stathopoulos P, Rallis G. Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin. Oral Surg Oral Med Oral Pathol Oral Radiol 2024;137(2):113-118 «PMID: 38155017»PubMed