Lecture 09: Odontogenic Infections

Question 1

How does inflammation damage the pulp?

Answer 1

it inc pulpal pressure which compromises blood flow resulting in tissue damage. if there is irreversible tissue damage it could lead to pulpal necrosis

Question 2

what is a common cause of inflammation and necrosis?

Answer 2

direct access of bacteria due to trauma (BACTERIA INFECTION)

• easier for bacteria to enter damaged teeth (cracks and fissures)
• infections happen quickly if pulps are not mechanically sealed

Question 3

how can bacteria get to the pulp and cause inflammation?

Answer 3

• via dental tubules from caries

- travel from bloodstream (anachoresis)(unlikely)

Question 4

in a non-vital tooth, how long does it take for infection to occur?

Answer 4

perhaps years (depends on bacterial access to pulp)
(since pulp non vital immune system is not working and bacteria grow once they arrive)

Question 5

what is absolutely necessary for pulpal and periapical diseases to occur?

Answer 5

BACTERIA!

• if no bacteria, tooth makes reparative dentin
• good seal is critical for success of pulpal therapy

Question 6

endodontic infections are what type of bacterial infections?

Answer 6

mixed bacterial infections

*bacterial symbiosis occurs— some species may not survive without the others

Question 7

an early stage endodontic infection in which the tooth is compromised by inflammation. the extent of bacterial growth is unclear and it can be reversed if treated early enough

Answer 7

pulpitis

Question 8

what signals the shift to irreversible status of inflammation and eventual pulpal necrosis in pulpitis?

Answer 8

onset of spontaneous pain

*can be quite severe, sharp, throbbing

Question 9

most bacteria that are cultured from necrotic pulps are what?

Answer 9

mostly anaerobic gram negative bacilli

*makes sense bc there is no O2 or sugar in the pulp

Question 10

these two species are responsible for periodical abscesses and are known for having a very foul odor

Answer 10

• prevotella

- porphyromonas

Question 11

as the pulp becomes necrotic, immune cells can’t enter necrotic root due to the lack of ______ and the inflammatory response shifts to the ______

Answer 11

• blood supply

- periapical tissues

Question 12

what happens in periodical lesions to keep the infection from spreading and becoming systemic?

Answer 12

bone resorption

*allows space for barrier of inflammatory cells to accumulate

Question 13

periapical lesions are often _____

Answer 13

asymptomatic and only detected on radiographs

Question 14

acute exacerbation of periapical lesion that is confined to bone at apex. it deals with pus and is very painful. tooth is sensitive to pressure with dull, aching pain

Answer 14

acute dentoalveolar (periapical) abscess

*drainage of pus brings relief (either via extraction or root canal)

Question 15

what are the two ways of treating pulpal and periapical diseases?

Answer 15

• pallative- relieve symptoms (antibiotics/anesthetics)

- definitive- ridding pt of cause of infection (extraction/root canal)

Question 16

when do persistent apical lesions occur?

Answer 16

after root canal treatment

*biofilm, debris, or foreign body is still present

Question 17

what is the treatment of a persistent apical lesion?

Answer 17

endodontic microsurgery

• clean apex of bacteria and necrotic tissue
• apex is removed, then sealed

Question 18

occurs when the infection spreads through soft tissues via vascular channels or direct autolysis of tissue. tissue is HARD and swollen

Answer 18

cellulitis

• if in lower face then almost always dental related
• in upper face they are dental related half the time

Question 19

what is important about abscesses?

Answer 19

they will not resolve on their own… need drainage

Question 20

when dental infections spread to surrounding tissues they are called what?

Answer 20

odontogenic infections

• range from alveolar area to systemic infections
• when they spread, the usual course is through cellulitis
• areas of abscess and necrosis might form secondarily to cellulitis

Question 21

cellulitis might proceed to form what?

Answer 21

abscess (pus pocket)

• O2 levels low
• will be able to move it much easier than cellulitis

Question 22

what is the treatment for cellulitis?

Answer 22

• managed temporarily with antibiotic therapy
• resolved quickly if source of infection is removed
• may require antibiotics even after extraction

Question 23

what is the treatment of abscesses?

Answer 23

• tooth extraction or root canal should provide drainage

- if not, surgical incision is required

Question 24

what are two common antibiotics for the treatment of odontogenic infections?

Answer 24

clindamycin and penicillin

Question 25

disease characterized by premature breakdown of fibrin clot exposing bone and bioflim formation on bone surface. throbbing pain and bad odor and taste

Answer 25

alveolar osteitis (dry socket)

Question 26

how is alveolar osteitis (dry sockets) treated?

Answer 26

gentle debridement with medicated dressing

*systemic antibiotics will NOT work

Question 27

what are the three types of bone infections ?

Answer 27

• alveolar osteitis
• osteomyelitis of the jaw
• medication-induced osteonecrosis of the jaw (MRONJ)

Question 28

disease characterized by the spread of odontogenic or periodontal infection to the jaw bone. may show fever and have pus

Answer 28

osteomyelitis of the jaw

Question 29

what is the typical treatment of osetomyelitis of the jaw?

Answer 29

surgical debridement and longterm antibiotic therapy

Question 30

disease characterized by exposed bone that does not heal that is commonly associated with cancer treatment or after dental extraction

Answer 30

medication-induced osetonecrosis of the jaw (MRONJ)
*rare, less that 2% of population has it

*NOT REPORTED IN CHILDREN

Question 31

why does MRONJ happen in cancer patients?

Answer 31

• bc they are often taking antiresorptive agents that inhibit osteoclasts and bone remodeling
• they are also taking antiangiogenic agents that inhibit blood vessel formation in tumors
• immunity compromised by chemotherapy

Question 32

how to treat MRONJ?

Answer 32

• remove biofilm by debridement
• systemic antibiotics ineffective
• stop taking anti-resorptive drugs (BISPHOPHONATES)