II. Definitions
- Odontogenic Infection
- Tooth Infections due to Dental Caries (periapical infection) and Periodontal Infections (Gingivitis, periodonitis)
III. Pathophysiology
- Complication of Irreversible Pulpitis (Dental Caries)
- Tooth cavity or injury allows infection to pass through the enamel and dentin into the pulp
- Infection spreads via the apical foramen at tooth base into the bone
- Ultimately infection expands into a Periapical Abscess, most commonly at the tooth's buccal aspect
IV. Symptoms
- Severe, persistent pain localized to affected tooth
- Focal swelling at the involved tooth or cheek
- Drainage may be present
V. Signs
- Apical Abscess may be present
- Fluctuant swelling at Buccal mucosa or Palate
- Drainage may be present
- Localized swelling of the cheek
- Percussion with metal object elicits pain
- Regional Lymphadenopathy of the Head and Neck
VI. Differential Diagnosis
- See Tooth Pain
- See Pulpitis
VII. Management
- See Dental Incision and Drainage (if abscess present)
- See Ludwig's Angina (surgical emergency!)
- Root canal or Tooth Extraction by dentist
- Antibiotics not required in most cases after Incision and Drainage
- Start if Periodontal Cellulitis suspected
- Infections are polymicrobial, both aerobic and anaerobic
- Options
- Clindamycin (preferred)
- Augmentin
- Penicillin and Metronidazole
- Even with Penicillin alone, 95% of patients improve
- Warnke (2008) Surg 36(8): 462-7 +PMID:18760616 [PubMed]
VIII. Complications
- Periodontal Cellulitis
- Regional spread (e.g. Acute Sinusitis)
- Ludwig's Angina
IX. References
- Delaney (2017) EM:Rap 17(10): 4
- Amsterdam in Marx (2002) Rosen's Emergency Med, p. 897
- Douglass (2003) Am Fam Physician 67(3):511-16 [PubMed]