Diabetic Patient has Molar Extracted and Contracts Life Threatening Infection

This case involves a thirty-year-old male patient with a past medical history of diabetes. He presented to his dentist for a molar extraction for braces. Following the procedure, the patient had a severe infection of the extraction site. The infection/abscess extended into the mandible and down into his neck. This complication required multiple hospitalizations and surgeries. On one occasion, he became septic and was admitted to the ICU which required IV antibiotics.

Question(s) For Expert Witness

1. What is the appropriate treatment of a dental abscess in a diabetic patient?

Expert Witness Response

Dental infections in diabetic patients are rare when treated properly with the correct antibiotics. Antibiotic therapy can often prevent the local spread of infection and usually indicated if fever and regional lymphadenopathy are present. At times the infection can involve the bones and can spread into surrounding soft tissue. When the infection has spread into the jaw, this results in a condition called osteomyelitis, which rather uncommon, unless the patients are severely immunocompromised. Examples of immunocompromised patients include those who are taking chronic steroid therapy, suffering from diabetes (as in this case) and are receiving radiation therapy. Empiric broad-spectrum antimicrobial therapy in these patients is warranted to reduce the risk of spreading orofacial infections.