Summary
Definition
History and exam
Key diagnostic factors
- dental pain/toothache
- thermal sensitivity of teeth
- fever
- intraoral and/or extraoral edema
- intraoral and/or extraoral erythema
- intraoral and/or extraoral discharge
- trismus
- tooth percussion sensitivity
- mobile teeth
- deep periodontal pockets, bleeding, gingival recession
- bone loss around teeth
- elevated/extruded tooth
- tachypnea
- dysphagia/drooling
- dysphonia
- dyspnea/respiratory stridor
- posturing
- uvular deviation
- floor of mouth elevation
- hypotension
Other diagnostic factors
- halitosis/bad taste in mouth
- xerostomia
- neurologic signs
Risk factors
- poor oral hygiene
- dental caries
- periodontal disease
- partially erupted or impacted tooth
- dental trauma
- fractured teeth
- excessive occlusal wear
- alcohol or drug misuse
- low socioeconomic status
- malnutrition
- age extremes
- prior radiation therapy
- certain medications
- immunosuppression or comorbidity (higher risk for complications)
- large dental restorations
- bruxism
- prior root canal treatment failure
Diagnostic tests
1st tests to order
- CBC with differential
- panoramic x-ray
Tests to consider
- periapical x-ray
- CT head and neck (with contrast)
- infection site aspiration Gram stain/culture and sensitivity
- CRP
- erythrocyte sedimentation rate (ESR)
- serum electrolytes
- plasma fibrinogen level
- MRI head and neck
- ultrasound of fascial spaces
- electric pulp testing
- thermal testing
- blood cultures
Emerging tests
- C-terminal cross-linking telopeptide (CTX)
Treatment algorithm
high risk
low risk
Contributors
Authors
Melanie S. Lang, DDS, MD
Associate Professor
Department of Oral and Maxillofacial Surgery
University of Washington School of Dentistry
Seattle
WA
Disclosures
MSL has contributed to Oakstone Audio Reviews in Oral and Maxillofacial Surgery. MSL has published two manuscripts related to perioperative antibiotic use with materials from the AAOMS. She is an AAOMS representative to the ADA for a group studying the use of antibiotics in dentistry. MSL is a member of the working group involved in the development of ADA guidelines, and she is also an author of several references cited in this topic.
Thomas B. Dodson, DMD, MPH
Professor and Chair
Department of Oral and Maxillofacial Surgery
University of Washington School of Dentistry
Seattle
WA
Disclosures
TBD is a paid Consultant-Associate Editor for the Journal of Oral and Maxillofacial Surgery and Consultant-Surgeon for ClearChoice Seattle and Federal Way. He is an unpaid committee member for the Research and Development Commission of the AOCMF and the Committee on Research for the Oral and Maxillofacial Surgery Foundation. TBD is an unpaid liaison to the Committee on Research and Technology Assessment, American Association of Oral and Maxillofacial Surgery. He is also an author of some references cited in this topic.
Peer reviewers
Samuel J. McKenna, DDS, MD
Professor and Chairman
Department of Oral and Maxillofacial Surgery
Vanderbilt University
Nashville
TN
Disclosures
SJM declares that he has no competing interests.
Kamran Ali, FDSRCS (Eng)
Associate Professor
Lead in Oral Surgery
Plymouth University Peninsula Schools of Medicine & Dentistry
Plymouth
UK
Disclosures
KA declares that he has no competing interests.
Differentials
- Sinusitis
- Sialadenitis
- Mumps
More DifferentialsGuidelines
- Antimicrobial prescribing in dentistry: good practice guidelines
- Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association
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