Last reviewed: 16 Sep 2021
Last updated: 08 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dental pain/toothache
  • thermal sensitivity of teeth
  • fever
  • intra-oral and/or extra-oral oedema
  • intra-oral and/or extra-oral erythema
  • intra-oral and/or extra-oral discharge
  • trismus
  • tooth percussion sensitivity
  • mobile teeth
  • deep periodontal pockets, bleeding, gingival recession
  • bone loss around teeth
  • elevated/extruded tooth
  • tachypnoea
  • dysphagia/drooling
  • dysphonia
  • dyspnoea/respiratory stridor
  • posturing
  • uvular deviation
  • floor of mouth elevation
  • hypotension

Other diagnostic factors

  • halitosis/bad taste in mouth
  • xerostomia
  • neurological 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 radiotherapy
  • certain medications
  • immunosuppression or comorbidity (higher risk for complications)
  • large dental restorations
  • bruxism
  • prior root canal treatment failure

Diagnostic investigations

Investigations 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

ACUTE
ONGOING

Contributors

Authors

Melanie S. Lang, DDS, MD
Melanie S. Lang

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
Thomas B. Dodson

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.

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