ODONTOGENIC INFECTIONS OF THE MAXILLO FACIAL & NECK REGION

ETIOLOGY
1. Pulp disease. 2. Periodontal disease. 3. Secondarily infected cysts or odontomes. 4. Remaining root fragment. 5. Residual infection. 6. Pericoronal infection.

Bacteriology
Aerobic 7%
G +ve Cocci ( Strep, Staph) & G-ve cocci (Neisseria) G +ve rods (Corny ) & G-ve rods

Anaerobic 33%
G +ve Cocci ( Strep, Pseudo strep) & G-ve cocci(veiollonela) G +ve rods (Lacto, Actino ) & G-ve rods (Bacteriodes)

Mixed 60%

TYPES
ACUTE In the acute stage infection may remain intra bony or spread into soft tissues in following clinical forms: 1. Abscess:
1.Circumscribed collection of pus in a pathological tissue space. 2.Thick walled cavity containing pus. 3.Aerobes & anaerobes--- large accumulation of pus--- pointing & drainage.

Abscess

2. Cellulitis:
1.This is spreading infection of loose CT. 1.It is a diffuse, erythematous, mucosal or cutaneous infection. 2.It is result of streptococci & does not result in large accumulation of pus. 3.Streptococci produce streptokinase, hyaluronidase.

3.Fulminating infections:
1.Spread of infection in various primary spaces in the orofacial region. 2.Here secondary spaces along the pathway of least resistance are involved. 3.Spread of deep cervical spaces and beyond.

Acute Peri Apical Abscess1

This is due to vascular dilatation, an exudate of neutrophil leucocytes & oedema in the peri apical region.

It is due to persistent irritation from chronic pulp or acute virulent infection, or less host resistance.

Etiology

Acute Peri Apical Abscess

Infective necrosis of pulp Caries. Traumatic exposure. Traumatic necrosis

Blow on teeth.

Mechanical & Chemical

CLINICAL FEATURES
Acute Peri Apical Abscess

1- History of previous pulpitis. 2- Carious or heavily filled tooth. 3- Tender and felt extruded in socket. 4- When pus has formed severe throbbing pain 5- sensitive to percussion. 6- Over lying gum may or may not be swollen

TREATMENT
Acute Peri Apical Abscess

Antibiotics ,Analgesics & Drainage through

pulp chamber.

Extraction or endodontic treatment.

Acute Dento Alveolar Abscess

When pus does not remain confined to the peri apical region.
It perforates the cortex and comes to lie under periosteum--- SUB PERIOSTEAL ABSCESS. The perforating abscess come into the soft tissues then called as ACUTE DENTOALVEOLAR ABSCESS

CLINICAL FEATURES
Acute Dento Alveolar Abscess Pain depend on the stage of disease. Sub mucosal swelling (Intra Oral). Facial swelling (extra Oral). Fluctuation may come after few days.

If untreated may point or burst producing a discharging sinus.

Radiographic features
Acute Dento Alveolar Abscess

Little informative in acute phase except little widening of periodontal ligament. But previous pathology if present will be seen.

Treatment
Acute Dento Alveolar Abscess

Same i.e. endo- or ext-.

Intra or extra oral drainage

CHRONIC PERI APICAL PERIODONTITIS

1

When the irritation in the peri apical tissues persists either due to,
incomplete resolution In complete treatment of acute periodontitis or pulpitis leading to necrotic pulp a forgotten blow or massive fillings or unsuccessful R.C.T lead to chronic periodontitis.

This goes on painlessly and become chronic

Skin Sinus Due Chronic infection from deciduous molar

FACIAL SPACE INFECTION

Fascialined areas-- potential spaces that do not exist in healthy persons. Filled by pus or exudation during infection. Neurovascular structure - compartments. Loose areolar CT------ Clefts

Primary facial spaces

Primary spaces are adjacent to tooth bearing area & are directly involved by infection.
Primary maxillary spaces.
Canine Buccal Infratemporal.

Primary mandibular spaces.

Submental. Buccal. Submandibular. Sublingual.

Secondary spaces
MASTICATORY SPACES Masseteric. Pterygomandibular. Superficial & deep temporal.

CERVICAL SPACES

Lateral pharyngeal Retropharyngeal Prevertebral

High Risk Infections or Lethal complications

Orbital & peri orbital cellulitis. Cavernous sinus thrombosis Ludwigs angina Cervical cellulitis ( Lung Abscess & Mediastinitis)

Orbital & Periorbital cellulitis

Cavernous Sinus Thrombosis

LUDWIG S ANGINA

Cervical Cellulitis

Principles of management
Determine the severity of infection Evaluate the state of patients host defense mechanism

Determine , whether treated by GDP or refer to specialist Appropriate antibiotic & their proper administration Treat infection surgically Diet & i-v fluids Evaluate pts frequently

Surgical Management