Management and Prevention of Dental Infections

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By Dentz32 ⋅ June 28, 2008 ⋅ Post a comment

The oral cavity is colonized by more than 400 species of aerobic and anaerobic bacteria. Anaerobic bacteria outnumber their aerobic counterparts by a ratio of 10:1 to 100:1. These organisms inhabit the teeth, the gingival crevice, the mucous membranes, the dorsum of the tongue, and saliva. Dental infections can occur in a number of ways: (1) via the introduction of pathogens of extra-oral origin, (2) through a change in the balance of the indigenous flora, or (3) with the entry of bacteria into the normally sterile vital pulp of the tooth.

Although an individual’s host defenses can affect the progression and severity of symptoms, it is essential that most dental infections be treated with antibiotics, antifungal, or antiviral medications. Systemic medications can inhibit and kill pathogens located at sites that are out of reach of dental instruments and topical antiseptics.

The goals of this Clinical Update are to provide an overview of infectious etiology of odontogentic infections, the proper selection of various antimicrobial agents for the prevention and treatment of dental infections, and the management of sequelae that may occur in association with dental procedures. Recommendations are based on the current literature and on the known susceptibility of the microorganisms involved in infections of the oral cavity.

It is important to recognize that differences in susceptibility to a particular organism may be seasonal and may also vary according to geographical location. Clinicians should be aware of the antimicrobial susceptibility unique to the area where their practice is located. Clinical resources, such as the package insert, should be consulted for information about the current dose, indications for use, and adverse effects for each prescription written.

Odontogenic infections are among the most common human infections.[1] Scientific evidence has linked severe infections with increased susceptibility to certain important systemic diseases and conditions such as cardiovascular disease, diabetes mellitus, adverse pregnancy outcomes, and pulmonary infections.[2] This is because the gram-negative bacilli that cause periodontal disease trigger production of lipopolysaccharides, heat-shock proteins, and proinflammatory cytokines. Because of the association between periodontal disease and other medical problems, it is imperative that dental infections be prevented when possible, or promptly recognized and adequately treated. Both dentists and physicians should be aware of the clinical implications of the inter-relationships between odontogenic infections and other medical conditions and treat affected patients in collaboration when needed.