Download - Odontogenic infections
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Odontogenic Infections
Dr. Rida F. WaseemBDS,
DemonstratorDepartment of Oral Surgery
IOD, CMH
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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.
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An odontogenic infection is an acute or chronic infection
originating from a tooth related pathology.
Periapical
Pericoronal
Periodontal
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Sequelae of Pulpitis
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Routes of Spread
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1) Localized Soft Tissue Abscess
or
2) Diffused widespread Cellulitis
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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
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Enzymes responsible for
connective tissue degradation
• Hyaluronidase (Produced by aerobes; causes cellulitis and lowers the pH)
• Collagenase (Produced by anaerobes; cause liquefactive necrosis; pus)
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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
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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
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Spaces
Primary
• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
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Mylohyoid Line
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Ludwig’s Angina
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Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
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Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
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Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
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SpacesSecondary• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
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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
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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
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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
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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
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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
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Distant Spread of Odontogenic Infections
• Maxillary Sinus• Orbit • Danger space• Mediastinum
Direct Spread
• Cavernous Sinus• Endocardium• Joints
Haematogenous Spread
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Cavernous Sinus
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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
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Clinical FeaturesSwelling (IO and/or
EO)
Redness
Fever and malaise
Trismus
Lymphadenopathy
Dehydration
Dyspnea
Dysphagia
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Investigations
Detailed History
Dental
Medical
Clinical Examinati
on
Radiographs
IOPA
OPG
CT Scan
Culture and
Sensitivity
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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
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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
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QUESTIONS?