Dental Infection

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Basics

Description

  • Pain ± swelling in the head and neck region from infection of the teeth and/or 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

Epidemiology

  • 18% of 5- to 19-year-olds have untreated dental caries.
  • 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.
  • 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

  • Dental caries is the most common worldwide chronic disease.
  • 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 transmitted to newly dentate infants by 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 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.

Risk Factors

  • 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)

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 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)

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