Dental Infections

Author: Hans Rosenberg, MD
Updated: 4/22/2011

Dental Infections

  • Dental caries - demineralization of protective enamel and subsequent tooth decay
  • Pulpitis - inflammation of pulp secondary to caries
  • Periodontitis - loss of supportive bone structure caused by chronic gingivitis

Cellulitis, necrotic pulp, and periapical abscess diagram

Impaction of food and bacteria diagram

Periapical Abscess

Collection of purulent material at apex of tooth

  • Secondary to bacterial invasion from carious destruction of enamel
  • History: Progressive pain, thermal sensitivity
  • Exam: Caries, decayed tooth, pain with percussion, palpation of apex, gingival swelling, erythema, parulis present, mobile tooth

  • Treatment:

  • Antibiotics

    • Uncomplicated: Penicillin or Clindamycin
    • Complicated: Penicillin + Metronidazole, Piperacillin/Tazobactam, or Clindamycin + Ceftriaxone

  • Pain control

  • I+D if abscess present: probe with 18g needle → purulent → 11 blade stab incision → hemostat blunt dissection +/- packing
  • Chlorhexidine 0.1% rinses q2-3h if I & D

  • Surgical referral, if complicated infection (Ludwig's, Lemierre's Syndrome)

  • Dentist followup:

  • Uncomplicated: Generalist in 1-2 days

  • Complicated: Oral Surgery as soon as possible

Periodontal Abscess

  • Localized purulent infection within the gingival wall of the periodontal pocket
  • History: Swelling, pain, loose tooth
  • Exam: Purulent discharge, erythema, fluctuant mass, dental extrusion

  • Treatment:

  • Pain Control: Dental block, NSAID’s +/- opioids

  • I & D abscess as needed: 11 blade stab incision → hemostat blunt dissection +/- packing

  • Antibiotics:

    • Penicillin or Clindamycin
    • Chlorhexidine 0.1% rinses q2-3h

  • Dentist followup

  • Generalist in 1-2 days

Pericoronitis

  • Inflammation +/- infection surrounding impacted or partially erupted tooth
  • History: Usually 3rd molar (wisdom tooth), erupting teeth, pain, swelling, halitosis
  • Exam: Erythema, swelling, +/- abscess

  • Treatment: Same as for Periodontal Abscess

    • Pain Control: Dental block, NSAID’s +/- opioids
    • I & D abscess as needed: 11 blade stab incision → hemostat blunt dissection +/- packing

    • Antibiotics:

      • Penicillin or Clindamycin
      • Chlorhexidine 0.1% rinses q2-3h

  • Dentist followup:

  • Generalist in 1-2 days

  • Definitive treatment: Oral Surgery

References

  • Nguyen DH, Martin JT. Common dental infections in the primary care setting. Am Fam Physician. 2008 Mar 15;77(6):797-802. [PubMed]