• Inflammation of pulp.
• Follow exposure to range of irritants like
thermal, chemical, mechanical.
• Dental caries is commonest cause of pulpal
• Others include accidental trauma,
Pulpitis and its possible outcomes
Infection of periodontal membrane
Acute periapical periodontitis
Chronic periapical periodontitis
Dentoalveolar abscess ←
Periapical granuloma or Cyst
Pulpitis following dental caries
Pulpitis through an open cavity
Pulpitis through the apical foramen
• Overall the related micro flora is similar to
that isolated from necrotic pulps.
• Part of normal flora, obligate anaerobes,
• Common infection
• Develops typically at apices of roots of teeth.
• Infection most commonly arises via the pulp
• Endogenous usually caused by mixture of
• Specimen collection - most imp.
• Method – aspiration with syringe and needle
• Gram stain and Z-N stain
• Culture- both aerobic and anaerobic
• Imaging -
• Aim- to establish the drainage of pus
• Antibiotics- useful adjuncts
- local instillation
- anti aerobic and anti anaerobic
• Life threatening infection.
• Bilateral infection of sublingual and
• Infection of fascial tissue covering glands
• Rare but serious – Mortality is close to 100%
• Cause – dental infection in 90% cases
Key clinical features
• Brawny edema with elevated tongue, airway
obstruction and very little pus.
• Maintenance of airway is of paramount
interest in management
• REMOVE SOURCE OF INFECTION – antibiotics
Osteomyelitis of jaw
• Uncommon now
• Definition- inflammation of medullary cavity
of bone spreading to involve cortical bone
• Acute or Chronic
• Commoner in Mandible than in Maxilla.
Etiology and Risk factors
• Seen in immunocompromised, diabetes,
• Reduced vascularity of bone(Pagets disease)
• Mixed infection.
• Requires both medical and surgical treatment
• Early acute suppurative –
- intense pain,
- high fever,
- paresthesia or anesthesia of
• Chronic - established suppurative lesion,
sinus, deep pain, fever, teeth tender and
loose, lymph node enlargement.
• Cellulitis of cheek and trismus.
• Anaerobic G –ve rods
• Anaerobic G +ve cocci ( Streptococci)
DIAGNOSIS AND TREATMENT
Specimen - pus
ANTIBIOTIC SENSITIVITY TESTS
Medical and surgical management
Drainage of pus, debridement, surgical
Chronic granulomatous infection
Swelling at angle of jaw.
Cervico-facial region – commonest type
Risk factors – trauma, dental extraction, ID.