Citation Information :
Goel M, Maliwad VK, Solanki R, Deep A, Saini N. Analysis of C-reactive Protein Level as a Monitoring Tool in Patients with Odontogenic Space Infection: A Prospective Clinical Study. J Oral Health Comm Dent 2023; 17 (2):37-43.
Aim: The aim of this study was to do analysis of C-reactive protein (CRP) level as an efficacy of treatment in odontogenic space infection in indoor patients to measure the severity of infection so that medicinal treatment response can be assessed and subsequently to avoid excessive postoperative antibiotic treatment given to the patients.
Materials and methods: A total number of 40 indoor patients of 17–50 years of age were analyzed for CRP levels as monitoring tools in odontogenic fascial space infection in the Department of Oral and Maxillofacial Surgery, PGIDS, in collaboration with the Department of Microbiology, PGIMS, to measure the severity of infection and to assess medicinal treatment response.
Results: The severity of infection and effectiveness of the treatment regime were determined using the correlation between clinical parameters and laboratory values of serum CRP, which explained the direct and linear relation between CRP and size of swelling, with CRP being a significant predictor of size of swelling (p < 0.05). The data for mouth opening explained an inverse relation between CRP and mouth opening.
Conclusion: The findings of this prospective analysis indicate that CRP can be served as effective markers for determining the severity of fascial space infections of odontogenic origin. Serum CRP reflects the immediate effect of the treatment and acts as a significant predictor of the severity of infection and effectiveness of the treatment regime, which can be incorporated as a monitoring tool for managing patients with fascial space infections of odontogenic origin.
Clinical significance: Looking at the scarcity of studies pertaining to CRP levels in odontogenic space infection patients, this prospective analysis study was conducted to monitor the levels of CRP level in odontogenic space infection patients to throw further light in this direction.
Topazian RG, Goldberg MH, Hupp JR. Oral and Maxillofacial Infections. Philadelphia: W.B. Saunders; 2002.
Stefanopoulos PK, Kolokotronis AE. The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(4):398–408. DOI: 10.1016/j.tripleo.2004.01.016.
Ohshima A, Ariji Y, Goto M, et al. Anatomic considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: Computed tomographic analyses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(5):589–597. DOI: 10.1016/S1079210404005074.
Singh M, Kambalimath DH, Gupta KC. Management of odontogenic space infection with microbiology study. J Maxillofac Oral Surg 2014;13(2):133–139. DOI: 10.1007/s12663-012-0463-6.
Tamma PD, Cosgrove SE, Maragakis LL. Combination therapy for treatment of infections with Gram-negative bacteria. Clin Microbiol Rev 2012;25(3):450–470. DOI: 10.1128/CMR.05041-11.
Peterson LJ. Contemporary management of deep infections of the neck. J Oral Maxillofac Surg 1993;51(3):226–231. DOI: 10.1016/s0278-2391(10)80162-4.
Mohanty S. Spread of oral infections. In: Saraf S, editor. Textbook of Oral Pathology. New Delhi (India): Jaypee Brothers Medical Publishers; 2006. p. 190.
Frydman WL, Abbaszadeh K. Diagnosis and management of odontogenic oral and facial infections. Oral Health 2014. Available at: http://www.oralhealth group.com/features/diagnosis-and-management-of-odontogenic-oral-and-facialinfectionswilliam-l-frydman-dds-ms-frcd-c/. [accessed March 9, 2017].
Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C-reactive protein, albumin or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. JAMA 1998;279(18):1477–1482. DOI: 10.1001/jama.279.18.1477.
Sharma A, Giraddi G, Krishnan G, et al. Efficacy of serum prealbumin and CRP levels as monitoring tools for patients with fascial space infections of odontogenic: A clinicobiochemical study. J Maxillofac Oral Surg 2014;13(1):1–9. DOI: 10.1007/s12663-012-0376-4.
Bagul R, Chandan S, Sane VD, et al. Comparative evaluation of C-reactive protein and WBC count in fascial space infections of odontogenic origin. J Maxillofac Oral Surg 2017;16(2):238–242. DOI: 10.1007/s12663-016-0953-z.
Rau B, Steinbach G, Gansauge F, et al. The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 1997;41(6):832–840. DOI: 10.1136/gut.41.6.832.
