Epidemiology, pathogenesis, and clinical manifestations of odontogenic infections
- Anthony W Chow, MD, FRCPC, FACP
Anthony W Chow, MD, FRCPC, FACP
- Professor Emeritus of Medicine
- University of British Columbia
Odontogenic infections, consisting primarily of dental caries and periodontal disease (gingivitis and periodontitis), are common and have local (eg, tooth loss) and, in some cases, systemic implications. In the United States, it is estimated that 25 percent of adults over the age of 60 have lost all their teeth (edentulism), approximately one-half from periodontal disease and one-half from dental caries .
In addition to producing pain and discomfort, odontogenic infections can extend beyond natural barriers and result in potentially life-threatening complications, such as infections of the deep fascial spaces of the head and neck. (See "Deep neck space infections".)
Periodontal infection can also be associated with a number of systemic disorders. These include fever of unknown origin, bacteremic seeding of heart valves and prosthetic devices, preterm birth of low birth weight children, and an increased risk for coronary heart disease and cerebrovascular events. (See 'Association with cardiovascular risk' below.)
A thorough understanding of the anatomic considerations and salient clinical features is essential for early recognition and effective treatment of these infections and their complications. The epidemiology, pathogenesis, and clinical manifestations of odontogenic infections will be reviewed here. The gingivitis and periodontitis syndromes that can occur and the complications, diagnosis, and treatment of these infections are discussed separately. (See "Gingivitis and periodontitis in adults: Classification and dental treatment" and "Complications, diagnosis, and treatment of odontogenic infections".)
Both dental caries and periodontal disease are prevalent in the United States and other countries . In a report from the National Health and Nutrition Examination Survey (NHANES) involving 8366 noninstitutionalized adults in the United States from 1988 to 1991, approximately 90 percent were dentate but only 30 percent still retained all of their natural teeth .
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- ANATOMIC CONSIDERATIONS
- Tooth structure
- Spread of infection
- PATHOGENESIS AND PREDISPOSING FACTORS
- Dental caries
- Periodontal disease
- Microbial specificity in odontogenic infections
- - Pathogenesis of caries
- - Pathogenesis of periodontal disease
- CLINICAL MANIFESTATIONS
- Dentoalveolar infections
- - Dental caries
- - Pulpitis and periapical abscess
- Periodontal infections
- - Gingivitis
- - Periodontitis
- - Periodontal abscess
- Association with cardiovascular risk