Description

• Very painful area ± swelling in the head and neck region arising from the teeth and supporting structures; if left untreated, can lead to serious and potentially life-threatening illnesses
• Assume any head and neck infection or swelling to be odontogenic in origin until proven otherwise.

Epidemiology

• Caries is a contagious bacterial infection that is transmitted vertically from caregivers.
• The introduction of fluoride has dramatically decreased dental caries.

• >25% of 2–5-year-olds have caries (1).
• Percent of children 6–19 years with untreated dental caries: 16.2% (2005–2008) (2)
• Percent of adults 20–64 with untreated dental caries: 23.7% (2005–2008) (2)
• 25% of children 5–17 years account for 80% of caries in the US (3).

Risk Factors

• Low socioeconomic status
• Parent and/or sibling with history of caries or existing untreated dental caries
• Previous caries
• Poor access to dental and health care
• Fear of dentist
• Poor oral hygiene
• Poor nutrition including high level of sugary foods and drinks
• Trauma to the teeth or jaws
• Inadequate access to and use of fluoride
• Gingival recession (increased risk of root caries)
• Physical and mental disabilities
• Decreased salivary flow (e.g., use of anticholinergic medications, immunologic diseases)

General Prevention

• Prevent caries and contagious bacterial infection (Streptococcus mutans).
• Majority of dental problems can be avoided through flossing, brushing with fluoride toothpaste, systemic fluoride (water; supplements for high-risk patients in nonfluoridated areas), fluoride varnish for moderate-high risk patients, and biannual cleaning (4)[A],(5)[B].
• Consider prevention of transmission of S. mutans from mother to infant by improving mother's dentition and decreasing mother's bacterial load through proper dental care, chlorhexidine gluconate rinses, and use of xylitol products.
• Avoid smoking, which is linked to severe periodontal disease.
• Good control of systemic diseases (e.g., diabetes)
• Xylitol gum (6)

Pathophysiology

Caries or trauma can lead to pulpal death, which in turn leads to infection of pulp and/or abscess of adjacent tissues via direct or hematogenous bacterial colonization.

Etiology

• S. mutans vertically transmitted to newly dentate infants from caregivers
• Acidic secretions from S. mutans are implicated in early caries.
• Often polymicrobial mix of strict anaerobes and facultative anaerobes:
  • Anaerobes, including Pepto streptococci, Bacteroides, Prevotella, and Fusobacterium, have been implicated. Lactobacilli not seen in healthy subjects, but seen in the rampant caries subjects (7)

Commonly Associated Conditions

• Rampant caries throughout dentition; faulty restorations; extractions and multiple missing teeth
• Periodontal abscess
• Soft-tissue cellulitis
• Periodontitis (deep inflammation ± infection of gingiva and ligaments)