From the Guidelines
Oral surgery or dental consultation is indicated for sialadenitis or mandibular infections that are severe, persistent, or complicated, and immediate referral is necessary for patients with signs of severe infection or complications, as recommended by recent guidelines 1. The indications for oral surgery or dental consultation in cases of sialadenitis or mandibular infection include severe, persistent, or complicated infections, with immediate referral necessary for patients presenting with facial cellulitis, trismus, difficulty swallowing, airway compromise, fever above 101°F, or infections spreading to deep facial spaces.
- Patients who fail to respond to initial antibiotic therapy within 48-72 hours should be referred, as should those with recurrent sialadenitis episodes or suspected sialoliths (salivary stones) 1.
- For initial management before referral, empiric antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days or clindamycin 300-450 mg four times daily for penicillin-allergic patients are recommended, along with warm compresses, hydration, sialagogues, and NSAIDs for pain control 1.
- Surgical interventions may include incision and drainage of abscesses, sialolithotomy for stone removal, or in severe recurrent cases, sialadenectomy (gland removal), with the goal of eliminating pain, controlling infection, and minimizing the progression of bone necrosis 1. The importance of early referral to a dental specialist is emphasized, particularly for patients at increased risk of medication-related osteonecrosis of the jaw (MRONJ), to confirm or rule out suspected MRONJ and to ensure close follow-up and communication among the dental specialist, community dentist, and medical oncologist 1.
From the Research
Indications for Oral Surgery/Dental Consult in Sialadenitis or Mandibular Infection
- The management of sialadenitis involves a combination of medical and surgical interventions, with oral surgery or dental consult being crucial in certain cases 2.
- Indications for oral surgery or dental consult include suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue, which require urgent referral to head and neck surgery or a visit to the emergency department 2.
- In cases of chronic submandibular sialolithiasis, an extraoral surgical approach may be necessary, which involves the removal of the submandibular gland through an extraoral route 3.
- The decision to perform oral surgery or dental consult should be based on the severity of the infection, the presence of complications, and the patient's overall health status 4, 5.
- Red flags such as severe pain, swelling, fever, and trismus (lockjaw) should prompt immediate referral to an oral surgeon or dentist for further evaluation and management 2.
- The use of antibiotics, such as amoxicillin/clavulanic acid, may be necessary in the management of odontogenic infections, and oral surgery or dental consult may be required to drain the infection or remove the source of the infection 4.