Upload
drahmadzuhdi
View
220
Download
0
Embed Size (px)
Citation preview
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 1/62
DentoDento--Alveolar Alveolar
infectionsinfectionsDr Ashraf Abu KarakyDr Ashraf Abu KarakyBDS MSc MfDSRCSEd FFDRCSIBDS MSc MfDSRCSEd FFDRCSI
Oral & Maxillofacial SurgeonOral & Maxillofacial Surgeon
The University of JordanThe University of Jordan
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 2/62
Microbiology of OdontogenicMicrobiology of Odontogenic
InfectionsInfections Bacteria causing infections are partBacteria causing infections are part
of normal floraof normal flora
Gingivitis, periodontitis, dentalGingivitis, periodontitis, dentalcaries.caries.
Access to deeper underlying tissuesAccess to deeper underlying tissues
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 3/62
Almost all odontogenic inf. areAlmost all odontogenic inf. arecaused by multiple bacteriacaused by multiple bacteria
AnaerobicAnaerobic--aerobic characteristic of aerobic characteristic of the bacteriathe bacteria
6060% Mixed% Mixed
55% Aerobic% Aerobic
3333% Anaerobic (Aderhold% Anaerobic (Aderholdet al et al
Oral SurgOral Surg 19811981))
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 4/62
Aerobic bacteria Aerobic bacteria 2525%%
Gram positive cocciGram positive cocci 8585%%
Most common StreptococciMost common Streptococci 9090%%
StaphylococciStaphylococci 55%% Rarely found bacteria: Neisseria spp,Rarely found bacteria: Neisseria spp,
Corynebacterium spp andCorynebacterium spp and
Haemophillus spp.Haemophillus spp.
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 5/62
Anaerobic Bacteria Anaerobic Bacteria 7575%%
Anaerobic gram positive cocciAnaerobic gram positive cocci 3030%%StreptococcusStreptococcusPeptostreptococcusPeptostreptococcus
Gram negative rodsGram negative rods 5050%%Provotella and Porphyromonas spp. (previouslyProvotella and Porphyromonas spp. (previously
Bacteroides)Bacteroides) 7575%%FusobacteriumFusobacterium 2525%%
Gram negative cocci; Veillonella spp.Gram negative cocci; Veillonella spp. Gram positive rods; Eubacteruim and LactobacillusGram positive rods; Eubacteruim and Lactobacillus
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 6/62
Anaerobic bacteria Anaerobic bacteria
Gram + cocci Streptococcus andGram + cocci Streptococcus andPeptostreptococcusPeptostreptococcus
GramGram ± ± rods Provotella and Fusobacteriumrods Provotella and Fusobacterium
PLAY A MORE IMPORTANTPLAY A MORE IMPORTANTPATHOGONIC ROLEPATHOGONIC ROLE
the other Gramthe other Gram ± ± cocci and Gram +cocci and Gram +rods appear to be opportunisticrods appear to be opportunisticorganismsorganisms
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 7/62
Microorganism Vs HostMicroorganism Vs Host
Microorganism:Microorganism: 11-- VirulenceVirulence
22-- numbernumber
33-- structurestructure
Host: immunity & resistanceHost: immunity & resistance
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 8/62
Causes of dentoCauses of dento--alveolar Infectionsalveolar Infections
Mainly odontogenicMainly odontogenic
PeriapicalPeriapical
PeriodontalPeriodontal PericoronalPericoronal
Others like;Others like;
Cystic originCystic origin Neoplastic originNeoplastic origin
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 9/62
Predisposing FactorsPredisposing Factors
TraumaticTraumatic
ChemicalsChemicals
NutritionalNutritional EndocrineEndocrine
HematologicalHematological
ImmunologicalImmunological
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 10/62
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 11/62
Method of infection:Method of infection:
Inoculation into deeper tissuesInoculation into deeper tissues
------ Invasive org. (strep.) start infection process,Invasive org. (strep.) start infection process,Cellulitis.Cellulitis.
