Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Complications, diagnosis, and treatment of odontogenic infections

Anthony W Chow, MD, FRCPC, FACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Odontogenic infections, consisting primarily of dental caries and periodontal disease (gingivitis and periodontitis), are common and have local (eg, tooth loss) and, in some cases, systemic implications. In the United States, it is estimated that 25 percent of adults over the age of 60 have lost all their teeth (edentulism), approximately one-half from periodontal disease and one-half from dental caries [1,2].

In addition to producing pain and discomfort, odontogenic infections can extend beyond natural barriers and result in potentially life-threatening complications, such as infections of the deep fascial spaces of the head and neck. (See "Deep neck space infections".)

Periodontal infection can also be associated with a number of systemic disorders. These include fever of unknown origin, bacteremic seeding of heart valves and prosthetic devices, preterm birth of low birth weight children, and an increased risk for coronary heart disease and cerebrovascular events.

The complications, diagnosis, and treatment of odontogenic infections will be reviewed here. The epidemiology, pathogenesis, and clinical manifestations of these infections are discussed separately. (See "Epidemiology, pathogenesis, and clinical manifestations of odontogenic infections" and "Gingivitis and periodontitis in adults: Classification and dental treatment".)


Suppurative odontogenic infections may extend to potential fascial spaces in the orofacial area (orofacial space infections) or deep in the head and neck (peripharyngeal space infections). The latter complication is often life threatening. (See "Deep neck space infections".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Beltrán-Aguilar ED, Barker LK, Canto MT, et al. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. MMWR Surveill Summ 2005; 54:1.
  2. Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999; 70:13.
  3. Chow AW. Infections of the oral cavity, neck and head. In: Principles and Practices of Infectious Diseases, 8, Mandell GL, Dolin R, Blaser MJ (Eds), Elsevier Churchill Livingstone, Philadelphia 2014. p.789.
  4. Mesgarzadeh AH, Ghavimi MA, Gok G, Zarghami A. Infratemporal space infection following maxillary third molar extraction in an uncontrolled diabetic patient. J Dent Res Dent Clin Dent Prospects 2012; 6:113.
  5. Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol 2007; 127:194.
  6. Tong AC, Ng IO, Yeung KM. Osteomyelitis with proliferative periostitis: an unusual case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102:e14.
  7. Kannan SK, Sandhya G, Selvarani R. Periostitis ossificans (Garrè's osteomyelitis) radiographic study of two cases. Int J Paediatr Dent 2006; 16:59.
  8. Sharkawy AA. Cervicofacial actinomycosis and mandibular osteomyelitis. Infect Dis Clin North Am 2007; 21:543.
  9. Hong SO, Lee CY, Jung J, et al. A retrospective study of osteomyelitis and osteonecrosis of the jaws and its etiologic implication of bisphosphonate in Asians. Clin Oral Investig 2016.
  10. Bartzokas CA, Johnson R, Jane M, et al. Relation between mouth and haematogenous infection in total joint replacements. BMJ 1994; 309:506.
  11. Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010; 50:8.
  12. Takai S, Kuriyama T, Yanagisawa M, et al. Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99:292.
  13. Durante-Mangoni E, Bradley S, Selton-Suty C, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med 2008; 168:2095.
  14. Terezhalmy GT, Safadi TJ, Longworth DL, Muehrcke DD. Oral disease burden in patients undergoing prosthetic heart valve implantation. Ann Thorac Surg 1997; 63:402.
  15. Suzuki J, Aoyama N, Ogawa M, et al. Periodontitis and cardiovascular diseases. Expert Opin Ther Targets 2010; 14:1023.
  16. Hurley MC, Heran MK. Imaging studies for head and neck infections. Infect Dis Clin North Am 2007; 21:305.
  17. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007; 369:51.
  18. Fedorowicz Z, van Zuuren EJ, Farman AG, et al. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2013; :CD004969.
  19. Nagle D, Reader A, Beck M, Weaver J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:636.
  20. Schlafer S, Vaeth M, Hørsted-Bindslev P, Frandsen EV. Endodontic photoactivated disinfection using a conventional light source: an in vitro and ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109:634.
  21. Williams JA, Pearson GJ, Colles MJ. Antibacterial action of photoactivated disinfection {PAD} used on endodontic bacteria in planktonic suspension and in artificial and human root canals. J Dent 2006; 34:363.
