Dentistry Book

Gingival Disorders

Tooth Disorders

  • Periodontal Cellulitis

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Periodontal Cellulitis

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  1. See Also
    1. Dental Caries
    2. Cellulitis
  2. Pathophysiology
    1. Complication of Apical Periodontitis
      1. See with extension of Dental Caries
  3. Symptoms
    1. Diffuse pain in region of affected tooth
  4. Signs
    1. Fever
  5. , Tense swelling and erythema
    1. Regional Lymphadenopathy of the Head and Neck
  6. Management: Superficial Cellulitis
    1. General
      1. Dentist should evaluate within 2 days
      2. Root canal or tooth extraction
      3. Analgesics with NSAIDs or mild Opioid
    2. Antibiotics
      1. Oral Penicillin
        1. Adults: 500 mg PO tid
        2. Children: 50 mg/kg/day divided tid
      2. Penicillin Allergy
        1. Erythromycin
        2. Clindamycin
  7. Management: Deep Cellulitis (Regional)
    1. Admit to hospital
    2. Observe for airway compromise
    3. Obtain surgical consultation
    4. CT Neck to define margins of infection
    5. Administer broad spectrum parenteral antibiotics
      1. Clindamycin 600-900 mg q8 hours IV or
      2. Cefoxitin 2 g q8 hours IV or
      3. Combination protocol
        1. Penicillin G 24 MU continuous infusion IV and
        2. Metronidazole 1 g IV load then 0.5 g q6 hours IV
  8. Complications
    1. Regional spread of Cellulitis into deep tissues
      1. Infection spreads along fascial planes
      2. Risk of Ludwig's Angina
    2. Periorbital spread (via maxillary sinus)
      1. Vision Loss
      2. Cavernous Sinus Thrombosis
      3. Meningitis
  9. References
    1. Douglass (2003) Am Fam Physician 67(3):511

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