Clinical Review

Management of severe acute dental infections

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1300 (Published 24 March 2015) Cite this as: BMJ 2015;350:h1300
  1. Douglas P Robertson, senior clinical lecturer and honorary consultant in restorative dentistry1,
  2. William Keys, specialist registrar and honorary clinical teacher in restorative dentistry2,
  3. Riina Rautemaa-Richardson, clinical senior lecturer in infectious diseases and medical education; and consultant in medical mycology3,
  4. Ronnie Burns, general medical practitioner4,
  5. Andrew J Smith, professor of clinical bacteriology and honorary consultant microbiology5
  1. 1Restorative Dentistry, Glasgow Dental School, Glasgow G2 3JZ, UK
  2. 2Dundee Dental School, University of Dundee, UK
  3. 3Respiratory Research Group, School of Translational Medicine, Education and Research Centre, Wythenshawe Hospital, Manchester, UK
  4. 4Parkhead Health Centre, Glasgow, UK
  5. 5Infection and Immunity Section, Glasgow Dental School, Glasgow, UK
  1. Correspondence to: D P Robertson douglas.robertson.2{at}glasgow.ac.uk

The bottom line

  • Dental infection is a common and potentially life threatening condition and in some areas admissions for surgical treatment of dental infections are increasing

  • As many doctors are asked inappropriately to see patients with dental pain, service providers must ensure out of hours access to emergency dental treatment

  • Antibiotics are ineffective in the treatment of pulpal pain evoked by hot and cold and are not appropriate in the absence of signs of spreading infection or systemic upset as they do not prevent the development of severe complications

  • Localised dental abscesses respond well to incision and drainage, root treatment, or extraction and therefore it is important to arrange for prompt dental surgery rather than prescribe unnecessary antibiotics

  • Patients presenting with signs of sepsis, facial swelling, trismus (limited mouth opening), or dysphagia should be reviewed by a dental or maxillofacial surgeon without delay for appropriate surgical and medical management

Acute dental infection typically occurs when bacteria invade the dental pulp (nerve) and spread to tissues surrounding the tooth. Radiological signs of tooth associated infection in the supporting bone are extremely common, affecting 0.5-13.9% (mean 5.4%) of all teeth in a large systematic analysis of cross sectional studies.1 In addition to localised disease, dental infections can spread regionally and haematogenously, causing serious disseminated infections, especially in patients who are medically compromised.2 3 General medical practitioners and those working in emergency departments are frequently asked to treat patients presenting with dental problems but often have little or no training in this area.4 The purpose of this review is to help general practitioners and non-specialists with the initial diagnosis and management of acute dental infections.

Sources and selection criteria

We searched Medline 1950-2013 for the keywords “dental abscess”, “odontogenic infection”, “endodontic abscess”, “periapical abscess and microbiology”, and “clinical trials”. Embase was also searched, including the Cochrane database …

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