Principles of management of odontogenic infection; When to administer antibiotics in odontogenic infection?

Principles of management of odontogenic infection; A series of principles are useful in treating patients who come to the
dentist with infections related to oral cavity including teeth and the gingiva. The dental surgeon must keep in mind following principles in a stepwise fashion, the clinician will certainly have met the standard of care, even though the expected result may not always be achieved. These principles are the most important in determining the outcome.

Also Read the Case of Buccal Space Infection In Dental Clinic; Examination, Diagnosis and Treatment Plan

Principle 1: Determine severity of infection:

Complete history of infection including time of onset, pain swelling for drainage.  also the course of infection, its progression, sign and symptoms with its severity.

History of difficulty in opening of mouth, difficulty in breathing and swallowing. 

Physical examination includes temperature, pulse rate, blood pressure and respiratory rate .

 Very soft mild tender swelling indicates the  inoculation Stage whereas an indurated swelling indicates the cellulitis stage and Central fluctuance indicates an abscess.

Principle 2: Evaluate state of patients host defence mechanism

Compromised Host Defenses

Uncontrolled Metabolic Diseases

• Poorly controlled diabetes
• Alcoholism
• Malnutrition
• End-stage renal disease

Immune System–Suppressing Diseases

• Human immunodeficiency virus/acquired immunodeficienc syndrome
• Lymphomas and leukemias
• Other malignancies
• Congenital and acquired immunologic diseases Immunosuppressive Therapies
• Cancer chemotherapy
• Corticosteroids
• Organ transplantation

Principle 3 Determine whether patient should be treated by general dentist for oral maxillofacial surgeon.

Criteria for referral to an oral and maxillofacial surgeon

1. Difficulty breathing
2.  Difficulty swallowing
3.  Dehydration
4.  Moderate-to-severe trismus( inter incisal opening less than 20 mm)
5.  Swelling extending beyond the alveolar process
6.  Elevated temperature( greater than 101 degree fahrenheit)
7.  Compromised was defence 
8. Need for general anaesthesia
9.  Failed prior treatment 

Principle 4: Treat infection surgically 

1. Extraction of of cause of infection
2. Endodontic treatment
3.  Incision and Drainage 

Soft tissue infections in the inoculation stage may be cured by removal of the odontogenic cause with or without supportive antibiotics, infections in the cellulitis or  abscess stage require removal of the dental cause of the infection with incision and Drainage and antibiotics support therapy.

Principle 5:  Support patient medically

Support the patient with medicines like analgesic, anti inflammatory, antipyretic

Encourage patients to drink sufficient water and take high calorie nutritional supplements.

Principle 6:  Choose and prescribe appropriate antibiotic

The appropriate antibiotic for treating and odontogenic infection must be chosen carefully

Indications for therapeutic use of antibiotic in dentistry:

1. Swelling extending beard alveolar process 
2. Cellulitis
3. Trismus
4. Lymphadenopathy
5. Temperature higher than 101 degree fahrenheit
6. Severe pericoronitis 
7. Osteomyelitis

Narrow spectrum antibiotics useful for treating simple odontogenic infections

1. Penicillin
2.  Amoxicillin
3.  Clindamycin
4.  Metronidazole

Broad spectrum antibiotics used for treating Complex odontogenic infection 

1. Amoxicillin with clavulanic acid( for sinus infections)
2.  Azithromycin
3.  Tetracycline
4.  Moxifloxacin

Principle 7: Administer Antibiotic properly

The antibiotic is prescribed and drugs should be administered in the proper dose and at the proper dose interval.

The antibiotic that would have the highest compliance would be the drug that could be given once a day for not more than 4- 5 days.

For odontogenic infections three or four day course of a penicillin combined with appropriate surgery has been effective as a 7 day course of antibiotic

Principle 8:  Evaluate patient frequently

Patient is asked to return to the dentist 2-3 days after completion of the therapy.

  If the swelling and pain would have decreased the treatment is considered successful.

Also other parameters such as temperature, trismus swelling and patients’ subjective feeling of improvement should also be evaluated.

If if there is no improvement then patient is referred to oral and maxillofacial surgeon.

Principles of  of management of of odontogenic infection

Conclusion:Treatment of odontogenic infection requires clinical judgement of condition as well as decision about setting of care, mode of treatment and prescription of appropriate antibiotics. 

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