Clinical manifestations of odontogenic orofacial infections are protean and are largely dictated by complex microbiota and anatomic routes of spread. Complications such as suppurative mediastinal or intracranial extension, retropharyngeal spread and airway obstruction, pleuropulmonary involvement, and hematogenous dissemination indicate the potentially serious nature of these infections. In this review we emphasize the pathogenetic mechanisms of infection, the principles of antimicrobial therapy, and the need for early surgical intervention.