Pericoronitis

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Pericoronitis

  1. 1. Infection in Oral & Maxillofacial Region
  2. 2. Infection--- in oral & maxillofacial region <ul><li>Infection Conception </li></ul><ul><li>Trait Anatomy </li></ul><ul><li>Arising Route </li></ul><ul><li>Mutation Influence factors </li></ul><ul><li>Diagnosis Principles </li></ul><ul><li>Treatment Principles </li></ul>
  3. 3. Infection---conception Infectious agent(bacteria) Host Inflammatory reaction Elimination the infectious pathogen Repair tissue injury Hypersensitivity Autoimmune disease Beneficial Harmful protective and defensive
  4. 4. Anatomy <ul><li>Oral and nasal cavity </li></ul><ul><li>Tooth </li></ul><ul><li>Space </li></ul><ul><li>Blood and Lymphoid system </li></ul><ul><li>Bacteria </li></ul>
  5. 5. Anatomy <ul><li>Oral and nasal cavity </li></ul><ul><li>Maxillary sinus </li></ul>Bacteria---Exist Temperature + Moisture (Beneficial) Reproduction + Developing
  6. 6. Anatomy Alveolar bone Soft tissue Fascial space Tooth Caries Pulpitis Apical infection
  7. 7. Anatomy Fascial space-loose connective tissue Among skin, maxillary and muscle <ul><li>Purulent--- spreading way </li></ul><ul><li>Do not exist in healthy state </li></ul><ul><li>Become filling during infection </li></ul>
  8. 8. Anatomy <ul><li>Blood and lymphoid system </li></ul><ul><li>Beneficial </li></ul><ul><li>Abundance </li></ul><ul><li>Harmful </li></ul><ul><li>Dangerous triangle </li></ul><ul><li>Lacking valves </li></ul><ul><li>Cavernous sinus </li></ul>Cavernous sinus thrombosis Encephalic infection
  9. 9. Trait of pathogenic bacterium <ul><li>Varied </li></ul><ul><li>Numerous </li></ul><ul><li>Streptococcus hemolyticus </li></ul><ul><li>Staphylococcus aureus </li></ul><ul><li>Escherichia coli </li></ul><ul><li>Anaerobe </li></ul><ul><li>Sterile </li></ul><ul><li>Simple </li></ul><ul><li>Complex </li></ul>Flora
  10. 10. Route of infection <ul><li>Odontogenic infection </li></ul><ul><li>Traumatic infection </li></ul><ul><li>Hematogenous infection </li></ul><ul><li>Iatrogenic infection </li></ul>
  11. 11. Odontogenic infection <ul><li>Periapical infection </li></ul><ul><li>Pericoronitis </li></ul>
  12. 12. Periapical infection Acute-chronic Periapical infection Fistular Cellulitis Intraoral soft tissue abscess Osteomyelitis Septicemia Deep fascial space infection Ascending facial-cerebral infection
  13. 13. Pathways of Periapical infection
  14. 14. Pericoronitis Lower third molar
  15. 15. Infection---Arising <ul><li>Host--- defense system </li></ul><ul><li>Microbe---virulence quantity </li></ul><ul><li>Local circumstance </li></ul>Balance Imbalance Scale
  16. 16. Mutation <ul><li>Influence factors </li></ul><ul><li>Changing directions </li></ul>
  17. 17. Influence factors <ul><li>Host--- defense system </li></ul><ul><li>Microbe---virulence quantity </li></ul><ul><li>Treatment strategy </li></ul>
  18. 18. Changing directions <ul><li>Localization and recovery </li></ul><ul><li>Acute chronic </li></ul><ul><li>Diffusion </li></ul>Blood system---Septicemia lymphoid system---Lymphadenopathy From submandible space infection to chest region
  19. 19. How to diagnose? <ul><li>Local Signs and Symptoms </li></ul><ul><li>Systemical Signs and Symptoms </li></ul>Signs and Symptoms
