II. Types: Infection
III. Precautions
- Observe for severe infection
- Signs: Fever, airway compromise, regional infection spread (see complications below)
- Consider CT Maxillofacial or CT Neck
- Consider hospitalization and intravenous Antibiotics
IV. Management
-
Dental Incision and Drainage
- Indicated if abscess present
-
Antibiotic Indications
- See Infections listed above
- Tooth Fracture into pulpal space
- Severe, but incomplete Tooth Luxation (no Tooth Avulsion)
- Tooth Extrusion (displaced tooth without alveolar Fracture)
- Lateral Tooth Luxation (displaced tooth, alveolar Fracture)
- Oral Antibiotic selection
- Penicillin VK (preferred)
- Amoxicillin
- Amoxicillin-Clavulanate (Augmentin)
- Clindamycin
V. Complications: Life-threatening Dental Infection complications
-
Ludwig Angina
- Submandibular Space Infection with secondary airway compromise
- Typically results from mandibular tooth with periapical infection
- Descending Necrotizing Mediastinitis
- Posterior spread of Oral Infection into retropharyngeal space and mediastinum
- Odontogenic Sinusitis
- Cervical Necrotizing Fasciitis
- Cavernous Sinus Thrombosis
- Brain Abscess
VI. Prevention
- See Dental Health
VII. References
- Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8
- Ogle (2017) Dent Clin North Am 61(2):235-252 +PMID:28317564 [PubMed]