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Infections of Pulp, Periapical
tissues, and jaw Bones
•
•
•
•
•

Pulpitis
Dentoalveolar abscess
Ludwig’s angina
Osteomyelitis of jaw
Actinomycosis.
Pulpitis
• Inflammation of pulp.
• Follow exposure to range of irritants like
thermal, chemical, mechanical.
• Dental cari...
Pulpitis and its possible outcomes

Irritant
↓

Pulpal inflammation
↓

↓

Acute pulpitis
Chronic pulpitis
Pulpal necrosis
...
•
•
•
•

Pulpitis following dental caries
Pulpitis through an open cavity
Pulpitis through the apical foramen
Pulpal necro...
Microbiology
• Overall the related micro flora is similar to
that isolated from necrotic pulps.
• Part of normal flora, ob...
Bacteria isolated from necrotic pulps
Obligate Anaerobes
•
•
•
•
•
•
•
•
•
•

Peptostreptococcus
Veillonella
Eubacterium
P...
Dentoalveolar abscesses
• Common infection
• Develops typically at apices of roots of teeth.
• Infection most commonly ari...
Diagnosis
• Specimen collection - most imp.
• Method – aspiration with syringe and needle
(anaerobes)
• Gram stain and Z-N...
TREATMENT
• Aim- to establish the drainage of pus
• Antibiotics- useful adjuncts
- local instillation
- anti aerobic and a...
Ludwig’s angina
• Life threatening infection.
• Bilateral infection of sublingual and
submandibular spaces.
• Infection of...
Micobiology
• Mixed type.
• Oral commensals - Anaeorobic gram negative
and anaerobic streptococci commonly
isolated.
• Sta...
Key clinical features
• Brawny edema with elevated tongue, airway
obstruction and very little pus.
Treatment
• Maintenance of airway is of paramount
interest in management
• AIRWAY
• BREATHING
• CIRCULATION
• REMOVE SOURC...
Osteomyelitis of jaw
• Uncommon now
• Definition- inflammation of medullary cavity
of bone spreading to involve cortical b...
Etiology and Risk factors
• Seen in immunocompromised, diabetes,
agranulocytosis
• Reduced vascularity of bone(Pagets dise...
Clinical Features
• Early acute suppurative –
- intense pain,
- high fever,
- swelling
- paresthesia or anesthesia of
ment...
c/f
• Chronic - established suppurative lesion,
sinus, deep pain, fever, teeth tender and
loose, lymph node enlargement.
•...
Microbiology
• Staphylococci
• Anaerobic G –ve rods
• Anaerobic G +ve cocci ( Streptococci)
DIAGNOSIS AND TREATMENT
•
•
•
•
•

Specimen - pus
CULTURE
ANTIBIOTIC SENSITIVITY TESTS
Medical and surgical management
Dra...
Actinomycosis
•
•
•
•
•

Chronic granulomatous infection
Endogenous infection
Swelling at angle of jaw.
Cervico-facial reg...
Microiology
• A.israeli – commonest actinomyectes causing
infection, A. naeslundii
• Others are Haemophyllus spp, Actinoba...
c/f
•
•
•
•

Common in young people, males.
Presents as swelling at angle of lower jaw.
Multiple draining sinuses
Dental f...
Lab diagnosis
• Specimen- aspirate clean, non contaminated
• Gram stain – gram positive long branching
filamentous
• Anaer...
Management
• Surgical drainage
• Extraction of dental focus of ifection.
• Long term administration of antibiotics
( penic...
To summarize
•
•
•
•
•

Pulpitis
Dentoalveolar abscess
Ludwig’s angina
Osteomyelitis of jaw
Actinomycosis.
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infections of pulp, periapical tissues,ludwig angina, osteomyelitis

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Clinical Microbiology
Fifth Year

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infections of pulp, periapical tissues,ludwig angina, osteomyelitis

