41
Volume1 Issue1
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S
upporting
Y
our
P
ractice
Investigation
RuleOutLocalPathologies
•
Obtaina thoroughmedical historyand recordvital signs.
•
Inquirewhether thepatient is immunocompromised.
•
Obtaina thoroughdental historyand inquireabout the
historyof pain (onset, location, duration, progression
over time, typeof pain).
•
Take intraoral andextraoral radiographs, pendingon the
patient’s cooperationandcomfort level.
•
Investigate thedegreeof anatomical site involvement,
ensuring that the spacesother than theoral cavityare
intact.
Diagnosis
Basedon theclinical observations and investigation, a
diagnosisof extensiveodontogenic infection isdetermined.
DifferentialDiagnosis
Non-odontogenic infections (major salivarygland infections,
peritonsillar abscesses, viral infections, cystic lesion infections)
Treatment
Common InitialTreatments
1.
Eliminate the sourceof infection (e.g., the infected
teeth).
2.
If the infection isfluctuant, aspirate toget samplesand
send forGram stainingandaerobicandanaerobiccultures.
3.
Inciseanddrain.
4.
Prescribeantibiotics:
•
IVantibiotics if thepatient is inanurgent care facility
•
if the infection ismild tomoderate, prescribe
penicillinV300–600mgorallyq.i.d. for at least 7
days (if thepatient is allergic topenicillin, prescribe
clindamycin300–600mgorallyq.i.d. for 7days), plus
anaerobiccoverage:
•
metronidazole (e.g., Flagyl®) 500mgorally t.i.d.
for 7days; or
•
amoxicillin500mgorally t.i.d. for 7days; or
•
amoxicillinwithclavulanatepotassium (e.g.,
Augmentin®) 500mgorally t.i.d. for 7days
5.
To successfullymanage thepain, acombination
of narcotics andanti-inflammatorydrugs is
recommended.
Advice
•
First lineof referral shouldbe toanoral surgeon to
expeditepatient’s treatment, as theyhaveaccess to
hospitals andhave theoptionof performing in-office
sedation (if patient’s safety isnot compromised).
•
If anoral surgeon isnot available, refer thepatient to
thehospital E.R. Contact theemergencydoctor directly
toconveyyour findings andaskwhether you should
prescribeantibioticsbefore referral.
•
Ensure thepatient understands the severityof the
conditionand that it could lead todeath if untreated
or if seeing the specialist isdelayed.
•
Emphasize the importanceof completing the full dose
of antibiotics.
a
SuggestedResources
1
MiloroM,editor.
Peterson’sPrinciplesofOralandMaxillofacialSurgery.
2nded.Hamilton:BCDecker Inc.;
2004.
2
TopazianRG,GoldbergMH,HuppJR.
OralandMaxillofacial Infections.
4thed.Philadelphia:W.BSaunders
Co.;2002
This articlewasoriginallycreated for
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clinical consults.
DentalEmergency
Scenario
