This document summarizes various infections of the pulp, periapical tissues, and jaw bones: pulpitis causes inflammation of the pulp due to irritants like caries; dentoalveolar abscesses develop at tooth roots from pulp infections; Ludwig's angina is a life-threatening bilateral infection of sublingual and submandibular spaces often from dental infections; osteomyelitis is bone inflammation usually from mixed infections that requires medical and surgical treatment; and Actinomycosis is a chronic granulomatous infection caused by Actinomyces bacteria often related to dental procedures.
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. Pulpitis and its possible outcomes
Irritant
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Pulpal inflammation
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Acute pulpitis
Chronic pulpitis
Pulpal necrosis
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Infection of periodontal membrane
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Acute periapical periodontitis
Chronic periapical periodontitis
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Dentoalveolar abscess ←
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Cellulitis,-- Osteomyelitis
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Periapical granuloma or Cyst
6. Microbiology
• Overall the related micro flora is similar to
that isolated from necrotic pulps.
• Part of normal flora, obligate anaerobes,
facultative anaerobes.
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. 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. TREATMENT
• Aim- to establish the drainage of pus
• Antibiotics- useful adjuncts
- local instillation
- anti aerobic and anti anaerobic
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
13. Key clinical features
• Brawny edema with elevated tongue, airway
obstruction and very little pus.
14. Treatment
• Maintenance of airway is of paramount
interest in management
• AIRWAY
• BREATHING
• CIRCULATION
• REMOVE SOURCE OF INFECTION – antibiotics
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. Etiology and Risk factors
• Seen in immunocompromised, diabetes,
agranulocytosis
• Reduced vascularity of bone(Pagets disease)
• Mixed infection.
• Requires both medical and surgical treatment
17. Clinical Features
• Early acute suppurative –
- intense pain,
- high fever,
- swelling
- paresthesia or anesthesia of
mental nerve
18. c/f
• Chronic - established suppurative lesion,
sinus, deep pain, fever, teeth tender and
loose, lymph node enlargement.
• Cellulitis of cheek and trismus.