THE SPREAD OF DENTAL INFECTION Gusriani

The Spread Of Dental Infection Arise trough : Pulpal and Periapical disease Pulpal and Periapical disease Periodontal Disease Periodontal Disease

Dental Plaque ( A complex mass comprising bacteria, their products host-derived material, and food debris which adheres to teeth) At the enamel surface At the gingival margin At the enamel surface At the gingival margin inflammation of the pulpal Inflammation of the periodontal tissues inflammation of the pulpal Inflammation of the periodontal tissues pulpal and periapical disease Periodontal disease pulpal and periapical disease Periodontal disease

PULPAL AND PERIAPICAL DISEASE DENTAL CARIES DENTAL CARIES Bacteria on plaque  enamel surface  elaborate acidic acid proteolytic products  demineralize the surface, digest the organic matrix  decay Bacteria on plaque  enamel surface  elaborate acidic acid proteolytic products  demineralize the surface, digest the organic matrix  decay Caries enamel  dentin  pulp  tooth destroyed Caries enamel  dentin  pulp  tooth destroyed If left untreated  the pulpal canal  adjacent soft tissues  initiate a painful and destructive inflammatory reaction  spread into the marrow spaces of the bone  soft tissues and muscles of the face and neck

PULPITIS PULPITIS Noxious stimuli (mechanical damage, thermal injury, chemical irritation, bacterial effects)  degranulation of mast cell, decreased nutrient flow, cellular damage  release of inflammatory mediators (histamin, bradikynin, neurokinins, neuropeptides, prostaglandin)  vasodilation, increased blood inflow, vascular leakage with edema 

 active dilation of the arterioles  increased pulpal pressure + accumulation of mediators  vessel damage + pulpal inflammation + tissue necrosis  spread to apical portion of the pulp  active dilation of the arterioles  increased pulpal pressure + accumulation of mediators  vessel damage + pulpal inflammation + tissue necrosis  spread to apical portion of the pulp reversible reversible Pulpitis Pulpitis (acute, chronic) irreversible (acute, chronic) irreversible

Reversible pulpitis Pulpal inflammation, the tissue is capable of returning to a normal state of health Clinical features : - Sudden mild to moderate pain of short duration - Cold stimuli : ice, beverages, cold air - Sweet or sour foods and beverages - Does not occur without stimuli - Subsides within seconds - If progressed  irreversible affected

IRREVERSIBLE PULPITIS Pulpal inflammation in higher level, the pulpal damage beyond the point of recovery Clinical features : - sharp, severe pain upon thermal stimulation - The pain continuous after stimulus is removed - The pain spontanious or continuous, exacerbated when lies down - Increases in intensity

CHRONIC HYPERPLASTIC PULPITIS (PULP POLYP) In children and young adults  large exposures of the pulp  entire dentinal roof often missing In children and young adults  large exposures of the pulp  entire dentinal roof often missing Mechanical irritation + Bacterial invasion  Chronic inflammation produces hyperplastic granulation tissue that extrudes from the chamber  Fills dentinal defect Mechanical irritation + Bacterial invasion  Chronic inflammation produces hyperplastic granulation tissue that extrudes from the chamber  Fills dentinal defect

Periapical abscess The accumulation of acute inflammatory cells at the apex of non vital tooth. Abscess formation may arise of a chronic periapical inflammatory lesion, acute exacerbation, initial periapical pathosis The source of infection :pulpal necrosis trauma related trauma related high occlusal contact high occlusal contact

Clinical Features : Tenderness Tenderness Pain, sensitive to percussion Pain, sensitive to percussion Extrusion of the tooth Extrusion of the tooth Swelling of the tissues Swelling of the tissues Does not respond to cold or electric pulp testing Does not respond to cold or electric pulp testing Headache, malaise, fever, chills Headache, malaise, fever, chills

With progression, the purulence With progression, the purulence - may extend through the medullary spaces away from the apical area  osteomyelitis - May perforate the cortex and spread diffusely trough the overlying soft tissue  cellulitis

Osteomyelitis An inflammatory process within medullary (trabecular) bone that involves the marrow spaces An inflammatory process within medullary (trabecular) bone that involves the marrow spaces Acute osteomyelitis : rapidly destructive inflammatory process within trabecular bone and bone marrow consists of granulation tissue, purulent exudates and sequestra Acute osteomyelitis : rapidly destructive inflammatory process within trabecular bone and bone marrow consists of granulation tissue, purulent exudates and sequestra Caused by direct extension of untreated periapical abscess Caused by direct extension of untreated periapical abscess Clinical features: - intense pain  physically ill Clinical features: - intense pain  physically ill - pyrexia, malaise - pyrexia, malaise

Cellulitis If an abscess is not able to establish drainage through the surface of the skin or into the oral cavity, it may spread diffusely through fascial planes of the soft tissue  cellulitis A painful swelling of the soft tissue of the mouth and face resulting from a diffuse spreading of purulent exudate along the fascial planes that separate the muscle bundles

Ludwig’s Angina/ phlegmon A cellulitis involving fascial spaces between muscles and other structures of the posterior floor of the mouth that compromise the air way

Clinical features : - Swelling of the floor of the mouth, tongue and submandibular region - Swelling of the floor of the mouth, tongue and submandibular region - Involvement of the sublingual space  elevation, posterior enlargement, and protrusion of the tongue (woody tongue) - Submandibular space spread  enlargement and tenderness of the neck above of the hyoid bone (bull neck)

- Pain in the neck and floor of mouth - Dysphagia,dysphonia, dysarthria, drooling, sore throat - Lateral pharyngeal space involvement  respiratory obstruction secondary to laryngeal edema - Tachypnea, dyspnea, tachycardia, stridor, restlessness - Fever, chills, leukocytosis

Cavernous sinus thrombosis Edematous periorbital enlargement with involvement of the eyelids and conjunctiva Edematous periorbital enlargement with involvement of the eyelids and conjunctiva Clinical features : Clinical features : - Protrusion and fixation of the eyeball - Indurations and swelling of the adjacent fore head and nose - Pupil dilation, lacrimation,photopobia, loss of vision - Pain over the eye and the trigeminal nerve - Fever, chills, sweating, tachycardia, nausea, vomitus - With progression  central nervous system involvement developed - meningitis, tachypnea, irregular breathing, stiffening of the neck, deepening stupor (advanced toxemia and meningeal involvement) - Occasionally  brain abscesses

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