5. Oral Infection Dental Extraction A Persian dentist of the late eighteen century extracts a tooth
6. Dental Extraction Tooth decay that has destroyed enough tooth structure to prevent restoration is the must frequent indication for extraction of teeth Extraction of impacted or problematic wisdom teeth are routinely performed Extractions are categorized as Simple or Surgical
7. Dental Extraction Infection, although rare, occurs on occasion; the dentist may opt to prescribe antibiotics pre-and /or post-operatively if he / she determines the patient to be at risk
9. Periodontal Diseases Gingivitis Periodontitis Destruction in the conjunctive attachment system and in the alveolar bone. Inflammation confined to the gingiva (gum)
10. Dental Plaque A biofilm of a clear color that builds up on the teeth. If not removed regularly, it can lead to dental cavities (caries) or periodontal problems (such as gingivitis) The microorganisms that form the biofilm are almost entirely bacteria (mainly streptococcus and anaerobes), with the composition varying by location in the mouth
11. Dental Plaque The microorganisms present in DP are all naturally present in the oral cavity, and are normally harmless. Failure to remove plaque by regular tooth brushing means that they are allowed to build up in a thicker layer. Those nearest the tooth surface convert to anaerobic respiration; it is in this state that they start to produce acids which consequently lead to demineralization of the adjacent tooth surface, and dental caries.
12. Dental Plaque Saliva is also unable to penetrate the build up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface The microorganisms change as the plaque ages Plaque which is 12 hours old is much less damaging than plaque which has not been removed in days
13. Dental Plaque A biofilm is a complex aggregation of microorganisms marked by the excretion of a protective and adhesive matrix
14. Odontogenic infectionPolymicrobial , result of “biofilm maturing”:a change in the predominant bacterial species (from predominantly gram -, facultative and saccharolytic flora to predominantly gram +, anaerobic and proteolytic flora).Fusobacterium nucleatum is considered as the central structural component of biofilm : co- aggregates with other harmless components and with periodontal pathogens, permitting biofilm evolution into infection.
15. Gingivitis Usually caused by bacterial plaque that accumulates in the spaces between the gums and the teeth and in calculus (tartar) that forms on the teeth Over the years, the inflammation causes deep pockets between the teeth and gums and loss of bone around teeth otherwise known as periodontitis
16. Gingivitis Since the bone in the jaws holds the teeth into the jaws, the loss of bone can cause teeth over years to become loose Regular cleaning disrupts this plaque biofilm and removes tartar to help prevent inflammation It takes approximately 3 months for the pathogenic type of bacteria (G- anaerobes and spirochetes) to grow back into deep pocket
17. Gingivitis People with healthy periodontium (gums, bone and ligament) or people with gingivitis only require periodontal debridement every 6 months When the teeth are not cleaned properly by regular brushing, bacterial plaque accumulates, and becomes mineralized by calcium and other minerals and other minerals in the saliva transforming it into a hard material called calculus (tartar) which harbors bacteria and irritates the gingiva (gums)
18. Gingivitis Association with low calcium intake is particularly evident for people in their 20s and 30s Gingivitis complications: - Recurrence of gingivitis - Periodontitis - Infection or abscess of the gingiva or the jaw bones - Trench mouth
19. Periodontitis Inflammatory disease affecting the tissues that surround and support the teeth It involves progressive loss of the bone around teeth which may lead to loosening and eventual loss of teeth if untreated Caused by bacteria that adhere to and grow on tooth surfaces (microbial plaque or biofilms), particularly in areas under the gum line
20. Periodontitis Inflammation of the periodontium, or one of the tissues that support the teeth (AROUND THE TOOTH) Gingiva, or gum tissue Cementum, or outer layer of the roots of teeth Alveolar bone, or the bony sockets into which the teeth are anchored Periodontal ligaments which are the connective tissue fibers that connect the cementum and the gingiva to the alveolar bone
21. Periodontitis Although the different forms of periodontitis are bacterial diseases, important risk factors include: - Smoking - Poorly controlled diabetes - Inherited susceptibility Treatment and prevention: Periodontal debridement; bacteria and plaque tend to grow back to pre cleaning level Check up each 6 months
22. Periodontitis Systemic antibiotic therapy can provide greatest benefit to periodontitis patients who do not respond well to mechanical periodontal therapy or who are experiencing fever or lymphadenopathy. Single antimicrobial drug therapies may be able to suppress various periodontal pathogens for a prolonged period of time depending on the effectiveness of the host defense and the oral hygiene efforts
23. Periodontitis Combination drug therapies, which aim at enlarging the antimicrobial spectrum and exploiting synergy between antibiotics, are often indicated with complex mixed periodontal infections. Prescription of any systemic antibiotic therapy requires a careful analysis of patients’ medical status and current medications. In severe infections, it may include antimicrobial sensitivity testing.
