INFECTION

EVALUATE THE STATE OF THE PATIENTS HOST DEFENSE MECHANISMS

A. Review of host defense mechanism B. Medical condition that compromise host defense

A. HOST DEFENSE MECHANISMS

LOCAL DEFENSES Intact anatomic barrier Indigenous bacteria HUMORAL DEFENSES Immunoglobulins Complement CELLULAR DEFENSES Phagocytes Granulocytes Monocytes Lymphocytes

B. COMPROMISED HOST DEFENSES

UNCONTROLLED METABOLIC DISEASES Uremia Alcoholism Malnutrition Severe diabetes SUPPRESSING DISEASES Leukemia Lymphoma SUPPRESSING DRUGS Cancer chemotherapeutic agents Immunosuppressive

INTACT ANATOMIC BARRIER

Intact skin Intact mucosa

BREACHES ANATOMIC BARRIER

Surgical incisions Deep periodontal pockets Necrotic Dental pulps

INDIGENOUS BACTERIA
Usually live in harmony Usually do not cause disease When normal bacteria are lost or altered will cause disease

DIFFERENCES BETWEEN CELLULITIS & ABSCESS

CHARACTERISTIC
Duration Pain Size Localization (peripheral definition) Palpation (texture) Presence of pus Degree of seriousness (potential danger) Bacteria

CELLULITIS
Acute Severe & Generalized Large Diffuse border Doughy to indurated NO Greater Aerobic

ABSCESS Chronic Localized Small Wellcircumscribed Fluctuant YES Less Anaerobic

continued..

DIFFERENCES BETWEEN CELLULITIS & ABSCESS

CRITERIA FOR REFERRAL TO A SPECIALIST

Difficulty in breathing Rapidly progressive infection Difficulty in swallowing Fascial space involvement

Continued.

CRITERIA FOR REFERRAL TO A SPECIALIST

Elevated temperature (greater than 38C) Severe jaw trismus (less than 10 mm) Toxic appearance Compromised host defenses

INDICATIONS FOR USE OF ANTIBIOTICS

Acute-onset infection Diffuse swelling Compromised host defenses Involvement of fascial spaces Severe pericoronitis OSTEOMYELITIS

SITUATIONS IN WHICH USE OF ANTIBIOTICS IS NOT NECESSARY

Chronic well-localized abscess

Minor vestibular abscess

Continued

SITUATIONS IN WHICH USE OF ANTIBIOTICS IS NOT NECESSARY

Dry socket Root canal sterilization Mild pericoronitis

EFFECTIVE ORALLY ADMINISTERED ANTIBIOTICS USEFUL FOR ODONTOGENIC INFECTIONS o Penicillin o Erythromycin o Clindamycin

Continued.

EFFECTIVE ORALLY ADMINISTERED ANTIBIOTICS USEFUL FOR ODONTOGENIC INFECTIONS o o o o Cephalexin Cefaclor Metronidazole Tetracycline

INDICATIONS FOR CULTURE AND ANTIBIOTIC SENSITIVITY TESTING

Rapidly spreading infection Post operative infection Non responsive infection Recurrent infection
Continued.

INDICATIONS FOR CULTURE AND ANTIBIOTIC SENSITIVITY TESTING

Compromised host defenses Osteomyelitis Suspected actinomycosis

REASONS FOR TREATMENT FAILURE

Inadequate surgery Depressed host defenses Foreign body

Continued.

REASONS FOR TREATMENT FAILURE

Antibiotic problems : - patient non compliance - drug not reaching site - drug dosage too low - wrong bacterial diagnosis - wrong antibiotic

ADVANTAGES OF APPROPRIATE PROPHYLACTIC ANTIBIOTIC USE Reduces incidence of infection Reduces health care costs Reduces total antibiotic usage Allows fewer resistant bacteria

DISADVANTAGES OF APPROPRIATE PROPHYLACTIC ANTIBIOTIC USE

Alters host flora May be of no benefit May encourage lax surgery

PRINCIPLES OF PROPHYLACTIC ANTIBIOTIC USE

Risk of infection must be significant Choose correct antibiotic Antibiotic level must be high Time the antibiotic correctly Use shortest effective antibiotic exposure

FACTORS RELATED TO POSTOPERATIVE INFECTION

Size of bacterial inoculum Extend and time of surgery Presence of foreign body State of host resistance

FACTORS NECESSARY FOR METASTATIC INFECTION

Distant susceptible site Hematogenous bacterial seeding Impaired local defenses

continued..

