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)