After 29 years of clinical practice treating odontogenic infections of the head, neck and oral cavity, my co-contributors and I sought to determine by a review of the literature and three clinical cases if Prevotella species were significant opportunistic pathogens in odontogenic infections of all kinds in the oral and maxillofacial region.
We performed a PubMed review of 40 articles using terms associated with odontogenic infections, pericoronitis, Prevotella and antibiotics used to treat common oral and maxillofacial infections. Three cases were reported, and the treatment was discussed. An additional 26 articles were reviewed to describe the pathogenesis of Prevotella.
Given the opportunity to become virulent—such as post-extraction wound healing of an extraction site adjacent to an intact dentition, excessive plaque and calculus, nearby gingivitis or periodontitis, or an immunocompromised host—we wondered if Prevotella could be targeted with antimicrobials mitigating, or even resolving, odontogenic infections in those cases of refractory to conservative surgical therapy that includes source control.
We found that Prevotella is a significant opportunistic pathogen in odontogenic infections. Prevotella is susceptible to Metronidazole (Flagyl), and it is effective in mitigating the disease process when basic principles of the treatment of odontogenic infections are employed. Infections not responsive to this empiric therapy should be cultured to determine the opportunistic organism’s sensitivity and susceptibility to specific antibiotic therapy.