-------- Local oxidation potential loweredLocal oxidation potential lowered
---------- Anaerobic bacteria growAnaerobic bacteria grow
------------ Chronic infection & AbscessChronic infection & Abscess
-------------- More AnaerobesMore Anaerobes
Early, Acute, Cellulitis: aerobic streptococcalEarly, Acute, Cellulitis: aerobic streptococcal
Late, Chronic, Abscess: anaerobicLate, Chronic, Abscess: anaerobic
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 12/62
Natural History of Progression of Natural History of Progression of
Odontogenic InfectionsOdontogenic Infections Periapical invasionPeriapical invasion
Periodontal invasionPeriodontal invasion
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 13/62
-- Necrosis of dental pulpNecrosis of dental pulp
---- bacteria enter periapical tissuebacteria enter periapical tissue
------ Active infectionActive infection-------- spread of infection Leastspread of infection Least
resistance Pathwayresistance Pathway
------------ Cancellous bone towards CorticalCancellous bone towards CorticalBoneBone
-------------- Perforation towards soft tissuePerforation towards soft tissue
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 14/62
The location of infection from specificThe location of infection from specifictooth is determined by:tooth is determined by:
11-- the thickness of the bone overlyingthe thickness of the bone overlyingthe apex of the tooththe apex of the tooth
22-- The relationship of the site of The relationship of the site of perforation of bone to muscleperforation of bone to muscleattachments of the maxilla andattachments of the maxilla andmandiblemandible
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 15/62
MaxillaMaxilla
-- Most infections erode through the labioMost infections erode through the labio--bucco cortical platebucco cortical plate
-- Most bellow attachment of the musclesMost bellow attachment of the muscles------
Vestibular AbscessVestibular Abscess-- Palatal abscessPalatal abscess«« Lateral Incisor andLateral Incisor and
palatal root of upper molarspalatal root of upper molars
-- Canine.. Superior to insertion of levatorCanine.. Superior to insertion of levator
anguli orisanguli oris ---------- Canine Space InfectionCanine Space Infection-- Molars.. Superior to insertion of buccinatorMolars.. Superior to insertion of buccinator
musclemuscle ± ±-------- Buccal Space InfectionBuccal Space Infection
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 16/62
MandibleMandible
-- Incisors, canines and premolars usually erodeIncisors, canines and premolars usually erode
labio bucco cortical plate and above associatedlabio bucco cortical plate and above associated
musclesmuscles ---------------------------- Vestibular AbscessVestibular Abscess
-- First Molar either buccally or linguallyFirst Molar either buccally or lingually-- Second Molar usually linguallySecond Molar usually lingually
-- Third molar almost always linguallyThird molar almost always lingually
--Mylohyoid muscle :Mylohyoid muscle : SublingualSublingual ororSubmandibular Space AbscessSubmandibular Space Abscess
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 17/62
Management of Dentoalveolar Management of Dentoalveolar
InfectionsInfectionsAims of treatment:Aims of treatment:
Elimination of causative factorElimination of causative factor
decrease virulence, and number of decrease virulence, and number of microorganismsmicroorganisms
Increase host resistanceIncrease host resistance
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 18/62
Principles of therapy of Principles of therapy of
odontogenic infectionsodontogenic infections PrinciplePrinciple 11:Determine severity of infection:Determine severity of infection
-- Complete historyComplete historyCC, HCC (onset, duration, rapidity), S&S (dolor, tumor, calor, ruborCC, HCC (onset, duration, rapidity), S&S (dolor, tumor, calor, rubor
and functio laesa), General feeling (fatigue and malaise), Previousand functio laesa), General feeling (fatigue and malaise), Previous
ttt,ttt,PMH, SH.PMH, SH.
-- Physical examination.Physical examination.General appearance ,Vital signs, swelling, erythema, mouth opening,General appearance ,Vital signs, swelling, erythema, mouth opening,
swallowing.swallowing.
Swelling: tender, warm, soft, hard, indurated, fluctuant (fluid filled,Swelling: tender, warm, soft, hard, indurated, fluctuant (fluid filled,pus)pus)
IOE (cause), RG examinationIOE (cause), RG examination
-- Cellulitis or abscess?Cellulitis or abscess?
