III. Precautions

  1. Observe for severe infection
    1. Signs: Fever, airway compromise, regional infection spread (see complications below)
    2. Consider CT Maxillofacial or CT Neck
    3. Consider hospitalization and intravenous antibiotics

IV. Management

  1. Dental Incision and Drainage
    1. Indicated if abscess present
  2. Antibiotic Indications
    1. See Infections listed above
    2. Tooth Fracture into pulpal space
    3. Severe, but incomplete Tooth Luxation (no Tooth Avulsion)
      1. Tooth Extrusion (displaced tooth without alveolar Fracture)
      2. Lateral Tooth Luxation (displaced tooth, alveolar Fracture)
  3. Oral antibiotic selection
    1. Penicillin VK (preferred)
    2. Amoxicillin
    3. Amoxicillin-Clavulanate (Augmentin)
    4. Clindamycin

V. Complications: Life-threatening Dental Infection complications

  1. Ludwig Angina
    1. Submandibular Space Infection with secondary airway compromise
    2. Typically results from mandibular tooth with periapical infection
  2. Descending Necrotizing Mediastinitis
    1. Posterior spread of Oral Infection into retropharyngeal space and mediastinum
  3. Odontogenic Sinusitis
  4. Cervical Necrotizing Fasciitis
  5. Cavernous Sinus Thrombosis
  6. Brain Abscess

VI. Prevention

VII. References

  1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8
  2. Ogle (2017) Dent Clin North Am 61(2):235-252 +PMID:28317564 [PubMed]

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