Updated Guidelines for Antibiotic Use in Pediatric Dentistry: Evidence-Based Recommendations

The judicious use of antibiotics in pediatric dentistry is crucial to combat antimicrobial resistance and ensure optimal patient outcomes. Overprescription and inappropriate antibiotic use in children contribute to the global health threat of antibiotic resistance, adverse drug reactions, and disruption of normal microbiota.

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... The use of antibiotics must be rational to avoid drug resistance of microorganisms (microbial resistance). Odontogenic infections can arise from caries or a periodontal problem, sometimes they can be due to dental trauma or iatrogenesis

This article discusses updated, evidence-based guidelines for antibiotic use in pediatric dental care, focusing on clinical indications, dosage, and the importance of antimicrobial stewardship.

Advertisement

✅ Indications for Antibiotic Use in Pediatric Dentistry
According to the American Academy of Pediatric Dentistry (AAPD) and other professional bodies, antibiotics should be prescribed in pediatric patients only when there is clear evidence of systemic involvement or the risk of spread of odontogenic infections. The primary indications include:

° Acute facial swelling or cellulitis with systemic symptoms (fever, malaise)
° Rapidly progressing infections such as Ludwig’s angina or deep space infections
° Persistent infections not resolved by local measures alone
° Prophylaxis in patients at risk of infective endocarditis or with immunocompromising conditions

Local dental infections like localized abscesses or pulpitis do not typically require systemic antibiotics and are best managed by definitive dental treatment such as extraction or pulpectomy.

📌 Recommended Article :

PDF 🔽 Dental pain in pediatric dentistry - Assessment tools ... We share an article that reviews the important aspects of pain in pediatric dentistry, and the tools for a correct evaluation today

✅ Commonly Recommended Antibiotics and Dosage
For pediatric patients, the most frequently recommended antibiotics are:

° Amoxicillin: 20–40 mg/kg/day divided every 8 hours, or 25–45 mg/kg/day if given twice daily
° Amoxicillin with Clavulanic Acid: Used when beta-lactamase resistance is suspected
° Clindamycin: 8–20 mg/kg/day in three divided doses (for penicillin-allergic patients)
° Azithromycin: 5–12 mg/kg on the first day followed by lower doses over 4 days

Prescribers must adjust dosages based on weight and age and consider the patient’s medical history, including allergies and hepatic or renal function.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient

✅ Antibiotic Prophylaxis
The AAPD, following the American Heart Association (AHA) guidelines, recommends antibiotic prophylaxis for pediatric patients at high risk of infective endocarditis, especially before procedures likely to cause bleeding (e.g., tooth extractions, periodontal surgery). This includes:

° Children with prosthetic heart valves
° Previous infective endocarditis
° Certain congenital heart conditions
° Cardiac transplant recipients with valvulopathy

The standard prophylactic regimen is amoxicillin 50 mg/kg orally one hour before the procedure.

📌 Recommended Article :

Dental Article 🔽 Severe Dental Infections: Symptoms, Treatment & Antibiotics ... Always consider patient-specific factors, such as age, weight, and allergy history, when selecting an antibiotic

💬 Discussion
Despite clear guidelines, studies reveal frequent antibiotic overprescription in pediatric dentistry. A cross-sectional study by Al-Jundi et al. (2022) indicated that many dentists prescribe antibiotics for non-indicated conditions such as reversible pulpitis, primarily due to parental expectations or time constraints. This inappropriate practice fosters resistance and increases adverse drug reactions, including gastrointestinal issues, allergic reactions, and alterations in the child’s developing microbiome.
Moreover, the COVID-19 pandemic initially led to increased remote consultations and a spike in empirical antibiotic prescriptions, further underscoring the need for robust antimicrobial stewardship programs in dental settings.
Educational interventions, integration of prescribing guidelines into electronic health systems, and continuing professional development can help reduce inappropriate prescribing practices. Collaborative efforts between pediatricians, pharmacists, and pediatric dentists are also essential.

📌 Recommended Article :

PDF/Video 🔽 How to manage dental infections? - Specific pharmacological treatment ... Let us know the causative agents of odontogenic infections and the clinical management and specific pharmacological treatment for each of them

💡 Conclusion
Antibiotic use in pediatric dentistry should be reserved for cases with systemic involvement or significant risk of progression. Adherence to updated, evidence-based guidelines is critical to minimizing resistance and ensuring patient safety. Dental professionals must prioritize definitive treatment over pharmacologic management when possible and engage in continuous education to refine prescribing practices.

📚 References

✔ Al-Jundi, S. H., Mahmoud, S. Y., & Alsafadi, Y. H. (2022). Antibiotic prescribing practices among pediatric dentists in Jordan: A cross-sectional survey. BMC Oral Health, 22(1), 105. https://doi.org/10.1186/s12903-022-02156-3

✔ American Academy of Pediatric Dentistry. (2023). Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/antibiotic-therapy/

✔ Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., ... & Baltimore, R. S. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095

📌 More Recommended Items

► Antibiotics in dental infections in children. Which one to use?
► Update on antibiotic prophylaxis in pediatric patients
► Antibiotics and its use in pediatric dentistry: A review

Updated Criteria for the Selection of Antibiotic Dosage and Regimen in Dentistry

Antibiotic therapy in dentistry is essential for preventing and treating infections resulting from dental procedures.

📌 Recommended Article :

PDF 🔽 Antibiotics and its use in pediatric dentistry: A review ... Antibiotics are commonly used in dentistry for prophylactic as well as for therapeutic purposes. Very often antibiotics are used in unwarranted situations, which may give rise to resistant bacterial strains

Correct selection of antibiotic dosage and regimen not only ensures therapeutic efficacy but also minimizes the risk of developing bacterial resistance and adverse effects.

