Oral Infection,Is it dangerous?

Aside from periodontal disease such as gingivitis, infections of the oral cavity most commonly involve HSV or Candida species. In addition to causing painful cold sores on the lips, HSV can infect the tongue and buccal mucosa, causing the formation of irritating vesicles. Although topical antiviral agents (such as acyclovir or penciclovir) can be used externally for cold sores, oral or intravenous acyclovir is often needed for primary infections, extensive oral infections, and infections in immunocompromised patients. Oropharyngeal candidiasis (thrush) is caused by a variety of Candida species, most often C. albicans. Thrush occurs predominantly in neonates, immunocompromised patients (especially those with AIDS), and patients who have received prolonged antibiotic or glucocorticoid therapy. In addition to sore throat, patients often complain of a burning tongue, and physical examination reveals friable white or gray plaques on the gingiva, tongue, and oral mucosa. Treatment usually consists of an oral antifungal suspension (nystatin or clotrimazole) or oral fluconazole. In the cases of fluconazole-refractory thrush seen occasionally in patients with AIDS, the limited therapeutic options include oral suspensions of either itraconazole or amphotericin B.

Vincent’s angina, also known as acute necrotizing ulcerative gingivitis or trench mouth, is a unique and dramatic form of gingivitis characterized by painful, inflamed gingiva with ulcerations of the interdental papillae that bleed easily. Since oral anaerobes are the cause, patients typically have halitosis and frequently present with fever, malaise, and lymphadenopathy. Treatment consists of debridement and oral administration of penicillin plus metronidazole, with clindamycin alone as an alternative.

Ludwig’s angina is a rapidly progressive, potentially fulminant cellulitis involving the sublingual and submandibular spaces that typically originates from an infected or recently extracted tooth, most commonly the lower second and third molars. Improved dental care has substantially reduced the incidence of this disorder. Infection in these areas leads to dysphagia, odynophagia, and “woody” edema in the sublingual region, forcing the tongue up and back with the potential for airway obstruction. Fever, dysarthria, and drooling may also be noted, and patients may speak in a “hot potato” voice. Intubation or tracheostomy may be necessary to secure the airway, as asphyxiation is the most common cause of death. Patients should be monitored closely and treated promptly with intravenous antibiotics directed against streptococci and oral anaerobes. Recommended agents include ampicillin/sulbactam and high-dose penicillin plus metronidazole.

Postanginal septicemia (Lemierre’s disease) is a rare anaerobic oropharyngeal infection caused predominantly by Fusobacterium necrophorum. The illness typically starts as a sore throat (most commonly in adolescents and young adults), which may present as exudative tonsillitis or peritonsillar abscess. Infection of the deep pharyngeal tissue allows organisms to drain into the lateral pharyngeal space, which contains the carotid artery and internal jugular vein. Septic thrombophlebitis of the internal jugular vein can result, with associated pain, dysphagia, and neck swelling and stiffness. Sepsis usually occurs 3 to 10 days after the onset of sore throat and is often coupled with metastatic infection to the lung and other distant sites. Occasionally, the infection can extend along the carotid sheath and into the posterior mediastinum, resulting in mediastinitis, or it can erode into the carotid artery, with the early sign of repeated small bleeds into the mouth. The mortality rate from these invasive infections can be as high as 50%. Treatment consists of intravenous antibiotics (penicillin G or clindamycin) and surgical drainage of any purulent collections. The concomitant use of anticoagulants to prevent embolization remains controversial but is often advised

Source: Harrison_s_Principles_of_Internal_Medicine_16th_Edition