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Odontogenic Infections - May 2010
It was great seeing many of you at our 10th annual OSHA event. Thank you all for your many years of Antibiotic misuse, (sometimes called
antibiotic abuse or antibiotic overuse)
a growing threat and becoming increasingly infections by "super bugs", sometimes out of relatively harmless bacteria. Antibiotic Harrison JW, Svec TA (April 1998). "The beginning of the end of the antibiotic era? Part II. Proposed solutions to antibiotic abuse". Quintessence International 29 (4): 223–9
call, the more likely they are to get an appointment which suits for your patients! David, Dean, Craig and David K. Hunter, DDSDean B. Spingola, DMD, MDCraig E. Buchmann, DDS Brandon R. Brown, DDS
440 W. Interstate Hwy. 635, Suite 445  Irving, TX 75063  972-401-8301 1612 Lancaster Drive  Grapevine, TX 76051  817-329-4979 1139 Keller Parkway  Keller, TX 76248  817-379-1654 Odontogenic Infections - May 2010
After three days of symptoms, anaerobic g- manage in dentistry is an odontogenic infection. rods begin to appear. Many (up to 60%) are Odontogenic infections may range from low Clinical penicillin resistant, suggesting penicillin would be grade, well-localized infections which require onl ineffective alone in treating mature or severe minimal treatment to severe, life-threatening odontogenic infections. The drug of choice under fascial space infections. Although the majorities these conditions is clindamycin. Many avoid the are easily managed by minor surgical procedures use of it because of the association with and appropriate antibiotic therapy, one must not clostridium dificile colitis. However, many forget these infections can become severe in a practitioners are unaware that colitis is more frequently associated with other antimicrobial agents such as penicillins and cephalosporins. polymicrobial, consisting of a greater than 60% Metronidazole (flagyl 250mg every 6 hours – combination of aerobic and anaerobic bacteria adult dose) remains an excellent antibiotic for which are usually part of the normal oral flora. obligate anaerobes with few resistant problems. It is used in combination with penicillin for (streptococci), anaerobic g+ cocci (streptococci mature (> 3 day duration) or severe infections and peptostreptococci), and anaerobic g- rods with no improvement on penicillin alone. (bacteroides, fusobacterium). Odontogenic Metronidazole should always be administered infections have two major origins: periodontal as with an agent (penicillin) effective against aerobic a result of deep periodontal pockets that allow or facultative streptococci. Warn your patients migration of the bacterium into the underlying the drug does have a disulfiram (antabuse) type soft tissues, and more commonly, periapical as a result of pulpal necrosis and subsequent bacterial Erythromycins including Biaxin and Zithromax are not recommended for empiric therapy due to treatment of odontogenic infections, adhere to Flouroquinolones (such as Cipro and Levaquin) are inactive against most anaerobic bacteria as well as aerobic gram + cocci. The use is also use the correct and narrow spectrum antibiotic restricted in children because of possible adverse effects on the cartilage and more recently tendon Odontogenic infections are very commonly treated in the dental office. Choosing the correct Antibiotic therapy for early infections (within emperic antibiotic with the proper dosage and the first three days of the onset of symptoms) duration of treatment is very effective in treating differs from that provided for infections of greater most infections. They can spread very rapidly duration. Early infections usually consist of oral through fascial planes or the valveless venous streptococci (especially S.milleri group) which are system of the face to nearby vital structures. very susceptible to penicillin. Therefore Pen VK Close follow-up is very important and appropriate 500mg every 6 hours for 7-10 days (for adult) is surgical intervention may be necessary to very effective. Do not change therapy for at prevent rapid development of severe life- least 48-72 hours. Clindamycin 150-300mg every 6 hours (adult dose) is an excellent alternative when a patient is Pen allergic. David K. Hunter, DDSDean B. Spingola, DMD, MDCraig E. Buchmann, DDS Brandon R. Brown, DDS
440 W. Interstate Hwy. 635, Suite 445  Irving, TX 75063  972-401-8301 1612 Lancaster Drive  Grapevine, TX 76051  817-329-4979 1139 Keller Parkway  Keller, TX 76248  817-379-1654

Source: http://ntfos.org/wp-content/uploads/2011/10/NTFOS-Paper-May-2010.pdf