Advertisement

✅ A. Determining Factors in Antibiotic Selection

1. Identification of the Etiological Agent
Odontogenic infections are often polymicrobial, predominantly involving anaerobic and gram-positive aerobic bacteria. Precise identification of the causative agent allows for the selection of an antibiotic with an appropriate spectrum. However, due to the difficulty in isolating and culturing these microorganisms in daily practice, empirical selection based on local epidemiology and the nature of the infection is common.

2. Antibiotic Spectrum
The chosen antibiotic should be effective against the most common pathogens in odontogenic infections. For example, amoxicillin is effective against a wide range of gram-positive bacteria and some gram-negative ones, while clindamycin is preferred in patients allergic to penicillins due to its activity against anaerobes and gram-positive aerobes.

3. Pharmacokinetics and Pharmacodynamics
Understanding the absorption, distribution, metabolism, and excretion of the antibiotic is crucial for determining the dosage and frequency of administration. For instance, amoxicillin has good oral bioavailability and a half-life that allows for administration every 8 hours. Clindamycin, on the other hand, requires administration every 6 to 8 hours due to its shorter half-life.

4. Patient's Condition
The patient's systemic conditions, such as renal or hepatic insufficiency, can affect drug elimination, requiring dosage adjustments. Additionally, in immunocompromised patients, more aggressive or prolonged treatment may be necessary.

5. Possible Interactions and Adverse Effects
It is essential to consider drug interactions, especially in polymedicated patients. For example, erythromycin can interact with other drugs metabolized by the cytochrome P450 system, increasing the risk of toxicity. Moreover, some antibiotics can cause gastrointestinal adverse effects or allergic reactions that must be monitored.

📌 Recommended Article :

PDF 🔽 Dental pain in pediatric dentistry - Assessment tools ... We share an article that reviews the important aspects of pain in pediatric dentistry, and the tools for a correct evaluation today

✅ B. Dosage and Regimen of Common Antibiotics in Dentistry
Below are the dosage and regimen recommendations for the most commonly used antibiotics in dentistry, based on clinical guidelines and recent studies:

1. Amoxicillin
° Indications: Common odontogenic infections.
° Adult dosage: 500 mg orally every 8 hours.
° Pediatric dosage: 20–40 mg/kg/day divided into three doses.
° Considerations: In severe infections, the dose may be increased to 1 g every 8 hours. Dosage adjustment is recommended in patients with renal insufficiency.

2. Amoxicillin/Clavulanic Acid
° Indications: Resistant infections or when beta-lactamase-producing bacteria are suspected.
° Adult dosage: 875 mg/125 mg orally every 12 hours.
° Pediatric dosage: 25–45 mg/kg/day divided into two doses.
° Considerations: The combination with clavulanic acid broadens amoxicillin's spectrum but may increase the incidence of gastrointestinal effects.

3. Clindamycin
° Indications: Patients allergic to penicillins; infections by anaerobes.
° Adult dosage: 300 mg orally every 6–8 hours.
° Pediatric dosage: 8–20 mg/kg/day divided into three or four doses.
° Considerations: Monitor for gastrointestinal side effects and the risk of pseudomembranous colitis.

4. Azithromycin
° Indications: Patients allergic to penicillins; infections by susceptible bacteria.
° Adult dosage: 500 mg once daily for three days.
° Pediatric dosage: 10 mg/kg once daily for three days.
° Considerations: Has a prolonged half-life, allowing for simplified dosing regimens.

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... We share a literature review that establishes guidelines for antimicrobial therapy in infections of odontogenic origin and clinical recommendations

✅ C. Conclusions on the Selection of Antibiotic Dosage and Regimen in Dentistry

1. Evidence-Based Selection: The choice of antibiotics in dentistry should be based on the identification of the etiological agent, appropriate antibiotic spectrum, and updated clinical guidelines to ensure efficacy and safety in treating odontogenic infections.
2. Importance of Pharmacokinetics and Pharmacodynamics: Dosage and regimen should be adjusted considering the drug's absorption, metabolism, and excretion, as well as the patient's systemic condition, to avoid overdosing or bacterial resistance.
3. First-Line Antibiotics and Alternatives: Amoxicillin remains the antibiotic of choice for common dental infections, while clindamycin and azithromycin are safe options for patients with penicillin allergies.
4. Avoiding Antibiotic Abuse and Resistance: Empirical prescription should be prudent, considering the increasing bacterial resistance and the impact of indiscriminate antibiotic use on oral and general microbiota.
5. Individualized Treatment: Each patient should receive personalized antibiotic therapy, taking into account their clinical history, drug interactions, and potential adverse effects to optimize therapeutic response and reduce complications.

In conclusion, the rational use of antibiotics in dentistry is essential for effective infection treatment, minimizing risks, and contributing to the fight against microbial resistance.

📚 References

✔ Bascones Martínez, A., Aguirre Urizar, J. M., Bermejo Fenoll, A., Blanco Carrión, A., Gay Escoda, C., González Moles, M. Á., ... & Llamas Martín, R. (2006). Documento de consenso sobre la utilización de profilaxis antibiótica en cirugía y procedimientos dentales. Avances en Odontoestomatología, 22(1), 43-53.

📌 More Recommended Items

► Update on antibiotic prophylaxis in pediatric patients
► Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation
► Severe Dental Infections: Symptoms, Treatment & Antibiotics

Comprehensive Pain Control Strategies in Pediatric Dentistry: Methods, Risks, and Considerations

Pain control in pediatric dentistry is a cornerstone for successful treatment and long-term oral health. Unlike adults, children may have limited ability to communicate pain or cooperate during procedures, necessitating tailored approaches to analgesia and anxiety control.

📌 Recommended Article :

PDF 🔽 Manual of Local Anesthesia - Anesthetic techniques and anatomical references ... We share a dental anesthesia manual, which teaches us in a practical and simple way the different anesthetic techniques and their anatomical references

The goal is to provide effective treatment while minimizing physical and psychological discomfort.

