dara session 6 inf odont

8/13/2019 Dara Session 6 Inf Odont

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Odontogenic Infection

Point of discussion

2



At the end of this session student have to

be able to explain the basic concept of

odontogenic infection

Learning objectives

3



Infection

Hard tissue J a w s

Dental pulpitis

Periapical abssess

Acute osteomyelitsChronic osteomyelitis

Osteitis

Oral tissue

Oral MucosaLips

Gingival

Palate mucosa

Tongue

Pharynx

Floor of the mouth

Sub mucous swelling

Gingival

Floor of mouth

Lips buccal mucous

Tongue

Palate

Neck

Mucosal surface lesion

Vesiculobulous diseases

Ulcerative conditionWhite lesions

Red blue lesions

Pigmented lesions

Verrucal papillary lesionDifferential 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

Diseases

Soft tissue

4

Example 1



odontogenic

Teeth component

Pulpitis

Pericoronitis

Periapical absess

PeriostitisSubperiosteal absess

Sub mucous abscess

Cellulitis

Phlegmoon

Subcutan absess

Bacterial infection

Actinomycosis

NUG

Pericoronitis

SyphylisGonorhoue

Sinusitis maxillaris

Tbc

Leprosi

Noma

Sinus cavernosus

thrombosis

Viral infection

Vesiculobulosa

Herpes simplex

Recurrent herpes

Varicellazoster virusHand foot mouth dis

Herpangina

Measeles

Mumps

Fungal infection

Candidiasis

Deepfungus infection

Subcutaneus fungus inf.

SporotricosisOpportunistic Infection

Mucor mycosis

Aspergillosis

Infection

Non odontogenic

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Example 2



Dental

Component

periapicalperiodontal pericoronary

perapical

granuloma

exacerbation

sinusitis maxillarisosteomyelitis periapical abssess

periostitis

sub periosteal abssess

tissue and bone

space abssess

submucous abssess

cellulitis

Algorithym odontogenic

infection

pericoronitis

Subcutan abssess

periodontitis

o.supurativa

o. sclerosing

o. proliferatif

acute

sinusitis

chronic

sinusitis



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9



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Tissue space

o Buccal space

o Infra orbital space

o Caninus space

o Infra temporal space

o Submental space

o Sublingual space

o Submandibular space

o Submasetteric space

o Lateral and

retropharyngeal space

o

Pterygomandibular space

Bone space

o Sinus paranasal

• Sinus maxillaris

• Sinus ethmoidalis

• Sinus frontalis

• Sinus sphenoidalis

Head space



Local spreading

of odontogenic

infection



Parapharyng

eal spaces :

Lateral

paryngeal dan

retropharyngeal spaces



Submasseteric

space



Sublingualis

space dan

Submaksilaris



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Teeth component

Pulpitis

Pericoronitis

Periapical absess

Periostitis

Subperiosteal absess

Sub mucous abscess

Cellulitis

Phlegmoon

Subcutan absess



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•Teeth component

• When external stimuli reach anoxious level, degranulation of

mast cells, decreased nutrient

flow and cellular damage occur.

• Numerous inflammatorymediator : histamine, bradykinin,

neurokins, neuropeptides,

prostaglandine are release.

• The mediators causevasodilation, increased blood

inflow and vascular leakage with

edema

Pulpitis

Noxious agent



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•Teeth component



edema

Pulpitis

Noxious agent

Pulp exist in aconfined area

The active dilatation of thearterioles leads to increase

pulpal pressure and

secondary compression of

the venous return,



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•Teeth component



edema

Pulpitis

Noxious agent

Pulp exist in aconfined area

The active dilatation of thearterioles leads to increase

pulpal pressure and

secondary compression of the

venous return,



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• 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 conservation’s lecture !



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Teeth componentPericoronitis

• 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.

http://en.wikipedia.org/wiki/Tooth_impaction

http://en.wikipedia.org/wiki/Third_molar

http://en.wikipedia.org/wiki/Third_molar

http://en.wikipedia.org/wiki/Tooth_impaction



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• The soft tissue covering a partially erupted molar tooth isknown 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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• 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

http://en.wikipedia.org/wiki/Abscess




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• Once the acute symptoms are controlled, the underlyingcause 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, orwhether 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 oralhygiene in the area thereafter to prevent another

episode of acute pericoronitis.



