Odontogenic Infections

Ashley Zeoli

---

Background

• Consist primarily of dental caries and periodontal disease (gingivitis and periodontitis) that can have local and systemic involvement
• Streptococcus species, peptostreptococcus, Veillonella, diphtheroid >80% of infections

Presentation

• Associated w/ fever of unknown origin (fever > 3 weeks without etiology), bacteremia w/ seeding of heart valves and prosthetic devices
• Periodontal abscess commonly encountered on wards

Evaluation

• Obtain panorex, use CT for osseous structures
• If needing additional assistance, consult OMFS

Management

• Pyogenic odontogenic infections: parenteral therapy is favored
  • Immunocompetent: unasyn 3g IV q6 hours (alternative is PCN G with metro)
  • Immunocompromised: zosyn 4.5g IV q6 OR cefepime 2g IV q12 + metro 500mg PO q8

Additional information

• Who needs antimicrobial ppx prior to dental procedures?
  • Does the pt have a high-risk condition or implanted device?
    • Yes? is the pt undergoing invasive dental procedure (manipulation of gingival tissue, periapical region of teeth, extraction, abscess drainage, routine teeth cleaning?)
      • Yes? Use antimicrobial ppx: Amoxicillin 2g
    • No? no abx ppx needed