Advertisement

✅ Behavioral and Non-Pharmacological Pain Management
Behavioral techniques are often the first line of intervention. These include:

➤ Tell-Show-Do: A technique where the dentist explains the procedure, demonstrates it on a model or finger, and then performs it.
➤ Positive Reinforcement: Rewarding desirable behavior to encourage future cooperation.
➤ Distraction Techniques: Use of music, videos, or toys to divert the child’s attention.
➤ Desensitization: Gradual exposure to feared procedures or instruments.

These techniques are crucial and often used in conjunction with pharmacological methods.

📌 Recommended Article :

Video 🔽 Inferior alveolar nerve block Technique For Children - Tips and tricks ... In pediatric dentistry, the inferior alveolar nerve block technique can be quite a challenge, and the video that we share offers several tips and tricks for its administration in pediatric patients

✅ Local Anesthesia
Local anesthesia is the most commonly used method for pain control in pediatric patients. Lidocaine, articaine, and mepivacaine are widely used agents.

➤ Techniques
° Infiltration: Often used in the maxilla due to porous bone structure.
° Nerve Blocks: Indicated for procedures in the mandible, especially the inferior alveolar nerve block.
➤ Considerations
° Dosage: Must be calculated based on the child’s weight to avoid toxicity.
° Needle Phobia: May require adjunctive behavioral strategies or sedation.
➤ Complications
° Soft tissue injury (e.g., lip or cheek biting)
° Allergic reactions (rare)
° Systemic toxicity in case of overdose

📌 Recommended Article :

Video 🔽 DENTAL ANESTHESIA : Mandibular Block for Pediatric Patients - Dental Injection Technique ... Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient

✅ Conscious Sedation
Conscious sedation involves the administration of sedatives that allow the child to remain responsive while reducing anxiety and pain perception.

➤ Agents Used
° Nitrous Oxide: Common due to its rapid onset and minimal side effects.
° Midazolam: Offers anxiolysis and amnesia.
° Hydroxyzine, Diazepam, and Ketamine may also be used in specific cases.
➤ Routes of Administration
° Oral
° Intranasal
° Intravenous
° Inhalation (nitrous oxide)
➤ Indications
° Mild to moderate anxiety
° Need for cooperation during complex procedures
➤ Contraindications
° Respiratory infections or obstruction
° History of adverse reactions
° Inadequate fasting status (when systemic sedation is used)
➤ Complications
° Nausea, vomiting
° Respiratory depression (rare in minimal sedation)
° Paradoxical reactions such as agitation

📌 Recommended Article :

Video🔽 Considerations for Pediatric Local Anesthesia ... We share a video that teaches us to calculate the dose and the most used local anesthetic techniques in pediatric dentistry

✅ General Anesthesia
General anesthesia (GA) renders the child fully unconscious and is performed in a hospital or surgical setting.

➤ Indications
° Extensive dental needs
° Severe anxiety or phobia
° Special healthcare needs
° Failure of other behavior management methods
➤ Contraindications
° Acute systemic illness
° Inadequate preoperative assessment
° Airway abnormalities
➤ Complications
° Nausea and vomiting
° Respiratory complications
° Postoperative delirium
° Rare but serious events such as malignant hyperthermia

📌 Recommended Article :

PDF 🔽 Local Anesthetics Allergies in Children ... Allergic reactions can be serious (anaphylaxis), even putting the patient's life at risk, but they can also present dizziness, nausea, hives, itching, angioedema

✅ Clinical Decision-Making
The selection of pain control techniques depends on:

° Patient age and developmental level
° Medical history
° Dental procedure complexity
° Behavioral assessment
° Parental preferences and informed consent

The American Academy of Pediatric Dentistry (AAPD) recommends a graded approach, starting from the least invasive (behavioral techniques) and progressing to general anesthesia only when necessary.

📌 Recommended Article :

PDF 🔽 Painless anesthesia in pediatric dentistry - Application techniques and systems ... There are several factors that ensure effective anesthesia, such as knowledge of the anatomical structures, dosage, and administration of the anesthetic solution

✅ Legal and Ethical Considerations
Informed consent is vital, especially for sedation and general anesthesia. Documentation should include:

° Explanation of risks and benefits
° Alternatives offered
° Pre- and post-operative instructions
° Emergency preparedness

✅ Conclusion
Effective pain control in pediatric dentistry combines behavioral, pharmacological, and sometimes surgical approaches. Each technique has specific indications, contraindications, and risks that must be carefully considered. With evidence-based protocols and proper training, dental professionals can ensure safe and effective care for young patients, fostering lifelong positive attitudes toward oral health.

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry, 292–310. https://www.aapd.org
✔ Coté, C. J., Wilson, S., & Work Group on Sedation. (2019). Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: Update 2019. Pediatrics, 143(6), e20191000. https://doi.org/10.1542/peds.2019-1000
✔ Malamed, S. F. (2020). Handbook of local anesthesia (7th ed.). Elsevier Health Sciences.
✔ Wilson, S., & Houpt, M. (2016). Project USAP 2016: Use of sedative agents by pediatric dentists. Pediatric Dentistry, 38(2), 127–133. https://www.aapd.org/globalassets/media/publications/archives/wilson-38-2.pdf
✔ Lourenço-Matharu, L., Roberts, G. J., & Ashley, P. F. (2022). Safety of oral midazolam sedation for dental treatment in children: A systematic review. International Journal of Paediatric Dentistry, 32(1), 3–17. https://doi.org/10.1111/ipd.12872
✔ McCann, M. E., & Soriano, S. G. (2019). General anesthesia in pediatric dental procedures: Clinical guidelines. Anesthesia & Analgesia, 129(5), 1424–1430. https://doi.org/10.1213/ANE.0000000000004323

📌 More Recommended Items

► What is the appropriate dose of local anesthetics in pediatric dentistry?
► Allergic manifestations to local anaesthetic in pediatric dentistry: Prevention and management
► Pediatric Anesthesia in Oral and Maxillofacial Surgery

Severe Dental Infections: Symptoms, Treatment & Antibiotics

Severe acute dental infections are critical conditions that require immediate attention to prevent serious complications.

