Last reviewed: April 2018
Last updated: May  2018



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 abuse
  • 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 investigations

1st investigations to order

  • CBC 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



Authors VIEW ALL

Melanie S. Lang

Assistant Professor

Department of Oral and Maxillofacial Surgery

University of Washington School of Dentistry




MSL is on the board for the Western Society of Oral and Maxillofacial Surgery, and has participated in AO lectures. MSL is attending a seminar sponsored by Stryker for VSP in orthognathic surgery in early October 2017, in which they are sponsoring her travel and accommodations.MSL owns insurance stock in OMNIC.

Thomas B. Dodson

Professor and Chair

Department of Oral and Maxillofacial Surgery

University of Washington School of Dentistry




TBD is a paid consultant to the American Association of Oral and Maxillofacial Surgeons, functioning as Associate Editor to the <i>Journal of Oral and Maxillofacial Surgery</i>. TBD is an unpaid chair to the board of directors at the Oral at the Maxillofacial Surgery Foundation.

Peer reviewers VIEW ALL

Professor and Chairman

Department of Oral and Maxillofacial Surgery

Vanderbilt University




SJM declares that he has no competing interests.

Associate Professor

Lead in Oral Surgery

Plymouth University Peninsula Schools of Medicine & Dentistry




KA declares that he has no competing interests.

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