Overview of acute odontogenic infections

Acute odontogenic (tooth-related) infections are common and can affect:

• dental pulp—secondary to restoration breakdown, dental caries or loss of tooth structure from trauma
• periodontal tissues—most commonly due to advanced periodontitis
• pericoronal tissues—most commonly from partially erupted mandibular third molars.

If an odontogenic infection is ignored or not appropriately treated, it can progress to a localised abscess or spread to the soft tissues of the face or neck. Rare but serious complications include Ludwig angina, airway compromise, sepsis, or spread to the bone, brain, neck or mediastinum. Immunocompromised patients are prone to rapidly spreading infection.

Persistent dental pain and swelling after dentoalveolar surgery could be due to alveolar osteitis or a postoperative infection.

Osteomyelitis of the jaw is an important differential diagnosis in patients with an unresolved oral infection with systemic features and localised bone pain or tenderness. If osteomyelitis of the jaw is suspected, refer the patient to hospital; expert advice is needed. Differential diagnoses include osteonecrosis (which can be medication-related osteonecrosis of the jaw) and osteoradionecrosis (which occurs in patients undergoing radiation therapy).