odontogenic infection 1

8/6/2019 Odontogenic Infection 1

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One of the most difficult

roblems to manage in dentistris an Odontogenic infection.

hese infections may range fromlow grade, well-localized

infections that require only

minimal treatment to severe, life threatening fascial spaceinfections.


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OUTLINE

Microbiology

Natural historyAssessmentManagement


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Causative organisms

Aerobes only 7 %

Anaerobes only 33 %

Mixed 60 %

Microbiology


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Aerobic 25%Gram-positive cocci 85%

Streptococcus spp. 90%

Streptococcus (group D) spp. 2%

Staphylococcus spp. 6%

Eikenella spp. 2%

Gram-negative cocci (Neisseria spp.) 2%

Gram-positive rods (Corynebacterium spp.) 3%

Gram-negative rods (Haemophilus spp.) 6%

Miscellaneous and undifferentiated 4%


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Anaerobic 75%Gram-positive cocci 30%

Streptococcus spp. 33%Peptostreptococcus spp. 65%

Staphylococcus spp. 65%

Gram-negative cocci (Veillonella spp.) 4%

Gram-positive rods 14%

Eubacteriumspp.

Lactobacillus spp.

Actinomyces spp.

Clostridia spp.

Gram-negative rods 50%

Bacteroides spp. 75%

Fusobacterium spp. 25%Miscellaneous 6%


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NaturalNatural histroy of progression ofhistroy of progression of

odontogenic infectionodontogenic infectionOriginOrigin

StagesStagesFactors affecting spread ofFactors affecting spread of

infectioninfection

Anatomical spaces involvementAnatomical spaces involvement


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originorigin

Periapical, as a result ofPeriapical, as a result of

pulpal necrosis.pulpal necrosis.

Periodontal, as a result of aPeriodontal, as a result of a

deep periodontal pocket.deep periodontal pocket.


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stagesstages

Periapical ostitis : infectionPeriapical ostitis : infection

still confined within thestill confined within the

alveolar bonealveolar bone

CellulitisCellulitis

AbscessAbscess


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Characteristics Cellulitis abscessCharacteristics Cellulitis abscess

Duration Acute Chronic

Pain Severe and generalized Localized

Size Large SmallLocalization Diffuse borders Wellcircumscribed

Palpation Doughy to indurated Fluctuant

Presence of pus No YesDegree of seriousness Greater Less

Bacteria Aerobic Anaerobic


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ANATOMIC SPACEINVOLVEMENT

Primary maxillary spaces

-Canine

-Buccal

-Infratemporal

Primary mandibular spaces

-Submental

-Buccal

-Submandibular-Sublingual


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Canine space infectionCanine space infection


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Buccal space infectionBuccal space infection


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Submandibular space infection


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Secondary fascial spaces

Masseteric

Pterygomandibular

Superficial and deep

temporal

Lateral pharyngeal

Retropharyngeal

Prevertebral


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Factors affecting spreadFactors affecting spreadof infection:of infection:general factors:general factors:

-- host resistance.host resistance.

--virulence of micro organismvirulence of micro organism

--number of micro organismnumber of micro organism

Rate of spread of infection =Rate of spread of infection =(virulence X no./host resistance)(virulence X no./host resistance)


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local factors:local factors:

--The thickness of the boneThe thickness of the bone

overlying the apex of the tooth.overlying the apex of the tooth.

--The relationship of the site ofThe relationship of the site ofperforation bone to muscleperforation bone to muscle

attachment of the mandible &attachment of the mandible &

maxilla.maxilla.


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AssessementAssessement

Identify cause

DetermineseverityEvaluate host defenses

General practitioner / specialist


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I-Identify cause

Caries

Periodontitis

Pericoronitis

Tooth tenderness

Tooth mobilityVestibular swelling


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II-Determine severity

-Complete history

Chief complaint

Time of onset

Change in symptoms

Elicit symptomsClinical signs: Dolor, tumor, calor, rubor,

and functio laesa


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-Vital signs

-Local involvementExtent and rate of progressionInvolved spaces

Trismus

Airway

Vital structures


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-Systemic involvement

MalaisePyrexia

Other signs


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III-Compromised Host Defenses Uncontrolled metabolic diseases

Uremia

Alcoholism

Malnutrition

Severe diabetes

Suppressing diseases

Leukemia

Lymphoma

-Malignant tumors

-Suppressing drugsChemotherapeutic agents

Immunosuppressives


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IV- Criteria for Referral to a Specialist:

Rapidly progressing infection

Difficulty breathing

Difficulty swallowing

Fascial space involvement

Elevated temperature (greater than 101F)

Severe trismus (less than 10 mm)

Toxic appearance

Compromised host defenses


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MnagementMnagement

Obtain drainage

Maintain drainage

Remove the cause

Provide supportive

care


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Obtain drainage

Pus must be drained

Adequate access

Blunt dissection

All loculations entered

Intra -oral and / or

extra -oral


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Obtain drainageObtain drainage


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Maintain drainage

All involved spaces

Dependent drainage

Insertion of drain

Maintenance of

patency

Slow advancement


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Provide supportive care

General

FluidsRest

Nutrition

Warmth Antibiotic therapy


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Principles of antibiotic usePrinciples of antibiotic use

II-- Determine need for antibiotic adminestration:Determine need for antibiotic adminestration:

* Indications for use of antibiotics:* Indications for use of antibiotics:

--Rapidly progressive swelling.Rapidly progressive swelling.

--Diffuse swelling.Diffuse swelling.--Compromised host defenses.Compromised host defenses.

--Involvement of fascial spaces.Involvement of fascial spaces.

--Severe pericoronitis.Severe pericoronitis.--Osteomylitis.Osteomylitis.


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* Situations in which use of antibiotics is not* Situations in which use of antibiotics is not

necessary:necessary:

--Chronic wellChronic well--localized abscess.localized abscess.--Minor vestibular abscess.Minor vestibular abscess.

--Dry socket.Dry socket.

--Mild pericornitis.Mild pericornitis.


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IIII-- Use emprical therapy routinely:Use emprical therapy routinely:

* Indications for culture and sensitivity* Indications for culture and sensitivitytesting:testing:

--Rapidly spreading infection.Rapidly spreading infection.

--PostPost--operative infection.operative infection.

--Nonresponsive infection.Nonresponsive infection.

--Compromised host defenses.Compromised host defenses.


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III Narrow spectrum

IV Low toxicity

V Bacteriocidal

VI Administer

properly

VII Cost


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Ludwigs anginaLudwigs angina

Definition:Definition:

Bilateral swelling of theBilateral swelling of the

subingual, submandibular,subingual, submandibular,

and submental spaces.and submental spaces.


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Osteomyelitis of the jawsOsteomyelitis of the jaws

Definition:Definition:Osteomyelitis is an inflammatory condition of bone involving theOsteomyelitis is an inflammatory condition of bone involving the

medullary cavity, the haversian system, and the adjacent cortex.medullary cavity, the haversian system, and the adjacent cortex.

Classification:Classification:Acute suppurative osteomyelitis.Acute suppurative osteomyelitis.

Chronic suppurative osteomyelitis.Chronic suppurative osteomyelitis.

Chronic sclerosing osteomyelitis:Chronic sclerosing osteomyelitis:

--diffuse.diffuse. --focal.focal.

Chronic osteomyelitis with proliferative periostitis.Chronic osteomyelitis with proliferative periostitis.

odontogenic infection 1

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