Background/Objectives: Treating odontogenic infections of the head, neck, and oral cavity requires surgical and pharmacotherapeutic interventions of single and multi-space infections. Prevotella species can become virulent during post-extraction wound healing at an extraction site, under conditions of excessive plaque, nearby gingivitis, or periodontitis, and in immunocompromised patients. The aims of this narrative review are to describe the pathogenesis of Prevotella species, particularly those resistant to surgery and empiric antibiotic therapy, and to emphasize the need for the identification of specific antibiotic-resistant Prevotella species. Methods: Three clinical cases from the lead author’s private practice were described, in which Prevotella species were significant opportunistic pathogens in odontogenic infections. The PubMed database was searched for “Prevotella and Odontogenic Infection and (or Amoxicillin or Clindamycin or Metronidazole or Flagyl^®)” from 1996 to 2024. Thirty additional references were used to develop the section on Prevotella pathogenesis. Results: Metronidazole administration was deemed necessary in the cases described here. This intervention mitigated or resolved these odontogenic infections that were refractory to conservative surgical therapy that included source control. Prevotella buccae was found to be prevalent in odontogenic infections and pericoronitis, and to be resistant to commonly used antibiotics. Prevotella species were highly susceptible to Metronidazole (Flagyl^®). The antibiotic was effective in mitigating the disease when basic principles of the treatment of odontogenic infections were employed. Conclusions: The clinical cases and the review of the literature indicate that Metronidazole is strongly indicated for the treatment of odontogenic opportunistic infections with Prevotella species.

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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 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.

Treating odontogenic infections of the head, neck and oral cavity requires the understanding of surgical and pharmacotherapeutic interventions as they apply to single and multispace infections. Three clinical cases are presented where Prevotella species were significant opportunistic pathogens. Since Prevotella can become virulent under conditions including 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, Metronidazole administration was deemed necessary in the cases described here. This intervention mitigated or resolved these odontogenic infections that were refractory to conservative surgical therapy that included source control. The involvement of Prevotella in odontogenic infections and pericoronitis, and the antibiotics used to treat common oral and maxillofacial infections with this bacterium are reviewed. Prevotella is susceptible to Metronidazole (Flagyl), and the antibiotic is effective in mitigating the disease process when basic principles of the treatment of odontogenic infections are employed.