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Odontogenic
Infections
Dr. Rida F. Waseem
BDS,
Demonstrator
Department of Oral Surgery
IOD, CMH
Objectives
By the end of this lecture the students
should be able to:
• Describe the sequelae of odontogenic
infections.
•...
An odontogenic infection is
an acute or chronic infection
originating from a tooth related
pathology.
Periapical
Pericoron...
Sequelae of Pulpitis
Routes of Spread
1) Localized Soft Tissue Abscess
or
2) Diffused widespread Cellulitis
What will it depend on?
 Number of Microorganisms
 Virulence of Microorganisms
 Host Defense
 In a healthy patient spr...
Enzymes responsible for
connective tissue degradation
• Hyaluronidase (Produced by aerobes; causes
cellulitis and lowers t...
Spread of infection takes the path of least
resistance in the tissues.
In the connective
tissue spaces
(potential)
Between...
Fascial Spaces
Primary Secondary
•Vestibular
•Buccal
•Canine
•Infratemporal
Maxillary
•Vestibular
•Submental
•Submandibula...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Spaces
Primary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Submental
o ...
Mylohyoid Line
Ludwig’s Angina
Spaces
Secondary
• Massetric space
• Superficial and Deep
temporal spaces
• Pterygomandibular
space
• Carotid sheath space...
Spaces
Secondary
• Massetric space
• Superficial and Deep
temporal spaces
• Pterygomandibular
space
• Carotid sheath space...
Spaces
Secondary
• Massetric space
• Superficial and Deep
temporal spaces
• Pterygomandibular
space
• Carotid sheath space...
Spaces
Secondary
• Massetric space
• Pterygomandibular
space
• Superficial and Deep
temporal space
• Carotid sheath space
...
Fascial Spaces
Primary Secondary
•Vestibular /Palatal
•Buccal
•Canine
•Infratemporal
Maxillary
•Vestibular
•Submental
•Sub...
Spaces
Primary Secondary
• Maxillary
o Vestibular/Palatal
o Buccal
o Canine
o Infratemporal
• Mandibular
o Vestibular
o Su...
Spaces
Primary Secondary
• Maxillary
o Vestibular
o Buccal
o Canine
o Infratemporal
• Mandibular
o Submental
o Submandibul...
Spaces
Primary Secondary
• Maxillary
o Vestibular
o Buccal
o Canine
o Infratemporal
• Mandibular
o Submental
o Submandibul...
Spaces
Primary Secondary
• Maxillary
o Vestibular
o Buccal
o Canine
o Infratemporal
• Mandibular
o Submental
o Submandibul...
Distant Spread of Odontogenic
Infections
• Maxillary Sinus
• Orbit
• Danger space
• Mediastinum
Direct Spread
• Cavernous ...
Cavernous Sinus
Prophylaxis Against
Infectious Endocarditis-60 min before
Situation Agent Adults Children
Oral Amoxicillin 2g 50mg/kg
Pare...
Clinical Features
Swelling (IO and/or EO)
Redness
Fever and malaise
Trismus
Lymphadenopathy
Dehydration
Dyspnea
Dysphagia
Investigations
Detailed
History
Dental
Medical
Clinical
Examination
Radiographs
IOPA
OPG
CT Scan
Culture and
Sensitivity
Treatment Options
Medical Surgical
• Empirical Oral
antibiotics/IV antibiotics
• Pain medication
• Hydration
• Nutrition
•...
Objectives
By the end of this lecture the students
should be able to:
• Describe the sequelae of odontogenic
infections.
•...
QUESTIONS?
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Transcript of "Odontogenic infections"

  1. 1. Odontogenic Infections Dr. Rida F. Waseem BDS, Demonstrator Department of Oral Surgery IOD, CMH
  2. 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. 3. An odontogenic infection is an acute or chronic infection originating from a tooth related pathology. Periapical PericoronalPeriodontal
  4. 4. Sequelae of Pulpitis
  5. 5. Routes of Spread
  6. 6. 1) Localized Soft Tissue Abscess or 2) Diffused widespread Cellulitis
  7. 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. 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. 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. 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. 11. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  12. 12. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  13. 13. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  14. 14. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  15. 15. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  16. 16. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  17. 17. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  18. 18. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  19. 19. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  20. 20. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  21. 21. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  22. 22. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  23. 23. Spaces Primary • Maxillary o Vestibular/Palatal o Buccal o Canine o Infratemporal • Mandibular o Vestibular o Submental o Submandibular o Sublingual
  24. 24. Mylohyoid Line
  25. 25. Ludwig’s Angina
  26. 26. Spaces Secondary • Massetric space • Superficial and Deep temporal spaces • Pterygomandibular space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space
  27. 27. Spaces Secondary • Massetric space • Superficial and Deep temporal spaces • Pterygomandibular space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space
  28. 28. Spaces Secondary • Massetric space • Superficial and Deep temporal spaces • Pterygomandibular space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space
  29. 29. Spaces Secondary • Massetric space • Pterygomandibular space • Superficial and Deep temporal space • Carotid sheath space • Lateral pharyngeal space • Retropharyngeal Space
  30. 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. 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. 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
  33. 33. 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
  34. 34. 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. 35. Distant Spread of Odontogenic Infections • Maxillary Sinus • Orbit • Danger space • Mediastinum Direct Spread • Cavernous Sinus • Endocardium • Joints Haematogenous Spread
  36. 36. Cavernous Sinus
  37. 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. 38. Clinical Features Swelling (IO and/or EO) Redness Fever and malaise Trismus Lymphadenopathy Dehydration Dyspnea Dysphagia
  39. 39. Investigations Detailed History Dental Medical Clinical Examination Radiographs IOPA OPG CT Scan Culture and Sensitivity
  40. 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. 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. 42. QUESTIONS?
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