Written by : Dr.Urusa I Inamdar

Diagnosis

• Specimen collection and processing
• Imaging techniques

Management

• prevention of the odontogenic infection is the golden standard.
• complex odontogenic infection may require an incision and drainage.
• mild odontogenic infection can be easily treated with simple antibiotic.
• Complicated odontogenic infection require patient admission and hospitalization.
• any odontogenic infection should be treated promptly and should not be underestimated.
• Determine the severity of infection.
• evaluate the host defence.

Severity of infection

• Rate of progression.
• Potential of airway compromise or affecting vital organs.
• Anatomic location of infection.

Incision and drainage

• Incise in healthy skin.
• Incise in gravity dependent aesthetic area – if possible.
• Explore entire abscess cavity.
• Non – absorbable drains.

Principles in the use of drains

• Drained wounds should be cleansed frequently.
• Bacteria can migrate into a wound along the drain surface.
• Latex Penrose drains are best used unmodified.

Empiric therapy of odontogenic infections

• penicillin
• penicillin + metronidazole
• allergic to penicillin give clindamycin

Management

• Determine severity- assess history of onset and progression perform physical examination of area:

1. Determine character and size of the swelling
2. Establish presence of trismus

• Evaluate host defense- evaluate:

1. Diseases that compromise the host
2. Medications that compromise the host

• Perform surgery- remove the cause of infection , drain pus , relieve pressure.
• Select antibiotic- Determine

1. Most likely causative organisms based on history
2. Host defense status
3. Allergy history
4. Previous drug history

• Follow up- confirm treatment response, evaluate for side effects and secondary infections.

Follow up

• out patient should return for f/u in 2-3 days.
• Patient should have decreased swelling, discharge, airway edema, malaise in 2-3 days.
• If no improvement consider:

1. Re- culture
2. Re- image
3. Repeat incision and drainage

References

• slideshare – odontogenic infection
• Shafer’s – Textbook of Oral Pathology (7th edition)