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 19/62
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 20/62
General differences betweenGeneral differences between
C
ellulitis and AbscessC
ellulitis and AbscessCharacteristic Cellulitis AbscessCharacteristic Cellulitis Abscess
Duration Acute ChronicDuration Acute Chronic
Pain severe & generalized LocalizedPain severe & generalized LocalizedSize Large SmallSize Large Small
Localization diffuse borders well circumscribedLocalization diffuse borders well circumscribed
Palpation indurated FluctuantPalpation indurated Fluctuant
Degree of Seriousness Greater LessDegree of Seriousness Greater Less
Bacteria Aerobic AnaerobicBacteria Aerobic Anaerobic Deep abscess is difficult to distinct from cellulitisDeep abscess is difficult to distinct from cellulitis
Indurated cellulitis may have areas of abscess formation in itIndurated cellulitis may have areas of abscess formation in it
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 21/62
PrinciplePrinciple 22: Evaluate state of : Evaluate state of patient`s host defense mechanismspatient`s host defense mechanisms
-- Uncontrolled metabolic diseasesUncontrolled metabolic diseasesUremiaUremia
AlcoholismAlcoholismMalnutritionMalnutritionSevere diabetesSevere diabetes
-- Suppressing diseasesSuppressing diseasesLeukemiaLeukemiaLymphomaLymphoma
Malignant tumorsMalignant tumors-- Suppressing drugsSuppressing drugsCancer chemotherapeutic agentsCancer chemotherapeutic agentsImmunosuppressive agentsImmunosuppressive agents
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 22/62
PrinciplePrinciple 33: Determine whether: Determine whetherpatient should be treated by generalpatient should be treated by generaldentist or specialistdentist or specialist
-- Rapid progressive infectionRapid progressive infection
-- Difficulty in breathingDifficulty in breathing-- Difficulty in swallowingDifficulty in swallowing-- Facial space involvementFacial space involvement-- Elevated temperatureElevated temperature
-- Severe jaw trismusSevere jaw trismus-- Toxic appearanceToxic appearance
-- Compromised host defenceCompromised host defence
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 23/62
PrinciplePrinciple 44: treat infection: treat infectionsurgicallysurgically
Abscess or CellulitisAbscess or Cellulitis
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 24/62
CellulitisCellulitis
Mild SevereMild Severe
remove causeremove cause remove causeremove cause(I&D)(I&D)
antistrep. Antibiotic antistrep. Antibioticantistrep. Antibiotic antistrep. Antibiotic
Resolve? Resolve?Resolve? Resolve?
If not: I&D If not: Additional SurgeryIf not: I&D If not: Additional Surgery
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 25/62
AbscessAbscess
remove causeremove cause
I & DI & DAntistrept. AntibiotcsAntistrept. Antibiotcs
antianaerobicantianaerobic
Resolve?Resolve?
If not: additional surgeryIf not: additional surgery
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 26/62
Incision & DrainageIncision & Drainage
Evacuation of pusEvacuation of pus
Prevent spread of infectionPrevent spread of infection
Decrease number of bacteriaDecrease number of bacteria Decrease pressure and painDecrease pressure and pain
Reduction in tissue tension whichReduction in tissue tension which
improve local blood supply andimprove local blood supply andincrease the delivery of hostincrease the delivery of hostdefenses to the localized area.defenses to the localized area.