FACTORS NECESSARY FOR METASTATIC INFECTION

Hematogenous bacterial seeding

CARDIAC VALVULAR LESIONS THAT MAY PREDISPOSE TOWARD ENDOCARDITIS

Prosthetic heart valve Most congenital heart malformations Rheumatic valve disease Degenerative valve disease
Continued.

CARDIAC VALVULAR LESIONS THAT MAY PREDISPOSE TOWARD ENDOCARDITIS

Idiopathic hypertrophic subaorthic

stenosis Mitral valve prolapse with insufficiency Previous episode of bacterial endocarditis

DENTAL PROSEDURES THAT REQUIRE ENDOCARDITIS PROPHYLAXIS

Tooth extraction Periodontal surgery Subgingival dental prophylaxis Endodontic surgery Incision and drainage of infections

DENTAL PROSEDURES THAT DO NOT REQUIRE ENDOCARDITIS PROPHYLAXIS

Supragingival prophylaxis Restorative tooth preparation Placement of orthodontic appliances Conservative endodontic therapy

ANTIBIOTIC REGIMEN FOR PROPHYLAXIS OF TOTAL JOINT REPLACEMENT INFECTION

STANDARD RECOMMENDATION 1. Cephalosporin (cefadroxil preferred) Pre operatively : 500 mg orally 1 hr before surgery Post operatively : 250 mg orally 6 hr after initial dose
OR 2. Clindamycin (penicillin-allergic patients) Pre operatively : 300 mg orally 1 hr before surgery Post operatively : 150 mg orally 6 hr after initial dose

SPACES INVOLVED IN ODONTOGENIC INFECTION

Primary maxillary spaces Canine Buccal Infra temporal

Primary mandibular spaces Submental Buccal Submandibular Sublingual

Secondary fascial spaces Masseteric Pterygomandibular Superficial and deep temporal Lateral pharyngeal Retropharyngeal Prevertebral

SPACES INVOLVED IN ODONTOGENIC INFECTIONS

Primary Maxillary Spaces Caninus Buccal Infratemporal

SPACES INVOLVED IN ODONTOGENIC INFECTIONS

Primary Mandibular Spaces Submental Buccal Submandibular Sublingual
Continued.

Buccal Space

Sublingual Space

Sublingual Space

Submandibular Space

SPACES INVOLVEMENT IN ODONTOGENIC INFECTION

Secondary Mandibular Spaces

Masseteric Pterygomandibular Superficial and deep temporal Lateral pharyngeal Retropharyngeal Prevertebral
Continued.

SPACES INVOLVEMENT IN ODONTOGENIC INFECTION

Secondary Mandibular Spaces

Continued.

SPACES INVOLVEMENT IN ODONTOGENIC INFECTION Secondary Mandibular Spaces

Lateral pharyngeal

Continued.

SPACES INVOLVEMENT IN ODONTOGENIC INFECTION

Secondary

Mandibular Spaces
Retropharyngeal

Continued.

COMPLEX ODONTOGENIC INFECTION

I. Fascial space infection A.Maxillary spaces B.Mandibular spaces C.Secondary fascial spaces D.Cervical fascial spaces E.Management of fascial space infections II. Osteomyelitis III. Actinomycosis IV. Candidosis Continued.

COMPLEX ODONTOGENIC INFECTION

II. Osteomyelitis

Continued.

COMPLEX ODONTOGENIC INFECTION

III. Actinomycosis

Continued.

COMPLEX ODONTOGENIC INFECTION

IV. Candidosis

The End