Oral sepsis and its

effect on systems
Oral foci of infection
periapical
lesions

INFECTIONS

infected
Periodontal
root
diseases
canals
Mechanism of spread
• Metastasis of micro organisms from an infected focus

Hematogenous / Lymphogenous

• Toxins carried through blood to distant site & Hypersensitive

reaction in the tissue.

eg:- scarlet fever, Rheumatic fever

Infections spread by hydrostatic pressure,
with the flow of infected fluids guided by the resistance of
certain tissue such as the fasciae, muscle, and bone.
 MAXILLA

Incisor labial, palatal abscess or vestibular abscess

canine labial / vestibular abscess or canine space abscess
Premolars canine space
molar buccal or palatal abscess or buccal space abscess
 MANDIBLE

incisor labial abscess / submental space abscess

canine labial / vestibular abscess
Premolars vestibular abscesses / sublingual abscesses
First molar vestibular abscess / buccal space abscess
sublingual abscess
Second molars vestibular or buccal space abscess
sublingual or a submandibular abscess
Third molars Submandibular / pterygomandibular
submasseteric abscesses
Odontogenic sinusitis
• The occurrence of maxillary sinusitis as a result of the
extension of dental infection

• When sinusitis is secondary to dental infection, the

microorganisms associated with the sinusitis are the same
as those associated with the dental infection
Clinical features
Numbness in
Refered pain to
Pressing over maxilla maxillary cuspid
cheek, molars,ear
increases pain

Postural pain
Severe pain with
swelling

Purulant nasal
Fever & Malaise
Fetid breath discharge
Treatment
• Removal of infected locus

• Antibiotics
cellulitis
• Diffuse inflammation of soft tissues

• Cellulitis of face and neck is most commonly from dental

infections either periapical, periodontal or pericoronal,
some times by tooth extraction and injections

How?
Micro organisms produce streptokinase, hyaluronidase and
fibrinolysins which breaks hyaluronic acid and fibrins.
Clinical features

• Moderately ill

• Elevated temperature

• Painful swelling of

soft tissue which is firm

and brawny
 Maxilla Mandible
perforation of outer cortical layer perforation of outer cortical layer
of bone of bone

Causes swelling in the upper half of causes diffuse swelling in the lower
the face. half of face

Extension towards the eye inner Infection spreads through cervical

canthus of eye vein causes tissues and causes respiratory
cavernous thrombosis discomfort
Ludwig’s angina
• Severe form of cellulitis

• Beginning in submaxillary space later involving

submental and sublingual space

• True ludwig’s angina – all spaces are involved

• Main Source of infection- mandibular molar

• Rapidly developing swelling

at the floor of the mouth

• painful and diffuse,

• Firm in consistency

• elevation of tongue.
Treatment
• Maintenance of airway

• Intense & prolonged antibiotic therapy

• Extraction of affected tooth

• Hydration

• Early surgical drainage

Osteomyelitis
• Osteomyelitis is defined as the inflammation of bone and
its marrow contents.

• Predisposing factors include

Fractures due to trauma and road traffic accidents;

Gunshot wounds,

Radiation damage,

Paget’s disease and

Osteopetrosis
INFLAMMATION
OF THE
MARROW
TISSUE
INFLAMMATORY
EXUDATE
SPREADS
THROUGH THE
MARROW
SPACES

COMPRESSION
OF BLOOD
VESSELS IN THE
BONE

THROMBOSIS

NECROSIS OF
THE BONE
Clinical features

elevation of
severe pain,
temperature with
trismus, Elevated WBC count
regional
paresthesia of the lips
lymphadenopathy

no swelling /
Loose and sore
Pus discharge from reddening until teeth
gingival margin
periostitis develops
 BACTEREMIA
• Bacteria that naturally attach to our teeth are displaced and
pass into the bloodstream during a dental procedure, flossing,
or even chewing food.

• Bacteremia after dental extraction, third-molar surgery, dental

scaling, endodontic treatment, and bilateral tonsillectomy has
been documented in literature
Intra cranial complication of dental
infection
• Cavernous sinus thrombosis / thrombophlebitis

• Brain abscess

• Leptomeningitis

• Subdural empyema

• Transverse myelitis

• Suppurative encephalitis
Significance of oral foci of
infection
• Arthritis

• Valvular heart diseases

• Gastrointestinal diseases

• Ocular diseases

• Skin diseases

• Renal diseases
 Rheumatoid Arthritis

• Though microorganisms cannot be cultured from the joints, the

patients frequently have a high antibody titer to group A
hemolytic streptococci

• This suggests a tissue hypersensitivity reaction as the cause for

the basic inflammatory reactions
Sub-acute Bacterial Endocarditis
Microbial infection of a heart valve

Streptococci – commensals in the upper respiratory tract

may enter the blood stream on chewing or teeth brushing or
at the time of dental treatment
Antibiotic prophylaxis
Normal patient Amoxicillin 2 g orally 1 hour prior to
the procedure
Not able to give Ampicillin 2 g i.m / i.v 1 hour prior to
oral dose
the procedure

Allergic to pencillin Clindamycin 600 mg orally 1 hour

prior to the procedure
Allergic to pencillin
and not able to Clindamycin 600 mg i.v 1 hour prior to
take oral dose the procedure
Pediatric Amoxicillin 50 mg / kg orally 1 hour
dose prior to the procedure
Diabetes Mellitus
• Diabetes mellitus is a clinical syndrome characterized by
hyperglycemia due to an absolute or relative deficiency of
insulin

• Diabetes is a risk factor for severe periodontal disease.

The converse possibility that periodontal disease either
predisposes or exacerbates the diabetic condition
Other conditions
Bacteria from a mother's mouth can be transmitted
through the blood and amniotic fluid in the womb to
her unborn child. This could contribute to the risk of a
premature delivery, a low birth weight baby,
premature onset of contractions, or infection of the
newborn child
Other conditions

• Aspiration of oral bacterial pathogens has been linked to

pneumonia in the institutionalized elderly

• patients with blood dyscrasias and white blood cell

defects benefit by more frequent periodontal

maintenance through the reduction of oral bacterial loads

Eye Uveitis / iritis

Respiratory Pneumonia

Renal Glomerulonephritis

Skeletal Arthritis

Git Crohn’s diseases

Skin Rosacea, Neurodermatitis, urticaria

Hormonal Diabetis

Cvs Infective endocarditis