Odontogenic Infections
Ashley Zeoli
Background
- Consist primarily of dental caries and peridontal disease (gingivitis and periodontitis) that can have local and systemic involvement
- Streptococcus species, peptostreptococcus, Veillonella, diptheroids >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
