Dental Abscess to Septic Shock: A Case Report and Literature Review

Sepsis is a leading cause of death in the United States, with a mortality rate in excess of 215,000 deaths per year. It may lead to septic shock, a complex pathophysiological process with microbial and host response events that progress to multisystem derangement. There is poor documentation of the relationship between dental infection and septic shock, with only a few case reports of septic shock secondary to dentoalveolar abscess. Presented is a case of sepsis/septic shock in a 23-year-old man with signs and symptoms of pulpal necrosis, acute apical abscess, and canine space infection that rapidly progressed to an altered mental state, hyperthermia, tachycardia, hypotension, acute respiratory failure, diarrhea, renal insufficiency, lactic acidosis, leukocytosis, and hyperglycemia. Once septic shock develops, the mortality rate is nearly 50%. Early antimicrobial intervention is associated with surviving severe sepsis, making it critical for dentists to understand local factors leading to the crisis and the signs and symptoms of the sepsis?septic shock continuum. (J Endod 2021;47:663?670.) Sepsis is a serious, complicated medical condition with a high mortality rate. Sepsis and septic shock are 2 entities occurring as a continuum, with sepsis leading to septic shock1. Sepsis was first defined in 1991 as a systemic inflammatory response syndrome due to suspected infection with 2 or more specified clinical criteria. Septic shock includes hypotension and organ dysfunction that persists despite volume resuscitation, along with the systemic inflammatory response syndrome criteria2. Using these definitions, the Surviving Sepsis Campaign developed guidelines for a protocol-driven model of care3. In 2016, the international Sepsis-3 Committee defined sepsis as ?a life-threatening condition caused by a dysregulated host response to infection, resulting in organ dysfunction,? whereas septic shock is ?circulatory, cellular, and metabolic abnormalities in septic patients, presenting as fluid-refractory hypotension requiring vasopressor therapy with associated tissue hypoperfusion (lactate . 2 mmol/L)?4. In the United States, the incidence of severe sepsis is estimated to be 300 cases per 10,000