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Point of discussion
Odontogenic Infection

Learning objectives
At the end of this session student have to be able to explain the basic concept of odontogenic infection

Example 1 Hard tissue Infection

Oral Mucosa Lips Gingival Palate mucosa Tongue Pharynx

Oral tissue

Soft tissue
Mucosal surface lesion Vesiculobulous diseases Ulcerative condition White lesions Red blue lesions Pigmented lesions Verrucal papillary lesion
Sub mucous swelling Gingival Floor of mouth Lips & buccal mucous Tongue Palate Neck

Jaws Dental pulpitis Periapical abssess Acute osteomyelits Chronic osteomyelitis Osteitis

Floor of the mouth

Differential diagnosis approach to jaw lesions Cyst of the Oral Region Odontogenic Tumors Benign Non Odontogenic Tumor Inflamatory Jaw Lesions Malignant Non-odont Neoplasm Metabolic and Genetic Jaw 4 Diseases

Example 2

Teeth component odontogenic Pulpitis Pericoronitis Periapical absess Periostitis Subperiosteal absess Sub mucous abscess Cellulitis Phlegmoon Subcutan absess

Infection Non odontogenic

Bacterial infection Actinomycosis NUG Pericoronitis Syphylis Gonorhoue Sinusitis maxillaris Tbc Leprosi Noma Sinus cavernosus thrombosis

Viral infection Vesiculobulosa Herpes simplex Recurrent herpes Varicellazoster virus Hand foot mouth dis Herpangina Measeles Mumps

Fungal infection Candidiasis Deepfungus infection Subcutaneus fungus inf. Sporotricosis Opportunistic Infection Mucor mycosis Aspergillosis

Oromaxillofacial Infection

Nonspecific Infections

Infectious Disease Specific

o Sexually transmitted disease: Gonorrhoea, Syphilis, HIV AIDS o Hand-foot and mouth disease o Varicella-zoster infections (chicken pox) o Herpes zoster o Herpes simplex o Tuberculosis o Morbili

Acute Non Odonto genic Oral Mucous Infection or exacerbation

o o o o o o
o o o

Non odontogenic Infection

o Surgical Site Infections (SSI)dry socket o Gangrene. o Toxemia o Bacteremia o Septicemia o Pyemia o Aseptic fever o Furuncel o Carbuncel o Cavernosus sinus thrombosis o Tetanus

Odontogenic Infection
o Periapical tissue infection : p.a. granuloma, p.a. abscess, osteomyelitis, cellulitis, Ludwig o Pericoronal infect o Tisssue space infection: buccal sp, sub mandib sp, sub mental sp, temporal sp o Bone space infec tion : s. maxilla ris, s. ethmoidalis , s. frontalis. s 6

Traumatic ulcers Drug reactions Contact allergy Mucosal burns Recurrent aphthous ulceration Erythema multiforme Erosive lichen planus Oral candidiasis Denture stomatitis

Algorithym odontogenic infection

Dental Component
periapical perapical granuloma exacerbation pericoronary pericoronitis

periodontal
periodontitis

osteomyelitis o.supurativa o. sclerosing

periapical abssess periostitis sub periosteal abssess

sinusitis maxillaris acute sinusitis chronic sinusitis

o. proliferatif submucous abssess tissue and bone space abssess

cellulitis Subcutan abssess

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Head space Tissue space

o o o o o o o o o Buccal space Infra orbital space Caninus space Infra temporal space Submental space Sublingual space Submandibular space Submasetteric space Lateral and retropharyngeal space o Pterygomandibular space

Bone space
o Sinus paranasal Sinus maxillaris Sinus ethmoidalis Sinus frontalis Sinus sphenoidalis

Local spreading of odontogenic infection

Parapharyng eal spaces : Lateral paryngeal dan retropharynge al spaces

Submasseteric space

Sublingualis space dan Submaksilaris

Teeth component
Pulpitis Pericoronitis Periapical absess Periostitis Subperiosteal absess Sub mucous abscess

Cellulitis
Phlegmoon Subcutan absess
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Pulpitis
Noxious agent

Teeth component
When external stimuli reach a noxious level, degranulation of mast cells, decreased nutrient flow and cellular damage occur. Numerous inflammatory mediator : histamine, bradykinin, neurokins, neuropeptides, prostaglandine are release. The mediators cause vasodilation, increased blood inflow and vascular leakage with edema
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Pulpitis
Noxious agent

