Contributor: Meghan Hurley, MD

Educational Pearls:

Dental infections can be categorized into two main groups

Infections of the gums

Pericoronitis

Tooth eruption leading to inflammation/irritation
Can progress to an infection
Requires pain control, no antibiotics

Gingivitis

Inflammation of the gums
Can lead to an infection requiring antibiotics

Abscess (gums)

If an infection develops in the gums it can progress to an abscess
May require drainage

Acute necrotizing ulcerative gingivitis (ANUG) aka Trench Mouth

Filmy, grayish discoloration of the gums with “punched out” lesions
Extremely painful
Can cause teeth to loosen and fall out
Treat with IV antibiotics + admission

Infections of the teeth

Dental caries

Causes sensitivity tooth enamel is worn through
Can lead to infection

Periapical abscess

Abscess that extends through the root of the tooth
Can develop up elsewhere in tooth/gums/mouth
Causes tooth sensitivity when tapped

Ludwig angina

Infection of the soft tissue under the tongue
Can compromise airway as it expands
Treat with extensive antibiotics and debridement

Antibiotic stewardship

Commonly used antibiotics for dental infections

Clindamycin
Augmentin
Amoxicillin

Chlorhexidine (Peridex)

Antiseptic and disinfectant that is helpful for gingival irritation

References

Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig's angina: An evidence-based review. Am J Emerg Med. Mar 2021;41:1-5. doi:10.1016/j.ajem.2020.12.030

Dufty J, Gkranias N, Donos N. Necrotising Ulcerative Gingivitis: A Literature Review. Oral Health Prev Dent. 2017;15(4):321-327. doi:10.3290/j.ohpd.a38766

Herrera D, Roldán S, Sanz M. The periodontal abscess: a review. J Clin Periodontol. Jun 2000;27(6):377-86. doi:10.1034/j.1600-051x.2000.027006377.x

Kumar S. Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis. Dent Clin North Am. Jan 2019;63(1):69-81. doi:10.1016/j.cden.2018.08.005

Kwon G, Serra M. Pericoronitis. StatPearls. StatPearls Publishing

Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD

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Podcast 844: Dental Infections