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3 - Dental and Odontogenic Infections

from Part I - Systems

Published online by Cambridge University Press:  15 December 2009

Preston C. Maxim
Affiliation:
Associate Clinical Professor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

Infections of the oral cavity are a common presenting complaint in the acute care setting and represent a diverse spectrum of disease ranging from dental caries to Ludwig's angina and retropharyngeal abscess. Odontogenic infections are generally due to normal mouth flora, specifically aerobic and anaerobic Streptococcus species, Bacteroides fragilis, and Prevotella intermedia.

EPIDEMIOLOGY

Dental infections are common in the general population, afflicting 40% of children by age 6 and 85% by age 17. The incidence approaches 100% by age 45, with approximately 50% having modest to severe periodontal disease. Comorbidities including diabetes, smoking, injection drug use, and poor oral hygiene increase the risk and severity of patients' periodontal disease. Fortunately, the incidence of secondary odontogenic infections has declined with the use of antibiotics, as has their morbidity and mortality. For example, although deep mandibular space abscesses, or Ludwig's angina, still represent 13% of the deep space infections of the neck, its mortality has declined from greater than 50% in the 1940s to approximately 5% currently.

CLINICAL FEATURES

Dentoalveolar Infections

Patients with dentoalveolar infections present to the acute care setting with a spectrum of disease ranging from caries to periapical abscesses. The persistent presence of dental plaque leads to the breakdown of the enamel and dentin layers that protect the dental pulp. Once the pulp is exposed, bacteria cause inflammation and subsequent necrosis.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2008

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References

Cummings, C W, et al. Otolaryngology head and neck surgery, 4th ed. 2005. Elsevier Mosby.Google Scholar
Kurian, M, Mathew, J, Job, A, et al. Ludwig's angina. Clin Otolaryngol Allied Sci 1997;22(3):263–5.CrossRefGoogle Scholar
Moyer, G P, Millon, J M, Martinez-Vidal, A. Is conservative treatment of deep neck space infections appropriate?Head Neck 2001;23(2):126–33.Google Scholar
Mandell, G L, Bennett, J E, Dolin, R. Principles and practice of infectious disease, 6th ed. 2005.
Rudolph, A M, Hoffman, J I E, Rudolph, C D. Rudolph's pediatrics, 20th ed. 1996. Appleton and Lange.Google Scholar

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  • Dental and Odontogenic Infections
    • By Preston C. Maxim, Associate Clinical Professor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.004
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  • Dental and Odontogenic Infections
    • By Preston C. Maxim, Associate Clinical Professor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.004
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Dental and Odontogenic Infections
    • By Preston C. Maxim, Associate Clinical Professor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.004
Available formats
×