Odontogenic Infections

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Odontogenic infections are infections arising primarily from the tooth. This occurs as the result of intraoral bacteria gaining access to pulp via a dental cavity such as a carious lesion. The pulp undergoes necrosis and an abscess collects at the tooth apex over time. 

Cause

  • Streptococci

Symptoms

  • Pain on chewing
  • Jaw swelling with persistent gnawing pain
  • Fever 
  • Chills

Signs

  • Tooth tenderness to percussion
  • Lymphadenopathy 

Investigations

  • X-ray of affected tooth

TreatmentTreatment Objectives

  • To control infection
  • To control pain
  • To remove source of infection 
  • To restore tooth integrity and function 

Non-pharmacological treatment

  • Root canal therapy with drainage, debridement, epicectomy etc.
  • Restoration of structure and function 

Pharmacological treatmentFor treatment of mild infection

1st Line Treatment: 

Evidence Rating: [B]

  • Amoxicillin, oral,

Adults

500 mg 8 hourly for 7 days

Children

5-18 years; 500 mg 8 hourly for 7 days

1-5 years; 250 mg 8 hourly for 7 days

1 month-1 year; 125 mg 8 hourly for 7 days

For treatment of mild infection-in patients allergic to penicillins

Evidence Rating: [B]

  • Doxycycline, oral,

Adults

100 mg 12 hourly for 7 days 

Note: Not recommended in pregnancy, lactating mothers and in children < 8 years  of age. 

For treatment of severe infection 

1st Line Treatment

Evidence Rating: [B]

  • Amoxicillin + Clavulanic Acid, oral, 

Adults

625 mg 8 hourly for 7 days

Children

> 12 years; One 500/125 tablet 12 hourly for 7-10 days 4-12 years; 5  ml  of  400/57  suspension  12  hourly  for  7-10 days

1-4 years; 5  ml  of  200/28  suspension  12  hourly  for  7-10 days

3 months - 1 year; 20 mg/kg (of amoxicillin) 12 hourly for 7-10  days 

< 3 months; 15 mg/kg (of amoxicillin) 12 hourly for 7-10  days

Or

  • Azithromycin, oral,  

Adults

500 mg daily for 5 days

Children 

10 mg/kg body weight daily for 5 days. 

Not recommended for children less than 6 months because of a risk of pyloric stenosis.

For treatment of severe infection-in patients allergic to penicillins

Evidence Rating: [B]

  • Azithromycin, oral,  

Adults

500 mg daily for 5 days

Children 

10 mg/kg body weight daily for 5 days 

Not recommended for children less than 6 months because of a risk  of pyloric stenosis.

Or 

  • Clindamycin, oral,

Adults

150-300 mg 6-8 hourly for 7 days

Children

12-18 years; 150-300 mg 6 hourly for 7 days

1 month-11 years; 3-6 mg / kg 6 hourly for 7 days

For pain relief 

Evidence Rating: [B]

  • Paracetamol, oral, 

Adults

500 mg-1 g 6 hourly as required 

Children

6-12 years; 250-500 mg 6 hourly as required

1-5 years; 125-250 mg 6 hourly as required

3 months-1 year; 62.5-125 mg 6 hourly as required

Referral Criteria

Refer all patients with odontogenic infections to a dental specialist after initiation of treatment.