Odontogenic spread Flashcards
Name the 4 ways tooth infection can spread
Direct -thru tissue
Direct thru fascial spaces
indirect by blood
Indirect by lymphatics
Name the primary fascial spaces for mandibular teeth infection spread and which teeth go there
Skin (all )
Vestibular space (all )
Buccal(premolar and molar)
Sublingual (Premolars) +Molars
Submental (incisors)
Submandibular (molars)
Name where the mandibular primary space infections can spread
- Buccal-<–>Canine space –>Cavernous sinus(brain)
- Sublingual <–>Submental.<–> Submandibular–> Lateral pharyngeal –>retropharyngeal –> mediastinum
- Sublingual –>Pterygomandibular–> Lateral pharyngeal–>retropharyngeal–>,mediastinum
Ie common pathways
Lateral pharyngeal->retropharyngeal _>mediastinum
Name 6 consequences of mandibular tooth infection
including 2 life threatening
Pulpitis
Dentoalveolar abscess
Fistula/Stoma formation
Cellulitis
Osteomyelitis
Ludwigs angina * life threatening
Mediastinitis *
Name the secondary facial spaces for mandibular teeth
Pterygomandibular space
Lateral pharyngeal space
retropharyngeal space
Where would a buccal space infection likely be arising from
Madbular premolar/molar infection
Name the primary fascial spaces of spread for maxillary teeth and which teeth
Skin
vestibular (ALL teeth )
Buccal (Pre molars/molars)
Canine (Canines and 1st premolars )
Palatal (All esp. lateral incisors/palatal roots molars)
Nasal ( anterior teeth)
Maxillary sinus (Molars /premolars )
Name consequences maxillary anterior teeth
Pulpitis
Dentoalveolar abscess
Stoma/fistula formation
Cellulitis
Cavernous sinus thrombosis
Name consequences maxillary posterior teeth
Pulpitis
Dentoalveolar abscess
Stoma./fistula formation
Cellulitis
Cavernous sinus thrombosis
Maxillary sinusitis
Mediastinitis
Name the communication spaces for the primary fascial spaces to spread ( which ones to where )
1.Buccal space<–>Canine –>cavernous sinus
2.Buccal –>Pterygomandibular space –>Lateral pharyngeal space –>Retropharyngeal–>mediastinum
Name 4 factors aggravate odontogenic infection
Chemotherapy
Immunodefificent (HIV)
Obesity
Long term diabetes
What are 3 aetiology of odontogenic infection
- Dental biofilms-eg progressive caries
- Erupting teeth eg pericoronitis
- Dental surgery - contaminate the dental site /needle tract infection
Name 3 lesions seen with odontogenic infection
Abscess
Cellulitis
Osteomyelitis
What is a abscess
Well circumscribed collection of trapped pathogens surrounded in pus
Fluctuant and if chronic can lead to a fistula being formed between it and skin ( chronically draining ) - follows path of least resistance to exit on skin or a mucous membrane
How to treat an abscess
Remove cause ie extraction
Antibiotics ( not normally work as centre abscess avascular )
Drainage
Moist warm compress/mouth rinses
Name 4 types dental abscess
Periapical
Periodontal
Gingival
Pericoronitis ( in emerging teeth )
NAme 5 factors affecting dental spread
Hosts defence ( eg immunocompromised etc)
Virulence microorganism
Bone thickness
Root apex proximity
Muscle attachments
If a tooth infection is to direct spread thru tissues ,name the primary ,secondary and tertiary sites
primary: plural chamber/ periodontal structures
secondary: alveolar bone
Tertiary: soft tissues
How does maxillary sinusitis arise from teeth and why is it dangerous
Maxillary back teeth roots close to maxillary sinus wall–>infection travels thru floor sinus ( or a infected tooth fragment displayed thru the floor in extraction ) then infection travels thru sinus to other sinus to brain !! MUST treat proper;y
What is the most common odontogenic infection
Vestibular abscess
Name 2 complications of blood spread of pathogens
Bacteraemia ( bacteria into blood)
Infected thrombus
Name the pathway of maxillary tooth infection in blood
Maxillary teeth –> superior alveolar vein
–>pterygoid venous plexus –>maxillary vein (joined by superficial temporal vein) –>retromandibular Vein –> internal/external jugular veins __> brachiocephalic –>superior vena cava __> heart
( RISK infection entering heart eg high risk patients with prosthetic valves etc MUST be pre-treated with antibiotics so the bacteraemia not occur )
As no valves on head veins also risk of back flow up into brain if increased pressure and infection into brain
Name the pathway of blood spread from mandibular teeth
Mandibular teeth –> inferior alveolar vein
–>pterygoid venous plexus –>maxillary vein (joined by superficial temporal vein) –>retromandibular Vein –> internal/external jugular veins __> brachiocephalic –>superior vena cava –> heart
what’s risk of bacteraemia from tooth infection
( RISK infection entering heart eg high risk patients with prosthetic valves etc MUST be pre-treated with antibiotics so the bacteraemia not occur )
As no valves on head veins also risk of back flow up into brain if increased pressure and infection into brain
what’s a cavernous sinus thrombosis and how does it occur from dental infection
Thrombus in cavernous sinus ( in sphenoid bone)
Dental infection- thrombus forms and bit breaks off ( embolus ) and as no valves in head veins can enter up into brain
Communicates with pterygoid plexus /superior ophthalmic artery - et spread from all maxillary teeth/mandibular posterior teeth /upper lip/non dental danger triangle face /infratemporal space
Signs of cavernous sinus thrombosis
Fever ,drowsy, headache ,eyelid swelling /diplopia /visual loss
Emergency - causes death
What is Ludwigs angina
Life threatening infection- fast progressive cellulitis involving BILATERAL submental/sublingual and submandibular spaces - from any mandibular tooth or tongue piercing etc
Swelling lifts tongue - blocks airway
Spreads rapidly to parapharyngeal and retropharyngeal areas - larynx oedema and complete airway obstruction –> death
Signs Ludwigs angina
Tongue elevated off floor mouth
High fevers
Swelling ++
Unable talk, swallow, breath properly
5 important steps to prevent dental infection spread
Provide regular quality dentistry
-1. ID potential infection sources /treat early
2. Id at risk patients —good histories to identify at risk patient and pre treat if required
3. Medical review if concerns
4. Strict hygiene control measures - sterile gloves/environment /equiptment
-antiseptic pre rinses
- no Local thru infected tissue
5.ANtibiotics if required
