1. ORO FACIAL INFECTION INTRODUCTION
Infections of Orofacial region, particularly those of odontogenic origin are most common.
These infections can be managed successfully without any complications but if not treated these can produce serious complications and can prove fatal.

2. Early recognition of orofacial infection, its cause and quick appropriate therapy is essential.
Proper knowledge of anatomy, anatomical landmarks and vital structures of the face and neck is necessary to predict pathways of spread of infections and to drain these spaces.

3. Causes & Types of Infection
Odontogenic infection are infections that arise within the jaw bones and can be classified on the basis of etiology as :
1. Based on the origin of infection.
Odontogenic
Pulp disease
Periodontal disease
Infected cysts
Remaining roots
Residual infection
Pericoronal infection
Traumatic
Implant surgery
From contaminated needle punctures
Salivary gland infections

4. 2. Based on the causative organisms.
Bacterial infections ( GRAM +VE & GRAM –VE )
Fungal infections
Viral infections

5. Types of infection
Acute
Acute peri-apical abscess
Acute periodontal abscess
Cellulitis
Chronic
Chronic abscess leading to fistulous tract or sinus formation

6. SPREAD & PATHWAY OF ODONTOGENIC INFECTION
Invasion of the dental pulp by bacteria after decay of a tooth Inflammation, edema and lack of collateral blood supply Venous congestion or avascular necrosis Reservoir for bacterial growth Periodic egress of bacteria into surrounding alveolar bone Periapical infection progress to other areas or spaces

7. Stages/Phases of Dento-alveolar Infections
Peri-apical osteitis
Intra-bony abscess
Cellulitis
Facial abscess

8. General Factors Affecting Spread of Infection
Host resistance (BODY).
Virulence of infecting organism.
Bacterial quantity.

9. Body Resistance Depends On
Humoral factors
Cellular factors
Humoral factors include polymorphonuclear leukocytes, monocytes, lymphocytes and tissue macrophages.
Cellular factors involves immunoglobulins derived from sensitized B- lymphocytes or plasma cells and complement.

10. Local Factors Affecting Spread of Infections
Anatomic location of the tooth
Position of muscle and facial attachments
Intact Anatomical Barriers
Alveolar bone
Periosteium
Adjacent muscles and fascia

12. Routes / Spread of Orofacial Infection
By direct continuity through the tissues
By lymphatics to regional lymph nodes
By blood stream

13. Phases & Fate of Infection
If untreated or improperly treated, infections can lead to
Focal osteomyelitis
Widespread osteomyelitis
Fistulous tract which may be
INTRAORAL/EXTRAORAL

14. Intraoral or Extraoral cutaneous soft tissue abscess
Cellulitis
Bacteremia – septicemia
Deep fascial space infection
Ascending facial cerebral infection

16. Diagnosis of Infection
History of toothache/headache with chills & fever.
Previous history of soft or hard tissue trauma.
History of localized swelling which may be tender.
Enlarged lymph nodes.

17. Extraoral & intraoral sinus tracts.
Trismus.
Dysphagia.
Radiological examination.
Other diagnostic aids.

18. Radiological Examination
Helpful in locating offending tooth or any other underlying cause :
IOPA
OPG
Lateral Oblique.
CT guided needle aspiration.
CT Scan.
MRI.