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.