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Dental Infection

para>In children, limit the frequency of sugary drinks and advise against sleeping with a bottle to decrease the chance of dental caries.

PATIENT EDUCATION

  • Manage dental disease, comprehensively-caries and periodontal disease need to be controlled.
  • Minimally, biannual dental visits after disease control
  • Nutritional educationLimit the frequency of sugar/carbonated drinks and sugary or sticky foods.
  • In young children, avoid sleeping with a bottle to decrease the chance of dental caries.
  • Brush twice daily and floss daily
  • Caretakers should tend to their personal oral hygiene ± chlorhexidine gluconate rinses in first 3 years of the child's life to decrease the risk of transmission of the caries-causing microorganisms.

PROGNOSIS

Prognosis is excellent with proper treatment.

COMPLICATIONS

  • Ludwig angina
  • Retropharyngeal and mediastinal infection
  • Osteomyelitis
  • Endocarditis
  • Submental infection
  • Submandibular infection
  • Can cause unstable diabetes in diabetics/worsen preexisting heart disease
  • Brain abscess/death

REFERENCES

11 Dye BA, Thornton-Evans G, Li X, et al. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS data brief, no 191. Hyattsville, MD: National Center for Health Statistics; 2015. http://www.cdc.gov/nchs/data/databriefs/db191.htm. Accessed 2015.22 National Center for Health Statistics. Health, United States, 2011: with special feature on socioeconomic status and health. Table 76. Hyattsville, MD: National Center for Health Statistics; 2012. http://www.cdc.gov/nchs/data/hus/hus11.pdf/. Accessed 2014.33 Robertson D, Smith AJ. The microbiology of the acute dental abscess. J Med Microbiol. 2009;58(Pt 2):155-162.44 Marinho VC, Higgins JP, Logan S, et al. Topical fluoride (toothpastes, mouth rinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(4):CD002782.55 Mickenautsch S, Yengopal V. Anticariogenic effect of xylitol versus fluoride-a quantitative systematic review of clinical trials. Int Dent J. 2012;62(1):6-20.66 Ong CK, Seymour RA. An evidence-based update of the use of analgesics in dentistry. Periodontol 2000. 2008;46:143-164.77 Douglass AB, Douglass JM. Common dental emergencies. Am Fam Physician. 2003;67(3):511-516.

ADDITIONAL READING

  • Clark MB, Douglass AB, Maier R, et al. Smiles for Life: A National Oral Health Curriculum. 3rd ed. Leawood, KS: Society of Teachers of Family Medicine; 2010. http://www.smilesforlifeoralhealth.com/buildcontent.aspx?tut=555&pagekey=62948&cbreceipt=0. Accessed 2014.
  • Dye BA, Li X, Beltr ¡n-Aguilar ED. Selected oral health indicators in the United States, 2005-2008. NCHS data brief, no 96. Hyattsville, MD: National Center for Health Statistics; 2012.
  • Flynn TR. What are the antibiotics of choice for odontogenic infections, and how long should the treatment course last? Oral Maxillofac Surg Clin North Am. 2011;23(4):519-536.
  • Lockhart PB ed. Oral Medicine and Medically Complex Patients. 6th ed. New York, NY: Elsevier; 2013.
  • U.S. Preventive Services Task Force. Dental caries in children from birth through age 5 years: screening. AHRQ Publication No. 12-05170-EF-2. http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/dental-caries-in-children-from-birth-through-age-5-years-screening. Accessed 2014.

CODES

ICD10

  • K02.9 Dental caries, unspecified
  • K04.7 Periapical abscess without sinus
  • K12.2 Cellulitis and abscess of mouth
  • K05.6 Periodontal disease, unspecified

ICD9

  • 521.00 Dental caries, unspecified
  • 522.5 Periapical abscess without sinus
  • 522.4 Acute apical periodontitis of pulpal origin
  • 528.3 Cellulitis and abscess of oral soft tissues
  • 522.0 Pulpitis

SNOMED

  • 427898007 infection of tooth (disorder)
  • 80967001 Dental caries (disorder)
  • 299709002 dental abscess (disorder)
  • 2556008 Periodontal disease (disorder)
  • 32620007 Pulpitis (disorder)

CLINICAL PEARLS

  • Do not ignore toothache pain.
  • Treat patients with facial swelling aggressively, as infections can spread quickly, leading to significant morbidity or death.
  • Promote prevention (oral hygiene, fluoride, dental visits) to avoid infections.