the spread of dental infection (1)

7/21/2019 The Spread of Dental Infection (1)

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THE SPREAD OFTHE SPREAD OF

DENTAL INFECTIONDENTAL INFECTION



The Spread Of DentalThe Spread Of Dental

InfectionInfectionArise trough :Arise trough :

Pulpal and Periapical diseasePulpal and Periapical disease

Periodontal DiseasePeriodontal Disease



Dental PlaqueDental Plaque( A complex mass comprising bacteria, their products host-derived( A complex mass comprising bacteria, their products host-derived

material, and food debris which adheres to teeth)material, and food debris which adheres to teeth)

At the enamel surface At the gingivalAt the enamel surface At the gingival

marginmargin

inammation of the pulpal nammation of theinammation of the pulpal nammation of theperiodontal tissuesperiodontal tissues

pulpal and periapical disease Periodontal diseasepulpal and periapical disease Periodontal disease



PULPAL AND PERIAPICALPULPAL AND PERIAPICAL

DISEASEDISEASE D!"#A$ %A&!'D!"#A$ %A&!'

acteria on plaueacteria on plaue enamel surfaceenamel surface elaborateelaborate

acidic acid proteol*tic productsacidic acid proteol*tic products deminerali+edeminerali+e

the surface, digest the organic matrixthe surface, digest the organic matrix deca*deca*

%aries enamel%aries enamel dentindentin pulppulp tooth destro*edtooth destro*ed

f left untreatedf left untreated the pulpal canalthe pulpal canal adacent softadacent softtissuestissues initiate a painful and destructive inammator*initiate a painful and destructive inammator*

reactionreaction spread into the marrow spaces of the bonespread into the marrow spaces of the bone soft tissues and muscles of the face and necsoft tissues and muscles of the face and nec



PULPITISPULPITIS

"oxious stimuli"oxious stimuli (mechanical damage,(mechanical damage,thermal inur*, chemical irritation, bacterialthermal inur*, chemical irritation, bacterial

e.ects)e.ects) degranulation of mast cell,degranulation of mast cell,

decreased nutrient ow, cellulardecreased nutrient ow, cellular

damagedamage release of inammator*release of inammator*

mediatorsmediators (histamin, bradi*nin, neuroinins,(histamin, bradi*nin, neuroinins,

neuropeptides, prostaglandin)neuropeptides, prostaglandin)

vasodilation, increased blood inow,vasodilation, increased blood inow,vascular leaage with edemavascular leaage with edema



active dilation of the arteriolesactive dilation of the arterioles increased pulpal pressure /increased pulpal pressure /

accumulation of mediatorsaccumulation of mediators vesselvessel

damage / pulpal inammation /damage / pulpal inammation /tissue necrosistissue necrosis spread to apicalspread to apical

portion of the pulpportion of the pulp

reversiblereversible

PulpitiPulpiti

(acute, chronic)(acute, chronic) irreversible irreversible



Re!eri"leRe!eri"le pulpitipulpiti

Pulpal inammation, the tissue is capable of Pulpal inammation, the tissue is capable of

returning to a normal state of healthreturning to a normal state of health

Clinical feature #Clinical feature #- 'udden mild to moderate pain of short duration'udden mild to moderate pain of short duration- %old stimuli : ice, beverages, cold air%old stimuli : ice, beverages, cold air- 'weet or sour foods and beverages'weet or sour foods and beverages- Does not occur without stimuliDoes not occur without stimuli- 'ubsides within seconds'ubsides within seconds- f progressedf progressed irreversible a.ectedirreversible a.ected



IRRE$ERSI%LE PULPITISIRRE$ERSI%LE PULPITIS

Pulpal inammation in higher level, the pulpalPulpal inammation in higher level, the pulpaldamage be*ond the point of recover*damage be*ond the point of recover*

Clinical feature #Clinical feature #- sharp, severe pain upon thermal stimulationsharp, severe pain upon thermal stimulation- #he pain continuous after stimulus is removed #he pain continuous after stimulus is removed

- #he pain spontanious or continuous, #he pain spontanious or continuous,exacerbated when lies downexacerbated when lies down

- ncreases in intensit*ncreases in intensit*



CHRONIC H&PERPLASTICCHRONIC H&PERPLASTIC

PULPITIS 'PULP POL&P(PULPITIS 'PULP POL&P( n children and *oung adultsn children and *oung adults largelarge

exposures of the pulpexposures of the pulp entireentire

dentinal roof often missingdentinal roof often missing 0echanical irritation / acterial0echanical irritation / acterial

invasioninvasion %hronic inammation%hronic inammation

produces h*perplastic granulationproduces h*perplastic granulationtissue that extrudes from thetissue that extrudes from the

chamberchamber 1ills dentinal defect1ills dentinal defect



Periapical a"cePeriapical a"ce

#he accumulation of acute inammator* #he accumulation of acute inammator*cells at the apex of non vital tooth2cells at the apex of non vital tooth2

Abscess formation ma* arise of a chronicAbscess formation ma* arise of a chronicperiapical inammator* lesion, acuteperiapical inammator* lesion, acuteexacerbation, initial periapical pathosisexacerbation, initial periapical pathosis

