Issue

Vol. 2 No. 2 (2025)

Date Log

Submitted
December 3, 2025
Published
December 3, 2025

Copyright (c) 2025 Yahya Ahmed Mohammed Baroot, Wardah Abdullah Mohammed Alotaibi, Athari Abeed Moadi Alotibi, Asma Mohammed Eisa Zalah, Omar Ahmed Darraj, Mohammad Nasser Hamdan Al Aftan, Hamdan Nasser Hamdan Alotaibi, Ibrahim Ahmed Abdo Khabrani, Hind Abdullah Al-Matroodi, Talal Mohammad Alotaiby, Ibrahim Mohammed As'ad, Hashemih Ali Mohammed Fattahi, Mohammad Soliman Jaber Alfaifi, Hassan Yazeed Yahya Ghazwani, Kholoud Omar Gramish, Kawther Mohsen Rizq Alkathere, Abdulrahman Abdullah Alamri

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Odontogenic Orofacial Infections in Pediatrics: Pathogenesis, Diagnostic Challenges, and Advanced Interdisciplinary Management in Clinical Practice

https://doi.org/10.64483/202522298
Yahya Ahmed Mohammed Baroot
Irada Hospital and Mental Health, Jazan, Ministry of Health, Saudi Arabia
Wardah Abdullah Mohammed Alotaibi
Rafaya Al-Jimsh Hospital, Ministry of Health , Saudi Arabia
Athari Abeed Moadi Alotibi
Rafaya Al-Jimsh Hospital, Ministry of Health , Saudi Arabia
Asma Mohammed Eisa Zalah
Jazan Specialized Hospital, Ministry of Health , Saudi Arabia
Omar Ahmed Darraj
Al-Mujsas Primary Health Care Center (PHC), Ministry of Health , Saudi Arabia
Mohammad Nasser Hamdan Al Aftan
Dawadmi General Hospital, Riyadh Third Health Cluster,Ministry of Health , Saudi Arabia
Hamdan Nasser Hamdan Alotaibi
Dawadmi General Hospital, Riyadh Third Health Cluster,Ministry of Health , Saudi Arabia
Ibrahim Ahmed Abdo Khabrani
Erada Mental Health Hospital, Jazan Health Complex, Ministry of Health , Saudi Arabia
Hind Abdullah Al-Matroodi
Alyamamah Hospital, Riyadh, Ministry of Health , Saudi Arabia
Talal Mohammad Alotaiby
King Abdulaziz Hospital, Jeddah, Ministry of Health , Saudi Arabia
Ibrahim Mohammed As'ad
Eastern Health Sector, Faifa, Jizan, Ministry of Health , Saudi Arabia
Hashemih Ali Mohammed Fattahi
Al-Eidabi Clinic / Al-Aidabi Health Care Center, Jazan, Ministry of Health , Saudi Arabia
Mohammad Soliman Jaber Alfaifi
Al Gowa Health Center, Jazan – Faif, Ministry of Health , Saudi Arabia
Hassan Yazeed Yahya Ghazwani
Eastern Health Sector, Faifa, Jizan, Ministry of Health , Saudi Arabia
Kholoud Omar Gramish
Al-Aidabi Health Center, Jazan, Ministry of Health , Saudi Arabia
Kawther Mohsen Rizq Alkathere
Al-Dowaimah Primary Health Care Center (PHCC), Ministry of Health , Saudi Arabia
Abdulrahman Abdullah Alamri
Ministry of health, Riyadh, Saudi Arabia

Corresponding Author(s) : Yahya Ahmed Mohammed Baroot

ybaroot@moh.gov.sa

Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)

Abstract

Background: Odontogenic orofacial infections in children are common, potentially serious conditions originating from dental caries, pulpal disease, or periodontal pathology. Historically linked to high mortality, they remain a frequent reason for emergency department visits. Pediatric patients, often first seen by non-dental clinicians, present unique diagnostic and management challenges.


Aim: This article provides a comprehensive review of the pathogenesis, clinical presentation, and evidence-based management of pediatric odontogenic infections, emphasizing an interdisciplinary approach for optimal outcomes.


Methods: A detailed narrative review synthesizes current literature on the microbial etiology, pathophysiological spread, and risk factors for severe infection. It evaluates diagnostic strategies, including clinical examination and imaging (e.g., panoramic radiograph, CT scan), and analyzes therapeutic protocols from major dental and medical guidelines.


Results: The pathophysiology involves polymicrobial flora spreading from necrotic pulp or periodontal pockets along fascial planes, risking deep neck space infections like Ludwig’s angina. High-risk groups include children with diabetes, immunosuppression, or poor access to dental care. Diagnosis hinges on recognizing “red flag” symptoms (trismus, dysphagia, airway compromise). Management prioritizes definitive source control via drainage, endodontic therapy, or extraction. Antibiotics (e.g., amoxicillin) are adjunctive for systemic signs, not a substitute for dental intervention. Analgesia favors NSAID/acetaminophen combinations over opioids.


