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.
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.
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.