Odontogenic
infection
Dr Amur Alsenaidi
BDS, MFD, CCST(OMFS-OMSB)
Assistant Professor,
Oral & Maxillofacial Surgeon, ODC
Learning Objectives:
❑Definition of Odontogenic Infections .
❑Classifications of odontogenic infection .
❑Etiology of facial infections
❑Routs of spreading of the infections
❑Facial Spaces.
❑Principles Of Prevention of Odontogenic Infections
❑Principles Of Management Of Odontogenic Infections
Classification of infections
❑According to the clinical appearance:
a) Acute infections
b) Chronic infections
❑Depending on the etiological agent:
a) Bacterial
b) Viral
c) Fungal
❑According to source of infection:
a) Odontogenic
b) Secondary infections of lesions such as cyst or tumors
c) Infections arises from contaminated wound/trauma
d) non-odontogenic infections.
❑According to location of infection:
A. Localized odontogenic infection
B. Spreading odontogenic infection.
Stages of infections
Stage I: Initiation of infection
• Mostly odontogenic in origin,
• Periapical/periodontal/pericoronal infection
• Mildly symptomatic or asymtomatic.
Stage II: Entry of infection in medullary bone
• Symptomatic, patient seeks treatment
• Tender on percussion
• No space for pus to drain starts effecting the medullary bone
Stage III: Path of drainage
• Pus follow path of least resistance
• Perforates cortex that is thinner
• Appears in soft tissues, extra oral swelling
• May lead to cellulitis or abscess formation
Stage IV: Spread of infection
• Spreads to another space along anatomical barriers
• May perforate the skin to form sinus
Odontogenic infections
• ROOTS OF SPREADS OF INFECTION
❑Spreads by direct continuity.
❑Spreads by lymphatics to regional lymph nodes.
❑spreads by blood stream.
Microbiology of odontogenic infections
• Bacterial composition
❑5%-aerobic bacteria
❑60%-anaerobic bacteria
❑ 35% mixed aerobic and anaerobic bacteria
odontogenic infections
➢Etiology:
❑Carious teeth / roots
❑Periodontal abscess
❑Post-surgical infection
❑Impacted teeth
❑Others / infected cyst.
Difference between Edema, cellulitis and abscess
odontogenic infection
• Abscess : collection of pus.
• Abscess is caused by an infection process with involvement of
bacteria.
odontogenic infection
The infection causes formation of pus locally and pus
accumulation in :-
❑Tissue spaces.
❑Between periosteam and bone.
❑Spaces present between muscle layers.
Odontogenic infections
• Classified into :
A. Localized odontogenic infection
B. Spreading odontogenic infection.
Localized odontogenic infection
➢Clinical presentation:
• Localized pain
• Involved tooth is tender to percussion
• Intra-oral swelling
• Erythema
• Sensitivity to temperature and air.
Localized odontogenic infection
Management:
• Managed as Out-patient .
• Drainage :
• Removal of the causative tooth
• RCT for causative tooth
• Antibiotics cover .
• Antibiotics should be used for :
• Compromised patient .
• Systemic involvement.
Spreading odontogenic infection
• The commonest type of serious and severe odontogenic infection in
facial region.
• Has direct spread in the facial region.
• Early management will minimize the complications.
Spreading odontogenic infection
➢Factors facilitate the spreading of the infection:
• Local factors:
• role of pathogen ( volume, mixed infections)
• Systemic factors:
• Immuno-compromised patient .
• Social factors:
• Smoking
• Drug abuse
• Poor OH
Facial spaces
➢Facial spaces of H&N region
.
• Potential spaces .
• Filled with loose connective
tissue
• Interconnected with each
other.
➢Anatomical position of each
facial spaces
• Teeth and relationship with
adjacent structure and
spaces
Severity of infection
Submental Space infection
Sublingual space infection
Submandibular space infection
Buccal space infection
Ludwig’s Angina
• 70% of cases, develop from spread of an
acute infection from lower molar teeth.
• prevalence in patients who are
immunocompromised
• secondary to disorders such as:
• diabetes mellitus
• organ transplantation
• acquired immunodeficiency
syndrome (AIDS)
• aplastic anemia.
Ludwig’s Angina
➢Clinical Features
• massive swelling on neck often extends
close to clavicle
• involvement of sublingual
• space results in elevation of the tongue.
Ludwig’s Angina
involvement of submandibular
Cavernous Sinus Thrombosis
• edematous periorbital enlargement
• with involvement of eyelids + conjunctiva
• involving canine space
Management of odontogenic infection
➢ Principle 1 of management :
1. Determine Severity Of Infection.
2. Complete History:
• How long has the infection been present?
• Progression rate.
• Symptoms [Cardinal signs of inflammation]
• How the patient feels in general
• Physical Examination.
• Vital signs.
• Patient’s general appearance.
• Infection area.
• Radiographs.
Management of odontogenic infection
• Principle 2 of management :
• Evaluate Patient’s medical history:
Management of odontogenic infection
➢Principle 3: Determine Whether Patient Should Be Treated by
General Dentist or Oral-Maxillofacial Surgeon:
Management of odontogenic infection
➢Principle 4: Treat Infection surgically
• Root Canal Treatment
• Extraction
• Incision and Drainage
• Primary Goal of this Principle is to REMOVE SOURCE OF INFECTION.
(Never let the sun shine on a undrained abscess)
Management of odontogenic infection
➢Principle 5: Support Patient Medically
• Fluids
• Nutrition
• Antibiotics
• Anti-Pyritic
• Analgesics
Management of odontogenic infection
➢Principle 6: Choose and Prescribe Appropriate Antibiotics
• Need for Antibiotics ?
Prevention of infection
• Regular Check-ups
• Preventive management of initially infected teeth
• Conservative management of moderately infected teeth
• Extraction of Non-Restorable teeth.
Thank you
