In The Name Of God
Dentoalveolar infection in pediatric patients
Dr Sara Maleki Kambakhsh
D.D.S M.Sc Pedodontist
Assistant professor of Qazvin University of Medical Science
CONTENT
• Introduction of dental decay• Incidence and prevalence• Dentoalveolar infection• Treatment modalities• Recommendations
Dental caries
Dental caries is the single most common chronic childhood disease (may 2000.AAPD)
Dental caries is five times more common than asthma and seven times more common than hay fever
Dental caries is not self-limiting, like the common cold, nor amenable to treatment with a simple course of antibiotics, like an ear infections
dental care is the most prevalent unmet health need among children
many variables contribute to the spread of the disease and thwart our efforts to eliminate this major health problem
• ECC ( early childhood caries )
presence of one or more decayed (noncavitated or cavitated), missing (as a result of caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger
• SECC ( sever ECC, nursing caries, baby battle tooth decay )
in children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries
Etiology of dental caries
• Is an infectious and communicable disease and that multiple factors influence the initiation and progression of the disease
host (tooth in the oral environment) a dietary substrate, and acid uric bacteria The saliva (viscosity / salivary flow ) And individual factors ( genetic) (anatomy and
morphology)
host (tooth in the oral environment)
• Oral hygiene• Critical PH (5.5/ 6.2)• Primary dentition
Microorganisms(cariogenic bacteria)
• S. mutans ,S.sobrinus and lactobacilli• Window of infectivity• Vertical and horizontal transmission
nutrition
Brest feeding (At once ) Bottle feeding snacks
Odontogenic infection have three major origins
Periapical ( 70%)
Periodontal (20%)
Pericronitis (10%)
Odontogenic Infections
Classic signs and symptoms of infection
include redness, pain, swelling,
and local and systemic temperature increases
The virulence of the microorganisms and the ability of the tissues to react to the infection probably determine whether the infection will be acute or chronic
the Importance in pediatric patients:Dentoalveolar infections can progress rapidly especially in pediatric patient.
Children are susceptible to becoming dehydrated and systemically ill from what may appear to be a relatively minor infection (as a result of his or her refusal to take fluids because of oral pain)
Because of wider marrow spaces in the child, an odontogenic infection can rapidly spread through the bone, and the surrounding tissue is less able to wall off the process
Most odontogenic infections in the child are not serious and can be easily managed with pulp therapy or removal of the involved tooth
Criteria for referral to a specialist
• Rapidly progressive infection (cellulitis)• Difficulty in breathing• Difficulty in swallowing• Facial space involvement• Elevated temperature (greater than 101F)• Severe jaw truisms (less than 10 mm)• Toxic appearance• Compromised host defense
Acute alveolar abscess
• The tooth is sensitive to percussion
and movement, and the patient may
have a slight fever
• The acute symptoms of an alveolar abscess can be relieved by using antibiotic therapy and establishment of drainage
• antibiotic therapy is not always necessary
(effective pain control)
Warm saline
Chronic alveolar abscess
characterized by less soreness, is often a
better-defined radiographic lesion
The patient will likely have some lymphadenopathy
Draining fistulas are also frequently associated with chronic alveolar abscesses
antibiotic therapy is unnecessary except in patients with an overriding systemic problem (e.g., patients susceptible to subacute bacterial endocarditis, patients with organ transplants, or those who are immunodeficient)
CELLULITIS
Cellulitis is a diffuse type of infection
of the soft tissues that may be caused
by a pulpless primary or permanent tooth
It often causes considerable swelling of the face or neck, and the tissue appears discolored
Cellulitis is a very serious infection. It can be lifethreatening and is a potential complication of all acute dental infections
• The child appears acutely ill and may have an alarmingly high temperature with malaise and lethargy
If a maxillary tooth is the problem, the swelling and redness may involve the eye
If cellulitis is treated too late, serious complications, such as involvement of the central nervous system or a cavernous sinus thrombosis, could occur
• If the infection involves the submandibular, sublingual, and submental spaces, it is called Ludwig angina. In this condition the tongue and floor of the mouth become elevated to the extent that the patient's airway is obstructed and swallowing is impossible
Bacteria Responsible for Odontogenic
Infection
Aerobic bacteria(25%)
Gram-positive Cocci Streptococcus
Anaerobic bacteria(75%) Gram-positive Cocci
Streptococcus, PeptostreptococcusGram-negative Bacilli Prevotella, porphyromonas
fusobacterium
Select antibiotic
• Causative organisms based on history
• Host defense history
• Allergy history
• Previous drug history
• Penicillin vk
• Amoxicillin
• Clindamycin
• Metronidazole
Adequate length of time
• Improvement in symptoms: within 2 days
• Reasonably asymptomatic: within 4 or 5 days
• At least 2 days after the symptoms disappear
• Usual prescription should be written for 6-7 days