24. Periodontitis The supragingival biofilm is fundamentally G +, facultative and saccharolytic, which means that in the presence of sugars, it produces acids that demineralise enamel, facilitating biofilm infiltration of dentin and pulp. With the bacterial invasion of the tooth’s internal tissue, the biofilm evolves, and thus root canals are infected with predominantly gram-negative, anaerobic and proteolytic bacteria.
25. Endodontics The most common procedure done in endodontics is Root-canal therapy. This procedure aims to save a tooth that would otherwise be extracted due to infection caused by decay Root canal therapy involves the removal of diseased pulp tissue inside the tooth
26. Endodontics Once the diseased pulp tissues are removed, the body’s defense system can then repair the damage created by disease Often, an intra pulpal medicament to inhibit bacterial growth is placed and the tooth is filled with a temporary restoration until the second appointment
27. Endodontics If decay progresses to the first stage, a small filling will be required If decay develops to the third stage depicted, root canal therapy will be required 1st Stage 2nd Stage 3rd Stage
28. Apical infection Pulpal necrosis is the result of a bacterial, thermal or traumatic attack. This necrosis is transformed into an apical infection: Multibacterial (aero & anaerobic) On surface, 28% of bacteria are aerobic and anaerobic in depth
29. Peri-apical infection Abscess in the alveolar bone regarding a tooth apex; bacterial infiltration starts from the bacterial plaque and or the saliva through the pulp chamber
30. Peri-apical infection Total eradication of bacteria from the radicular canal, Canal preparation, Hermetic canal obstruction.
31. Cellulitis / Abcess Infection in the cellular tissue, complicating the apical infection. Radio transparent image in regard of the causal tooth. Streptococcus, Staphylococcus & peptostreptococcus
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33. Cellulitis / Abcess Antibiotic controls the infective bacterial load Therapeutic action combines mechanical debridement, and / or surgery, and / or systemic antibiotic therapy, where appropriate. The first step in the case of dental abscess is to drain and debride the abscess using mechanical-surgical techniques. Drainage is performed by making an incision in the area of greatest fluctuation.
34. Cellulitis / Abcess Mechanical-surgical techniques have a quantitative effect on bacterial load giving the host the opportunity to recover homeostasis through immune system action.
35. Osteitis / Alveolitis* Acute or chronic inflammatory process in the connective tissue, the medullar tissue and Havers canals * Osteitis localized in the alveoli of an extracted tooth (not healing )
36. Osteitis / Alveolitis* Dried alveolitis: Antibiotherapy is unnecessary. Suppurative alveolitis: Prevotella, Fusobacterium, Staphylococcus aureus and streptococcus pyogenes
38. Sinusitis of dental origin The development of an apical infection in antral teeth ends in the sinusal cavity and we talk about sinusitis of dental origin.
39. Pericoronitis Infection of the pericoronal sac within a tooth in the process of eruption and which is partially restrained. In most of the cases it is the wisdom tooth. Most frequent organisms are: P. intermedia, P. micros, Veillonella, F. nucleatum
40. Per implantitis Infection of the tissues that surround the implant. Radiological examination shows a radio transparency image that surrounds one or several parts of the implant.
41. Debridement should be the first step in therapy as draining the infection and eliminating necrotic waste will facilitate antimicrobial action Antimicrobials alone are indicated when the severity of the infection advises delaying surgical techniques due to the risk of spreading the infection during debridement itself. Antibiotic prophylaxis achieves better results if the antimicrobial agent is administered pre-operatively.
42. Treatment of chronic asymptomatic infection can cause an acute exacerbation of the infectious process. Periodontal and endodontic over-instrumentation can cause bleeding and exudates in periodontal and periapical tissues, providing bacteria with nutrients, and thus stimulating proliferation, which may overcome the host’s immune resistance.
43. This factor should be given special consideration in immunodepressed patients and in patients whose microbiological studies reveal odontopathogens or bacterial associations that are particularly resistant to therapy. In these cases, it is essential to use an effective antimicrobial agent.
44. Wide spectrum antibiotics must be used in view of the polymicrobial, mixed nature of odontogenic infections, and such antibiotics must be especially active against the commonest odontopathogens, made for natural resistance (e.g. Streptococcus sp.; Actinomyces sp. and A. actinomycetemcomitans )
