Open Journal of Stomatology, 2021, 11, 399-410

https://www.scirp.org/journal/ojst
ISSN Online: 2160-8717
ISSN Print: 2160-8709

Epidemiological Aspects of Cervicofacial

Cellulitis Due to Dental Origin in the City of
Ouagadougou (Burkina Faso)

Wendpouiré Patrice Laurent Guiguimdé1,2*, Kouamé Patrice Attogbain3, Jocelyne V. W. Garé1,2,

Yamsoulougri C. L. Ouédraogo4, Mathieu Millogo1,2, Tarcissus Konsem1,2
1
Training and Research Unit in Health Sciences (UFR/SDS), Joseph Ki Zerbo University, Ouagadougou, Burkina Faso
2
Department of Odontostomatology and Maxillofacial Surgery, Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina
Faso
3
Department of Surgery, UFR of Odonto-Stomatology, Félix Houphouët-Boigny University of Abidjan, Abidjan, Republic of Côte
d’Ivoire
4
Department of Odontostomatology and Maxillofacial Surgery, Bogodogo University Hospital Center, Ouagadougou, Burkina
Faso

How to cite this paper: Guiguimdé, W.P.L., Abstract

Attogbain, K.P., Garé, J.V.W., Ouédraogo,
Y.C.L., Millogo, M. and Konsem, T. (2021) Background: Head and neck cellulitis of dental origin are polymicrobial bac-
Epidemiological Aspects of Cervicofacial terial infections involving the cellulo-adipose spaces of the face and neck. The
Cellulitis Due to Dental Origin in the City of
objective of this work was to describe the epidemiological and clinical profile
Ouagadougou (Burkina Faso). Open Journal
of Stomatology, 11, 399-410. of patients with head and neck cellulitis. Methods: This was a cross-sectional
https://doi.org/10.4236/ojst.2021.1110035 study conducted from 1 January to 30 June 2020. All patients consulting for
cervico-facial cellulitis of dental origin in 2 university hospitals in Ouaga-
Received: August 30, 2021
Accepted: September 27, 2021
dougou were included in the study. The usual parameters of descriptive sta-
Published: September 30, 2021 tistics were estimated for each variable. Results: Two hundred and nine-
ty-two cases (184 men and 108 women), aged 3 to 85 years were collected.
Copyright © 2021 by author(s) and
The 25 - 35 years old were the most affected (33%). Decay was the leading
Scientific Research Publishing Inc.
This work is licensed under the Creative dental cause (95.6%). The delay in consultation was included within 7 days in
Commons Attribution International 74.66% of cases. Ninety-one-point forty-four percent of patients had poor oral
License (CC BY 4.0). hygiene. Diffuse cellulitis was the most common (64.04%) and peri-mandibular
http://creativecommons.org/licenses/by/4.0/
regions were the most invaded (42.81%). Conclusion: The frequencies ob-
Open Access
served in our study allow us to conclude that cervicofacial cellulitis of dental
origin is still frequent and affects a young and disadvantaged population.

Keywords
Cervicofacial Cellulitis, Odontogenic Infection, Epidemiological and Clinical
Profile, Ouagadougou

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W. P. L. Guiguimdé et al.

1. Introduction
Cervicofacial cellulitis of dental origin is an infectious process of the celluloa-
diputic tissue of the face with a dental starting point, often with unclear boun-
daries and extensive tendency [1]. They involve the vital prognosis due to the
speed of evolution and gravity of complications [2]. If, cervico-facial cellulitis
is clearly regressing in developed countries, they are still very present. Surpri-
singly, in recent years we have noted their increasing incidence in developing
countries [3]-[8]. In Burkina Faso, there is a resurgence of cellulitis due to the
lack of access to health care, delayed consultation of patients, the complexity of
therapeutic itinerary of patients, self-medication, poor use of antibiotics, and
the impoverishment of the population... No study on the scale of the city of
Ouagadougou, which includes several hospitals and has taken stock of the ep-
idemiological situation, has yet been carried out on cervicofacial cellulitis due
to dental origin, hence the interest of this work. The aim of this study is to
examine the different epidemiological and clinical aspects of these pathologies
in Ouagadougou.

