Infectious Disease Compendium

Dental Infection

Diagnosis

Usually pain and/or hypersensitivity with heat and cold. Fevers are unusual.

Epidemiologic Risks

Dental work and poor dentition.

Microbiology

Streptococci, (the viridins strep predominate) and anaerobes.

Empiric Therapy

Oral therapy is fine even for jaw osteomyelitis.

Options: amoxicillin OR doxycycline OR clindamycin OR amoxicillin/clavulanate. In one clinical trial 5 days of moxifloxacin was superior to clindamycin for resolution of pain, probably because of increased clindamycin resistance (18th European Congress of Clinical Microbiology and Infectious Diseases: Abstract O83. Presented April 18, 2008).

Specific therapy: Dental abscesses get 10-14 days, osteomyelitis is usually six weeks of oral. If treating Osteomyelitis I usually give amoxicillin AND metronidazole.

Pearls

Lumpy Jaw, from Actinomyces, is an unusual complication, as is Lemmiers Disease and various abscesses of the neck.

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

dental abscess 522.5.