Teeth component
The mediators cause vasodilation, increased blood inflow and vascular leakage with edema Pulp exist in a confined area

The active dilatation of the arterioles leads to increase pulpal pressure and secondary compression of the venous return, 18

Pulpitis
Noxious agent

Teeth component
The mediators cause vasodilation, increased blood inflow and vascular leakage with edema Pulp exist in a confined area

The active dilatation of the arterioles leads to increase pulpal pressure and secondary compression of the venous return, 19

The increase pulpal pressure combined with the accumulation of mediators can lead to vesses damage, pulpa inflammation and tissue necrosis.
Severe localized pulpal damage can spread progressively to involve the apical. Noxious stimuli : Mechanical damage Thermal injury Chemical irritative

Bacterial effects

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Pulpitis can be classified as :

Acute or chronic Subtotal or generalized

Infected or sterile

Look at your conservations lecture !

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Pericoronitis

Teeth component

Pericoronitis (also known as operculitis, and derived from Greek peri, "around", Latin corona "crown" and -itis, meaning a disease involving inflammation), is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle.

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Pericoronitis

Teeth component

Most commonly pericoronitis occurs with a partially erupted or partially erupted and impacted mandibular third molar (lower wisdom tooth).

Periocoronitis is a common dental problem, often occurring in young adults (15-24), since this is roughly the age when the wisdom teeth are erupting into the mouth.

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Pericoronitis

Teeth component

The soft tissue covering a partially erupted molar tooth is known as an operculum. Pericoronitis may occur for several reasons : usually involving an inflammatory response in the soft tissues An upper tooth may also start to bite into the soft tissues over a lower tooth and cause inflammation.

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Pericoronitis

Teeth component

The signs and symptoms of pericoronitis are variable

Chronic inflammation may cause few if any symptoms, whereas an acute episode of pericoronitis, often associated with the formation of a pericoronal abscess (a collection of pus within the soft tissues), The infection can spread to other parts of the face or neck,
The treatment of acute pericoronitis is normally addressed first by cleaning the area underneath the operculum with an antiseptic solution, and with painkillers, regular hot salt water mouthwashes/ mouth baths and improved oral hygiene in the affected area
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Pericoronitis

Teeth component

Once the acute symptoms are controlled, the underlying cause is assessed and a decision is made as to whether to remove or retain the affected tooth. Often this is related to whether the tooth will continue to grow into the mouth and reach a normal position, or whether it is stuck against another tooth, and to other factors such as the presence of decay or periodontal disease in the area. If the tooth is retained, it usually requires improved oral hygiene in the area thereafter to prevent another episode of acute pericoronitis.
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Pericoronitis

Teeth component

Sign and symptom

Pain, The pain may be throbbing and radiate to the ear, throat, temporomandibular joint, posterior submandibu lar region and floor of the mouth, pain when biting
Tenderness, erythema (redness) and Edema (swelling) of the tissues around the involved tooth The operculum is characteristically very painful when pressure is applied

Bad taste in the mouth.Intra-oral halitosis

Formation of pus (i.e. a pericoronal abscess),
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Pericoronitis

Teeth component

Sign and symptom

Signs of trauma on the operculum, such as indentations of the cusps of the upper teeth

Ulceration , Trismus, one of the most common causes of temporary trismus.

Dysphagia (difficulty swallowing).

Cervical lymphadenitis of the submandibular nodes

Facial swelling, and rubor, often of the cheek that overlies the angle of the jaw Pyrexia (fever). Leukocytosis Malaise (general feeling of being unwell, Loss of appetite.
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Periapical absess

Teeth component

Is the result of a chronic, localized infection located at the tip, or apex, of the root of a tooth. To achieve resolution, endodontic therapy must be performed to debride the root canal or canals and remove pathogens. Tooth #4, after extraction. The two singleheaded arrows point to the CEJ, which is the line separating the crown (in this case, heavily decayed) and the roots. The double headed arrow (bottom right) shows the extent of the abscess that surrounds the apex of the palatal root.

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Teeth component
Periostitis Periostitis, also known as periostalgia, is a medical condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone The condition is generally chronic, and is marked by tenderness and swelling of the bone and an aching pain.

