Last reviewed: June 2018
Last updated: May  2018

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 abuse
  • 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

1st investigations to order

  • FBC with differential
  • panoramic x-ray
Full details

Investigations to consider

  • periapical x-ray
  • CT head and neck (with contrast)
  • infection site aspiration Gram stain/culture and sensitivity
  • CRP
  • ESR
  • serum electrolytes
  • plasma fibrinogen level
  • MRI head and neck
  • ultrasound of fascial spaces
  • electric pulp testing
  • thermal testing
  • blood cultures
Full details

Emerging tests

  • C-terminal cross-linking telopeptide (CTX)
Full details

Treatment algorithm

ACUTE
ONGOING

Contributors

Authors VIEW ALL

Melanie S. Lang

Assistant Professor

Department of Oral and Maxillofacial Surgery

University of Washington School of Dentistry

Seattle

WA

Disclosures

MSL was a board member with the ADA Council on Access, Prevention and Interprofessional Relations (CAPIR) and a Consultant to the AAOMS Committee on Hospitals and Interprofessional Affairs (CHIA) in 2016. She has contributed to Oakstone Audio Reviews in Oral and Maxillofacial Surgery. MSL has received travel and lodging support through Stryker for a VSP and Surgical Navigation course and has received registration and lodging support through the Laura Bush Foundation for a meeting on Sex and Gender in Health Education (SGHE). MSL has published two manuscripts related to perioperative antibiotic use with materials from the AAOMS. She is to be an AAOMS representative to the ADA for a group studying the use of antibiotics in dentistry. MSL is to receive sponsorship from KLS for a conference on orthognathic surgery in October 2018.

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. He acts as an unpaid board member for the Oral and Maxillofacial Surgery Foundation and as an unpaid committee member for the Research and Development Commission of the AOCMF.

Peer reviewers VIEW ALL

Professor and Chairman

Department of Oral and Maxillofacial Surgery

Vanderbilt University

Nashville

TN

Disclosures

SJM declares that he has no competing interests.

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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