Descending Necrotizing Mediastinitis is a rare complication that can be secondary to dental infections or surgical procedures involving the oral region. Despite a prompt pharmacological therapy and surgical intervention, a delayed diagnosis is still responsible for a too high mortality rate (about 40%). We present a review of the current literature on Descending Necrotizing Mediastinitis, focusing on the evolution of its management from Pearse to today. In particular, recent patents focused on novel compositions and methods to prevent and treat oral infections.