Dental Abscess And “Unexpected Death”

Even though we are living in an era of major technical-scientific advances and effective antimicrobial and antiviral therapy, dental infections are still the most important predisposing factors for head and neck infections. Odontogenic infections can cause severe complications, e.g. compromised airways, tissue necrosis, deep neck infections, mediastinitis, endocarditis and sepsis. These severe odontogenic infections can be potentially life-threatening. Usually odontogenic infections respond well to a combination of surgical treatment (incision, drainage) and antibiotic therapy. However, especially when the medico-surgical therapy is installed late, cases may evolve unfavourably and be fatal. The authors report a case of a 30-year-old man who was observed on three consecutive occasions by the General Practitioner in a District Hospital, for a decayed tooth with abscess and was, then, referred to a Central Hospital. There, he was examined for the fourth time, this one by a Stomatologist at the Emergency Department, where he died. The post mortem examination revealed bacterial (Gram +) acute neutrophilic (purulent) infection of soft tissues of the mandibular region and neck with para-tracheal extension, as well as thrombosis of the left jugular vein. Circumstantial clinical information, post mortem findings, pathophysiology (including complications and progression of the disease to death) are discussed, highlighting the relevance of accurate and timely diagnosis and treatment to avoid malpractice and mortality.