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: amp-sulbactam 3g IV q6 hours (alternative is PCN G with metro bid)
- Immunocompromised (ANC<500, HIV/AIDS, immune suppressing meds, on prolonged abx ppx): pip-tazo 4.5g IV q6 OR cefepime 2g IV q12 + metro 500mg PO q12h
Who Needs Antimicrobial Ppx Prior to Dental Procedures?
