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- Pain ± swelling in the head and neck region from infection in the teeth and supporting structures; if left untreated, 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.
- System(s) affected: oropharynx, throat, dental, gastrointestinal
- Synonym(s): odontogenic infections, dental abscess
- 18% of 5- to 19-year-olds have untreated dental caries (1).
- 28% of individuals age >20 years have untreated dental caries (1).
- Rates are higher in Hispanic (21.7%) and black (23%) children/teens (1)[A].
- 92% of adults 20 to 64 years have had dental caries (1).
- 25% of children 5 to 17 years account for 80% of caries in the United States.
- 17% of adults age >64 years are edentulous (1).
Etiology and Pathophysiology
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 vertically transmitted to newly dentate infants from caregivers.
- Acidic secretions from S. mutans are implicated in early caries.
- Often there is polymicrobial mix of anaerobes in dental abscess (viridans streptococci and Streptococcus anginosus).
- Anaerobes, including peptostreptococci, Bacteroides, Prevotella, and Fusobacterium, have also been implicated. Lactobacilli not seen in healthy subjects but is common in patients with extensive caries (2).
- Preventable with good oral hygiene, low cariogenic diet, access to fluoride, and professional dental care
- Fluoride has dramatically decreased dental caries.
- Low socioeconomic status
- 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
- Decreased salivary flow (e.g., use of anticholinergic medications, immunologic diseases, radiation therapy to head and neck)
- Prevent caries and contagious bacterial infection (S. mutans).
- 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 nonfluoridated areas); fluoride varnish for moderate- to high-risk patients and all children age <6 years; regular dental cleanings (1,3).
- Prevent transmission of S. mutans from mother/caregiver to infant by improving maternal dentition, chlorhexidine gluconate rinses, and use of xylitol products for mother especially during first 2 years of a child’s life. Avoid smoking, which is linked to severe periodontal disease (2).
- Good control of systemic diseases (e.g., diabetes)
- Fluoride varnish provided by dental or medical primary care providers twice per year (2,3)
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)