odontogenic infections
TRANSCRIPT
Odontogenic Infections
Dr. Rida F. WaseemBDS,
DemonstratorDepartment of Oral Surgery
IOD, CMH
Objectives
By the end of this lecture the students should be able to: • Describe the sequelae of odontogenic
infections.• Describe the spread of odontogenic
infections to primary, secondary and distant spaces.
• Diagnose a patient with odontogenic infections.
An odontogenic infection is an acute or chronic infection
originating from a tooth related pathology.
Periapical
Pericoronal
Periodontal
Sequelae of Pulpitis
Routes of Spread
1) Localized Soft Tissue Abscess
or
2) Diffused widespread Cellulitis
What will it depend on?
Number of Microorganisms Virulence of Microorganisms Host Defense In a healthy patient spread is localized and
drained to the buccal or lingual cortex In an immune compromised patient spread is
diffused and spreads to the bone osteomyelitis
Enzymes responsible for
connective tissue degradation
• Hyaluronidase (Produced by aerobes; causes cellulitis and lowers the pH)
• Collagenase (Produced by anaerobes; cause liquefactive necrosis; pus)
Spread of infection takes the path of
least resistance in the tissues.
In the connective
tissue spaces (potential)
Between the bone and
periosteum
Spaces between the
muscle layers
Fascial SpacesPrimary Secondary
• Vestibular • Buccal• Canine• Infratemporal
Maxillary
• Vestibular• Submental• Submandibular• Sublingual
Mandibular
Massetric space
Superficial and Deep temporal spaces
Pterygomandibular space
Carotid sheath space
Lateral pharyngeal space
Retropharyngeal Space
Spaces
Primary
• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatal o Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Spaces
Primary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibularo Submentalo Submandibularo Sublingual
Mylohyoid Line
Ludwig’s Angina
Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
Spaces
Secondary
• Massetric space• Superficial and Deep
temporal spaces• Pterygomandibular
space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
SpacesSecondary• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal space• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Space
Fascial SpacesPrimary Secondary
•Vestibular /Palatal•Buccal•Canine•Infratemporal
Maxillar
y
•Vestibular•Submental•Submandibular•Sublingual
Mandibular
Massetric space
Superficial and Deep temporal spaces
Pterygomandibular space
Carotid sheath space
Lateral pharyngeal space
Retropharyngeal Space
Spaces
Primary Secondary
• Maxillaryo Vestibular/Palatalo Buccalo Canineo Infratemporal
• Mandibularo Vestibular o Submentalo Submandibularo Sublingual
• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal spaces• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Spaces
Primary Secondary
• Maxillaryo Vestibularo Buccalo Canineo Infratemporal
• Mandibularo Submentalo Submandibularo Sublingual
• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal spaces• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Spaces
Primary Secondary
• Maxillaryo Vestibularo Buccalo Canineo Infratemporal
• Mandibularo Submentalo Submandibularo Sublingual
• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal spaces• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Spaces
Primary Secondary• Maxillary
o Vestibularo Buccalo Canineo Infratemporal
• Mandibularo Submentalo Submandibularo Sublingual
• Massetric space• Pterygomandibular
space• Superficial and Deep
temporal spaces• Carotid sheath space • Lateral pharyngeal
space• Retropharyngeal
Distant Spread of Odontogenic Infections
• Maxillary Sinus• Orbit • Danger space• Mediastinum
Direct Spread
• Cavernous Sinus• Endocardium• Joints
Haematogenous Spread
Cavernous Sinus
Prophylaxis Against
Infectious Endocarditis-60 min before
Situation Agent Adults Children
Oral Amoxicillin 2g 50mg/kg
Parenteral Ampicillin 2g IM/IV 50mg/kg IM/IV
Cefazolin/ceftriaxone
1g IM/IV 50mg/kg IM/IV
Penicillin allergy, Oral
ClindamycinAzithromyci/Clarithromycin
600mg500mg
20mg/kg15mg/kg
Penicillin allergy, Parentral
Clindamycin 600mg IM/IV 20mg/kg IM/IV
Clinical FeaturesSwelling (IO and/or
EO)
Redness
Fever and malaise
Trismus
Lymphadenopathy
Dehydration
Dyspnea
Dysphagia
Investigations
Detailed History
Dental
Medical
Clinical Examinati
on
Radiographs
IOPA
OPG
CT Scan
Culture and
Sensitivity
Treatment OptionsMedical Surgical
• Empirical Oral antibiotics/IV antibiotics
• Pain medication• Hydration• Nutrition• Control any systemic
disease
• Remove the dental cause (RCT/debridement/extraction)
• Incision and drainage(IO/EO)
• Follow up
ObjectivesBy the end of this lecture the students should be able to: • Describe the sequelae of odontogenic
infections.• Describe the spread of odontogenic
infections to primary, secondary and distant spaces.
• Diagnose a patient with odontogenic infections
QUESTIONS?