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 27/62
TechniqueTechnique
Stab incision, bladeStab incision, bladenumbernumber 1111
Most prominentMost prominent
area or lowestarea or lowest
HemostatHemostat
IrrigationIrrigation
DrainDrain
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 28/62
Type of drainsType of drains
Rubber dam stripsRubber dam strips
Rubber tubesRubber tubes(Penrose drain)(Penrose drain)
Corrugated drainsCorrugated drains
Vacuum drainsVacuum drains
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 29/62
Avoid Vital Structures Avoid Vital Structures
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 30/62
PrinciplePrinciple 55: support patient medically: support patient medically
-- fluid intakefluid intake
-- nutritional supplementsnutritional supplements
-- restrest
-- analgesicsanalgesics
-- Assess the need for HOSPITALIZATIONAssess the need for HOSPITALIZATION
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 31/62
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 32/62
PrinciplePrinciple 66: choose and prescribe: choose and prescribeappropriate antibioticappropriate antibiotic
-- Determine need for antibioticDetermine need for antibiotic
Rapidly progressive swellingRapidly progressive swellingDiffuse swellingDiffuse swelling
Compromised host defensesCompromised host defenses
Involvement of facial spacesInvolvement of facial spaces
Severe pericoronitisSevere pericoronitisOsteomyelitisOsteomyelitis
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 33/62
Use of antibiotic is not necessaryUse of antibiotic is not necessary
-- Chronic wellChronic well--localized abscesslocalized abscess
-- Minor vestibular abscessMinor vestibular abscess-- Mild pericoronitisMild pericoronitis
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 34/62
-- Use narrowest spectrum antibioticUse narrowest spectrum antibiotic
-- Use antibiotic with lowest incidenceUse antibiotic with lowest incidence
of toxicity and side effectsof toxicity and side effects-- Use bactericidal antibiotic, if possible.Use bactericidal antibiotic, if possible.
-- Be aware of the cost of antibioticsBe aware of the cost of antibiotics
-- Administer antibiotic properlyAdminister antibiotic properly
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 35/62
PrinciplePrinciple 77: evaluate patient: evaluate patientfrequentlyfrequently
Reasons for treatment failure:Reasons for treatment failure:
-- Causative factor not eliminatedCausative factor not eliminated-- Inadequate surgeryInadequate surgery
-- Foreign bodyForeign body
-- Antibiotic problems;Antibiotic problems;Patient nonPatient non--compliancecompliance
Drug not reached siteDrug not reached site
Wrong bacterial diagnosisWrong bacterial diagnosis
Wrong antibioticWrong antibiotic
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 36/62
Principles of prophylaxis of woundPrinciples of prophylaxis of wound
infectioninfection
Reduce incidence of infection andReduce incidence of infection andthereby postoperative morbiditythereby postoperative morbidity
Reduces cost of health careReduces cost of health care Fewer opportunities exist forFewer opportunities exist for
resistant bacteria to arise whenresistant bacteria to arise wheneffective prophylactic antibiotics areeffective prophylactic antibiotics areusedused
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 37/62
Disadvantages of prophylacticDisadvantages of prophylactic
antibioticsantibiotics
Alter host bacteriaAlter host bacteria
More resistant bacteriaMore resistant bacteria
More pathogenic bacteriaMore pathogenic bacteria May encourage lax surgical techniqueMay encourage lax surgical technique
CostCost
Drugs toxicityDrugs toxicity
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 38/62
Principles of prophylactic antibioticPrinciples of prophylactic antibiotic
11--Risk of infection must be significantRisk of infection must be significant
-- size of bacterial inoculumsize of bacterial inoculum
-- extent and time of surgeryextent and time of surgery
-- presence of foreign bodypresence of foreign body
-- state of host resistancestate of host resistance
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 39/62
22--Choose correct antibioticChoose correct antibiotic
-- effective against the organismeffective against the organism
-- narrow spectrumnarrow spectrum-- least toxicleast toxic
-- bactericidalbactericidal
Drug of choice: PENICILLINDrug of choice: PENICILLIN
Allergy: Cefadroxil (broad spectrum)Allergy: Cefadroxil (broad spectrum)
ClindamycinClindamycin(less effective against strep.)(less effective against strep.)