Conclusion: Successful management requires early recognition, accurate risk stratification, and prompt referral to dental specialists. A coordinated, interprofessional team approach is essential to prevent life-threatening complications and ensure effective treatment.

Keywords

Odontogenic infection, pediatric dentistry, deep neck space infection, dental abscess, antimicrobial stewardship, interdisciplinary management.
Baroot, Y. A. M., Wardah Abdullah Mohammed Alotaibi, Athari Abeed Moadi Alotibi, Asma Mohammed Eisa Zalah, Omar Ahmed Darraj, Mohammad Nasser Hamdan Al Aftan, … Abdulrahman Abdullah Alamri. (2025). Odontogenic Orofacial Infections in Pediatrics: Pathogenesis, Diagnostic Challenges, and Advanced Interdisciplinary Management in Clinical Practice. Saudi Journal of Medicine and Public Health, 2(2), 1480–1496. https://doi.org/10.64483/202522298
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. Robertson D, Smith AJ. The microbiology of the acute dental abscess. Journal of medical microbiology. 2009 Feb:58(Pt 2):155-162. doi: 10.1099/jmm.0.003517-0.
  2. Thomas TT. III. Ludwig's Angina (Part II): An Anatomical, Clinical and Statistical Study. Annals of surgery. 1908 Mar:47(3):335-73
  3. Vytla S, Gebauer D. Clinical guideline for the management of odontogenic infections in the tertiary setting. Australian dental journal. 2017 Dec:62(4):464-470. doi: 10.1111/adj.12538.
  4. Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nature reviews. Disease primers. 2017 May 25:3():17030. doi: 10.1038/nrdp.2017.30.
  5. Nguyen DH, Martin JT. Common dental infections in the primary care setting. American family physician. 2008 Mar 15:77(6):797-802
  6. Ricucci D, Loghin S, Siqueira JF Jr. Correlation between clinical and histologic pulp diagnoses. Journal of endodontics. 2014 Dec:40(12):1932-9. doi: 10.1016/j.joen.2014.08.010.
  7. Agnihotry A, Fedorowicz Z, van Zuuren EJ, Farman AG, Al-Langawi JH. Antibiotic use for irreversible pulpitis. The Cochrane database of systematic reviews. 2016 Feb 17:2():CD004969. doi: 10.1002/14651858.CD004969.pub4.
  8. Nagle D, Reader A, Beck M, Weaver J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2000 Nov:90(5):636-40
  9. Siqueira JF Jr, Rôças IN. Microbiology and treatment of acute apical abscesses. Clinical microbiology reviews. 2013 Apr:26(2):255-73. doi: 10.1128/CMR.00082-12.
  10. Candamourty R, Venkatachalam S, Babu MR, Kumar GS. Ludwig's Angina - An emergency: A case report with literature review. Journal of natural science, biology, and medicine. 2012 Jul:3(2):206-8. doi: 10.4103/0976-9668.101932.
  11. Bascones Martínez A, Aguirre Urízar JM, Bermejo Fenoll A, Blanco Carrión A, Gay-Escoda C, González-Moles MA, Gutiérrez Pérez JL, Jiménez Soriano Y, Liébana Ureña J, López Marcos JF, Maestre Vera JR, Perea Pérez EJ, Prieto Prieto J, de Vicente Rodríguez JC. Consensus statement on antimicrobial treatment of odontogenic bacterial infections. Medicina oral, patologia oral y cirugia bucal. 2004 Nov-Dec:9(5):369-76; 363-9
  12. Bartold PM. Lifestyle and periodontitis: The emergence of personalized periodontics. Periodontology 2000. 2018 Oct:78(1):7-11. doi: 10.1111/prd.12237.
  13. Yekani M, Dastgir M, Fattahi S, Shahi S, Maleki Dizaj S, Memar MY. Microbiological and molecular aspects of periodontitis pathogenesis: an infection-induced inflammatory condition. Frontiers in cellular and infection microbiology. 2025:15():1533658. doi: 10.3389/fcimb.2025.1533658.
  14. Boykin MJ, Gilbert GH, Tilashalski KR, Shelton BJ. Incidence of endodontic treatment: a 48-month prospective study. Journal of endodontics. 2003 Dec:29(12):806-9
  15. Wang J, Ahani A, Pogrel MA. A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital. International journal of oral and maxillofacial surgery. 2005 Sep:34(6):646-9
  16. Dye BA, Li X, Beltran-Aguilar ED. Selected oral health indicators in the United States, 2005-2008. NCHS data brief. 2012 May:(96):1-8
  17. Beltrán-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin SO, Hyman J, Jaramillo F, Kingman A, Nowjack-Raymer R, Selwitz RH, Wu T, Centers for Disease Control and Prevention (CDC). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002). 2005 Aug 26:54(3):1-43
  18. Rahimi-Nedjat RK, Sagheb K, Sagheb K, Hormes M, Walter C, Al-Nawas B. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clinical oral investigations. 2021 Nov:25(11):6279-6285. doi: 10.1007/s00784-021-03926-4.
  19. Saleh W, Xue W, Katz J. Diabetes Mellitus and Periapical Abscess: A Cross-sectional Study. Journal of endodontics. 2020 Nov:46(11):1605-1609. doi: 10.1016/j.joen.2020.08.015.
