Infections

Sources of infections
What is the optimal treatment?
Best time to extract the offending tooth
Antibiotics
Complications

Sources of infections
Oral and facial infections are most commonly caused by teeth. Caries or periodontal disease can lead to localized abscesses which, if not treated, can expand and result in further bone loss, pain, and swelling. Oral and facial infections can be very dangerous and spread quickly to the neck and throat regions causing potentially life threatening complications. Infections may also originate from salivary glands or sinuses and may present with pain, swelling, and drainage. Infections must be treated immediately.

What is the optimal treatment?
Emergency treatment for infections includes all of the following:

  • Elimination of the infection source (immediate extraction or root canal treatment).
  • Appropriate antibiotics.
  • Drainage, if necessary.

Remember, antibiotics alone do not cure the infection. It is critical to eliminate the source of infection via extraction or root canal treatment as soon as possible.


Best time to extract the offending tooth
In the presence of infection, swelling, and drainage, the offending tooth must be extracted immediately. It is not advised to wait and treat with antibiotics first before extraction.

Antibiotics
For minor infections, Penicillin (500 mg qid) is the drug of choice. Amoxicillin may be preferred if sinus infection is present. Penicillin-allergic patients may be placed on Erythromycin (333 mg qid), Cephazolin (500 mg qid), or Clindamycin (300-450 mg qid).
For more significant infections, Augmentin (500 tid or 875 bid) is the antibiotic of choice. If allergic to penicillin, patients may take Clindamycin (300-450 mg qid).
The course of treatment should be followed for seven to 10 days. The patient must complete the course of treatment even if the condition improves.

Complications
Complications associated with oral and facial infections may include the following:

  • Trismus — inability to open mouth
  • Spread to multi-fascial spaces
  • Potential airway compromise
  • Ludwigs’s angina
  • Mediastanitis

Such complications are dangerous and can be life-threatening. To prevent such complications, remember the following rules:

  1. Remove the source of infection immediately
  2. Establish drainage if necessary
  3. Begin antibiotic treatment as soon as possible