Dental Infection
Basics
Description
- Pain ± swelling in the head and neck region with odontogenic (teeth and supporting structures) origin of infection; if left untreated, it can lead to serious and potentially life-threatening illnesses.
- Assume any head and neck infection or swelling to be odontogenic in origin until proven otherwise.
- Antibiotics should be prescribed as an adjunct to proper dental intervention. Antibiotics should be prescribed for acute infections for 3 to 7 days.
- Gingivitis and periodontal disease may be treated with oral antibiotics. Soft tissue infections may require IV antibiotic treatment.
Epidemiology
~20% of Americans have untreated dental caries. 75% have had at least one dental restoration. 35% of Americans between the ages of 30 to 90 years have periodontal disease. 1 in 2,600 hospital admissions are related to dental infection. The presence of odontogenic disease is closely linked to socioeconomic status as fewer Americans have dental insurance than health insurance.
Incidence
- Overall incidence of dental caries in children is ~47%.
- Rates of untreated dental caries are highest in Latino and non-Latino black individuals below the poverty line (up to 58%).
Prevalence
- Dental caries are the most common chronic disease worldwide.
- 90% of adults aged 20 to 64 years have had dental caries in their permanent teeth.
Etiology and Pathophysiology
- >90% of all head and neck infections have an odontogenic origin.
- Caries or trauma can lead to death of the tooth pulp, which can lead to infection and/or abscess of adjacent tissues via direct or hematogenous bacterial colonization.
- Caries (tooth decay; “cavity”) represent a contagious bacterial infection causing demineralization and destruction of the tooth tissue (enamel, dentin, and cementum).
- Streptococcus mutans is easily transmitted to newly dentate infants by caregivers.
- Acidic secretions from S. mutans are implicated in early caries.
- Typical oral microbiome includes numerous anaerobic bacteria. The most common pathologic aerobic bacteria is Streptococcus spp.
- Anaerobic bacteria are more common with infections near the tooth base (1).
Risk Factors
- Low socioeconomic status
- Smoking
- Parent and/or sibling with history of caries or existing untreated dental caries (especially in past 12 months)
- Previous dental caries
- Poor access to dental/health care; lack of dental insurance; fear of dentist
- Poor oral hygiene; poor nutrition, including diet containing high level of sugary foods and drinks
- Trauma to the teeth or jaw
- Inadequate access to and use of fluoride
- Gingival recession (increased risk of root caries)
- Physical and mental disabilities
- Poorly controlled systemic diseases (e.g., diabetes)
- Decreased salivary flow (e.g., use of anticholinergic medications, immunologic diseases, radiation therapy to head and neck)
General Prevention
- Most dental problems can be avoided through flossing/use of interdental brushes; brushing with fluoride toothpaste, systemic fluoride (fluoridated bottled water; fluoride supplements for high-risk patients and in non-fluoridated areas); fluoride varnish for all children aged <6 years and moderate- to high-risk patients; regular dental cleanings (2),(1)[B]
- Prevent transmission of S. mutans from mother/caregiver to infant by improving maternal dentition, chlorhexidine gluconate rinses, and the use of xylitol products for mother especially during the first 2 years of a child’s life. Avoid smoking, which is linked to severe periodontal disease.
- Good control of systemic diseases (e.g., diabetes) and changes in lifestyle (e.g., smoking cessation)
- Fluoride varnish provided by dental or medical primary care providers twice per year
Commonly Associated Conditions
- Extensive caries, crowding, multiple missing teeth
- Periapical and periodontal abscess
- Soft tissue cellulitis
- Periodontitis (deep inflammation ± infection of gingiva, alveolar bone support, and ligaments)
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Citation
Domino, Frank J., et al., editors. "Dental Infection." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116939/2.4/Dental_Infection.
Dental Infection. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116939/2.4/Dental_Infection. Accessed December 3, 2024.
Dental Infection. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116939/2.4/Dental_Infection
Dental Infection [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116939/2.4/Dental_Infection.
* Article titles in AMA citation format should be in sentence-case
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T1 - Dental Infection
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ED - Baldor,Robert A,
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ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
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