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ETIOLOGY1
General classification:
Odontogenic:
Pulp disease. Periodontal disease. Secondarily infected cysts or odontomes. Remaining root fragment. Residual infection. Pericoronal infection.
Traumatic:
Penetrating soft & hard tissue wounds.
Odontogenic infections1
Acute. Chronic. 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.It is a thick walled cavity containing pus. 3.Suppurative infections characteristic of staphylococci & anaerobes--- large accumulation of pus--- pointing & drainage.
Abscess
Odontogenic infections2
2.Cellulitis.
1.This is spreading infection of loose CT. 2.It is a diffuse, erythematous, mucosal or cutaneous infection. 3.It is result of streptococci & does not result in large accumulation of pus. 4.Streptococci produce streptokinase (fibrinolysin), hyaluronidase & streptodornase. 5.These break down fibrin & CT ground substance and lyse cellular debris, thus spread of exudation along the tissue planes.
Cellulitis
Odontogenic infections3
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.
Clinical features:
History of previous pulpitis. Carious or heavily filled tooth.
When the irritation in the peri apical tissues persists either due incomplete resolution or treatment of acute periodontitis or pulpitis leading to necrotic pulp or a forgotten blow or massive fillings or unsuccessful R.C.T lead to chronic periodontitis. This goes on painlessly and chronic
periodontitis converts in to granulation tissue, which grows and causes the resorption of surrounding bone by the initiation of osteoclastosis and become separated from the surrounding bone by a layer of collagen. This lesion is called the DENTAL GRANULOMA.
SIGNS AND SYMPTOMS Usually no symptoms and it is chance finding on routine X-rays. Involved tooth is discolored and non-vital. Some times there is mild discomfort or intermittent pain, tooth may be slightly tender to percussion and over lying gum tissues opposite tooth apex may also
tender to touch. If pus has formed in side the granuloma (Central Abscess) there will be local tissue swelling and pus may penetrate the tissues forming chronic discharging sinus. In long standing cases pus may track to the skin forming extra-oral skin sinus.
PATHOLOGY It is the typical chronic inflammatory reaction that is infiltration of Lymphocytes, Plasma cells and Macrophages.
RADIOGRAPHY There is well circumscribed radiolucent area around the apex and is due to the resorption of bone around the granuloma. This is usually with in the limits of 5mm. More than 5mm and if out line is sharply defined than cyst is forming but is always confirmed by histopathology.
BACTERIOLOGY Some granulomas are sterile but bacteria can be cultured from many and mixed infection is the rule.
Dental granuloma grows symptomlessly causing resorption of bone or the root apex Central abscess formation chronic sinus or track to the skin to form the Skin sinus. Acute exacerbation
Maxillary teeth
Molars
PALATAL ABSCESS BUCCAL VESTIBULAR/ SULCULAR ABSCESS FACIAL SWELLING OR ABSESS which may lead to cellilitis.
Cellulitis from maxillary teeth cause swelling of upper half of face direction towards eye may cause dangerous complication CAVERNOUS SINUS THROMBOSIS.
Usually odontogenic infection remained confined in the peri apical area or periodontal pockets. Peri apical infections may perforate cortex and form local abscess or spread intra medullary chronic infection or focal osteomyelitis.
FACIAL SPACES
Fascialined areas-- potential spaces that do not exist in healthy persons. They become filled by pus or exudation during infection. Some contain neurovascular structure compartments. Others filled with loose areolar CT-- Clefts
Masseteric. Pterygomandibular. Superficial & deep temporal. This group is also known as the MASTICATOR SPACE because muscle & fascia of mastication bound them.
When bilateral submandibular, sublingual & submental spaces become involved --- Ludwig's angina. It is a rapidly spreading cellulitis and commonly spread to secondary mandibular spaces. This usually produce life threatening condition.
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
MANAGEMENT
Proper diagnosis. Antibiotics. Other Adjuncts. I&D