Odontogenic Infections Flashcards
What is an abcess and how is it managed?
A collection of pus that presents as a fluctuant swelling.
Managed by incision and drainage
What are the basic steps in a spreading infection?
1) Pulp death secondary to dental decay
2) Periapical infection
3) Spreading infection through bone to soft tissues
4) Spread of infection through soft tissues aided by enzymes that dissolve connective tissues
5) Soft tissues react with the production of more adhesive fibrous tissues that tries to confine the infection
What are the clinical presentation of an odontogenic infection associated with an upper central incisor?
The infection usually tracts through the buccal plate. There is normally a minimal tissue reaction and at most a localised collection which ruptures or points with minimal lip swelling.
Can then result in a draining fistula
How does an odontogenic infection associated with an upper lateral incisor spread?
As the root is angled towards the palate, pus normally normally tracts towards the palate resulting in a palatal abcess.
Normally very painful as the thick perioosteum is stretched by the infection.
Can sometimes tract posteriorly resulting in swelling at the soft/hard palate junction
How does an odontogenic infection associated with an upper canine spread?
The pus tracks up under the muscles and emerges between the oral and ocular muscles.
The swelling normally occurs laterally to the eyes and can affect the eyelids limiting the opening of the eye (canine fossa abcess)
This can result in tracking up the facial veins, along the floor of the orbit. There is a risk to spread to the brain.
How does an odontogenic infection associated with upper premolars track?
If the roots are short, it usually pennetrates bucally into the mouth.
If the roots are long, they normally sit above the muscles of facial expression e.g. buccinator. This means that infection sits in between the skin and the buccinator hence producing a BUCCAL ABCESS.
Occasionally can also result in a canine fossa abcess as well as buccal
How does an odontogenic infection associated with an upper molar spread?
As the roots of upper molars are above the buccinator muscles, they normally result in a buccal abcess.
The masticatory muscles are normally not affected hence patient can normally still open mouth.
How does an odontogenic infection of the lower incisors and canines track?
Usually into the mouth via the buccal plate. Occasionally lingually and inferiorly beneath the mylohyoid muscle resulting in a submental abcess.
How do odontogenic infections of lower premolars track?
Short rooted: into the mouth
Long rooted: Under buccinators as a buccal abcess
How does an odontogenic infection of a lower molar spread?
Buccally tilted roots: Buccal abcess
Lingually tilted roots: Tend to sit beneath the mylohyoiid muscle resulting in a submandibular abcess in the submanduibular triangle.
Which abcesses spread into the submandibular space?
Buccal abcesses
Subblingual abcesses
Submental Abcesses
Where can a submandibular abcess drain into?
POsterior:
Lateral pharynngeal spaces, infratemporal space, submasseteric
Inferior:
into the neck and can crossover bilaterally
can then spread to the mediastinum (structures in the thorax)
what is Ludwigs Angina?
Infection involving both sides of the neck from the submandibular triangle to the clavicles.
How should a patient with an odontogenicc infection be assessed?
1) General - malaise, febrile, dehydrated?
2) Medically compromised?
3) Airways
- swallowing?
4) Swelling
5) Treatment
- remove cause - usually extraction
- drainage - if in doubt drain more than less
6) Support the host - rehydrate, antipyretics, analgesics
7) Antibiotics
What is osteomyelitis?
Infection of the bone most commonly caused by the bacterium Staphylococcus aureus. Can cause irrevversible damage to bone cells.