  20. Rotstein I, Katz J. Association of periodontal disease and the prevalence of acute periapical abscesses. Journal of the American Dental Association (1939). 2025 Mar:156(3):234-238. doi: 10.1016/j.adaj.2024.12.010.
  21. Katz J, Rotstein I. Acute periapical abscesses and obese patients. American journal of dentistry. 2024 Aug:37(4):197-200
  22. Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002 May 1:34(9):1215-23
  23. Cope AL, Chestnutt IG. The implications of a cost-of-living crisis for oral health and dental care. British dental journal. 2023 Apr:234(7):501-504. doi: 10.1038/s41415-023-5685-0.
  24. Steele J, Shen J, Tsakos G, Fuller E, Morris S, Watt R, Guarnizo-Herreño C, Wildman J. The Interplay between socioeconomic inequalities and clinical oral health. Journal of dental research. 2015 Jan:94(1):19-26. doi: 10.1177/0022034514553978.
  25. Kailembo A, Quiñonez C, Lopez Mitnik GV, Weintraub JA, Stewart Williams J, Preet R, Iafolla T, Dye BA. Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011-2014. BMC oral health. 2018 Aug 23:18(1):147. doi: 10.1186/s12903-018-0613-4.
  26. Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annual review of public health. 2020 Apr 2:41():513-535. doi: 10.1146/annurev-publhealth-040119-094318.
  27. Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. British dental journal. 2020 Sep:229(6):363-370. doi: 10.1038/s41415-020-2114-5.
  28. James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. The Cochrane database of systematic reviews. 2017 Mar 31:3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2.
  29. Bosshardt DD. The periodontal pocket: pathogenesis, histopathology and consequences. Periodontology 2000. 2018 Feb:76(1):43-50. doi: 10.1111/prd.12153.
  30. Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. Journal of periodontology. 2018 Jun:89 Suppl 1():S46-S73. doi: 10.1002/JPER.17-0576.
  31. Mardini S, Gohel A. Imaging of Odontogenic Infections. Radiologic clinics of North America. 2018 Jan:56(1):31-44. doi: 10.1016/j.rcl.2017.08.003.
  32. Beech N, Goh R, Lynham A. Management of dental infections by medical practitioners. Australian family physician. 2014 May:43(5):289-91
  33. Miah MR, Ali AS. Ludwig's angina. British dental journal. 2020 Sep:229(5):268. doi: 10.1038/s41415-020-2132-3.
  34. Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. Journal of the American Dental Association (1939). 2019 Nov:150(11):906-921.e12. doi: 10.1016/j.adaj.2019.08.020.
  35. Zirk M, Buller J, Goeddertz P, Rothamel D, Dreiseidler T, Zöller JE, Kreppel M. Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2016 Aug:44(8):1081-8. doi: 10.1016/j.jcms.2016.05.019.
  36. Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. International endodontic journal. 2017 Dec:50(12):1169-1184. doi: 10.1111/iej.12741.
  37. Carrasco-Labra A, Polk DE, Urquhart O, Aghaloo T, Claytor JW Jr, Dhar V, Dionne RA, Espinoza L, Gordon SM, Hersh EV, Law AS, Li BS, Schwartz PJ, Suda KJ, Turturro MA, Wright ML, Dawson T, Miroshnychenko A, Pahlke S, Pilcher L, Shirey M, Tampi M, Moore PA. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. Journal of the American Dental Association (1939). 2024 Feb:155(2):102-117.e9. doi: 10.1016/j.adaj.2023.10.009.
  38. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2022 Nov 4:71(3):1-95. doi: 10.15585/mmwr.rr7103a1.
  39. Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. Journal of the American Dental Association (1939). 2018 Apr:149(4):256-265.e3. doi: 10.1016/j.adaj.2018.02.012.
  40. da Silva PB, Mendes AT, Cardoso MBF, da Rosa RA, do Nascimento AL, Pereira JR, Só MVR. Comparison between isolated and associated with codeine acetaminophen in pain control of acute apical abscess: a randomized clinical trial. Clinical oral investigations. 2021 Mar:25(3):875-882. doi: 10.1007/s00784-020-03374-6.
  41. Almuqamam M, Gonzalez FJ, Sharma S, Kondamudi NP. Deep Neck Infections. StatPearls. 2025
  42. Sanders JL, Houck RC. Dental Abscess. StatPearls. 2025 Jan
  43. Yeo GS, Kim HY, Kwak EJ, Jung YS, Park HS, Jung HD. Cavernous sinus thrombosis caused by a dental infection: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2014 Aug:40(4):195-8. doi: 10.5125/jkaoms.2014.40.4.195.
  44. Cariati P, Cabello-Serrano A, Monsalve-Iglesias F, Roman-Ramos M, Garcia-Medina B. Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction. Journal of clinical and experimental dentistry. 2016 Oct:8(4):e469-e472
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 690 Download : 550