An overview of
infection as it applies to the oral and maxillofacial region has been provided. The following conclusions are drawn: odontogenic
infections are caused by microbes found in the host's oral flora; cultures of purulent material generally will yield three to six anaerobes and one aerobe, (the aerobe is usually a Streptococcus species); Gram stains of purulent material can aid in therapeutic strategies; anaerobic as well as aerobic cultures are necessary to isolate all pathogens; pathogens found in
infections of
bite wounds reflect the oral flora of the aggressor; early
postoperative wound infections are caused by the host's own flora, whereas later
infections may be caused by hospital-acquired bacteria; and
hepatitis B and herpes simplex virus are occupational hazards. Recommendations have been made for antimicrobial prophylaxis and for treatment. We recognize that some of these selections may be controversial. For instance, the value of prophylactic
antibiotics in
orthognathic surgery is not well defined; recommendations were made only in certain instances. However, in severe penetrating
maxillofacial injuries with devitalized tissue, recommendations for
antibiotics were for broad and prolonged coverage. In this instance, use of
antibiotics is considered therapeutic and not prophylactic. In each instance, we tried to validate the selection. Our rationale has been to choose the
antibiotics most active against the likely pathogens; additionally, consideration was given to
drug toxicity and adverse reactions. We regard
penicillin as the preferred agent for prophylaxis and treatment of most odontogenic
infections. Alternative drugs include
cephalosporins,
doxycycline, and
clindamycin. Erythoromycin and
tetracycline are considered less effective than the former agents. Finally, we believe that successful treatment of
infection depends as much on changing the microenvironment of the infected tissue by
debridement and drainage as on appropriate antimicrobial
therapy.