What are the emergency department (ED) precautions for a patient with gingival infection?

Emergency Department Precautions for Gingival Infection

Standard infection control precautions must be implemented for all patients with gingival infections to prevent disease transmission and ensure proper management of potentially serious oral infections.

Initial Assessment and Airway Management

• Assess airway, breathing, and circulation as the first priority, as maxillofacial infections can lead to airway compromise due to soft-tissue edema 1
• Evaluate for signs of respiratory distress including dyspnea, stridor, or desaturation which would indicate urgent airway intervention 1
• Secure the airway immediately if there is any concern for compromise 1

Personal Protective Equipment (PPE)

• Wear gloves for all patient interactions and procedures 2
• Use additional PPE (protective eyewear, mask, and gown) when spattering of blood or other body fluids is likely 2
• Use sterile surgeon's gloves when performing oral surgical procedures 2

Infection Control Measures

• Perform surgical hand antisepsis using an antimicrobial product before donning sterile gloves for surgical procedures 2
• Use sterile saline or sterile water as a coolant/irrigant when performing oral surgical procedures 2
• Use devices specifically designed for delivering sterile irrigating fluids (e.g., bulb syringe, single-use disposable products) 2
• Do not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids 2

Specimen Handling

• Place biopsy specimens in a sturdy, leakproof container labeled with the biohazard symbol during transport 2
• If a specimen container is visibly contaminated, clean and disinfect the outside or place it in an impervious bag labeled with the biohazard symbol 2

Medication Administration

• Do not administer medication from a syringe to multiple patients, even if the needle is changed 2
• Use single-dose vials for parenteral medications when possible 2
• Cleanse the access diaphragm with 70% alcohol before inserting a device into multidose vials 2
• Keep multidose vials away from the immediate patient treatment area to prevent contamination by spray or spatter 2

Disposition Decision-Making

• Consider hospital admission for patients with 1:
  • Spreading infection
  • Signs of systemic toxicity
  • Inability to maintain oral hydration

Follow-up Care Instructions

• Instruct patients on warning signs that should prompt immediate return to the ED, including increasing swelling or difficulty breathing/swallowing 1
• Recommend warm saline rinses to promote drainage and reduce inflammation 1
• Advise patients to avoid painful stimuli including smoking, alcohol, and spicy or hot foods 1
• Consider alcohol-free antimicrobial mouth rinses such as 0.2% chlorhexidine to reduce bacterial load 1

Common Pitfalls to Avoid

• Failure to recognize potential airway compromise is the most dangerous pitfall in managing dental facial swellings 1
• Inadequate infection control practices can lead to cross-contamination between patients 2
• Underestimating the severity of gingival infections can lead to delayed treatment of potentially life-threatening conditions 1