eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Dental, Infections: Follow-up

Author: Lynnus F Peng, MD, Assistant Clinical Professor, Department of Anesthesia, University of California at Irvine; Chairman of Anesthesia, Department of Surgery, St Jude Medical Center at Fullerton
Coauthor(s): A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon; Willard Peng, MS, Doctor of Dental Surgery Candidate, Department of Oral Medicine, University of Southern California; Rebecca Cheng, University of California at San Diego
Contributor Information and Disclosures

Updated: Aug 11, 2009

Follow-up

Complications

Complications of dental infections include the following:

  • Abscess
  • Sepsis

Patient Education

Miscellaneous

Special Concerns

Prophylaxis controversy continues regarding who should have antibiotic prophylaxis for dental procedures and which antibiotics to use.

Current recommendations by the American Heart Association 2007 for dental, oral, respiratory tract, or esophageal procedures, if the patient has one of the following conditions:4

  • Prosthetic cardiac valve
  • Previous infective endocarditis
  • Congenital heart disease (CHD)
  • Unrepaired cyanotic CHD, including palliative shunts and conduits
  • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
  • Cardiac transplantation recipients who develop cardiac valvulopathy

Recommendations for dental, oral, respiratory tract, and esophageal procedures for patients with one of the conditions listed above include the following:

  • For adults, administer amoxicillin 2 g PO 1 hour before procedure. Administer amoxicillin 50 mg/kg PO for pediatric patients. If by IV, administer ampicillin 2 g for adults and 50 mg/kg for children within 30 minutes before the procedure.
  • For patients allergic to penicillin, give clindamycin 600 mg PO/IV 1 hour before the procedure. For pediatric patients, administer clindamycin 20 mg/kg PO/IV. Alternatively, azithromycin or clarithromycin 500 mg PO 1 hour before the procedure may be administered for adults and 15 mg/kg PO may be administered for pediatric patients.

Current recommendations by the American Heart Association for genitourinary/GI procedures are for patients with GI or GU tract infection, if they have any of the conditions listed above (same as for dental), then the patient should undergo prophylaxis and have the antibiotic regimen include an agent active against enterococci, such as penicillin, ampicillin, piperacillin, or vancomycin.4

  • For adults, administer ampicillin 2 g IV plus gentamicin 1.5 mg/kg (not to exceed 120 mg) within 30 minutes before the procedure; 6 hours later, administer ampicillin 1 g IV or amoxicillin 1 g PO 1 hour before procedure. Administer amoxicillin 50 mg/kg PO for pediatric patients.
  • For patients allergic to penicillin, administer vancomycin 1 g IV over 1-2 hours plus gentamicin 1.5 mg/kg (not to exceed 120 mg); complete infusion within 30 minutes before the procedure.

Prophylactic regimens are for patients with prosthetic heart valves, previous bacterial endocarditis, congenital cyanotic heart disease, pulmonary shunt placement, cardiac myopathies, acquired valvular disease, and mitral prolapse with regurgitation.4

  • Only 25% of patients who should receive prophylactic antibiotics actually receive them.
  • With 100% compliance, estimates suggest that the incidence of bacterial endocarditis would be reduced 3-6%.

 


More on Dental, Infections

Overview: Dental, Infections
Differential Diagnoses & Workup: Dental, Infections
Treatment & Medication: Dental, Infections
Follow-up: Dental, Infections
Multimedia: Dental, Infections
References
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References

  1. Maruyama F, Kobata M, Kurokawa K, et al. Comparative genomic analyses of Streptococcus mutans provide insights into chromosomal shuffling and species-specific content. BMC Genomics. Aug 5 2009;10(1):358. [Medline].

  2. Holmstrup P, Poulsen AH, Andersen L, Skuldbol T, Fiehn NE. Oral infections and systemic diseases. Dent Clin North Am. Jul 2003;47(3):575-98. [Medline].

  3. Daramola OO, Flanagan CE, Maisel RH, Odland RM. Diagnosis and treatment of deep neck space abscesses. Otolaryngol Head Neck Surg. Jul 2009;141(1):123-30. [Medline].

  4. [Guideline] Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Apr 19 2007;[Medline].

  5. Harwood-Nuss A, Linden C, Luten R, eds. Dental, oral and salivary gland infections. In: The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia: Lippincott Williams & Wilkins Publishers; 1996:73-77.

  6. Kuriyama T, Williams DW, Yanagisawa M, Iwahara K, Shimizu C, Nakagawa K, et al. Antimicrobial susceptibility of 800 anaerobic isolates from patients with dentoalveolar infection to 13 oral antibiotics. Oral Microbiol Immunol. Aug 2007;22(4):285-8. [Medline].

  7. Marioni G, Rinaldi R, Staffieri C, Marchese-Ragona R, Saia G, Stramare R, et al. Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006). Acta Otolaryngol. Aug 22 2007;1-6. [Medline].

  8. Pogrel MA. Antibiotics in general practice. Dent Update. Sep 1994;21(7):274-80. [Medline].

  9. Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health. May 1995;85(5):7-10, 13-4, 17-8 passim. [Medline].

  10. Reznick J. Infections of odontogenic origin. Oral Health. 1993;1-6.

  11. Roberts J, Hedges JR. Emergency dental procedures. In: Clinical Procedures in Emergency Medicine. 2nd ed. Philadelphia: W B Saunders Co; 1991:1045-1069.

  12. Rosen P, Barkins R. Dental emergencies. In: Emergency Medicine: Concepts and Clinical Practice. Vol 3. 3rd ed. St Louis: Mosby-Year Book; 1992:2381-2398.

  13. Sands T, Pynn BR, Katsikeris N. Odontogenic infections: Part two. Microbiology, antibiotics and management. Oral Health. Jun 1995;85(6):11-4, 17-21, 23 passim. [Medline].

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Further Reading

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Keywords

dental infection, tooth infection, retropharyngeal space infection, Ludwig angina, Ludwig's angina, gingivitis, odontogenic infection, infection of tooth, dental caries, pulpitis, necrotic dental pulp, Streptococcus mutans, deep neck infection, hot potato voice, Horner syndrome, upper respiratory infection, URI, cellulitis, airway obstruction, lymphadenopathy, erythematous gingiva, treatment, diagnosis

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Contributor Information and Disclosures

Author

Lynnus F Peng, MD, Assistant Clinical Professor, Department of Anesthesia, University of California at Irvine; Chairman of Anesthesia, Department of Surgery, St Jude Medical Center at Fullerton
Lynnus F Peng, MD is a member of the following medical societies: Alpha Omega Alpha and American Society of Anesthesiologists
Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Willard Peng, MS, Doctor of Dental Surgery Candidate, Department of Oral Medicine, University of Southern California
Disclosure: Nothing to disclose.

Rebecca Cheng, University of California at San Diego
Disclosure: Nothing to disclose.

Medical Editor

Michael Glick, DMD, Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey
Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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