Approach to managing acute odontogenic infections

An acute odontogenic infection requires prompt management with dental treatment (eg extraction, root canal) or surgical intervention, to address the source of the infection. Antibiotic therapy is not a substitute for dental treatment, but may be required if dental treatment is not likely to be received within 24 hours. Whether the patient can be managed in the community or requires hospital admission depends on the severity of the infection (see #dtg3-c14-s2__tdtg3-c14-tbl2).

Seek expert advice for patients with recurrent infection who have received antibiotics but not dental treatment.

Odontogenic infection is usually polymicrobial, involving anaerobic and aerobic oral bacteria. Metronidazole is used in conjunction with a penicillin because of increased rates of resistance to penicillins in some oral bacteria (eg Prevotella oralis). However, amoxicillin+clavulanate has adequate anaerobic activity, so can be used as a single preparation.