  20. 20. Local Signs and Symptoms <ul><li>Pain </li></ul><ul><li>Swelling </li></ul><ul><li>Surface erythema </li></ul><ul><li>Pus formation </li></ul><ul><li>Limitation of motion </li></ul>Locally
  21. 21. Systemical Signs and Symptoms <ul><li>Fever </li></ul><ul><li>Lymphadenopathy </li></ul><ul><li>Malaise </li></ul><ul><li>Toxic appearance </li></ul><ul><li>Elevated white blood cell count </li></ul>
  22. 22. How to treat? <ul><li>Acute stage </li></ul><ul><li>Chronic stage </li></ul>
  23. 23. Acute stage <ul><li>Host </li></ul><ul><li>Antibiotic therapy </li></ul><ul><li>Surgical drainage and incision </li></ul>
  24. 24. Host <ul><li>Migration of white blood cell </li></ul><ul><li>Production of antibodies </li></ul><ul><li>Most important factor --- final outcome </li></ul><ul><li>The infections--- cured by the host, not by antibiotics </li></ul>Critical Principles Defense Mechanisms
  25. 25. Principles for choosing appropriate antibiotic <ul><li>causative organism </li></ul><ul><li>sensitivity </li></ul><ul><li>specific, narrow-spectrum antibiotic </li></ul><ul><li>least toxic antibiotic </li></ul><ul><li>drug history(success, allergic and toxic) </li></ul>Antibiotic era
  26. 26. Principles of antibiotic administration <ul><li>Proper dose </li></ul><ul><li>Proper time interval </li></ul><ul><li>Proper route of administration(oral, parenteral) </li></ul><ul><li>Combination antibiotic therapy </li></ul>
  27. 27. Surgical drainage and incision <ul><li>How to judge the pus formation? </li></ul><ul><li>Purposes of surgical drainage and incision </li></ul><ul><li>Principles of surgical drainage and incision </li></ul>
  28. 28. How to judge the pus formation? <ul><li>Three stages </li></ul><ul><li>Inoculation </li></ul><ul><li>Cellulitis </li></ul><ul><li>Abscess </li></ul><ul><li>Duration--- >5 days </li></ul><ul><li>Palpation---Fluctuant </li></ul><ul><li>Appearance---Reddened </li></ul><ul><li>Needle aspiration </li></ul><ul><li>B-ultrasound </li></ul><ul><li>CT </li></ul>Characteristic
  29. 29. Fluctuant examination
  30. 30. Purposes of surgical drainage & incision <ul><li>Rid the body of toxic purulent material </li></ul><ul><li>Decompress the tissues </li></ul><ul><li>Allowing better perfusion of blood containing antibiotics and defensive elements </li></ul><ul><li>Increased oxygenation of the infected area </li></ul>
  31. 31. Infection in masseteric space
  32. 32. Infection in multi-space Ludwig’s angina
  33. 33. Principles of surgical drainage & incision <ul><li>Place the incision in an esthetically acceptable </li></ul><ul><li>Place the incision in a dependent position to encourage drainage by gravity </li></ul><ul><li>Dissect bluntly through deeper tissues and explore all portions of the abscess </li></ul><ul><li>Place a drain and stabilize it with sutures </li></ul>
  34. 34. Principles of surgical drainage & incision
  35. 35. <ul><li>Lesion tooth---Impacted tooth </li></ul><ul><li>Osteomyelitis </li></ul>Chronic stage Surgical removal of the focus
  36. 36. Conclusion <ul><li>The trait of Infection </li></ul><ul><li>Odontogenic infection </li></ul><ul><li>mutation of infectious </li></ul><ul><li>Diagnosis of the infection </li></ul><ul><li>Diagnosis of the abscess formation </li></ul><ul><li>The principles of the treatment </li></ul>Infection in oral & maxillo-facial region
  37. 37. Thank you

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