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In Reference to Risk Perception of Septic Shock with Multiple Organ Failure Due to Acute Exacerbation of an Infectious Dental Disease [Letter]

Authors Baba Y , Takada S, Kato Y 

Received 4 October 2021

Accepted for publication 27 October 2021

Published 4 November 2021 Volume 2021:17 Pages 1163—1164


Checked for plagiarism Yes

Editor who approved publication: Professor Garry Walsh

Yuh Baba, 1 Satoshi Takada, 2 Yasumasa Kato 3

1Department of Otorhinolaryngology, Ohu University Dental Hospital, Koriyama City, Fukushima, 963-8611, Japan; 2Department of Oral and Maxillofacial Surgery, Ohu University Dental Hospital, Koriyama City, Fukushima, 963-8611, Japan; 3Department of Oral Function and Molecular Biology, Ohu University School of Dentistry, Koriyama City, Fukushima, 963-8611, Japan

Correspondence: Yuh Baba Email [email protected]

View the original paper by Dr Sato and colleagues
A Response to Letter has been published for this article.

Dear editor

We read with interest the article “Risk Perception of Septic Shock with Multiple Organ Failure Due to Acute Exacerbation of an Infectious Dental Disease” by Sato et al.1

In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in Wuhan, China.2 While it was recommended to postpone the treatment for patients with non-urgent diseases, emergent diseases such as peritonsillar abscess, acute supraglottitis, acute deep neck infection, and septicemia due to acute exacerbation of infectious dental disease like this case must receive emergent conservative or surgical management even during the COVID-19 pandemic. Furthermore, Takahashi et al suggested that periodontopathic bacteria promotes SARS-CoV-2 infection by increasing the expression of angiotensin-converting enzyme 2 (ACE2) which is the host cellular receptor and that pro-inflammatory cytokines such as interleukin-6 and −8 also stimulate SARS-CoV-2 infection.3

Thus, we have serious concerns about the increase in the mortality of SARS-CoV-2 by infection of the periodontopathic bacteria in this case. At first, the authors should indicate this case report before or during the COVID-19 pandemic, and also, explain the reason why the swelling spreads to the left buccal region, nevertheless pus discharge from the periodontal pocket was observed. Of course, one reason is the fact that antibiotics were not prescribed in this case. As another reason, it is possible that the abscess is not unilocular but multilocular. The abscess at masticator space frequently extends from the molar teeth, and the abscess can result in trismus,4 leading to more difficulty while eating like this case. Furthermore, deep neck abscess such as parapharyngeal space and danger space infection can lead to severe life-threatening complications such as mediastinitis and septic shock. Chest CT in this case indicated pleural effusion. Taken together, we speculate that deep neck abscess which extended from the molar teeth resulted in trismus, mediastinitis, and septic shock.

Please clarify the possible pathway of the extension from infectious dental disease to septic shock, in addition to the infecting organism. We do not know accurate onset of sepsis in this case, although the authors speculate that “the patient′s rapid progression from dental infection to dehydration and septicemia may have been related to the difficulty while eating for three days”. When screening for sepsis, doctors often use the Systemic Inflammatory Response Syndrome (SIRS) or the quick Sepsis-related Organ Failure Assessment (qSOFA) or the National Early Warning Score (NEWS). Usman et al indicated that NEWS is the most useful for the early identification of sepsis out of these evaluations.5 Thus, we regret that the dentist did not evaluate NEWS daily in this case when sterilization was performed daily. We hope to hear the author′s opinion at this point.


The authors report no conflicts of interest in this communication.


1. Sato H, Tamanoi T, Suzuki T, et al. Risk perception of septic shock with multiple organ failure due to acute exacerbation of an infectious dental disease. Ther Clin Risk Manag. 2021;17:365–369. doi:10.2147/TCRM.S286764

2. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020;92(4):401–402. doi:10.1002/jmv.25678

3. Takahashi Y, Watanabe N, Kamio N, et al. Expression of the SARS-CoV-2 Receptor ACE2 and proinflammatory cytokines induced by the periodontopathic bacterium fusobacterium nucleatum in human respiratory epithelial cells. Int J Mol Sci. 2021;22(3):1352. doi:10.3390/ijms22031352

4. Lim HK, Wang JM, Hung ST, Ku HC. A dangerous cause of airway obstruction: deep neck infection. Signa Vitae. 2021;17(2):4–9.

5. Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the emergency department. Am J Emerg Med. 2019;37(8):1490–1497. doi:10.1016/j.ajem.2018.10.058

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