Dental Infections in Emergency Medicine Workup

  • Author: Lynnus F Peng, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Mar 9, 2011
 

Laboratory Studies

  • In dental infections, a CBC count with differential is not mandatory, but a large outpouring of immature granulocytes may indicate the severity of the infection.
  • Blood cultures in patients who are toxic may help guide management if the course is prolonged.
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Imaging Studies

  • Panorex and periapical dental films are used to identify involvement of tooth and surrounding bone in the infectious process. A limited facial series may also be performed to help visualize the offending area if these studies are not available; cooperation and communication with the radiology technician and radiologist is necessary.
  • A soft-tissue radiograph of the neck can be used to identify gas-producing infections and determines any mass effect that may potentially compromise the airway.
  • CT scan may be used for severe fascial plane infections to determine the extent, size, and location of the infectious process. Soft tissue planes may be seen; with increasing infection, inflammation, and fat streaking, the planes may be difficult to differentiate from adjacent muscle. CT scan helps elucidate abscesses, venous thrombosis, and lymph node involvement.
  • MRI is not yet favored because of cost and limited availability. CT scan is preferred for rapid visualization of odontogenic infections.
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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, 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 and California Dental Association

Disclosure: Nothing to disclose.

Rebecca Cheng  University of California at San Diego

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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.

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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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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