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