Odontogenic infections

1. Odontogenic Infections Dr. Rida F. Waseem BDS, Demonstrator Department of Oral Surgery IOD, CMH

2. Objectives By the end of this lecture the students should be able to: • Describe the sequelae of odontogenic infections. • Describe the spread of odontogenic infections to primary, secondary and distant spaces. • Diagnose a patient with odontogenic infections.

3. An odontogenic infection is an acute or chronic infection originating from a tooth related pathology. Periapical PericoronalPeriodontal

4. Sequelae of Pulpitis

5. Routes of Spread

6. 1) Localized Soft Tissue Abscess or 2) Diffused widespread Cellulitis

7. What will it depend on?  Number of Microorganisms  Virulence of Microorganisms  Host Defense  In a healthy patient spread is localized and drained to the buccal or lingual cortex  In an immune compromised patient spread is diffused and spreads to the bone  osteomyelitis

8. Enzymes responsible for connective tissue degradation • Hyaluronidase (Produced by aerobes; causes cellulitis and lowers the pH) • Collagenase (Produced by anaerobes; cause liquefactive necrosis; pus)

9. Spread of infection takes the path of least resistance in the tissues. In the connective tissue spaces (potential) Between the bone and periosteum Spaces between the muscle layers

10. Fascial Spaces Primary Secondary •Vestibular •Buccal •Canine •Infratemporal Maxillary •Vestibular •Submental •Submandibular •Sublingual Mandibular Massetric space Superficial and Deep temporal spaces Pterygomandibular space Carotid sheath space Lateral pharyngeal space Retropharyngeal Space

11. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual

24. Mylohyoid Line

25. Ludwig’s Angina

26. Spaces Secondary • Massetric space • Superficial and Deep temporal spaces • Pterygomandibular space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space

29. Spaces Secondary • Massetric space • Pterygomandibular space • Superficial and Deep temporal space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space

30. Fascial Spaces Primary Secondary •Vestibular /Palatal •Buccal •Canine •Infratemporal Maxillary •Vestibular •Submental •Submandibular •Sublingual Mandibular Massetric space Superficial and Deep temporal spaces Pterygomandibular space Carotid sheath space Lateral pharyngeal space Retropharyngeal Space

31. Spaces Primary Secondary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual • Massetric space • Pterygomandibular space • Superficial and Deep temporal spaces • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal

32. Spaces Primary Secondary • Maxillary o Vestibular o Buccal o Canine o Infratemporal • Mandibular o Submental o Submandibular o Sublingual • Massetric space • Pterygomandibular space • Superficial and Deep temporal spaces • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal

35. Distant Spread of Odontogenic Infections • Maxillary Sinus • Orbit • Danger space • Mediastinum Direct Spread • Cavernous Sinus • Endocardium • Joints Haematogenous Spread

36. Cavernous Sinus

37. Prophylaxis Against Infectious Endocarditis-60 min before Situation Agent Adults Children Oral Amoxicillin 2g 50mg/kg Parenteral Ampicillin 2g IM/IV 50mg/kg IM/IV Cefazolin/ceftriaxo ne 1g IM/IV 50mg/kg IM/IV Penicillin allergy, Oral Clindamycin Azithromyci/Clarit hromycin 600mg 500mg 20mg/kg 15mg/kg Penicillin allergy, Parentral Clindamycin 600mg IM/IV 20mg/kg IM/IV

38. Clinical Features Swelling (IO and/or EO) Redness Fever and malaise Trismus Lymphadenopathy Dehydration Dyspnea Dysphagia

39. Investigations Detailed History Dental Medical Clinical Examination Radiographs IOPA OPG CT Scan Culture and Sensitivity

40. Treatment Options Medical Surgical • Empirical Oral antibiotics/IV antibiotics • Pain medication • Hydration • Nutrition • Control any systemic disease • Remove the dental cause (RCT/debridement/extr action) • Incision and drainage(IO/EO) • Follow up

41. Objectives By the end of this lecture the students should be able to: • Describe the sequelae of odontogenic infections. • Describe the spread of odontogenic infections to primary, secondary and distant spaces. • Diagnose a patient with odontogenic infections

42. QUESTIONS?

Odontogenic infections

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