Odontogenic Infections

Question 1

What are rare but serious complications of untreated odontogenic infections?

Answer 1

• Ludwig’s angina
• Airway compromise
• Sepsis
• Spread to bone, brain, neck or mediastinum

Question 2

Usually, antibiotic therapy isn’t a substitute for dental treatment, but when can it potentially be prescribed?

Answer 2

If the patient can’t see the dentist in the next 24 hours.

Question 3

What is classified as a localised odontogenic infection?

Answer 3

An odontogenic infection is considered to be localised if there is dental pain without facial swelling or systemic features. Can present with abscess.

Question 4

Is antibiotic therapy needed for a localised odontogenic infection after dental treatment?

Answer 4

NO, unless an infected tooth breaks out during an extraction and there is a delay in removing residual bone or root fragments.

Question 5

What are the dental treatment options for a periapical abscess?

Answer 5

1. RCT

2. Exo

Question 6

What are the dental treatment options for a periodontal abscess?

Answer 6

1. Periodontal treatment (debridement)

2. Exo

Question 7

What are the dental treatment options for a pericoronal infection, including an abscess?

Answer 7

1. Exo

2. Remove or recontour the opposing tooth

Question 8

What is classified as a spreading odontogenic infection without severe or systemic features?

Answer 8

Odontogenic infection that HAS caused facial swelling but no severe or systemic features are present. Can be managed at an outpatient dental clinic.

Question 9

What is the management of spreading odontogenic infection without severe or systemic features?

Answer 9

• Drain the pus (culture test)
• Appropriate surgical or dental treatment (endo, perio or exo)
• Oral antibiotic therapy (ideally after culture results have returned)

Question 10

What is the recommended antibiotic therapy for spreading odontogenic infection without severe or systemic features?

Answer 10

1. Metronidazole 400mg orally 12 hourly for 5 days
   PLUS EITHER
   - Phenoxymethyl 500mg oral, 6 hourly for 5 days
   OR
   - Amox 500mg orally, 6 hourly for 5 days
2. Amox +clavulanate 875 + 125 mg orally, 12 hourly for 5 days.

Question 11

What is the recommended antibiotic therapy for a spreading odontogenic infection without severe or systemic features for PENICILLIN-HYPERSENSITIVE PATIENTS?

Answer 11

Clindamycin 300mg orally, 8 hourly for 5 days.

Question 12

When should patients with spreading odontogenic infection without severe or systemic features be reviewed?

Answer 12

Within 48-72 hours after starting treatment.

Question 13

What is classified as a spreading odontogenic infection with severe or systemic features?

Answer 13

A spreading odontogenic infection includes severe features such as: facial swelling and pain, trismus, breathing difficulty, neck swelling and difficulty swallowing.

+ systemic infections which include: tachycardia, pallor, sweating, and an axillary temperature above 38 degrees.

Question 14

What is the protocol for patients presenting with a spreading odontogenic infection with severe or systemic features?

Answer 14

Arrange urgent transfer of the patient to a hospital that has an OMFS or other appropriate expert.

Question 15

What are patients with a spreading odontogenic infection with severe or systemic features usually given for AB medication?

Answer 15

Benzylpenicillin and metronidazole IV.

Question 16

What is Ludwig’s Angina?

Answer 16

A severe spreading infection involving the bilateral submandibular, submental, and sublingual spaces with cellulitis.

Question 17

What are the signs and symptoms of postoperative dental infection?

Answer 17

• Cellulitis adjacent to the surgical site
• Fluctuant surgical site
• Purulent discharge from the surgical site
• Pain and swelling that is worsening or not improving 48 hrs after surgery