2. Material and Methods

Our study was conducted in the Stomatology and Maxillofacial Surgery (S/CMF)
departments of the Yalgado Ouédraogo University Hospital (CHU-YO) and the
Bogodogo University Hospital (CHU-B).
This was a descriptive cross-sectional study. Data were collected from January
1 to December 31, 2020. All patients consulting for cervico-facial cellulitis due to
dental origin, regardless of sex or age, were included in the study, and consent
was obtained.
The data were collected using a collection form developed for this purpose
(attached). The variables studied concerned socio-demographic data (age, sex,
level of education, marital status, socio-professional category, residence and re-
sources), the characteristics of the patients on admission (reason for consulta-
tion, time of consultation, medical history, general signs, etc.), the characteristics
of patients in the hospital, and the characteristics of patients in the community,
medical history, general signs, tobacco, alcohol and/or drug consumption,
self-medication and medication taken and clinical data (oral hygiene, etiology of
cellulitis, clinical type of cellulitis, topography of the lesion, teeth concerned).
Data entry was performed using EPIDATA software. The analysis, which was
done with the help of R software version 4.1.0, consisted of a descriptive analysis
of the data. The usual parameters of descriptive statistics were estimated for each
variable. These were the proportions for the qualitative variables, the average
and the standard deviation for the quantitative variables whose distribution was
normal.
The anonymity of patients and the confidentiality of collected information
were preserved. No identifying data were recorded in the database or used in the
analysis.

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 W. P. L. Guiguimdé et al.

3. Results
During the period of our study , we recorded́ 292 cases of cervico-facial cellulitis
of dental origin. The average monthly number of cellulitis cases was 24.3 pa-
tients. There were 3 peaks in frequency in April (34 cases), June (34 cases), and
October (43 cases) (Figure 1).
Socio-demographic characteristics
The average age of patients was 35.41 ± 16.64 years. The extreme ages were 3
and 85 years. Table 1 shows the age distribution according to age ranges.
The sex ratio was 1.73. Patients not attending school represented 45.2% of our
study population. There were two (02) patients covered by health insurance and
75.95% of patients lived in the central region. Table 2 shows the distribution of
patients according to their socio-demographic characteristics.
Patient characteristics at admission
The majority of patients consulted within the first week of the onset of symp-
toms (74.6%) and pain was the main reason for the consultation (93.2%); 49.3%
used self-medication before the consultation (Table 3).
The general signs presented by the patients on admission are described in Ta-
ble 4. Trismus was the dominant sign (66.7%) followed by dysphagia (56.7),
conjunctival pallor (42.52%), odynophagia (35.96%), hyperthermia (33.79%).

Figure 1. Monthly incidence of cervicofacial cellulitis cases.

Table 1. Distribution of patients by age range.

Age Number n = 292 (%) Mean Standard deviation

Years 35.41 16.64

<15 ans 26 8.9

[15 - 25] 38 13.0

[25 - 35] 99 33.0

[35 - 45] 46 15.0

[45 - 55] 40 13.6

[55 - 65] 23 7.8

≥65 ans 20 6.8

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W. P. L. Guiguimdé et al.

Table 2. Distribution of patients according to socio-demographic characteristics.

Variables Modalities Number = 292 (%)

Gender

Male 184 63.0

Female 108 37.0

Marital status

Single 95 32.5

In couple 197 67.5

Study level

Not in school 132 45.2

Primary 102 34.9

Secondary and higher 58 19.9

Socio-professional category

Employed 26 8.9

Self-employed 100 34.2

Without remuneration 148 50.7

Other 18 6.2

Resource

Indigent 99 33.9

Insurance 2 0.7

Private 191 65.4

Residence

Central region 221 76.0

Other regions 65 22.3

Other countries 5 1.7

Table 3. Distribution of patients according to patient characteristics at admission.

Variables Modalities Number n = 292 (%)

Reasons for consultation

Pain 272 93.2

Swelling 20 6.8

Consultation deadlines

≤7 days 218 74.6

]7, 14] 37 12.7

]15, 540] 37 12.7

Medical history

Cardiovascular disease 3 1.0

Diabetes 7 2.4

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 W. P. L. Guiguimdé et al.

Continued

Pregnancy 9 3.1

Immunosuppression (HIV) 3 1.0

UGD 4 1.3

Mental illness 2 0.7

Other* 5 1.7

No 259 88.7

Self-medication

Yes 144 49.3

Types of medication

Antibiotic 61 70.1

Anti-inflammatory 29 33.3

Traditional 6 6.67

Analgesics 43 49.3

Origin of the drugs

Officine 39 27.1

Personal or family reserve 31 21.5

Gift (friend, relative) 12 12.5

Market or street 56 38 .9

Alcohol consumption

Yes 42 14.4

Tobacco use

Yes 81 27.7

Drug use

Yes 5 1.7

*Herniated disc, Epistaxis, Sciatica, Asthma, Renal insufficiency.

Table 4. Distribution of patients according to general signs.

