Uncommon complications of odontogenic infections.

The emergency physician is familiar with the presentation of dental abscesses and periodontal disease. The majority of these cases are easily managed with analgesia, antibiotics, and appropriate follow-up with the dentist or oralmaxillofacial surgeon. The emergency physician, however, must be aware of several unusual complications arising from odontogenic infections. Among these complications are dentocutaneous fistula, osteomyelitis, cavernous sinus thrombosis, and Ludwig's angina. The first two sequelae are not associated with mortality, but morbidity and cosmesis are significantly affected. Cavernous sinus thrombosis and Ludwig's angina have been associated with significant morbidity and mortality, although mortality rates have declined significantly with Ludwig's angina since the advent of effective antibiotics and aggressive airway management. Awareness of these potentially serious complications and a high index of suspicion in the early stages of the disease process may prevent unnecessary treatment regimens, as well as significant morbidity and mortality.