Failure of Antibiotic Therapy in a Chronic Carious Tooth with Purulent Discharge: Case Report of Successful Outcome Post-Extraction

Background: Chronic dental infections, especially those associated with carious teeth and persistent purulent discharge, pose a significant therapeutic challenge, particularly when antibiotic treatment fails. The emergence of antimicrobial resistance (AMR) and complicating factors such as biofilm formation and limited drug penetration contribute to treatment failure and persistent infection. Case Presentation: This report describes a 17-year-old female presenting with a cutaneous sinus tract on the lower border of the mandible, unresponsive to multiple antibiotic regimens. Initial misdiagnosis led to delayed appropriate care. Clinical and radiographic evaluation revealed a severely carious mandibular first molar (36) with associated periapical radiolucencies and soft tissue changes consistent with a chronic dental abscess. Tooth extraction was performed, and purulent material was drained from both the socket and sinus tract. Postoperative recovery was uneventful, and complete resolution of symptoms was observed within three weeks. Discussion: Odontogenic cutaneous sinus tracts are rare and frequently misdiagnosed as dermatologic conditions. This case highlights the limitations of antibiotic therapy in chronic dental infections and underscores the importance of early dental evaluation and imaging in persistent cutaneous lesions. Panoramic radiography proved critical for diagnosis. Surgical intervention, including tooth extraction, remains a definitive treatment when conservative measures fail. Conclusion: Dental infections should be considered in the differential diagnosis of unexplained cutaneous facial lesions. Early recognition and appropriate surgical management are key to preventing complications and addressing antibiotic resistance in odontogenic infections.