Dental infections


Infection arising as a secondary complication of an inflammation of the dental pulp. The severity and the treatment of dental infections depend on their evolution: localised to the infected tooth, extended to adjacent anatomical structures or diffuse infections.

Clinical features and treatment

Infection localised to a tooth and its surroundings (acute dental abscess)

– Intense and continuous pain.

– On examination: swelling limited to the gum surrounding the infected tooth. Purulent exudate may be present draining either through the root canal, or through the periodontal ligament (loosening the tooth) or through a gingival fistula. There are no signs of the infection extending to adjacent anatomical structures nor general signs of infection.

– Treatment:
• Treatment is only surgical (the source of infection is inaccessible to antibiotics): root canal therapy (disinfection of the root canal) if possible or extraction of the tooth.
• Pain: paracetamol or ibuprofen PO (see Pain, Chapter 1).

Infections extending to adjacent anatomical structures (acute dento-alveolar abscess)

Local spreading of an acute dental abscess into the surrounding bone and tissue.

– Painful gingival and buccal swelling with warm and tender skin, developing into a ripe abscess: intense pain, with trismus, particularly if the infection is in a posterior tooth, presence of general signs (fever, fatigue, cervical lymphadenopathy).

– In patients with acute gangrenous cellulitis (crepitations on palpation), treat as an infection extending into the cervico-facial tissues (see below).

– Treatment:
• First surgical: incision and drainage of the pus or extraction of the tooth.
• Then antibiotic treatment for 5 days following the procedure: amoxicillin PO
Children: 25 mg/kg 2 times daily 
Adults: 1 g 2 times daily
Notes:
If the dental procedure has to be delayed (local anaesthesia not possible due to inflammation, significant trismus), start an antibiotherapy, but the dental procedure must be completed in the following days.
If there is no improvement within 48 to 72 hours after the dental procedure, do not change antibiotic, but start a new procedure on the tooth.
• Pain: paracetamol or ibuprofen PO (see Pain, Chapter 1).

Infections extending into the cervico-facial tissues

– Extremely serious cellulitis, with rapidly spreading cervical or facial tissue necrosis and signs of septicaemia.

– Treatment:
• treatment in an intensive care unit.
• high dose antibiotic treatment (see Necrotising infections of the skin and soft tissues).
• extraction of the tooth.