Acute periostitis is due to infection, is characterized by diffuse formation of pus, severe pain, constitutional symptoms, and usually results in necrosis.

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Teeth component
Periostitis Bone formation within a periosteas reaction is a common finding in a wide variety of intraosseous pathosis Common causes of periosteal new bone formation are osteomyhelitis, trauma, cysts and neoplasma.

Garre reported periostitis on inflammatory periosteal hyperplasia.

The most frequent cause is dental caries with associated periapical inflammatory disease. Most cases arise in the premolar and molar area of the mandible.
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Teeth component
Subperiosteal absess Definitions: an abscess between the periosteum and cortical plate of the bone.

In periostitis, the infections get under the periosteum in the vestibular and or palatal and lingual surface of the alveolar prosess.
A bulge occurs and a subperiosteal abscess is formed. The mucosa overlying is, erythematous with fluctuation and collatera edema of the skin in adjacent region.
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Teeth component
Subperiosteal absess, Sub mucous abscess A collection of an inflammatory exudate in, berween the bone surface and periosteum is accompanmied by intence clinical symptom of pain and fever Mucosal soreness elicited by pressure spontaneus stabbing pain and painful regional lymph nodes If necrosis occurs and the periosteum is perforated, the suppuration penetrated under the mucosa and forms a submucous abscess If the inflammation spread in the opposite direction, a skin fistula may emerge relief at this phase.
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Teeth component
Cellulitis Infection of the teeth or other surrounding oral structures may present as a cellulitis or as an abscess. Cellulitis is a diffuse, hard, erythematous swelling resulting in the spread of microorganisms through the soft-tissue fascia. An abscess is a localized cavity lined by fibrous connective tissue that contains exudate. Two types of abscesses involve the teeth: endodontic and periodontal.
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Cellulitis Two especially dangerous forms warrant further discussion is Ludwigs angina (LA) and cavernous sinus thrombosis (CST) Dental infections account for approximately 80% of cases of Ludwig's angina, (cellulitis of the submandibular space). Mixed infections, due to both aerobes and anaerobes, are commonly associated with the cellulitis of Ludwig's angina. Typically this includes alpha-hemolytic streptococci, staphylococci and bacteroides groups

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Cellulitis

Teeth component

Permanent third molars, as a cause, commonly referred to as wisdom teeth, are the last to erupt in the oral cavity ages 17 and 21, when jaw growth is complete. These teeth may have insufficient space to erupt Other cause are peritonsillar or parapharyngeal abscess, oral lacerations, fractures of the mandible or submandibular sialadenitis. The distal cusps of the tilted tooth are often exposed to the oral environment, where bacteria and infection can spread beneath the gingival tissue into the bony space occupied by the impacted tooth.
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Cellulitis

Teeth component

This resulting pain and swelling. To prevent recurrences of this condition, most impacted teeth are extracted surgically. Surgical removal of painfully infected teeth or roots should be delayed until acute infection is controlled with antibiotics, otherwise a serious form of spreading bone infection (osteomyelitis) may result. Cavernosis sinus thrombosis (CST) can occur when infection from maxillary premolar or molar teeth perforates the buccal cortical plate and extends into the maxillary sinus, the ptrerygompalatine space or the infratemporal fossa reaching the orbit via the inferior 39 orbital fissure.

Cellulitis Clinical features

Teeth component

Ludwigs anginais (LA) an aggressive and rapidly spreading cellulitis that involves the sublingual, submandibular and submental.spaces Once the infection enters the submandiblar space it may spreading to the lateral pharyngeal space and then to the retropahryngeal space
LA creates massive swelling of the neck that often extends close to the clavicles.

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Cellulitis Clinical features

Teeth component

Involvement of the sublingual space results in elevation posterior enlargement and protrusion of the tongue (woody tongue) Submandibular space spread causes enlargement and tenderness of the neck above the level of the hyoid bone (bull neck) Result in pain movement, dysphagia,d, dysartria, drooling and sore throat

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Cellulitis Clinical features

Teeth component

Involvement of lateral pharyngeal space can cause respiratory obstruction secondary to laryngeal edema. Fever, chills, leukocytosis and elevated sedimentation rate.

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Cellulitis

Teeth component

Treatment and prognosis

LA centers around four activities:

o Maintenance of the airway o Incision and drainage o Antibiotic therapy o Elimination of original focus of infedction

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Concept

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