Chapter 1 - Odontogenic Infection PDF

Dr Hussein Abdel Motelep khalil Lecturer of oral and maxillofacial Surgery, Sinai University Kantara Odontogenic infection  Definitions Infection: The invasion of the body by micro-organisms producing disease. Odontogenic: Caused by teeth. An odontogenic infecti...

Dr Hussein Abdel Motelep khalil Lecturer of oral and maxillofacial Surgery, Sinai University Kantara Odontogenic infection  Definitions Infection: The invasion of the body by micro-organisms producing disease. Odontogenic: Caused by teeth. An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues  The germs (micro-organisms) may be bacteria, fungi, viruses, or other microorganisms. Exp, of other microorganisms : transmissible spongiform encephalopathy is caused by prions, abnormally folded proteins, that build up in the brain causing brain damage produce the disease.  Inflammation is a protective body response to harmful stimuli, such as pathogens, involving molecular mediators, blood vessels, and immune cells.  5 cardinal signs of inflammation Hotness Redness Swelling Pain and loss of function.  Types of inflammation Acute: rapid progressive response with typical signs and symptoms Subacute: considered transition from between chronic and acute. Chronic: prolonged course with mild signs and symptoms Pathogenesis of odontogenic infection Dental Abscess  Causes of Dental Abscess A dental caries periodontal disease and Poor oral hygiene An injury caused to the tooth (trauma) A cracked tooth gum surgery Immune-compromised patients, such as diabetes, and those having treatment, including steroid medication, chemotherapy, etc.  Dental Abscess Symptoms Sharp pain in the affected tooth that may come on suddenly and gradually worsen Pain that has spread to the jaw, ear, and neck Pain that’s worse when lying down Sensitivity to hot or cold food and drinks An unpleasant taste in the mouth Difficulty in eating and swallowing.  Treatments for dental abscess Dental abscesses are treated by removing the source of the infection and draining away the pus. If the tooth can be restored, root canal therapy can be performed. Non-restorable teeth must be extracted, followed by curettage of all apical soft tissue. Supportive antibiotic medication Pericoronal infection  The operculum: The soft tissue covering a partially erupted tooth, an area which can be difficult to access with normal oral hygiene methods. Operculitis technically refers to inflammation of the operculum alone. Pericoronitis is inflammation of the soft tissues surrounding the crown of a partial erupted tooth, including the gingiva (gums) and the dental follicle.  Causes of pericoronitis Food impaction Trauma from opposing tooth Virulent micro-organisms Low body immunity  Treatment of pericoronitis Removal of the cause  Gentle irrigation with saline solution to remove impacted food debri. (hydrogen peroxide)  Smoothening of the opposing tooth or even extract it. Drainage of the pus Antibiotic supportive treatment Then after acute inflammation subsides, definitive treatment include Removal of impacted tooth. (remove operculum?).  MICROBIOLOGY of odontogenic infection. Mixed infection of aerobic and non aerobic bacteria. Example: Aerobic gram positive cocci bacteria- (streptococci milleri, strep. Sanguis, strep. Salivarius, strep. Mutans. strep/.Viridans). Anaerobic Cocci-p Bacteriodes-porphyromonas, prevotella  Spread of infection Cellulitis: spread of infection into loose CT. Suppurative infection: characterized by pus formation.  cellulitis Edematous spread of acute inflammatory process NOT able to establish drainage through the surface of skin or into oral cavity. may spread diffusely through facial planes of soft tissue Suppurative infection Spread of infection to tissue spaces  Factors affecting spread of infection Virulence of micro-organism Immunity of the patient Anatomical landmarks that affect direction of spread  source of infection site Break point at which pus escape Anatomical barriers (muscles and fascia). Buccal space  Management of odontogenic infection 1- Removal of the cause end of the infection 2- Incision and drainage ( never let sun set on pus) 3- supportive treatment (antibiotic- anti inflammatory analgesic).  Removal of the cause If the tooth can be restored, root canal therapy can be performed. Non-restorable teeth must be extracted, followed by curettage of all apical soft tissue using surgical curette.  Incision and drainge Incision and drainage are minor surgical procedures to release pus or pressure built up under the skin or mucous membrane, such as from an abscess, boil, or tissue space infection. abbreviated as "I&D" or "IND  Principles of incision and drainage Incision must be in healthy skin or mucous membrane (not in the pointing area) Esthetically accepted area as possible Avoid injury to facial nerve. Involve only skin and subcutaneous layer the blunt dissection to deep layers. Drain should be used after evacuation of pus Wound margin should be cleaned daily to remove debris and clots Sample of pus is sent to lab, for antibiotic senstivity test.  Methods of drainage Through: Root canal Extracted socket Fenestration in bone Through incision  The drain Purpose 1- keep the incision patent 2- allow discharge pus to get out 3- allow for irrigatiom  Types of drain 1- corrugated ‫الحصيره‬ 2- penrose 3- vacuum 4- simple gauze 1- corrugated drain 2- penrose 3- vacuum drain  Medications 1. hydration 2. Soft diet 3. Analgesic 4. Antibiotic 5. Maintain oral hygiene  Guides to use antibiotics 1- determine the causative organism 2- antibiotic sensitivity test 3-use Least toxic antibiotic Usually use bactericidal better tha bacteriostatic Cost factor 4- prescribe proper dose for adequate length.  Indications for combination of antibiotic 1- virulent micro-organism and increase spread of infection 2- fear of develop bacterial resistance 3- to gain bactericidal effect 4- increase antibiotic spectrum.  Causes of failure of antibiotic 1- improper type of antibiotic 2- improper dose or duration 3- decrease patient immunity 4- presence of foreign body 5- improper surgical management.  Fatal (life threaten condition). Ludwig's angina Cause by : 1- dental infection 90% 2-fracture mandible 3- submandibular gland infection 4- cut or piercing inside the mouth  is a type of severe cellulites involving the floor of the mouth[and is often caused by bacterial sources. floor of the mouth raises due to swelling, leading to difficulty swallowing saliva. As a result, patients may present with difficulty speaking and drooling. As the condition worsens, the airway may be compromised and hardening of the spaces on both sides of the tongue may develop. Overall, this condition has a rapid onset over a few hours.  Management of Ludwig's Angina There are four principles that guide the treatment of Ludwig's Angina: 1. Sufficient airway management, 2. early and aggressive antibiotic therapy, 3. incision and drainage 4. and adequate nutrition and hydration support. Air way tracheostomy