#he source of infection : #he source of infection : pulpal necrosispulpal necrosis trauma relatedtrauma related

high occlusal contacthigh occlusal contact



Clinical Feature #Clinical Feature #

#enderness #enderness

Pain, sensitive to percussionPain, sensitive to percussion

!xtrusion of the tooth!xtrusion of the tooth

'welling of the tissues'welling of the tissues

Does not respond to cold or electricDoes not respond to cold or electricpulp testingpulp testing

3eadache, malaise, fever, chills3eadache, malaise, fever, chills



4ith progression, the purulence4ith progression, the purulence- ma* extend through the medullar*ma* extend through the medullar*

spaces awa* from the apical areaspaces awa* from the apical area

oteo)*elitioteo)*eliti- 0a* perforate the cortex and spread0a* perforate the cortex and spread

di.usel* trough the overl*ing softdi.usel* trough the overl*ing soft

tissuetissue celluliticelluliti



Oteo)*elitiOteo)*eliti

An inammator* process within medullar* (trabecular) boneAn inammator* process within medullar* (trabecular) bonethat involves the marrow spacesthat involves the marrow spaces

Acute oteo)*elitiAcute oteo)*eliti : rapidl* destructive inammator*: rapidl* destructive inammator*process within trabecular bone and bone marrow consists ofprocess within trabecular bone and bone marrow consists ofgranulation tissue, purulent exudates and seuestragranulation tissue, purulent exudates and seuestra

%aused b* direct extension of untreated periapical abscess%aused b* direct extension of untreated periapical abscess

%linical features: - intense pain%linical features: - intense pain ph*sicall* illph*sicall* ill - p*rexia, malaise- p*rexia, malaise



CellulitiCelluliti

f an abscess is not able to establish drainagef an abscess is not able to establish drainage

through the surface of the sin or into the oralthrough the surface of the sin or into the oral

cavit*, it ma* spread di.usel* through fascialcavit*, it ma* spread di.usel* through fascial

planes of the soft tissueplanes of the soft tissue celluliticelluliti

A painful swelling of the soft tissue of theA painful swelling of the soft tissue of the

mouth and face resulting from a di.usemouth and face resulting from a di.usespreading of purulent exudate along the fascialspreading of purulent exudate along the fascial

planes that separate the muscle bundlesplanes that separate the muscle bundles



Lud+i,- An,ina.Lud+i,- An,ina.

phle,)onphle,)onA cellulitis involving fascial spacesA cellulitis involving fascial spaces

between muscles and otherbetween muscles and other

structures of the posterior oor of thestructures of the posterior oor of themouth that compromise the air wa*mouth that compromise the air wa*



Clinical feature #Clinical feature #

- 'welling of the oor of the mouth,- 'welling of the oor of the mouth,tongue and submandibular regiontongue and submandibular region

- nvolvement of the sublingual space- nvolvement of the sublingual space

elevation, posterior enlargement, andelevation, posterior enlargement, and

protrusion of the tongue (protrusion of the tongue (woodywoody

tonguetongue))

- 'ubmandibular space spread- 'ubmandibular space spread

enlargement and tenderness of theenlargement and tenderness of thenec above of the h*oid bone (bullnec above of the h*oid bone (bull

nec)nec)



- Pain in the nec and oor of mouthPain in the nec and oor of mouth

- D*sphagia,d*sphonia, d*sarthria,D*sphagia,d*sphonia, d*sarthria,

drooling, sore throatdrooling, sore throat

- $ateral phar*ngeal space involvement$ateral phar*ngeal space involvement

respirator* obstruction secondar*respirator* obstruction secondar*

to lar*ngeal edemato lar*ngeal edema

- #ach*pnea, d*spnea, tach*cardia, #ach*pnea, d*spnea, tach*cardia,

stridor, restlessnessstridor, restlessness- 1ever, chills, leuoc*tosis1ever, chills, leuoc*tosis



Ca!ernou inuCa!ernou inu

thro)"oithro)"oi !dematous periorbital enlargement with involvement!dematous periorbital enlargement with involvement

of the e*elids and conunctivaof the e*elids and conunctiva

%linical features :%linical features :- Protrusion and 5xation of the e*eballProtrusion and 5xation of the e*eball- ndurations and swelling of the adacent fore headndurations and swelling of the adacent fore head

and noseand nose- Pupil dilation, lacrimation,photopobia, loss of visionPupil dilation, lacrimation,photopobia, loss of vision- Pain over the e*e and the trigeminal nervePain over the e*e and the trigeminal nerve- 1ever, chills, sweating, tach*cardia, nausea, vomitus1ever, chills, sweating, tach*cardia, nausea, vomitus- 4ith progression4ith progression central nervous s*stemcentral nervous s*stem

involvement developedinvolvement developed- meningitis, tach*pnea, irregular breathing, sti.eningmeningitis, tach*pnea, irregular breathing, sti.ening

of the nec, deepening stupor (advanced toxemiaof the nec, deepening stupor (advanced toxemiaand meningeal involvement)and meningeal involvement)

- 6ccasionall*6ccasionall* brain abscessesbrain abscesses



than *ou7than *ou7

the spread of dental infection (1)

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