📌 Recommended Article :

PDF 🔽 Guideline on use of antibiotic therapy for pediatric dental patients ... These recommendations are intended to provide guidance in the proper and judicious use of antibiotic therapy in the treatment of oral conditions

Understanding the nature of dental infections, recognizing their signs and symptoms, identifying common types, and knowing the appropriate treatment protocols, including antibiotic usage and dosages for both adults and children, is essential for effective management

Advertisement

A. What Is a Dental Infection?
A dental infection, or odontogenic infection, originates within the teeth or surrounding supporting structures and can spread to adjacent tissues if not promptly addressed. These infections typically begin when bacteria infiltrate the dental pulp—the innermost part of the tooth containing nerves and blood vessels—leading to inflammation and the formation of an abscess. Common causes include untreated dental caries (cavities), periodontal disease, or trauma to the tooth.

B. Signs and Symptoms of Dental Infection
Recognizing the early signs and symptoms of a dental infection is crucial for timely intervention. Common indicators include:
° Pain: Persistent, throbbing toothache that may radiate to the jawbone, neck, or ear.
° Sensitivity: Discomfort when consuming hot or cold foods and beverages.
° Swelling: Inflammation in the face or cheek, indicating the spread of infection.
° Fever: Elevated body temperature as the body responds to the infection.
° Swollen Lymph Nodes: Tenderness in the lymph nodes under the jaw or in the neck.
° Difficulty Swallowing or Breathing: Severe cases may lead to swelling that impinges on the throat, necessitating immediate medical attention.
If any of these symptoms are present, it is imperative to seek prompt dental care to prevent the infection from spreading and causing more severe health issues.

📌 Recommended Article :

PDF 🔽 Antibiotics and its use in pediatric dentistry: A review ... Good knowledge about the indications of antibiotics is the need of the hour in prescribing antibiotics for dental conditions

C. Common Severe Acute Dental Infections
° Pericoronitis: This infection occurs around the crown of a partially erupted tooth, often a wisdom tooth. Symptoms include redness, swelling, and pain in the gums. If untreated, it can lead to severe complications like Ludwig's angina or sepsis.
° Acute Dentoalveolar Abscess: A localized collection of pus in the alveolar bone at the root apex of a tooth, typically resulting from untreated dental caries or trauma. Symptoms include intense pain, swelling, and tenderness. Treatment involves drainage of the abscess and addressing the source of infection.
° Cellulitis: A diffuse inflammation of the soft tissues that can spread rapidly, leading to swelling, redness, and severe pain. It may result from untreated dental abscesses and can progress to life-threatening conditions if not managed promptly.

D. Treatment of Dental Infections
The primary goal in treating dental infections is to eliminate the source of infection and prevent its spread. Treatment strategies include:
° Drainage of Abscess: Incision and drainage procedures are performed to release pus and reduce pressure. This can be achieved through root canal therapy or tooth extraction, depending on the severity and location of the infection.
° Antibiotic Therapy: Antibiotics are prescribed to control and eradicate bacterial infections, especially if there are signs of systemic involvement or if the infection is spreading. The choice of antibiotic depends on the severity of the infection, patient age, and any known allergies. It's crucial to follow local guidelines and consult with a healthcare professional for individualized treatment plans.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient

E. Commonly Used Antibiotics and Dosages
1. For Adults:
° Amoxicillin: 500 mg every 8 hours or 1,000 mg every 12 hours.
° Clindamycin: 300 mg or 600 mg every 8 hours.
° Metronidazole: 500–750 mg every 8 hours.
2. For Children:
° Amoxicillin:
1–11 months: 125 mg every 8 hours.
1–4 years: 250 mg every 8 hours.
5–11 years: 500 mg every 8 hours.
° Phenoxymethylpenicillin:
1–5 years: 125 mg every 6 hours.
6–11 years: 250 mg every 6 hours.
For severe infections, consider 12.5 mg/kg (max. 1 g) every 6 hours.
° Metronidazole:
1–2 years: 50 mg every 8 hours.
3–6 years: 100 mg every 12 hours.
7–9 years: 100 mg every 8 hours.
10–17 years: 200 mg every 8 hours.
For severe infections or children at extremes of body weight, consider 30 mg/kg (max. 1 g) every 8 hours.

📌 Recommended Article :

Video 🔽 How to Reduce a TMJ Dislocation? ... Dislocation of the temporomandibular joint is a painful condition that occurs when the mandibular condyle becomes fixed in the anterosuperior aspect of the articular eminence

Conclusions
Effective management of severe acute dental infections involves timely diagnosis, appropriate antibiotic therapy, and, when necessary, surgical intervention. Adhering to recommended antibiotic regimens and dosages is crucial to ensure efficacy and minimize the risk of resistance. Always consider patient-specific factors, such as age, weight, and allergy history, when selecting an antibiotic. Consultation with dental and medical professionals is essential for optimal patient outcomes.

You may also like :
► Correct use of analgesics and anti-inflammatories in pediatric dentistry - Indications and secondary effects
► Appropriate use of antibiotics in pediatric odontogenic infections
► What is Ludwig's Angina? What are the symptoms and treatment?

Management of Severe Acute Dental Infections

Severe acute dental infections are a critical concern in dentistry, as they can progress rapidly, causing systemic complications and posing a life-threatening risk if not managed promptly.

📌 Recommended Article :

Video 🔽 Management of antibiotics in odontogenic infections in pediatric dentistry ... Antibiotic treatment in pediatric dentistry should be carried out taking into account the pharmacodynamic characteristics of the pediatric patient

This article provides an overview of the etiology, clinical presentation, and management strategies for severe dental infections, emphasizing evidence-based approaches.

