Lecture 09: Odontogenic Infections Flashcards
How does inflammation damage the pulp?
it inc pulpal pressure which compromises blood flow resulting in tissue damage. if there is irreversible tissue damage it could lead to pulpal necrosis
what is a common cause of inflammation and necrosis?
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
how can bacteria get to the pulp and cause inflammation?
- via dental tubules from caries
- travel from bloodstream (anachoresis)(unlikely)
in a non-vital tooth, how long does it take for infection to occur?
perhaps years (depends on bacterial access to pulp) (since pulp non vital immune system is not working and bacteria grow once they arrive)
what is absolutely necessary for pulpal and periapical diseases to occur?
BACTERIA!
- if no bacteria, tooth makes reparative dentin
- good seal is critical for success of pulpal therapy
endodontic infections are what type of bacterial infections?
mixed bacterial infections
*bacterial symbiosis occurs— some species may not survive without the others
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
pulpitis
what signals the shift to irreversible status of inflammation and eventual pulpal necrosis in pulpitis?
onset of spontaneous pain
*can be quite severe, sharp, throbbing
most bacteria that are cultured from necrotic pulps are what?
mostly anaerobic gram negative bacilli
*makes sense bc there is no O2 or sugar in the pulp
these two species are responsible for periodical abscesses and are known for having a very foul odor
- prevotella
- porphyromonas
as the pulp becomes necrotic, immune cells can’t enter necrotic root due to the lack of ______ and the inflammatory response shifts to the ______
- blood supply
- periapical tissues
what happens in periodical lesions to keep the infection from spreading and becoming systemic?
bone resorption
*allows space for barrier of inflammatory cells to accumulate
periapical lesions are often _____
asymptomatic and only detected on radiographs
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
acute dentoalveolar (periapical) abscess
*drainage of pus brings relief (either via extraction or root canal)
what are the two ways of treating pulpal and periapical diseases?
- pallative- relieve symptoms (antibiotics/anesthetics)
- definitive- ridding pt of cause of infection (extraction/root canal)
when do persistent apical lesions occur?
after root canal treatment
*biofilm, debris, or foreign body is still present
what is the treatment of a persistent apical lesion?
endodontic microsurgery
- clean apex of bacteria and necrotic tissue
- apex is removed, then sealed
occurs when the infection spreads through soft tissues via vascular channels or direct autolysis of tissue. tissue is HARD and swollen
cellulitis
- if in lower face then almost always dental related
- in upper face they are dental related half the time
what is important about abscesses?
they will not resolve on their own… need drainage
when dental infections spread to surrounding tissues they are called what?
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
cellulitis might proceed to form what?
abscess (pus pocket)
- O2 levels low
- will be able to move it much easier than cellulitis
what is the treatment for cellulitis?
- managed temporarily with antibiotic therapy
- resolved quickly if source of infection is removed
- may require antibiotics even after extraction
what is the treatment of abscesses?
- tooth extraction or root canal should provide drainage
- if not, surgical incision is required
what are two common antibiotics for the treatment of odontogenic infections?
clindamycin and penicillin
disease characterized by premature breakdown of fibrin clot exposing bone and bioflim formation on bone surface. throbbing pain and bad odor and taste
alveolar osteitis (dry socket)
how is alveolar osteitis (dry sockets) treated?
gentle debridement with medicated dressing
*systemic antibiotics will NOT work
what are the three types of bone infections ?
- alveolar osteitis
- osteomyelitis of the jaw
- medication-induced osteonecrosis of the jaw (MRONJ)
disease characterized by the spread of odontogenic or periodontal infection to the jaw bone. may show fever and have pus
osteomyelitis of the jaw
what is the typical treatment of osetomyelitis of the jaw?
surgical debridement and longterm antibiotic therapy
disease characterized by exposed bone that does not heal that is commonly associated with cancer treatment or after dental extraction
medication-induced osetonecrosis of the jaw (MRONJ)
*rare, less that 2% of population has it
*NOT REPORTED IN CHILDREN
why does MRONJ happen in cancer patients?
- 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
how to treat MRONJ?
- remove biofilm by debridement
- systemic antibiotics ineffective
- stop taking anti-resorptive drugs (BISPHOPHONATES)
