Theme notesDiagnosis & infection
Theme notesDiagnosis & infection
Diagnosis, imaging & infection
Describe the problem before labeling it. Choose the next investigation because it can change care, and separate localized dental disease from a spreading infection.
Remember
Describe → differentiate → investigate → act → review.
Key points
Describe location, size, appearance, symptoms, duration, and change. Give a focused differential and a defined review or referral plan.
Oral pathology (PDF opens in a new tab)Radiographs follow the history, examination, caries risk, dentition, and diagnostic question. Age or insurance alone is not an indication; review existing images first.
Radiographs (PDF opens in a new tab)Antibiotics are adjuncts when indicated. In an otherwise appropriate patient, localized pulpal infection without systemic signs needs dental source treatment, not a routine antibiotic prescription.
Antibiotics (PDF opens in a new tab)Prophylaxis is not treatment (2026): endocarditis prophylaxis is for the highest-risk cardiac conditions before procedures that manipulate gingiva or the periapical region. Amoxicillin is first choice, one dose 30–60 minutes before; clindamycin is no longer recommended, and neither is routine prophylaxis for prosthetic joints.
Antibiotic prophylaxis (PDF opens in a new tab)Answer aloud
How should you decide whether to observe an oral lesion or obtain a biopsy?
- Observe: A likely self-limited lesion can be observed with a review date.
- Investigate persistence: Persistence beyond two weeks after removing a suspected cause or empiric care generally warrants biopsy/referral.
- Act sooner: Suspicious lesions merit earlier evaluation.
When is CBCT justified?
When conventional views cannot answer a question that matters for diagnosis or treatment and benefit outweighs added radiation. Minimize the field/dose and arrange interpretation of the whole volume.
Radiographs (PDF opens in a new tab)How does management differ between localized dental pain and a spreading facial infection?
- Localized disease: provide definitive source care.
- Progressive swelling, fever, dysphagia, dyspnea, or other systemic/airway signs require urgent escalation, source control, and adjunctive antibiotics; severe cases need hospital-level care.
IE procedure exemptions
IE procedure exemptions include routine anesthetic injections through noninfected tissue, dental radiographs, placement/removal of removable appliances, placement of orthodontic brackets, adjustment of orthodontic appliances, shedding primary teeth, and bleeding from lip/oral trauma. A qualifying cardiac condition alone does not override these exemptions.
Antibiotic prophylaxis (PDF opens in a new tab)Compare antibiotic decisions
Scroll across to view all columns
| Scenario | Antibiotic decision | Source |
|---|---|---|
| Contained pulpal or periapical infection, no fever or facial swelling | No routine antibiotic; treat the source | Antibiotic therapy, takeaway |
| Facial swelling or cellulitis, no systemic signs | Drainage and source control, plus amoxicillin or amoxicillin-clavulanate; 3–5 days may match 7 days | Antibiotic therapy 2–4 |
| Fever, trismus, dysphagia, or breathing difficulty | Hospital: surgical care and IV antibiotics | Antibiotic therapy 3–4 |
| Intraoral wound contaminated by soil or debris, or an open fracture | Systemic antibiotic; confirm tetanus immunity | Antibiotic therapy, oral wounds |
| Highest-risk cardiac condition and qualifying procedure | Single prophylactic dose, 30–60 minutes before | Prophylaxis 2–6 |
| Avulsed permanent incisor | Adjunctive systemic antibiotic; amoxicillin or penicillin first | Antibiotic therapy, avulsion |
Quick decisions
What should determine whether a child needs dental radiographs?
from history, exam, risk & question, not age or insurance; review existing images
Who qualifies for infective endocarditis prophylaxis, and what timing and antibiotic choices apply?
highest-risk cardiac only; amoxicillin 30–60 min before; no clindamycin; not for prosthetic joints
Decision pathways
Sources
- Management Considerations for Pediatric Oral Pathology, 2025 (AAPD latest revision; manual edition is 2026-2027)
- Prescribing Dental Radiographs for Infants, Children, Adolescents, and Individuals with Special Health Care Needs, 2025 (AAPD latest revision; body notes the prior revision was 2024)
- Use of Antibiotic Therapy for Pediatric Dental Patients, 2026 (AAPD latest revision; manual edition is 2026-2027)
- Antibiotic Prophylaxis for Dental Patients at Risk for Infection, 2026
Official but unformatted 2026 PDF; page numbers may shift when typeset.