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Dental Infections in Emergency Medicine Follow-up

  • Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Apr 06, 2016
 

Further Inpatient Care

A study that investigated the determinants of the length of hospitalization due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013 found that the most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.[12]

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Inpatient & Outpatient Medications

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:[5]

  • 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.

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.[5]

  • 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%.
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Complications

Complications of dental infections include the following:

  • Abscess
  • Sepsis
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Patient Education

See the list below:

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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, American Society of Anesthesiologists

Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, 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, DDS, MS Keck School of Medicine of the University of Southern California

Willard Peng, DDS, MS is a member of the following medical societies: American Dental Association, California Dental Association

Disclosure: Nothing to disclose.

Rebecca Cheng Loma Linda University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Michael Glick, DMD Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

References
  1. Bahl R, Sandhu S, Singh K, Sahai N, Gupta M. Odontogenic infections: Microbiology and management. Contemp Clin Dent. 2014 Jul. 5(3):307-11. [Medline]. [Full Text].

  2. 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. 2009 Aug 5. 10(1):358. [Medline].

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

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

  5. [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. 2007 Apr 19. [Medline].

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

  7. Kim MK, Allareddy V, Nalliah RP, Kim JE, Allareddy V. Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2012 Jan 25. [Medline].

  8. Hodgdon A. Dental and related infections. Emerg Med Clin North Am. 2013 May. 31(2):465-80. [Medline].

  9. Cachovan G, Phark JH, Schön G, Pohlenz P, Platzer U. Odontogenic infections: An 8-year epidemiologic analysis in a dental emergency outpatient care unit. Acta Odontol Scand. 2013 May-Jul. 71(3-4):518-24. [Medline].

  10. Igoumenakis D, Giannakopoulos NN, Parara E, Mourouzis C, Rallis G. Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial. J Oral Maxillofac Surg. 2015 Jul. 73 (7):1254-8. [Medline].

  11. Rastenienė R, Pūrienė A, Aleksejūnienė J, Pečiulienė V, Zaleckas L. Odontogenic Maxillofacial Infections: A Ten-Year Retrospective Analysis. Surg Infect (Larchmt). 2015 Jun. 16 (3):305-12. [Medline].

  12. Rasteniene R, Aleksejuniene J, Puriene A. Determinants of Length of Hospitalization due to Acute Odontogenic Maxillofacial Infections: A 2009-2013 Retrospective Analysis. Med Princ Pract. 2015. 24(2):129-35. [Medline].

  13. 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. 2007 Aug. 22(4):285-8. [Medline].

  14. 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. 2007 Aug 22. 1-6. [Medline].

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

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

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

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

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

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

 
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Obvious swelling of the right cheek.
Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
Gingiva with swelling and erythema.
 
 
 
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