General signs Number n = 292 %

Asthenia 16 5.5

Anorexia 22 7.6

Altered Consciousness 6 2.1

Thoracic Diffusion 6 2.1

Hyperthermia 98 33.8

Altered General Condition 27 9.3

Dehydration 15 5.1

Emphysema 0 0

Respiratory distress 10 3.4

Trismus 195 66.7

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W. P. L. Guiguimdé et al.

Continued

Dyspnea 13 4.4

Odynophagia 105 35.9

Dysphagia 165 56.7

Dysphonia 20 6.8

Bleeding 13 4.4

Conjunctival pallor 130 42.5

Tonsillitis 4 1.4

Pharyngeal abscess 9 3.1

I and C = incisors and canines. PM = premolars. M = molars.

Figure 2. Distribution of the frequency of causal teeth.

Clinical aspects
Poor oral hygiene was present in 91.44% of the patients. Dental caries were
the main etiology of cervicofacial cellulitis of dental origin, and mandibular mo-
lars (temporary and permanent) were the most affected (Figure 2). Diffuse
suppurative cellulitis (Photo 1) was the predominant clinical form and the pe-
ri-mandibular site (Photo 2) was the most common topography. Table 5 shows
the distribution of clinical characteristics of cellulitis.

4. Discussion
Socio-demographic characteristics
Two hundred and ninety-two cases of cervicofacial cellulitis were recorded
during our study period, representing a monthly hospital frequency of 24.3 cas-
es. The hospital frequency of cervicofacial cellulitis is largely underestimated in
our context because all cases do not reach our hospitals [7]. Despite this unde-
restimation, the frequency of cases in our series remains high and we note an
annual increase in cervicofacial cellulitis, as observed by other African authors:

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 W. P. L. Guiguimdé et al.

Photo 1. 46-year-old patient with diffuse cellulitis affecting the facial, cervical and tho-
racic regions with necrotic areas, who died in septic shock (Source: S/CMF Department of
the CHU-YO).

Photo 2. 69-year-old patient with diffuse cervicofacial cellulitis with compression of the
VADS and a greenish pus flow (Source: S/CMF Department of the YO University Hos-
pital).

9.66 cases per year in the series of Ngouoni in Congo [9], 11.2 cases per year in
that of Rakotoarison in Madagascar [10], 14.8 cases per year in that of Ag Mo-
hammed in Mali [11]. This increase in the number of cases of cellulitis seems to
be due to a decrease in the immune defense caused by abusive self-medication
with anti-inflammatory drugs, instead of using non-anti-inflammatory analges-
ics [12]. In addition, the misuse of antibiotics, still in self-medication, causes an

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W. P. L. Guiguimdé et al.

Table 5. Shows the distribution of clinical forms of cellulitis.

Variables Modalities Number n = 292 (%)

Oral hygiene

Good hygiene 25 8.6

Poor hygiene 267 91.4

Etiologies of cellulite

Tooth decay 279 95.6

Post extraction 10 3.4

Others* 4 1.0

Clinical signs of cellulitis

Circumscribed serous 25 8.5

Circumscribed suppurative 76 26.0

Circumscribed gangrenous 4 1.4

Diffuse serous 16 5.5

Diffuse suppurated 162 55.5

Diffuse gangrenous 9 3.1

Topography of the cellulitis

Peri-maxillary 121 41.5

Peri-mandibular 125 42.8

Cervico-thoracic 31 10.6

Periorbital 3 1.0

Temporo-Masseterine 9 3.1

Other** 3 1.0

*Periodontal disease, Alveolodentomaxillary trauma; **Not specified.

increase in the resistance and virulence of germs, as well as the inaccessibility of

oral care to our poor populations [7] [13].
It was a young adult condition as evidenced by the most affected average age
(35.41 ± 16.64 years) and the majoritý of the data concerning Africa [6] [14] [15]
[16]. Indeed, young people represent a very large proportion of the population
in African countries. In addition, the abuse of cariogenic foods and the frequen-
cy of wisdom teeth evolution accidents would be inherent risk factors for this
age group [8] [17].
The male predilection for dental cellulitis has been reported in most of the
studies conducted throughout the world, particularly in Africa [6] [10] [17] [18]
[19] [20] [21]. In men, risk factors have been suggested (poor oral hygiene, al-
cohol, smoking) [2]. In women, in addition to hygiene, a better immune re-
sponse has also been mentioned [16]. However, studies conducted in Africa and
Europe have reported a predominance of women [8] [19]. This reversal of the
trend would be explained by a greater susceptibility to pain and infection in
women, as well as by greater illiteracy, which would favor persistent recourse to

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 W. P. L. Guiguimdé et al.

