Periodontal Cellulitis

Aka: Periodontal Cellulitis, Periodontal Infection

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II. Pathophysiology

  1. Complication of Apical Periodontitis
    1. See with extension of Dental Caries

III. Symptoms

  1. Diffuse pain in region of affected tooth

IV. Signs

  1. Fever
  2. Tense swelling and erythema
  3. Regional Lymphadenopathy of the Head and Neck

V. 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

VI. 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 ParenteralAntibiotics
    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

VII. 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

VIII. References

  1. Douglass (2003) Am Fam Physician 67(3):511-16 [PubMed]

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