Advertisement

A. Etiology and Pathogenesis
Severe dental infections are often caused by bacterial invasion into the dental pulp or surrounding structures. Common sources include:
° Untreated dental caries: Progression into pulpitis and periapical abscess.
° Periodontal infections: Spread to adjacent tissues.
° Traumatic injuries: Leading to necrosis of the pulp.
° Post-surgical complications: Including infections after extractions or implant placement.
The most frequently implicated bacteria are anaerobic organisms such as Prevotella and Fusobacterium, often in polymicrobial infections.

📌 Recommended Article :

PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Medical-dental management considerations ... We share an article that details the clinical characteristics, pharmacological and multidisciplinary management of odontogenic facial cellulite in children

B. Clinical Presentation
Patients with severe dental infections typically present with:
° Localized swelling: Often associated with pain and erythema.
° Fever and malaise: Indicating systemic involvement.
° Trismus and dysphagia: In cases of space infections such as Ludwig’s angina.
° Fluctuant abscesses or purulent drainage.
In advanced cases, airway compromise may occur, necessitating emergency intervention.

C. Management Strategies
1. Early Diagnosis
Timely identification of infection severity is crucial. Clinical examination, imaging (e.g., periapical radiographs, CT scans), and laboratory tests (e.g., white blood cell count) help guide diagnosis.
2. Drainage and Debridement
The cornerstone of treatment is surgical drainage to evacuate pus and relieve pressure. This may involve:
° Incision and drainage (I&D) of abscesses.
° Endodontic therapy: For infections localized to the pulp.
° Tooth extraction: For non-restorable teeth.
3. Antibiotic Therapy
Antibiotics are essential when systemic involvement is evident. Empiric therapy targets anaerobes and includes:
° Amoxicillin-clavulanate.
° Clindamycin (for penicillin-allergic patients).
°Metronidazole, in combination with penicillin or other broad-spectrum antibiotics.
Antibiotics should be adjusted based on culture and sensitivity results if available.
4. Supportive Care
° Analgesics: Non-steroidal anti-inflammatory drugs (NSAIDs) for pain control.
° Hydration and nutrition: To prevent systemic deterioration.
° Hospitalization: In cases of airway compromise, systemic sepsis, or failure of outpatient management.
5. Referral to Specialists
Complex infections, such as those involving the deep cervical spaces or spreading to the mediastinum, require multidisciplinary management by oral and maxillofacial surgeons, otolaryngologists, or infectious disease specialists.

📌 Recommended Article :

PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Diagnosis, treatment and multidisciplinary management ... Facial cellulite spreads to other anatomical regions, aponeurotic plane and tissue spaces. Clinically, facial cellulite is of a soft consistency and with inflammatory signs

D. Prevention
Preventive strategies include regular dental check-ups, patient education on oral hygiene, and prompt treatment of early dental caries or periodontal disease.

E. Conclusion
Severe acute dental infections demand swift and comprehensive management to prevent serious complications. Clinicians should focus on early diagnosis, appropriate surgical intervention, effective antimicrobial therapy, and interdisciplinary care in complex cases.

References
1. Flynn, T. R. (2006). Oral and maxillofacial infections: Current therapy. Oral and Maxillofacial Surgery Clinics of North America, 18(4), 493-511.
2. Brook, I. (2011). *Microbiology and management of endodontic infections in children. Journal of Clinical Pediatric Dentistry, 36(2), 189-193.
3. Kuriyama, T., et al. (2000). *Factors affecting the clinical outcome of odontogenic infections. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 90(1), 95-100.

📌 More Recommended Items

► What is odontogenic infection? - Symptoms, diagnosis and treatment
► What is dental abscess? - Causes, diagnosis and treatment
► What is pericoronitis? Causes, symptoms and treatment

Oral cysts in newborns: Characteristics, diagnosis and treatment

Oral mucosal cysts in newborns are classified according to their origin and location. In the case of neonates, oral alterations are difficult to detect by the clinician.

📌 Recommended Article :

Video 🔽 Formation and development of the face and oral cavity (Orofacial Complex) ... The formation of the face starts from the five prominences (one frontonasal, two maxillary and two mandibular). The prominences develop giving rise to different regions of the face

Diagnosis and treatment is necessary to prevent alterations from intervening in normal functions such as complex sucking, swallowing and phonation.

Advertisement

We share a list of cases of oral cysts in newborns, detailing the characteristics, diagnosis and treatment.

📌 Recommended Article :

PDF 🔽 Guide for the surgical management and oral pathology of the pediatric patient ... Some of the pathologies that we can frequently find in children that need surgical procedures are: supernumerary and impacted teeth, congenital cysts, mucoceles

📌 Read and download the article in PDF 1 :

👉 "Gingival Cyst of Newborn" 👈
Gingival Cyst of Newborn. Aman Moda. 10.5005/jp-journals-10005-1087.

📌 Read and download the article in PDF 2 :

👉 "Exuberant Upper Gum Lesions in a Neonate" 👈
Exuberant Upper Gum Lesions in a Neonate. J Pediatr 2013;163:1521.. Vol. 163, No. 5

📌 Read and download the article in PDF 3 :

👉 "Dental lamina cyst in the newborn" 👈
Dental lamina cyst in the newborn. Deepak Sharma, Jaivinder Yadav, Eva Garg, Hanish Bajaj. Sri Lanka Journal of Child Health, 2015: 44(4): 236-237

📌 Read and download the article in PDF 4 :

👉 "Unusual symptomatic inclusion cysts in a newborn: a case report" 👈
Marini et al.: Unusual symptomatic inclusion cysts in a newborn: a case report. Journal of Medical Case Reports 2014 8:314.

