Pediatric Guidance
Oral and Dental Infections

Oral and Dental Infections

Note

Guidance is given only for oral and dental infections where antibiotic treatment may be required. Common dental procedures are beyond the scope of this guidance

Definitions

  • Abscess: Localized collection of pus caused by a bacterial infection in the tooth, gums or alveolar bone supporting the tooth. Abscesses can be categorized as:
    • Apical Abscess (more common): Infection at the apex of the dental root that originates from within the dental pulp usually resulting from untreated dental caries
    • Periodontal abscess: Collection of pus between the root and alveolar bone usually resulting from serious gum diseases
  • Pericoronitis: Inflammation of the gingiva (gum) surrounding a partially erupted tooth, often a lower wisdom tooth, which may be associated with an infection
  • Necrotizing periodontal disease: A severe gum infection characterized by necrosis and ulcerations caused by a bacterial infection. Previously known as necrotizing ulcerative gingivitis
  • Noma: An acute necrotizing disease that destroys the soft tissues and bones of the mouth and face as it progresses from necrotizing periodontal disease (previously known as necrotizing ulcerative gingivitis), mostly in malnourished children living in extreme poverty and with weakened immune systems
  • Alveolar bone: Part of the jawbones that surrounds and supports the teeth
  • Dental pulp: Blood vessels and nerves within the inner part of the tooth
  • Gingivae (gums): Soft tissue covering the alveolar bone
  • Plaque: Biofilm of microbes, mainly bacteria, which grows on surfaces within the mouth and contributes to oral diseases such as caries and periodontal disease

Diagnosis

Mild cases: Usually not needed

Severe cases requiring hospitalization: Consider doing blood and/or pus aspirates cultures

Mild cases: Usually not needed

Severe cases requiring hospitalization: White blood cell count, C-reactive protein and/or procalcitonin

Dental radiographs should be undertaken wherever possible as part of the diagnosis to differentiate between the various causes of dental pain

Point-of-care tests can be done to establish the source of the dental pain/infection and make appropriate treatment decisions, for example:

  • Tapping the tooth to evaluate response to percussion:
    • Tenderness indicates that the pain originates in the supporting bone and may be due to an abscess
  • Periodontal probing can identify:
    • A periodontal abscess if pus exudes from a pocket greater than 3mm
    • Necrotizing ulcerative disease if there is extremely tender gingival tissue and grey sloughing
  • Checking response to a cold stimulus:
    • No response to cold may indicate a non-vital/necrotic pulp

Microbiology

Prevention

  • Minimize sugar consumption
  • Prevent the accumulation of dental plaque with regular dental cleaning and good oral hygiene; fluoride is important because it strengthens the tooth enamel making it more resistant to caries
  • Promote smoking cessation and encourage people not to smoke

Treatment

  • Important:
    • Most dental infections and dental pain can be treated without antibiotic treatment by removal of the cause and drainage of the infection using a dental procedure (e.g. extraction of the tooth)
    • Antibiotics do not prevent severe complications and cannot replace local surgical treatment
    • Antibiotics should not be used before a dental procedure to "decrease inflammation" or to cure toothache. Antibiotics should not be used prior to most dental procedures to prevent surgical site infections
  • Regular use of mouthwashes with an antiseptic product (e.g. chlorhexidine) is not necessary for the control of dental infections; rinsing with salty water is usually adequate
  • Antibiotic treatment is not needed in most cases but can be considered (always complementary to dental procedures):
    • In patients with severe, spreading infections with systemic signs (e.g. facial swelling, inability to open the mouth, fever >38.0°C, tachycardia)
    • In severely immunocompromised patients and patients with uncontrolled diabetes (higher risk of complications)

Additional Information

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