  22. Bonsor SJ, Nichol R, Reid TM, Pearson GJ. Microbiological evaluation of photo-activated disinfection in endodontics (an in vivo study). Br Dent J 2006; 200:337.
  23. Hull MW, Chow AW. An Approach to Oral Infections and Their Management. Curr Infect Dis Rep 2005; 7:17.
  24. Krayer JW, Leite RS, Kirkwood KL. Non-surgical chemotherapeutic treatment strategies for the management of periodontal diseases. Dent Clin North Am 2010; 54:13.
  25. Baker KA, Fotos PG. The management of odontogenic infections. A rationale for appropriate chemotherapy. Dent Clin North Am 1994; 38:689.
  26. Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontol 2000 2002; 28:106.
  27. Loesche WJ, Giordano J, Soehren S, et al. Nonsurgical treatment of patients with periodontal disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81:533.
  28. Borges I, Faveri M, Figueiredo LC, et al. Different antibiotic protocols in the treatment of severe chronic periodontitis: a 1-year randomized trial. J Clin Periodontol 2017.
  29. Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol 2005; 76:1227.
  30. Salvi GE, Mombelli A, Mayfield L, et al. Local antimicrobial therapy after initial periodontal treatment. J Clin Periodontol 2002; 29:540.
  31. Warburton PJ, Palmer RM, Munson MA, Wade WG. Demonstration of in vivo transfer of doxycycline resistance mediated by a novel transposon. J Antimicrob Chemother 2007; 60:973.
  32. Little JW, Falace DA, Miller CS, Rhodus NL. Antibiotic prophylaxis in dentistry: an update. Gen Dent 2008; 56:20.
  33. Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg 2007; 65:177.
  34. Brook I. Antibiotic resistance of oral anaerobic bacteria and their effect on the management of upper respiratory tract and head and neck infections. Semin Respir Infect 2002; 17:195.
  35. Marchand-Austin A, Rawte P, Toye B, et al. Antimicrobial susceptibility of clinical isolates of anaerobic bacteria in Ontario, 2010-2011. Anaerobe 2014; 28:120.
  36. Wybo I, Van den Bossche D, Soetens O, et al. Fourth Belgian multicentre survey of antibiotic susceptibility of anaerobic bacteria. J Antimicrob Chemother 2014; 69:155.
  37. Poeschl PW, Spusta L, Russmueller G, et al. Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110:151.
  38. Rossi-Fedele G, Scott W, Spratt D, et al. Incidence and behaviour of Tn916-like elements within tetracycline-resistant bacteria isolated from root canals. Oral Microbiol Immunol 2006; 21:218.
  39. Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws--a current overview--Part 2: dental management and therapeutic options for treatment. Oral Maxillofac Surg 2010; 14:81.
  40. Lentrodt S, Lentrodt J, Kübler N, Mödder U. Hyperbaric oxygen for adjuvant therapy for chronically recurrent mandibular osteomyelitis in childhood and adolescence. J Oral Maxillofac Surg 2007; 65:186.
  41. Ran T, Chattopadhyay SK, Community Preventive Services Task Force. Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review. Am J Prev Med 2016; 50:790.
  42. O'Connell J, Rockell J, Ouellet J, et al. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood) 2016; 35:2224.
  43. Hicks J, Garcia-Godoy F, Flaitz C. Biological factors in dental caries: role of remineralization and fluoride in the dynamic process of demineralization and remineralization (part 3). J Clin Pediatr Dent 2004; 28:203.
  44. Caufield PW, Dasanayake AP, Li Y. The antimicrobial approach to caries management. J Dent Educ 2001; 65:1091.
  45. Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: A systematic review and meta-analyses. J Nat Sci Biol Med 2017; 8:16.
  46. Forgie AH, Paterson M, Pine CM, et al. A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents. Caries Res 2000; 34:432.
  47. Okada EM, Ribeiro LN, Stuani MB, et al. Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis. Braz Oral Res 2016; 30:e115.
  48. DePaola PF, Jordan HV, Soparkar PM. Inhibition of dental caries in school children by topically applied vancomycin. Arch Oral Biol 1977; 22:187.
  49. Rodríguez G, Ruiz B, Faleiros S, et al. Probiotic Compared with Standard Milk for High-caries Children: A Cluster Randomized Trial. J Dent Res 2016; 95:402.
  50. Kobayashi R, Kobayashi T, Sakai F, et al. Oral administration of Lactobacillus gasseri SBT2055 is effective in preventing Porphyromonas gingivalis-accelerated periodontal disease. Sci Rep 2017; 7:545.
  51. Alok A, Singh ID, Singh S, et al. Probiotics: A New Era of Biotherapy. Adv Biomed Res 2017; 6:31.
  52. Smith DJ. Dental caries vaccines: prospects and concerns. Expert Rev Vaccines 2010; 9:1.
  53. Beirne P, Forgie A, Worthington HV, Clarkson JE. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2005; :CD004625.