📌 More Recommended Items

► How to treat anaphylaxis in children? - Clinical manifestations and treatment
► Hereditary Gingival Fibromatosis in a pediatric patient - Characteristics and treatment
► Ameloblastoma in a pediatric patient - Characteristics, treatment and clinical case

Malformations and anomalies of the branchial arches - Diagnosis and management

The branchial or pharyngeal arches are slits that are located on both sides of the embryo, and from them originate the muscles, bones, cartilage and nerves of the face, head and neck.

📌 Recommended Article :

Video 🔽 Formation and development of the face and oral cavity (Orofacial Complex) ... The formation of the face starts from the five prominences (one frontonasal, two maxillary and two mandibular). The prominences develop giving rise to different regions of the face

During the process of growth and development of tissues, alterations may occur that lead to sinuses, fistulas or cysts. The location of the alteration determines which branchial arch it belongs to.

Advertisement

Learn what the alterations and malformations of the branchial arches are, detailing the clinical management and treatment.

📌 Recommended Article :

PDF 🔽 Guide for the surgical management and oral pathology of the pediatric patient ... Some of the pathologies that we can frequently find in children that need surgical procedures are: supernumerary and impacted teeth, congenital cysts, mucoceles

📌 Read and download the article in PDF 1 :

👉 "First and second branchial arch syndromes: multimodality approach" 👈
Senggen E, Laswed T, Meuwly JY, Maestre LA, Jaques B, Meuli R, Gudinchet F. First and second branchial arch syndromes: multimodality approach. Pediatr Radiol. 2011 May;41(5):549-61. doi: 10.1007/s00247-010-1831-3. Epub 2010 Oct 6. PMID: 20924574.

📌 Read and download the article in PDF 2 :

👉 "Management of congenital third branchial arch anomalies: A systematic review" 👈
Nicoucar K, Giger R, Jaecklin T, Pope HG Jr, Dulguerov P. Management of congenital third branchial arch anomalies: a systematic review. Otolaryngol Head Neck Surg. 2010 Jan;142(1):21-28.e2. doi: 10.1016/j.otohns.2009.09.001. Epub 2009 Nov 25. PMID: 20096218.

📌 Read and download the article in PDF 3 :

👉 "Management of congenital fourth branchial arch anomalies: a review and analysis of published cases" 👈
Nicoucar K, Giger R, Pope HG Jr, Jaecklin T, Dulguerov P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg. 2009 Jul;44(7):1432-9. doi: 10.1016/j.jpedsurg.2008.12.001. PMID: 19573674.

📌 More Recommended Items

► How to treat anaphylaxis in children? - Clinical manifestations and treatment
► Hereditary Gingival Fibromatosis in a pediatric patient - Characteristics and treatment
► Ameloblastoma in a pediatric patient - Characteristics, treatment and clinical case

What is odontogenic infection? - Symptoms, diagnosis and treatment

Odontogenic infections are those that begin in the oral cavity, generally from dental caries, but also from periodontal pathology.

📌 Recommended Article :

PDF 🔽 Odontogenic infection in facial spaces - Pharmacological and surgical management in pediatric patients ... Infections that affect the head and neck are generally of odontogenic origin, and have a rapid evolution that put the patient's life at risk. Treatment must be immediate and in many cases multidisciplinary

Odontogenic infections can spread through the bone and affect structures far from the oral cavity such as the neck region. These infections can occur in both children and adults, and the dentist must be familiar with the management and treatment to avoid serious consequences.

Advertisement

Learn about the complications, diagnosis and symptoms of odontogenic infections and the most effective treatment.

📌 Recommended Article :

PDF 🔽 Ludwig's angina in a pediatric patient - Case report (diagnosis, symptoms and treatment) ... Ludwig's angina is a severe and life-threatening infectious process with rapid progression. It is common in adults but can occur in children with suppressed immunity

📌 Read and download the article in PDF :

👉 "Odontogenic Infection. Review of the Pathogenesis, Diagnosis, Complications and Treatment" 👈
Ortiz R, Espinoza V (2021) Odontogenic Infection. Review of the Pathogenesis, Diagnosis, Complications and Treatment. Res Rep Oral Maxillofac Surg 5:055. doi.org/10.23937/2643- 3907/1710055

📌 Watch video: "Management of Odontogenic Infections: 6 Effective Treatments"

Youtube/ World Of Dentistry

📌 More Recommended Items

► Antibiotics in dental infections in children. Which one to use?
► How to treat anaphylaxis in children? - Clinical manifestations and treatment
► Guideline on Pediatric Oral Surgery

Mucocele in Pediatric Dentistry: Clinical and pathological characteristics

Mucocele is a benign lesion that occurs in the oral mucosa and is the product of an alteration in the minor salivary glands. It is recognized as a swelling with mucous content, well circumscribed, and bluish in color.

📌 Recommended Article :

PDF 🔽 Marsupialization of a large mandibular cyst in a pediatric patient - Clinical Case ... Various techniques are used to surgically remove the mandibular cyst, enucleation when the cyst is small, or marsupialization when it is large

The presence of a mucocele may be due to trauma or ductal obstruction. The treatment is surgical and anesthesia is local, but depending on the behavior of the pediatric patient it can be performed with general anesthesia.

Advertisement

Let's know the clinical and pathological characteristics of salivary mucocele in children and adolescents.

📌 Recommended Article :

PDF 🔽 Surgical excision of mucocele with local anesthesia in an 8-month-old baby ... We share the case of the surgical removal of a mucocele in an 08-month-old baby under local anesthesia

📌 Read and download the article in PDF 1:

👉 "Salivary Mucoceles in Children and Adolescents: A Clinicopathological Study" 👈
Poulopoulos A, Andreadis D, Parcharidis E, Grivea I, Syrogiannopoulos G, et al. (2017) Salivary Mucoceles in Children and Adolescents: A Clinicopathological Study. Glob J Medical Clin Case Rep 4(1): 011-014. DOI: 10.17352/2455-5282.000035

📌 Read and download the article in PDF 2:

👉 "MUCOCELES OF MINOR SALIVARY GLANDS IN CHILDREN. OWN CLINICAL OBSERVATIONS" 👈
Lewandowski B, Brodowski R, Pakla P, Makara A, Stopyra W, Startek B. Mucoceles of minor salivary glands in children. Own clinical observations. Dev Period Med. 2016;20(3):235-242. PMID: 27941195.

