16.1 Odontogenic tooth infections
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Gingivitis | Not required | Not required | Since it is a localized and superficial infection, it requires oral hygiene maintenance and scaling of teeth (only in few cases). |
| Periodontitis | Metronidazole 400mg q8h | If the local treatment and 5 days course of Metronidazole 400mg q8h is not effective surgical treatment is required. In very few cases:Amoxicillin 1g q8h may be advised. | Local treatment (scaling of teeth, pocket treatment) and removal of causative agent. In case patient is diabetic, adequate glycemic control will help in improving. |
| Complicated (severe infections, immunocompromised/ neutropenic etc) eg Ludwig’s Angina, Odontogenic Sinusitis, Cavernous Sinus Thrombosis, Brain Abscess etc. | Metronidazole 400mg q8h + Amoxicillin 1g q8h may be advised. | Amoxicillin- clavulanic acid 1g q12h | Removal of cause of the complication will help. (improving immune status and neutrophil counts) |
For common etiological agents of Odontogenic tooth infections, see Annexure B.16.1
Additional Information
- Apart from gingiva, the infections involving pulp may reach via tooth root to the jaw bone and can cause peri-apical infections. However, all pulp infections should be treated by doing root canal treatment and debridement. In rare cases when peri-apical infection spreads to other soft tissue planes and cause systemic symptoms like fever, malaise and extensive swelling then they can be treated with systemic antibiotics.
References
1. Tahmasebi, E.; Keshvad, A.; Alam, M.; Abbasi, K.; Rahimi, S.; Nouri, F.; Yazdanian, M.; Tebyaniyan, H.; Heboyan, A.; Fernandes, G.V.O. Current Infections of the Orofacial Region: Treatment, Diagnosis, and Epidemiology. Life 2023, 13, 269. Available from: https://doi.org/10.3390/life13020269
2. https://my.clevelandclinic.org/health/treatments/antibiotics-for-tooth-in