odontogenic infections

Odontogenic Infections

Dr. Rida F. WaseemBDS,

DemonstratorDepartment of Oral Surgery

IOD, CMH

Objectives

By the end of this lecture the students should be able to: • Describe the sequelae of odontogenic

infections.• Describe the spread of odontogenic

infections to primary, secondary and distant spaces.

• Diagnose a patient with odontogenic infections.

An odontogenic infection is an acute or chronic infection

originating from a tooth related pathology.

Periapical

Pericoronal

Periodontal

Sequelae of Pulpitis

Routes of Spread

1) Localized Soft Tissue Abscess

or

2) Diffused widespread Cellulitis

What will it depend on?

Number of Microorganisms Virulence of Microorganisms Host Defense In a healthy patient spread is localized and

drained to the buccal or lingual cortex In an immune compromised patient spread is

diffused and spreads to the bone osteomyelitis

Enzymes responsible for

connective tissue degradation

• Hyaluronidase (Produced by aerobes; causes cellulitis and lowers the pH)

• Collagenase (Produced by anaerobes; cause liquefactive necrosis; pus)

Spread of infection takes the path of

least resistance in the tissues.

In the connective

tissue spaces (potential)

Between the bone and

periosteum

Spaces between the

muscle layers

Fascial SpacesPrimary Secondary

• Vestibular • Buccal• Canine• Infratemporal

Maxillary

• Vestibular• Submental• Submandibular• Sublingual

Mandibular

Massetric space

Superficial and Deep temporal spaces

Pterygomandibular space

Carotid sheath space

Lateral pharyngeal space

Retropharyngeal Space

Spaces

Primary

• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Spaces

Primary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibularo Submentalo Submandibularo Sublingual

Mylohyoid Line

Ludwig’s Angina

Spaces

Secondary

• Massetric space• Superficial and Deep

temporal spaces• Pterygomandibular

space• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Space

Spaces

Secondary

• Massetric space• Superficial and Deep

temporal spaces• Pterygomandibular

space• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Space

Spaces

Secondary

• Massetric space• Superficial and Deep

temporal spaces• Pterygomandibular

space• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Space

SpacesSecondary• Massetric space• Pterygomandibular

space• Superficial and Deep

temporal space• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Space

Fascial SpacesPrimary Secondary

•Vestibular /Palatal•Buccal•Canine•Infratemporal

Maxillar

y

•Vestibular•Submental•Submandibular•Sublingual

Mandibular

Massetric space

Superficial and Deep temporal spaces

Pterygomandibular space

Carotid sheath space

Lateral pharyngeal space

Retropharyngeal Space

Spaces

Primary Secondary

• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal

• Mandibularo Vestibular o Submentalo Submandibularo Sublingual

• Massetric space• Pterygomandibular

space• Superficial and Deep

temporal spaces• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Spaces

Primary Secondary

• Maxillaryo Vestibularo Buccalo Canineo Infratemporal

• Mandibularo Submentalo Submandibularo Sublingual

• Massetric space• Pterygomandibular

space• Superficial and Deep

temporal spaces• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Spaces

Primary Secondary

• Maxillaryo Vestibularo Buccalo Canineo Infratemporal

• Mandibularo Submentalo Submandibularo Sublingual

• Massetric space• Pterygomandibular

space• Superficial and Deep

temporal spaces• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Spaces

Primary Secondary• Maxillary

o Vestibularo Buccalo Canineo Infratemporal

• Mandibularo Submentalo Submandibularo Sublingual

• Massetric space• Pterygomandibular

space• Superficial and Deep

temporal spaces• Carotid sheath space • Lateral pharyngeal

space• Retropharyngeal

Distant Spread of Odontogenic Infections

• Maxillary Sinus• Orbit • Danger space• Mediastinum

Direct Spread

• Cavernous Sinus• Endocardium• Joints

Haematogenous Spread

Cavernous Sinus

Prophylaxis Against

Infectious Endocarditis-60 min before

Situation Agent Adults Children

Oral Amoxicillin 2g 50mg/kg

Parenteral Ampicillin 2g IM/IV 50mg/kg IM/IV

Cefazolin/ceftriaxone

1g IM/IV 50mg/kg IM/IV

Penicillin allergy, Oral

ClindamycinAzithromyci/Clarithromycin

600mg500mg

20mg/kg15mg/kg

Penicillin allergy, Parentral

Clindamycin 600mg IM/IV 20mg/kg IM/IV

Clinical FeaturesSwelling (IO and/or

EO)

Redness

Fever and malaise

Trismus

Lymphadenopathy

Dehydration

Dyspnea

Dysphagia

Investigations

Detailed History

Dental

Medical

Clinical Examinati

on

Radiographs

IOPA

OPG

CT Scan

Culture and

Sensitivity

Treatment OptionsMedical Surgical

• Empirical Oral antibiotics/IV antibiotics

• Pain medication• Hydration• Nutrition• Control any systemic

disease

• Remove the dental cause (RCT/debridement/extraction)

• Incision and drainage(IO/EO)

• Follow up

ObjectivesBy the end of this lecture the students should be able to: • Describe the sequelae of odontogenic

infections.• Describe the spread of odontogenic

infections to primary, secondary and distant spaces.

• Diagnose a patient with odontogenic infections

QUESTIONS?