📌 More Recommended Items

► Natal teeth and Riga Fede ulcer: Diagnosis and treatment
► Management of antibiotics in odontogenic infections in pediatric dentistry
► Guideline on Pediatric Oral Surgery

Appropriate use of antibiotics in pediatric odontogenic infections

Oral infections in pediatric patients can trigger a severe septic condition that can put the patient's life at risk. The appropriate use of antibiotics is effective in the treatment of oral infections of odontogenic origin.

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... Odontogenic infections can arise from caries or a periodontal problem, sometimes they can be due to dental trauma or iatrogenesis

Knowledge of antibiotic pharmacokinetics and pharmacodynamics prevents resistance and adverse drug reactions. In addition, we must take a correct anamnesis to avoid allergic processes.

Advertisement

We share updated information on the appropriate use of antibiotics in infectious processes of odontogenic origin in pediatric patients.

📌 Recommended Article :

PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Medical-dental management considerations ... The infant's immune system is diminished, so it is necessary to control and eliminate the causative agent

📌 Read and download the article in PDF:

👉 "Use of Antibiotic Therapy for Pediatric Dental Patients" 👈

American Academy of Pediatric Dentistry. Use of antibiotic therapy for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:537-41.

📌 More Recommended Items

► What is dental abscess? - Causes, diagnosis and treatment
► Facial swelling in a pediatric patient - Causes, clinical and radiological manifestations
► Ludwig's Angina. Presentation of a pediatric case

What is Ludwig's Angina? What are the symptoms and treatment?

Dental caries is a disease that affects children and adults, and its presence affects the dental structure. When this progress is not stopped, it can put the general health and life of the patient at risk.

📌 Recommended Article :

PDF 🔽 Management of acute orofacial infection of odontogenic origin in children - PDF Guide ... This infection can invade different neighboring anatomical spaces, compromising the general health of the pediatric patient

Ludwig's angina is a serious infectious process and its treatment is based on clinical, pharmacological and surgical management.

Advertisement

Learn what Ludwig's angina is, its etiology, the symptoms that we should take into account, and the effective treatment (pharmacological and surgical).

📌 Recommended Article :

Article PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Diagnosis, treatment and multidisciplinary management ... Facial cellulitis is an infectious process, usually odontogenic, that puts the life of the pediatric patient at serious risk if it does not have the appropriate treatment

📌 Read and download the article in PDF:

👉 "A Severe Case of Ludwig’s Angina with a Complicated Clinical Course" 👈

Kovalev V (April 16, 2020) A Severe Case of Ludwig’s Angina with a Complicated Clinical Course. Cureus 12(4): e7695. DOI 10.7759/cureus.7695

📌 Watch video: "Ludwig Angina: An Airway Emergency"

Youtube / Larry B. Mellick, MD

📌 More Recommended Items

► Odontogenic Infection in Pediatric Dentistry: Facial Cellulitis, Ludwig's Angina - Diagnosis, clinical and pharmacological management
► Antimicrobial therapies for odontogenic infections in children and adolescents
► Facial swelling in a pediatric patient - Causes, clinical and radiological manifestations

What is dental abscess? - Causes, diagnosis and treatment

The progression of caries destroys the tooth structure and compromises the pulp, spreading the infection to the alveolar bone. The infectious process causes excruciating pain and requires immediate treatment.

📌 Recommended Article :

Video - PDF 🔽 Dental abscess, facial cellulitis and Ludwig's Angina in a pediatric patient - Diagnosis and treatment ... We share a complete list of clinical cases, scientific articles, videos on the diagnosis, surgical and pharmacological treatment of odontogenic infections in pediatric patients

Tooth abscess presents several signs and symptoms, the main ones being: intense pain when chewing, swelling, accumulation of pus and general discomfort.

Advertisement

Learn about the definition, causes, diagnosis, symptoms, clinical and pharmacological management of dental abscess in children and adults.

📌 Recommended Article :

Article PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Medical-dental management considerations ... In the initial stages, cellulite is of a soft consistency, in advanced stages it is hardened. The infant's immune system is diminished, so it is necessary to control and eliminate the causative agent

📌 Read and download the article in PDF 1:

👉 "Management of Oral Parafunctional Habits: A Case Report" 👈

Compiled by the GOSH web team in collaboration with the Child and Family Information Group Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH www.gosh.nhs.uk

📌 Watch video 1 "Dental abscess - causes, symptoms, diagnosis, treatment, pathology"

Youtube/ Ósmosis

📌 Watch video 2 "What is an Abscessed Tooth & What To Do About It "

Youtube/ Ósmosis

📌 More Recommended Items

► How to manage dental infections? - Specific pharmacological treatment
► Antibiotics in dental infections in children. Which one to use?
► Dental pain in pediatric dentistry - Assessment tools

Post-extraction care for wisdom teeth - Tips and recommendations

When wisdom teeth do not have enough space to emerge properly it can cause inflammation, pain and infection. In these cases, the wisdom tooth (third molar) must be extracted.

📌 Recommended Article :

VIDEO 🔽 What is a dry socket? All you need to know ... Dry socket is the inflammation of the dental alveolus, and it happens after a post-extraction dental complication, it is very painful, and infrequent, but with the right treatment it disappears in a few days

The procedure is outpatient, and the patient must comply with the pre- and post-operative recommendations. These recommendations aim to avoid some complications such as hemorrhages and alveolitis.

Advertisement

Post-operative care is important, which is why we share some tips and recommendations to avoid complications after wisdom tooth extraction.

