Clinical application of povidone-iodine oral antiseptic 1% (Betadine mouthwash) and povidone-iodine skin antiseptic 10% (Betadine solution) for the management of odontogenic and deep fascial space infection

Treatment of infections largely encompasses the field of dental medicine. Prevention and management of infection in the oral and maxillofacial region involve every facet of dental care that may be necessary due to caries, periodontal disease, pulpal pathology, trauma, reconstructive and surgical implants. One of the first surgical procedures in the treatment of localized infection commenced with the opening of bulbous abscesses with sharp stones and pointed sticks. The principles for the management of infection basically remain the same although the surgical technique has remarkably improved. It takes a qualitative and quantitative amount of bacterial insult to produce a certain degree of infection that may eventually lead to facial swelling, asymmetry, discomfort and loss of function. In the oral cavity and its surrounding structures, the predominant organisms such as the staphylococci and streptococci release enzymes responsible for the breakdown of fibrin (connective tissue ground substances) and lyse cellular debris, which facilitates a rapid spread of infection. At the University of the Philippines, Philippine General Hospital Medical Center, where I have served for 18 years, 90% of dental consultations from the outpatient department and emergency room complex concern infection, and 85% of facial swelling is dental in origin. A typical odontogenic infection is a dentoalveolar abscess that spreads deeply into the soft tissue rather than exiting superficially through the oral and cutaneous route, consequently involving the fascial spaces. Following the path of least resistance through connective tissue and along fascial planes, infection may diffuse quite distantly from its dental source, causing damage to the surrounding structures. Appreciation not only of the anatomy of the face and neck is necessary to predict sufficiently the pathway of spread of these infections, but also knowledge of how to drain these spaces adequately.