Persistent fever due to occult dental infection: case report and review

Dental sepsis is one potential cause of persistent fever that can escape detection. A patient with febrile episodes due to an occult tooth abscess of 2 years' duration is described. A search of the English-language literature revealed 20 other cases of fever of obscure origin arising from dental sources. This diagnosis may be suggested by repeated questioning of the patient about his or her medical history, repeated physical examination, an elevated erythrocyte sedimentation rate, or a history of failure to respond to antibiotic therapy. Dental infection is unlikely in patients who have a white blood cell count of > 11 x 10(9)/L, a temperature of > 39.5 degrees C, or positive blood cultures. The diagnosis may be made by repeated focused clinical examination, dental roentgenography, or radiolabeled leukocyte scintigraphy. Detection of dental sepsis is worthwhile since the febrile condition can be cured in all instances by tooth extraction and abscess drainage, with or without concurrent antibiotic therapy.