Odontogenic Infections

Abstract

Odontogenic infections often arise from dental caries (usually the mandibular teeth) or from dental extraction. Acute necrotizing ulcerative gingivitis (ANUG) is more common in immunocompromised patients. These infections may spread into the parapharyngeal and retropharyngeal spaces, involving the airway and mediastinum. Airway management is critical as odontogenic infections can compromise airways via mass effect. Complications include the following: abscess, facial or orbital cellulitis/abscess, intracranial invasion, Ludwig’s angina, Lemierre syndrome, carotid artery erosion, descending necrotizing mediastinitis, airway compromise, hematogenous dissemination to distant organs, intraoral or dentocutaneous fistula formation, and cardiovascular disease. Antibiotics are not a substitute for definitive airway management. In addition, many cases of odontogenic infection will require surgical drainage, either at the bedside in the emergency department or in the operating room. Prior to this, consider using a nerve block to obtain anesthesia to the affected area of the face. Patients with necrotizing infections need emergent surgery with wide local debridement.