PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS - Oral and Maxillofacial Surgery

According to Contemporary Oral and Maxillofacial Surgery, 6th Edition, the PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS are:

Principle 1: Determine Severity of Infection
Principle 2: Evaluate State of Patient’s Host Defense Mechanisms

Compromised Host Defense States:

Uncontrolled Metabolic Diseases
• Poorly controlled diabetes
• Alcoholism
• Malnutrition
• End-stage renal disease

Immune System–Suppressing Diseases
• Human immunodeficiency virus/acquired immunodeficiency
syndrome
• Lymphomas and leukemias
• Other malignancies
• Congenital and acquired immunologic diseases

Immunosuppressive Therapies
• Cancer chemotherapy
• Corticosteroids
• Organ transplantation

Principle 3: Determine Whether Patient Should Be Treated by General Dentist or Oral-Maxillofacial Surgeon

Criteria for Referral to an Oral-Maxillofacial Surgeon

• Difficulty breathing
• Difficulty swallowing
• Dehydration
• Moderate to severe trismus (interincisal opening less than 20 mm)
• Swelling extending beyond the alveolar process
• Elevated temperature (greater than 101°F)
• Severe malaise and toxic appearance
• Compromised host defenses
• Need for general anesthesia
• Failed prior treatment

Principle 4: Treat Infection Surgically

Principle 5: Support Patient Medically

Principle 6: Choose and Prescribe Appropriate Antibiotic

Guidelines for consideration when choosing a specific antibiotic:

- Determine the need for antibiotic administration.

- Use empirical therapy routinely.

- Use the narrowest-spectrum antibiotic.

- Use the antibiotic with the lowest incidence of toxicity and

side effects.

- Use a bactericidal antibiotic, if possible. 

- Be aware of the cost of antibiotics.

Principle 7: Administer Antibiotic Properly

Principle 8: Evaluate Patient Frequently