In The Name Of God

Dentoalveolar infection in pediatric patients Dr Sara Maleki Kambakhsh D.D.S M.Sc Pedodontist Assistant professor of Qazvin University of Medical Science

CONTENT Introduction of dental decay Incidence and prevalence Dentoalveolar infection Treatment modalities Recommendations

Dental caries  Dental caries is the single most common chronic childhood disease (may 2000.AAPD)  Dental caries is five times more common than asthma and seven times more common than hay fever  Dental caries is not self-limiting, like the common cold, nor amenable to treatment with a simple course of antibiotics, like an ear infections

 dental care is the most prevalent unmet health need among children  many variables contribute to the spread of the disease and thwart our efforts to eliminate this major health problem

ECC ( early childhood caries ) presence of one or more decayed (noncavitated or cavitated), missing (as a result of caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger SECC ( sever ECC, nursing caries, baby battle tooth decay ) in children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries

Etiology of dental caries Is an infectious and communicable disease and that multiple factors influence the initiation and progression of the disease  host (tooth in the oral environment)  a dietary substrate,  and acid uric bacteria  The saliva (viscosity / salivary flow )  And individual factors ( genetic) (anatomy and morphology)

host (tooth in the oral environment) Oral hygiene Critical PH (5.5/ 6.2) Primary dentition

Microorganisms(cariogenic bacteria) S. mutans,S.sobrinus and lactobacilli Window of infectivity Vertical and horizontal transmission

nutrition  Brest feeding (At once )  Bottle feeding  snacks

Odontogenic infection have three major origins Periapical ( 70%) Periodontal (20%) Pericronitis (10%)

Odontogenic Infections  Classic signs and symptoms of infection include redness, pain, swelling, and local and systemic temperature increases  The virulence of the microorganisms and the ability of the tissues to react to the infection probably determine whether the infection will be acute or chronic

the Importance in pediatric patients: Dentoalveolar infections can progress rapidly especially in pediatric patient. Children are susceptible to becoming dehydrated and systemically ill from what may appear to be a relatively minor infection (as a result of his or her refusal to take fluids because of oral pain)

 Because of wider marrow spaces in the child, an odontogenic infection can rapidly spread through the bone, and the surrounding tissue is less able to wall off the process  Most odontogenic infections in the child are not serious and can be easily managed with pulp therapy or removal of the involved tooth

Criteria for referral to a specialist Rapidly progressive infection (cellulitis) Difficulty in breathing Difficulty in swallowing Facial space involvement Elevated temperature (greater than 101F) Severe jaw truisms (less than 10 mm) Toxic appearance Compromised host defense

Acute alveolar abscess The tooth is sensitive to percussion and movement, and the patient may have a slight fever The acute symptoms of an alveolar abscess can be relieved by using antibiotic therapy and establishment of drainage antibiotic therapy is not always necessary (effective pain control) Warm saline

Chronic alveolar abscess  characterized by less soreness, is often a better-defined radiographic lesion  The patient will likely have some lymphadenopathy  Draining fistulas are also frequently associated with chronic alveolar abscesses  antibiotic therapy is unnecessary except in patients with an overriding systemic problem (e.g., patients susceptible to subacute bacterial endocarditis, patients with organ transplants, or those who are immunodeficient)

CELLULITIS  Cellulitis is a diffuse type of infection of the soft tissues that may be caused by a pulpless primary or permanent tooth  It often causes considerable swelling of the face or neck, and the tissue appears discolored  Cellulitis is a very serious infection. It can be lifethreatening and is a potential complication of all acute dental infections

The child appears acutely ill and may have an alarmingly high temperature with malaise and lethargy  If a maxillary tooth is the problem, the swelling and redness may involve the eye  If cellulitis is treated too late, serious complications, such as involvement of the central nervous system or a cavernous sinus thrombosis, could occur If the infection involves the submandibular, sublingual, and submental spaces, it is called Ludwig angina. In this condition the tongue and floor of the mouth become elevated to the extent that the patient's airway is obstructed and swallowing is impossible

Bacteria Responsible for Odontogenic Infection Aerobic bacteria(25%) Gram-positive Cocci Streptococcus Anaerobic bacteria(75%) Gram-positive Cocci Streptococcus, Peptostreptococcus Gram-negative Bacilli Prevotella, porphyromonas fusobacterium

Select antibiotic Causative organisms based on history Host defense history Allergy history Previous drug history

Penicillin vk Amoxicillin Clindamycin Metronidazole

Adequate length of time Improvement in symptoms: within 2 days Reasonably asymptomatic: within 4 or 5 days At least 2 days after the symptoms disappear Usual prescription should be written for 6-7 days