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The Normal Flora Oral cavity provides an environment

favorable to microorganism growth Flora of children is similar to adults Bacterial counts range 10,000,000

10,000,000,000 organisms/ml of saliva Modifies microbial population

Age, anatomic relationship, eruption of teeth,presence of decayed teeth, diet, oral hygiene,antibiotic therapy, systemic disease, cancertherapy

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NOT all residents of oral flora arepathogens

Progression of initiating infection (byoral streptococci) predominance of oralanaerobes occursPeriodontal infectionsare polymicrobial

Infections fromnonodontegeniccauses (facial trauma,

surgical manipulation,tonsillitis)Staph.aureusStreptococcus spp.

Infections originatingsolely from dentalperiapical tissues

anareobic

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Pattern of toothdecay affectingmainly the primary

upper incisors andfrequently theupper and lowerprimary molars

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Practice of puttingthe child to bed witha nursing bottle

filled with sugar-containing drink(milk, juice,softdrink)

Can destroys entireprimary dentition asit erupts

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Extension of microorganismthrouroot apex

leads to formationof abscessRadiographicevidence of bone

destruction 7-14days

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Indications that toothhas becomeabscessed:

Sensitivity to heatstimulus (relieved bycold)

Sensitivity topercussion

Tenderness to fingerpressure on thealveolar process

Chronic abscess Looseness of tooth Suppuration from

draining sinus tracksor gingival crevice Radiolucency on

radiographscellulitis swollenface, pain, fever andmalaise

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Prevalent in allages

Severe in diabetics,

compromised hostsPoor oral hygiene

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Severe infectionProgresses yearsbefore recognition

Hypertrophiedgingivae

purulent discharge Painless

Localizedperiodontal hygieneMeticulous oralhygiene

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Localized to the molar &incisor regionsDeep gingival pocketing &severe bone resorption, inotherwise healthy childrenEtiology: gram negativeanaerobe

A.actinomycetemcomitans

Tetracyline + periodontalsurgery

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Trench mouth,Vincents infectionCaused by fusiform

bacilli andspirochetesFrank ulceration attips of interdental

papillae (+)spontaneousbleeding

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Pseudomembranous necrotic exudatealong marginal gingivae & interdentalpapillae

Pain, foul breath & taste, thick ropy saliva,malaise, occasional fever

Therapy: Penicillin Localized gingival curettage oral rinse with 0.5% hydrogen peroxide or

0.12% Chlorhexidine

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Impaction of microorganism &debris under the softtissue overlying the

crown of a tooth(often mandibular 3 rd molar)Polymicrobial

Prevotella,Porphyromonas spp.,Treponema denticola,Streptococcus milleri )

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Lower 3 rd molars lie in proximity to the pterygomandibular space ( a portion of

the masticator space)Infection spreads to masticator space

Trismus

Deep parapharyngeal space involvement

Therapy: local I&D, extraction of offending toothPenicillin, hospitalization (in presence of fever and trismus)

Resolution expected < 7days

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Most commonFiery-red 2-to-3 mmwide linear band of

inflammation of gingivaCandida spp., maybe a possible cause

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HSV1 commonly manifests as herpeticgingivostomatitis direct contact with people who have

draining lesions asymptomatic carriers incidence: 2-4 yrs.old

infants protected by maternal antibodies

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Incubation period: 6 days

Small vesicles

Coalesce to form larger lesionsSevere cases: lip, gingivae, oralmucosa, pharynx

Healing: 1-2 wksGradual crusting

Re-epithelization

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Latency: Continue throughout life Reactivation triggered by

Actinic radiationEmotional/physical stress

Recurrent disease: Vesicles along mucocutanoeus border

Painfuly for 2 days crusting & complete healingin 7-8 days Up to 50% adults suffer

Unaware of recurrent cold sores, thereby transmitthe disease

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Odontogenicinfection of primarymolars

Superficial spreadof cellulitis thatfollows theplatysma muscles

cheek neck anterior chest wallGroup Astreptococci