Pearce A, Thornton L, Sutton PA, et al. Post-operative C-reactive protein profile following abdominal wall reconstruction with transversus abdominis posterior components separation. Int J Surg Case Rep 2017;40:17–19. DOI: 10.1016/j.ijscr.2017.08.027.
Lee PT, Bird S, Zou J, et al. Phylogeny and expression analysis of C-reactive protein (CRP) and serum amyloid-P (SAP) like genes reveal two distinct groups in fish. Fish Shellfish Immunol 2017;65:42–51. DOI: 10.1016/j.fsi.2017.03.037.
Du Clos TW. Function of C-reactive protein. Ann Med 2000;32(4):274–278. DOI: 10.3109/07853890009011772.
Volanakis JE. Human C-reactive protein: Expression, structure, and function. Mol Immunol 2001;38(2):189–197. DOI: 10.1016/s0161-5890(01)00042-6.
Markic J, Saraga M, Dahlem P. Sepsis biomarkers in neonates and children: C-reactive protein and procalcitonin. J Child Sci 2017;1(01):e89–e95. DOI: 10.1055/s-0037-1603895.
Sharma A, Gokkulakrishnan S, Shahi AK, et al. Efficacy of serum CRP levels as monitoring tools for patients with fascial space infections of odontogenic origin: A clinicobiochemical study. Natl J Maxillofac Surg 2012;3(2):148–151. DOI: 10.4103/0975-5950.111369.
Ren YF, Malmstrom HS. Rapid quantitative determination of C-reactive protein at chair side in dental emergency patients. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol 2007;104(1):49–55. DOI: 10.1016/j.tripleo.2007.01.007.
Paraskevas S, Huizinga JD, Loos BG. A systemic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol 2008;35(4):277–290. DOI: 10.1111/j.1600-051X.2007.01173.x.
Young B, Gleeson M, Cripps AW. C-reactive protein: A critical review. Pathology 1991;23(2):118–124. DOI: 10.3109/00313029109060809.
Stumpf C, Hilgers KF. C-reactive protein: More than just a marker of inflammation? J Hypertens 2009;27(9):1748–1749. DOI: 10.1097/HJH.0b013e32832f4c64.
Walia IS, Borle RM, Mehendiratta D, et al. Microbiology and antibiotic sensitivity of head and neck space infections of odontogenic origin. J Maxillofac Oral Surg 2014;13(1):16–21. DOI: 10.1007/s12663-012-0455-6.
Fating NS, Saikrishna D, Kumar GV, et al. Detection of bacterial flora in orofacial space infections and their antibiotic sensitivity profile. J Maxillofac Oral Surg 2014;13(4):525–532. DOI: 10.1007/s12663-013-0575-7.
Patankar A, Dugal A, Kshirsagar R. Evaluation of microbial flora in orofacial space infections of odontogenic origin. Natl J Maxillofac Surg 2014;5(2):161–165. DOI: 10.4103/0975-5950.154820.
Bahl R, Sandhu S, Singh K, et al. Odontogenic infections: Microbiology and management. Contemp Clin Dent 2014;5(3):307–311. DOI: 10.4103/0976-237X.137921.
Bali RK, Sharma P, Gaba S, et al. A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015;6(2):136–143. DOI: 10.4103/0975-5950.183867.
Singh WT, Singh WR, Devi WM, et al. C-reactive protein as a monitoring tool for facial space infections of odontogenic origin: A prospective study. Int J Contemp Dent 2013;3(3). Corpus ID: 54122673.
Naik S, BalReddy, Sridhar, et al. Efficacy of serum C-reactive protein levels as monitoring tools for patients with infections of odontogenic origin – A clinical and biochemical study. Int J Healthcare Biomed Res 2015;1(4):32–39. DOI: 10.1007/s12663-012-0376-4.
Ylijoki S, Suuronem R, Jousimies-Somer H, et al. Differences between patients with or without the need for intensive care due to severe odontogenic infections. J Oral Maxillofac Surg 2001;59(8):867–872. DOI: 10.1053/joms.2001.25017.
Rega AJ, Aziz SR, Ziccardi VB. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. J Oral Maxillofac Surg 2006;64(9):1377–1380. DOI: 10.1016/j.joms.2006.05.023.
Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem 2004;279(47):48487–48490. DOI: 10.1074/jbc.R400025200.