  1. 1. Infections of Pulp, Periapical tissues, and jaw Bones
  2. 2. • • • • • Pulpitis Dentoalveolar abscess Ludwig’s angina Osteomyelitis of jaw Actinomycosis.
  3. 3. Pulpitis • Inflammation of pulp. • Follow exposure to range of irritants like thermal, chemical, mechanical. • Dental caries is commonest cause of pulpal necrosis • Others include accidental trauma, instrumentation,
  4. 4. Pulpitis and its possible outcomes Irritant ↓ Pulpal inflammation ↓ ↓ Acute pulpitis Chronic pulpitis Pulpal necrosis ↓ Infection of periodontal membrane ↓ ↓ Acute periapical periodontitis Chronic periapical periodontitis ↓ Dentoalveolar abscess ← ↓ Cellulitis,-- Osteomyelitis ↓  Periapical granuloma or Cyst
  5. 5. • • • • Pulpitis following dental caries Pulpitis through an open cavity Pulpitis through the apical foramen Pulpal necrosis
  6. 6. Microbiology • Overall the related micro flora is similar to that isolated from necrotic pulps. • Part of normal flora, obligate anaerobes, facultative anaerobes.
  7. 7. Bacteria isolated from necrotic pulps Obligate Anaerobes • • • • • • • • • • Peptostreptococcus Veillonella Eubacterium Propionibacterium Arachnia Porphyromonas Prevotella Fusobacterium Campylobacter Wolinella Facultative Anaerobes • • • • Lactobacillus Eikenella Streptococcus Capnocytophaga
  8. 8. Dentoalveolar abscesses • Common infection • Develops typically at apices of roots of teeth. • Infection most commonly arises via the pulp chamber • Endogenous usually caused by mixture of bacteria.
  9. 9. Diagnosis • Specimen collection - most imp. • Method – aspiration with syringe and needle (anaerobes) • Gram stain and Z-N stain • Culture- both aerobic and anaerobic separately • Imaging -
  10. 10. TREATMENT • Aim- to establish the drainage of pus • Antibiotics- useful adjuncts - local instillation - anti aerobic and anti anaerobic
  11. 11. Ludwig’s angina • Life threatening infection. • Bilateral infection of sublingual and submandibular spaces. • Infection of fascial tissue covering glands • Rare but serious – Mortality is close to 100% • Cause – dental infection in 90% cases
  12. 12. Micobiology • Mixed type. • Oral commensals - Anaeorobic gram negative and anaerobic streptococci commonly isolated. • Staph, Strepto, Enterobacteria.
  13. 13. Key clinical features • Brawny edema with elevated tongue, airway obstruction and very little pus.
  14. 14. Treatment • Maintenance of airway is of paramount interest in management • AIRWAY • BREATHING • CIRCULATION • REMOVE SOURCE OF INFECTION – antibiotics
  15. 15. Osteomyelitis of jaw • Uncommon now • Definition- inflammation of medullary cavity of bone spreading to involve cortical bone and periosteum • Acute or Chronic • Commoner in Mandible than in Maxilla. MIXED infection
  16. 16. Etiology and Risk factors • Seen in immunocompromised, diabetes, agranulocytosis • Reduced vascularity of bone(Pagets disease) • Mixed infection. • Requires both medical and surgical treatment
  17. 17. Clinical Features • Early acute suppurative – - intense pain, - high fever, - swelling - paresthesia or anesthesia of mental nerve
  18. 18. c/f • Chronic - established suppurative lesion, sinus, deep pain, fever, teeth tender and loose, lymph node enlargement. • Cellulitis of cheek and trismus.
  19. 19. Microbiology • Staphylococci • Anaerobic G –ve rods • Anaerobic G +ve cocci ( Streptococci)
  20. 20. DIAGNOSIS AND TREATMENT • • • • • Specimen - pus CULTURE ANTIBIOTIC SENSITIVITY TESTS Medical and surgical management Drainage of pus, debridement, surgical reconstruction
  21. 21. Actinomycosis • • • • • Chronic granulomatous infection Endogenous infection Swelling at angle of jaw. Cervico-facial region – commonest type Risk factors – trauma, dental extraction, ID.
  22. 22. Microiology • A.israeli – commonest actinomyectes causing infection, A. naeslundii • Others are Haemophyllus spp, Actinobacillus actinomycetemcomitans • Obligate Anaerobes
  23. 23. c/f • • • • Common in young people, males. Presents as swelling at angle of lower jaw. Multiple draining sinuses Dental focus of infection
  24. 24. Lab diagnosis • Specimen- aspirate clean, non contaminated • Gram stain – gram positive long branching filamentous • Anaerobic culture • Sulphur granules – particles seen in pus, aggregates of actinomyeces filaments • Sunray appearance - Gram stain and H& E STAIN
  25. 25. Management • Surgical drainage • Extraction of dental focus of ifection. • Long term administration of antibiotics ( penicillin)
  26. 26. To summarize • • • • • Pulpitis Dentoalveolar abscess Ludwig’s angina Osteomyelitis of jaw Actinomycosis.

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