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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),

http://en.wikipedia.org/wiki/Temporomandibular_joint

http://en.wikipedia.org/wiki/Floor_of_mouth

http://en.wikipedia.org/wiki/Erythema

http://en.wikipedia.org/wiki/Edema

http://en.wikipedia.org/wiki/Halitosis

http://en.wikipedia.org/wiki/Pus



http://en.wikipedia.org/wiki/Pus

http://en.wikipedia.org/wiki/Halitosis

http://en.wikipedia.org/wiki/Edema

http://en.wikipedia.org/wiki/Erythema

http://en.wikipedia.org/wiki/Floor_of_mouth






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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.

http://en.wikipedia.org/wiki/Mouth_ulcer

http://en.wikipedia.org/wiki/Trismus

http://en.wikipedia.org/wiki/Dysphagia

http://en.wikipedia.org/wiki/Lymphadenitis

http://en.wikipedia.org/wiki/Rubor

http://en.wikipedia.org/wiki/Pyrexia

http://en.wikipedia.org/wiki/Leukocytosis

http://en.wikipedia.org/wiki/Malaise

http://en.wikipedia.org/wiki/Malaise

http://en.wikipedia.org/wiki/Leukocytosis

http://en.wikipedia.org/wiki/Pyrexia

http://en.wikipedia.org/wiki/Rubor

http://en.wikipedia.org/wiki/Lymphadenitis

http://en.wikipedia.org/wiki/Dysphagia

http://en.wikipedia.org/wiki/Trismus

http://en.wikipedia.org/wiki/Mouth_ulcer



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Teeth componentPeriapical absess

• 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 rootcanal or canals and remove pathogens.

• Tooth #4, after extraction. The two single-

headed 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.

http://en.wikipedia.org/wiki/Chronic_%28medicine%29

http://en.wikipedia.org/wiki/Infection

http://en.wikipedia.org/wiki/Dental_anatomy

http://en.wikipedia.org/wiki/Endodontic_therapy

http://en.wikipedia.org/wiki/Root_canal


http://en.wikipedia.org/wiki/Pathogen

http://en.wikipedia.org/wiki/Cementoenamel_junction

http://en.wikipedia.org/wiki/Crown_%28tooth%29

http://en.wikipedia.org/wiki/Commonly_used_terms_of_relationship_and_comparison_in_dentistry

http://en.wikipedia.org/wiki/Commonly_used_terms_of_relationship_and_comparison_in_dentistry

http://en.wikipedia.org/wiki/Crown_%28tooth%29

http://en.wikipedia.org/wiki/Cementoenamel_junction

http://en.wikipedia.org/wiki/Pathogen



http://en.wikipedia.org/wiki/Endodontic_therapy

http://en.wikipedia.org/wiki/Dental_anatomy


http://en.wikipedia.org/wiki/Chronic_%28medicine%29



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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, constitutionalsymptoms, and usually results in necrosis.

http://en.wikipedia.org/wiki/Inflammation

http://en.wikipedia.org/wiki/Periosteum

http://en.wikipedia.org/wiki/Connective_tissue


http://en.wikipedia.org/wiki/Necrosis

http://en.wikipedia.org/wiki/Necrosis


http://en.wikipedia.org/wiki/Connective_tissue

http://en.wikipedia.org/wiki/Periosteum

http://en.wikipedia.org/wiki/Inflammation



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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 spontaneusstabbing 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 swellingresulting 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 Ludwig’s 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

http://en.wikipedia.org/wiki/Ludwig%27s_angina

http://en.wikipedia.org/wiki/Streptococcus

http://en.wikipedia.org/wiki/Bacteroides

http://en.wikipedia.org/wiki/Bacteroides




http://en.wikipedia.org/wiki/Ludwig%27s_angina



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Teeth componentCellulitis

• 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 parapharyngealabscess, 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 canspread beneath the gingival tissue into the bony space

occupied by the impacted tooth.



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• This resulting pain and swelling. To prevent recurrencesof this condition, most impacted teeth are extracted

surgically.

• Surgical removal of painfully infected teeth or roots

should be delayed until acute infection is controlled withantibiotics, otherwise a serious form of spreading bone

infection (osteomyelitis) may result.

• Cavernosis sinus thrombosis (CST) can occur when

infection from maxillary premolar or molar teethperforates the buccal cortical plate and extends into

the maxillary sinus, the ptrerygompalatine space or the

infratemporal fossa reaching the orbit via the inferior

orbital fissure.



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Clinical features

• Ludwig’s 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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Clinical features

• 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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Clinical features

• Involvement of lateral pharyngeal space can cause

respiratory obstruction secondary to laryngeal edema.

• Fever, chills, leukocytosis and elevated sedimentation

rate.



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Teeth component

CellulitisTreatment 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



Concept

50

dara session 6 inf odont

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