📌 Recommended Article :

VIDEO 🔽 Tooth Extraction: Post-Surgical Care and Tips ... The professional should talk with the patient about the care that he should have to avoid complications after the surgical procedure

📌 Watch video " Post-extraction care for wisdom teeth - Tips"

Youtube/ Medinaz

📌 More Recommended Items

► THIRD MOLARS: To extract or not to extract?
► How is an oral biopsy taken? - Step by step procedure
► Why is it recommended to extract a tooth to children?

How to manage dental infections? - Specific pharmacological treatment

Various types of infections (caries, gingivitis, periodontitis, etc.) can originate in the oral cavity, all of them of different severity. In some cases they can put the patient's life at risk and require hospital care.

📌 Recommended Article :

Video - PDF 🔽 Dental abscess, facial cellulitis and Ludwig's Angina in a pediatric patient - Diagnosis and treatment ... We share a complete list of clinical cases, scientific articles, videos on the diagnosis, surgical and pharmacological treatment of odontogenic infections in pediatric patients

The dentist must recognize the symptoms, the clinical and pharmacological management of odontogenic infections, in order to act immediately and thus avoid the aggravation of the conditions.

Advertisement

Let us know the causative agents of odontogenic infections and the clinical management and specific pharmacological treatment for each of them.

📌 Recommended Article :

Article PDF 🔽 Odontogenic facial cellulitis in a pediatric patient - Medical-dental management considerations ... In the initial stages, cellulite is of a soft consistency, in advanced stages it is hardened. The infant's immune system is diminished, so it is necessary to control and eliminate the causative agent

📌 Read and download the article in PDF:

👉 "How are odontogenic infections best managed?" 👈

J Can Dent Assoc 2010;76:a37

📌 Watch video "Oral Medicine | Pain & Infection Management"

Youtube/ Mental Dental

📌 More Recommended Items

► Ludwig's Angina. Presentation of a pediatric case
► Video: Dental Abscess in 3d
► Inferior alveolar nerve block Technique For Children - Tips and tricks

Manual of extraction techniques in pediatric dentistry - Step by step

Tooth extraction is a routine treatment in the pediatric dentist's office. This procedure is performed when the tooth presents a deep caries and impossible reconstruction, fracture due to trauma, eruptive problems.

📌 Recommended Article :

Article PDF 🔽 Manual of Local Anesthesia - Anesthetic techniques and anatomical references ... The professional must know the appropriate administration technique for the dental procedure, the anatomical references, and the recommended dose for the patient

The characteristics of the primary teeth and the presence of the germs of the permanent teeth must be taken into account when performing a dental extraction.

Advertisement

We share an article that shows us the anatomical considerations and the appropriate surgical technique when extracting teeth in pediatric patients.

📌 Recommended Article :

Article PDF 🔽 Guide for the surgical management and oral pathology of the pediatric patient ... Some of the pathologies that we can frequently find in children that need surgical procedures are: supernumerary and impacted teeth, congenital cysts, mucoceles

📌 Read and download the article in PDF : Extraction of Primary Dentition From Handbook of Clinical Techniques in Pediatric Dentistry



Chapter 8: Extraction of Primary Dentition From Handbook of Clinical Techniques in Pediatric Dentistry. Edited by Jane A. Soxman

📌 More Recommended Items

► Webinar - Minor Oral Surgery in Pediatric Dentistry
► Ankyloglossia in infants - Diagnosis and surgical protocol
► Guideline on Pediatric Oral Surgery

What is frenectomy? Step by step surgical procedure

In the oral cavity we can find two types of frenulum: the lingual and the labial. The alterations of the braces can cause aesthetic and phonetic problems. Treatment is sometimes multidisciplinary: pediatric dentist and speech therapist.

📌 Recommended Article :

Article PDF 🔽 Oral Surgery: Use of laser in lingual frenectomy in pediatric patients ... We share an interesting clinical case of a 7-year-old girl referred by the orthodontist for a lingual frenectomy

The frenectomy is performed under local anesthesia and has a short postoperative period without major complications. This surgical procedure can be performed on pediatric and adult patients.

Advertisement

We share complete information about frenectomy, effectiveness and the step-by-step procedure regarding a clinical case. In addition to the case of a laser frenectomy in pediatric patients.

📌 Watch video "What is a Frenectomy?"

Youtube/ Joseph R Nemeth DDS

📌 Read and download the article in PDF 1:

👉 "Surgical techniques for the treatment of ankyloglossia in children: a case series" 👈

Junqueira MA, Cunha NN, Costa e Silva LL, Araújo LB, Moretti AB, Couto Filho CE, Sakai VT. Surgical techniques for the treatment of ankyloglossia in children: a case series. J Appl Oral Sci. 2014 Jun;22(3):241-8. doi: 10.1590/1678-775720130629. PMID: 25025566; PMCID: PMC4072276.

📌 Read and download the article in PDF 2:

👉 "Frenectomy for the Correction of Ankyloglossia: A Review of Clinical Effectiveness and Guidelines" 👈

Frenectomy for the Correction of Ankyloglossia: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Jun 15. PMID: 27403491.

📌 Read and download the article in PDF 3:

👉 "Treatment of ankyloglossia with dental laser in paediatric patients: Scoping review and a case report" 👈

Garrocho-Rangel A, Herrera-Badillo D, Pérez-Alfaro I, Fierro-Serna V, Pozos-Guillén A. Treatment of ankyloglossia with dental laser in paediatric patients: Scoping review and a case report. Eur J Paediatr Dent. 2019 Jun;20(2):155-163. doi: 10.23804/ejpd.2019.20.02.15. PMID: 31246095.

📌 More Recommended Items

► Benefits of Tongue Tie Surgery
► Ankyloglossia in infants - Diagnosis and surgical protocol
► Guideline on Pediatric Oral Surgery