traditional practitioners [8]. The low socioeconomic and educational levels of

our patients also play an important role in the genesis of these cervicofacial cel-
lulites [6] [7] [15] [22] [23]. In our study, the majority of the patients were
non-occupational subjects who could not seek care due to lack of financial
means. Indeed, the lack of financial means that do not allow access to adequate
care often makes people opt for self-medication, recourse to radiotherapists and
late consultations. The same is true for the level of education, the more educated
people are, the more they pay attention to their oral health.
Clinic
We recorded a delay in consultation ranging from 01 to 540 days, with an av-
erage of 13.86 days. Delays in consultation are explained by self-medication and
traditional treatments on the one hand, and by financial inaccessibility to care
on the other. As in several series, we also found in our sample the favourable
factors frequently incriminated in the occurrence and spread of cellulitis, such as
pregnancy, diabetes, HIV infection, alcohol, tobacco and drug addiction [6] [9]
[14] [23].
The majority of the patients (91.44%) had poor oral hygiene. It was estab-
lished that poor oral hygiene is one of the key factors to be considered. This re-
sult only supports the data usually reported on the role of defective hygiene as a
factor favoring the occurrence of cellulitis [4] [6] [16] [24].
The diagnosis of cervicofacial cellulitis is clinical based on the conjunction of
a severe infectious condition and physical cervicofacial signs. Often, a recent
history of dental avulsion, dental care or dental abscess is found, sometimes still
evolving. The cervico-facial swelling, almost constant, is inflammatory and
painful. This swelling is highly suggestive of cellulitis. The association with tris-
mus and odynophagia is usual and the general signs are rarely absent. Dental
causes, as many studies have shown, were dominated by dental necrosis subse-
quent to caries [6] [10] [25]. In our series, 95.55% of cases were indeed due to
this etiology. The carious pathology is often neglected, hence the high rate in the
occurrence of cervico-facial cellulitis. Our study showed ́ that 64.1% of cellulitis
were diffuse forms and 35.95% were circumscribed forms. Diallo A, in Ouaga-
dougou in an older study on cervico-facial cellulitis of dental origin at CHUYO,
found 73.4% circumscribed cellulitis and 11.8% diffuse cellulitis [26], Bengondo
& al. found 84.3% circumscribed cellulitis and 15.7% diffuse forms in their study
in Yaounde [18]. Niang et al. in Dakar reported 90.3% of circumscribed cellulitis
and 9.7% of diffuse cellulitis [14]. Delayed consultations, self-medication, par-
ticularly the abusive use of anti-inflammatory drugs instead of analgesics could
explain the spread of circumscribed cellulitis. Non-steroidal anti-inflammatory
drugs are frequently mentioned in the literature as factors likely to promote the
onset or progression of the infectious process. They are generally taken alone or
in combination with antibiotic therapy, which is often inappropriate.
The predominant sites of cellulitis in our study were by far peri-mandibular
(42.81%) and peri-maxillary (41.44%). Bengondo et al. reported 78.4% of pe-
ri-mandibular forms and 21.6% of peri-maxillary forms. The peri-mandibular

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W. P. L. Guiguimdé et al.

forms are the most important because the mandibular teeth, particularly the
molars, are the most incriminated in the literature review [6] [7] [14] [18] [27].
Indeed, mandibular molars are very exposed to caries and its complications be-
cause of their volume, their morphology (grooves on the occlusal surface) and
their appearance on the arch at an age when the principles and techniques of
oral hygiene are not perfectly assimilated. The ease of diffusion of the infection
in the cellulo-fatty tissue of the peri-mandibular regions would also explain the
frequency of cellulitis on the lower level of the face. The lower frequency of cel-
lulitis in the maxilla is due to the depth of the vestibule and the lack of cellular
tissue, particularly in the palate where the adherent fibro-mucosa limits the
spread of infection, leading to the formation of a subperiosteal abscess [15] [27].

5. Conclusion
Cervicofacial cellulitis is a frequent and varied pathology in its clinical forms, in
full recrudescence in odontostomatology. The young subject with low economic
power is the most affected. Self-medication and recourse to traditional treatment
would delay consultation and worsen the prognosis. The prevention of cellulitis
requires all the means of prevention of caries and a regular odontological ex-
amination which allows diagnosing dental lesions and treating them early in or-
der to avoid the development of complications.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.

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Annex
https://docs.google.com/document/d/13BOeqHIFvcto0KwaYhrym7hkpK7sl-pm
/edit?usp=sharing&ouid=103872500155260047162&rtpof=true&sd=true

DOI: 10.4236/ojst.2021.1110035 410 Open Journal of Stomatology