Infectious Disease Compendium

Dental Infection

Diagnosis

Usually pain and, depending on extent, mass effect. Fevers are unusual.

They can dissect/erode into vital structures of the head and neck, so be wary (PubMed). For example "Infection of maxillary teeth most commonly spread to the buccal space, whereas infection originating in the mandible mostly spread to the submandibular, pterygomandibular, and buccal spaces (PubMed)."

Epidemiologic Risks

Dental work and poor dentition.

Microbiology

Streptococci, (the viridans strep predominate) and anaerobes.

Empiric Therapy

As with all infections: can source control be attempted: pull the tooth, drain the abscess etc.

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.

In patient severe infections: at least ceftriaxone and metronidazole.

Pearls

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

"Antibiotics are ineffective in the treatment of pulpal pain evoked by hot and cold and are not appropriate in the absence of signs of spreading infection or systemic upset as they do not prevent the development of severe complications (PubMed)."

Can be a cause of FUO (PubMed).

Last Update: 06/19/18.