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
