What is it about?
Removing a wisdom tooth is usually safe, but infections can sometimes spread deep into the neck. We describe a healthy 26-year-old woman who developed fever, facial swelling and inability to open her mouth 12 days after a lower wisdom tooth extraction. A CT scan showed a large abscess in the jaw muscles, and she later developed abscesses in the lungs as well. She needed a tracheostomy to breathe safely and surgical drainage. The standard culture grew only a few colonies of Enterobacter cloacae, which led to treatment that did not work. Molecular testing (16S rRNA gene sequencing), which identifies bacteria from their DNA without needing to grow them, revealed that the real culprits were anaerobic bacteria typical of the mouth. Antibiotics were adjusted accordingly and she recovered completely.
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Why is it important?
Infections arising from the teeth are usually caused by mixtures of anaerobic bacteria that are hard to grow in the laboratory, so routine cultures can be misleading and steer therapy in the wrong direction. This case shows the practical value of 16S rRNA sequencing in complicated or non-responding infections, and encourages its earlier use to guide targeted, effective antibiotic treatment.
Perspectives
This case is a lesson in humility for clinicians: a positive culture is not always the right answer. Molecular microbiology changed the course of treatment for this young patient. It was the result of close teamwork between microbiologists, maxillofacial surgeons, hygienists and infectious diseases specialists in Trieste.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: The critical role of 16S rRNA sequencing in diagnosis and management of an odontogenic deep neck abscess: A case report, IDCases, January 2026, Elsevier,
DOI: 10.1016/j.idcr.2026.e02759.
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