Odontogenic Infections

Question 0

What are the treatment options for acute localised odontogenic infections?

Answer 0

1) Periapical abcess:
RCT or exo
2) Periodontal abcess:
Periodontal treatment (scaling, root planing) or exo
3) Pericoronal infection
Local treatment - remove or recontour opposing tooth if impinging on tissues, irrigate with sterile solition, warm salline or CHX mouthwash
Exo

Question 1

What are the types of localised odontogenic and periodontal infections?

Answer 1

1) Perocoronal infection
2) Pericoronal abcess
3) Gingivits
4) Periodontitis
5) Periodontal abcess
6) Caries
7) Periapical inflammation or abcess

Question 2

What are the overall steps in the management of a spreading odontogenic infection?

Answer 2

1) Draining any pus
2) Remove the cause (endo, perio tx or exo)
3) Support patient with analgesics and rehydration
4) Consider antibiotics

Question 3

How should severe superficial odontogenic infections be managed?

Answer 3

Ab in addition to local surgical or dental treatment.
-> Penicillin V 500mg (child 12.5mg per kg up to 500mg) orally qid for 5 days
or
-> amoxycillin 500mg orally tid for 5 days
Patient should be advised to contact dentist if condition deteriorates. All patients with infection should be reviewed wihtin 2-3 days of commencing treatment.

Question 4

How should an unresponsive severe superficial dental infection be managed?

Answer 4

prescribe:
1) Metronidazole 400mg (child 10mg/kg) orally bid for 5 days
with either:
2) Penicillin V 500mg orally qid 5 days
or 
3) amoxycillin 500mg orally tid 5 days
OR as a single drug:
1) amoxycilllin (825mg) with clavulanate (125mg) orally bid 5 days

Question 5

what should a patient who is hypersensitive to penicillin be prescribed for a severe superficcial odontogenic infection?

Answer 5

Clindamycin 300mg (7.5mg child) orally tid 5 days

Question 6

What is a deep odontogenicc infection?

Answer 6

Spread to the submandibular and pharyngeal spaces in the upper neck. Patients with a mouth opening of less than 2cm and trismus should be assessed for airway compromise.

Question 7

What are the signs of airway compromise?

Answer 7

Stridor (noisy breathing)
Dyspnoea (difficulty breathing)
Dysphagia (difficulty swallowing)
Elevation and firmness of the tongue

Question 8

How should a patient with severe deep opddontogenic infection be managed?

Answer 8

Urgent referral to an appropriate specialist or hospital emergency department.