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 40/62
33-- Antibiotic plasma level must beAntibiotic plasma level must behighhigh
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 41/62
Routs of spread of infectionRouts of spread of infection
-- Direct continuityDirect continuity
-- Blood streamBlood stream
-- Lymphatic systemLymphatic system
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 42/62
Phases & Fate of infectionPhases & Fate of infection
AcuteAcute
ChronicChronic
ResolutionResolution
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 43/62
Types of dentoTypes of dento--alveolar infectionsalveolar infections
Acute dentoalveolar abscessAcute dentoalveolar abscess
Early stageEarly stage
Late stageLate stage Chronic dentoalveolar abscessChronic dentoalveolar abscess
Periapical GranulomaPeriapical Granuloma
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 44/62
Acute dentoalveolar abscess/Early Acute dentoalveolar abscess/Early
stagestage
SuppurativeSuppurative
No soft tissueNo soft tissueinvolvementinvolvement
No cortexNo cortexpenetrationpenetration
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 45/62
Clinical PresentationClinical Presentation
Tender to percussion or masticationTender to percussion or mastication
Elongated teeth sensationElongated teeth sensation
NonNon--vital tooth or teethvital tooth or teeth Throbbing painThrobbing pain
Generalized symptoms of infectionGeneralized symptoms of infection
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 46/62
Acute dentoalveolar abscess/Late Acute dentoalveolar abscess/Late
stagestage
SuppurativeSuppurative
Cortical perforationCortical perforation
Soft tissueSoft tissue
involvementinvolvement
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 47/62
SwellingSwelling
NonNon-- vital tooth or teethvital tooth or teeth
Symptoms related to local spread;Symptoms related to local spread;trismus, dysphagiatrismus, dysphagia
Generalized symptomsGeneralized symptoms
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 48/62
Chronic dentoalveolar abscessChronic dentoalveolar abscess
Long standingLong standing
Low gradeLow grade
Sinus tractSinus tract
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 49/62
Clinical presentationClinical presentation
AsymptomaticAsymptomatic
NonNon--vital tooth or teethvital tooth or teeth
Acute exacerbationsAcute exacerbations
SuperinfectionsSuperinfections
Sinus tract & fistulaSinus tract & fistula
Chronic generalized symptoms;Chronic generalized symptoms;
lymphadenopathy, increased lymphocyteslymphadenopathy, increased lymphocytesincreased ESRincreased ESR
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 50/62
Periapical granulomaPeriapical granuloma
Well definedWell definedgraulation tissuegraulation tissuesurrounding the apexsurrounding the apexof the toothof the tooth
Etiology: odontogenicEtiology: odontogenicwith predisposingwith predisposingfactorsfactors
Bacteriology: mainlyBacteriology: mainlystreptococcus & streptococcus &
staph., anaerobesstaph., anaerobesothers lactobacilliothers lactobacilli
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 51/62
Clinical presentationClinical presentation
AsymptomaticAsymptomatic
Discovered by routine examinationDiscovered by routine examination
Discolored nonDiscolored non--vital teethvital teeth
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 52/62
RadiographyRadiography
Periapical xPeriapical x--raysrays
OPGOPG
Occlussal filmOcclussal filmCTCT
MRIMRI
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 53/62
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 54/62
Acute/Early stage Acute/Early stage
NegativeNegative
SometimesSometimeswidening of PDLwidening of PDL
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 55/62
Acute/Late stage Acute/Late stage
Widening of PDLWidening of PDL
Interruption of Interruption of lamina durralamina durra
With or withoutWith or withoutlocalized ill definedlocalized ill definedRLRL
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 56/62
Chronic dentoalveolar abscessChronic dentoalveolar abscess
Irregular periapicalIrregular periapicalRLRL
With or withoutWith or without
apex resorptionapex resorption
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 57/62
Periapical granulomaPeriapical granuloma
Small well definedSmall well definedRL at the apexRL at the apexsurrounded by ROsurrounded by RO
line (condensingline (condensingOstitis)Ostitis)
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 58/62
Primary carePrimary care
HospitalizationHospitalization
Air wayAir way
IV fluidIV fluid
FeverFever IV antibioticIV antibiotic
Vital structuresVital structures
Medical statusMedical status
Social statusSocial status
GAGA
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 59/62
Management of fistulasManagement of fistulas
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 60/62
ComplicationsComplications
ChronicityChronicity
CellulitesCellulites
OsteomylitisOsteomylitis Laryngeal oedemaLaryngeal oedema
Cavernous sinusCavernous sinus
Heamtogenous spreadHeamtogenous spread
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 61/62
PericorinitisPericorinitis
8/2/2019 Dento-Alveolar infectionsPart 1&2
http://slidepdf.com/reader/full/dento-alveolar-infectionspart-12 62/62
Thank youThank you