Acute Odontogenic and salivary gland infections

Question 1

what are possible sources of odontogenic infections?

Answer 1

• dental pulp secondary to caries, trauma, leakage around restoration margins.
• periodontal tissues - usually from severe periodontitis
• pericoronitis

Question 2

what types of bacteria cause these infections?

Answer 2

Usually a mix of aerobic and anaerobic oral bacteria

Question 3

What happens if left untreated?

Answer 3

infections usually start in the vicinity of the tooth and if left untreated usually progresses to a localized abscess that can then spread to secondary fascial spaces. Can cause trismus and can lead to life threatening conditions such as Ludwig’s angina.

Question 4

What is the first line of management for odontogenitc infections?

Answer 4

• odontogenic infections are emergency situations.
• first line management should be active dental treatment +/- drugs for adjunctive therapy.
• if source of infection not treated by dental tx, giving antibiotics alone may resolve symptoms but can lead to increasingly severe acute infections with risk of airway compromised as well as AB resistance

Question 5

outline the treatment options for acute localized odontogenic infections

Answer 5

Periapical abscess 
- RCT or Exo 
Periodontal Abscess 
- perio tx - SRP or Exo 
Pericoronal Infection 
- local tx: remove/recontour the opposing tooth if impinging on operculum. Irrigate with sterile solution and warm saline or chx mouthwashes 
or Exo

Question 6

outline how you would manage spreading odontogenic infections?

Answer 6

Spreading odontogenic infection can lead to abscess formation or cellulitis. Treatment:

• draining any pus
• removing source of infection: RCT, perio tx, exo
• Analgesics +/- antibiotics

Question 7

When should we consider prescribing antibiotics to adjunct treatment of infection? What antibiotic would you choose?

Answer 7

If infection is severe and patient has systemic symptoms such as fever. ALL patients with infection should be reviewed in 48-72 hours after tx.
Can prescribe:
500mg Pen V (12.5mg/kg in kids up to 500mg) 6 hourly for 5 days
OR
500mg amoxycillin (12.5mg/kg in kids up to 500mg) 8 hourly for 5 days
IF allergic to penicillin
300mg Clindamycin (7.5mg/kg in kids up to 300mg) 8 hourly for 5 days

Question 8

What do you do if infection is unresponsive to treatment and antibiotics prescribed?

Answer 8

If infection has not resolved in 5 days; check to see if any pus left to drain and that the cause has been removed.
Can use combination therapy with ab:
metronidazole 400mg 2x daily + PenV/Amoxy 500mg 3x/4x daily OR
Clindamycin + Claculanate 875mg+125 mg 2xdaily for 5 days

IF allergic to penicillin
300mg Clindamycin (7.5mg/kg in kids up to 300mg) 8 hourly for 5 day