Abstract Orofacial odontogenic infections are common. Current evidence indicates that anaerobes play a major role in these infections and that the most common microbial isolates are Bacteroides, fusobacteria, peptococci, and peptostreptococci as well as some viridans streptococci. Drainage must be established where possible. Penicillin is still the drug of first choice for therapy, with metronidazole a good alternative. Nevertheless, not all clinicians are aware of current views and, therefore, this article is a state-of-the-art review for the practicing clinician of the microbiology and antimicrobial therapy of orofacial odontogenic infections.