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Oral and maxillofacial surgeons treat severe infections of the head and neck that have spread from the teeth to the surrounding tissue. Such infections have a few common causes:
- The tooth's pulp has become infected and the infection has spread to the bone or soft tissue.
- A partially impacted wisdom tooth (one that has emerged only partially through the gum) allows bacteria to accumulate under the flap of gum covering the tooth and the bacteria spread deeper under the tissue.
- An infection sets in after a tooth is extracted and spreads to surrounding tissue.
- Periodontal (gum) infections may spread to adjacent tissue.
Oral and maxillofacial surgeons also treat infections of the salivary glands and sinuses and infections caused by trauma.
Symptoms of an infection include pain, swelling, difficulty opening the mouth, local redness and fever. If you experience any of these symptoms, contact your dentist. If you have a local infection, your dentist can often treat it without referring you to an oral and maxillofacial surgeon. An oral and maxillofacial surgeon is necessary if the infection has spread, if swelling is extensive or if the person appears ill from the infection.
The goal of treatment is to remove the source of the infection. This is usually done by removing the infected tooth and, in some cases, making an incision to drain the pus. While many infections remain localized, some spread quickly throughout the face and jaw, making it difficult to open your mouth, swallow and control your saliva. Some infections can cause your throat to swell and make it difficult to breathe. If that happens, you will be hospitalized so the infection can be treated appropriately and to ensure that your airway remains clear. Your treatment in the hospital may include having fluids and antibiotics intravenously, having the source of the infection removed, and having surgery to open the abscess so it can drain. People with severe infections that make breathing difficult usually will have a tube inserted through the mouth or nose and into the windpipe. These people are also treated in the intensive care unit until the swelling subsides.
To drain the abscess, the oral surgeon makes a small incision in the mouth or under the jaw, depending on where the swelling occurs. The surgeon inserts a small tube to allow for drainage and sutures the tube to the opening. A sterile gauze dressing is placed over the tube. The dressing must be changed frequently according to your oral surgeon's instructions.
If this procedure is done in an outpatient setting, you will return daily to your oral surgeon to have the incision cleaned and the drainage checked. Once the drainage is complete — usually after one to three days — the tube is removed. The incision is not stitched, but it should heal cleanly.
A sample of the pus may be sent to a laboratory, which will determine the type of bacteria causing the infection. You will be given antibiotics — orally or intravenously — to fight the infection.
After the incision and drainage procedure, you will notice that your fever (if you had one) has receded. It may be easier to open and close your mouth now as well. The swelling will take one or two days to disappear and you will still feel some pain, from the infection and the surgery, but your oral surgeon should prescribe pain medication.
A salivary gland usually becomes infected when the ducts that drain the gland becomes obstructed by a salivary stone. These infections are treated by removing the stone. Occasionally, the stone cannot be removed and the gland needs to be removed. If this happens, the person will be treated with antibiotics and the surgery will be done after the infection subsides.
©2002-2005 Aetna, Inc. All rights reserved.
Reviewed by the faculty of Columbia University College of Dental Medicine
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