Dental Infection



  • 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.


~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.


  • 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%).


  • 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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