Pericoronitis

Infection inInfection inOral & Oral & Maxillofacial Maxillofacial RegionRegion

Infection--- inInfection--- inoral & maxillofacial regionoral & maxillofacial region

InfectionInfection ConceptionConception TraitTrait AnatomyAnatomy ArisingArising RouteRoute MutationMutation Influence factorsInfluence factors DiagnosisDiagnosis PrinciplesPrinciples TreatmentTreatment PrinciplesPrinciples

Infection---conceptionInfection---conception

Infectious agent(bacteria)Infectious agent(bacteria) HostHost

Inflammatory reactionInflammatory reaction

Elimination the infectious pathogenElimination the infectious pathogen Repair tissue injury Repair tissue injury

Hypersensitivity Autoimmune diseaseHypersensitivity Autoimmune disease

Beneficial

Harmful

protective and defensive

AnatomyAnatomyAnatomyAnatomy

Oral and nasal cavityOral and nasal cavity

ToothTooth

SpaceSpace

Blood and Lymphoid systemBlood and Lymphoid system

BacteriaBacteria


Oral and nasal cavityOral and nasal cavity

Maxillary sinusMaxillary sinus

Temperature + Moisture

(Beneficial)

Reproduction + Developing

Bacteria---Exist

Alveolar bone

Soft tissue

Fascial space

Alveolar bone

Soft tissue

Fascial space


TootToot

hhCaries

Pulpitis

Apical infection

Caries

Pulpitis

Apical infection


Fascial space-loose connective tissue

Among skin, maxillary and muscle

•Purulent--- spreading way

•Do not exist in healthy state

•Become filling during infection


Blood and lymphoid system

Beneficial

Abundance Harmful

Blood and lymphoid system

Beneficial

Abundance Harmful

Dangerous triangle

•Lacking valves

•Cavernous sinus

Dangerous triangle

•Lacking valves

•Cavernous sinus

Cavernous sinus thrombosisCavernous sinus thrombosis

Encephalic infectionEncephalic infection

Trait of pathogenic Trait of pathogenic bacteriumbacterium

Trait of pathogenic Trait of pathogenic bacteriumbacterium

VariedVaried NumerousNumerous

Streptococcus hemolyticusStreptococcus hemolyticus

Staphylococcus aureusStaphylococcus aureus Escherichia coliEscherichia coli

AnaerobeAnaerobe

• Sterile

• Simple

• Complex

• Sterile

• Simple

• Complex

FloraFlora

Route of infectionRoute of infectionRoute of infectionRoute of infection

Odontogenic infectionOdontogenic infection

Traumatic infection Traumatic infection

Hematogenous infectionHematogenous infection

Iatrogenic infectionIatrogenic infection

Odontogenic infectionOdontogenic infectionOdontogenic infectionOdontogenic infection

• Periapical infection

• Pericoronitis

• Periapical infection

• Pericoronitis

Periapical infectionPeriapical infectionPeriapical infectionPeriapical infection

Acute-chronic

Periapical infection

Acute-chronic

Periapical infection

FistularFistular

CellulitisCellulitis

Intraoral soft tissue abscessIntraoral soft tissue abscess

OsteomyelitisOsteomyelitis

SepticemiaSepticemia

Deep fascial space infection

Deep fascial space infection

Ascending facial-cerebral infectionAscending facial-cerebral infection

Pathways of Periapical Pathways of Periapical infection infection

Pathways of Periapical Pathways of Periapical infection infection

PericoronitisPericoronitisPericoronitisPericoronitis

Lower third molar Lower third molar

Infection---ArisingInfection---ArisingInfection---ArisingInfection---Arising

Host--- defense systemHost--- defense system

Microbe---virulenceMicrobe---virulence

quantity quantity

Local circumstanceLocal circumstance

Balance ImbalanceBalance Imbalance

ScaleScale

MutationMutationMutationMutation

Influence factorsInfluence factors

Changing directionsChanging directions

Influence factorsInfluence factorsInfluence factorsInfluence factors

Host--- defense systemHost--- defense system

Microbe---virulenceMicrobe---virulence

quantity quantity

Treatment strategyTreatment strategy

Changing directionsChanging directionsChanging directionsChanging directions

Localization and recoveryLocalization and recovery

Acute chronicAcute chronic

DiffusionDiffusion

Blood system---Septicemia

lymphoid system---Lymphadenopathy

Blood system---Septicemia

lymphoid system---LymphadenopathyFrom submandible space infection to chest regionFrom submandible space infection to chest region

How to diagnose?How to diagnose?How to diagnose?How to diagnose?

Local Signs and Symptoms Local Signs and Symptoms

Systemical Signs and SymptomsSystemical Signs and Symptoms

Signs and Symptoms

Local Signs and Symptoms Local Signs and Symptoms Local Signs and Symptoms Local Signs and Symptoms

Pain Pain

Swelling Swelling

Surface erythema Surface erythema

Pus formation Pus formation

Limitation of motionLimitation of motion

LocallyLocally

Systemical Signs and Systemical Signs and SymptomsSymptoms

Systemical Signs and Systemical Signs and SymptomsSymptoms

Fever Fever

Lymphadenopathy Lymphadenopathy

Malaise Malaise

Toxic appearance Toxic appearance

Elevated white blood cell countElevated white blood cell count

How to treat?How to treat?How to treat?How to treat?

Acute stageAcute stage

Chronic stageChronic stage

Acute stageAcute stageAcute stageAcute stage

Host Host

Antibiotic therapyAntibiotic therapy

Surgical drainage and incisionSurgical drainage and incision

HostHostHostHost

Migration of white blood cellMigration of white blood cell

Production of antibodiesProduction of antibodies

Most important factor --- final outcomeMost important factor --- final outcome

The infections--- cured by the host, not by antibioticsThe infections--- cured by the host, not by antibiotics

Critical PrinciplesCritical Principles

Defense MechanismsDefense Mechanisms

Principles for choosing Principles for choosing appropriate antibioticappropriate antibiotic

Principles for choosing Principles for choosing appropriate antibioticappropriate antibiotic

causative organismcausative organism

sensitivitysensitivity

specific, narrow-spectrum antibioticspecific, narrow-spectrum antibiotic

least toxic antibioticleast toxic antibiotic

drug history(success, allergic and toxic)drug history(success, allergic and toxic)

Antibiotic eraAntibiotic era

Principles of antibiotic Principles of antibiotic administrationadministration

Principles of antibiotic Principles of antibiotic administrationadministration

Proper doseProper dose

Proper time intervalProper time interval

Proper route of administration(oral, parenteral)Proper route of administration(oral, parenteral)

Combination antibiotic therapyCombination antibiotic therapy

Surgical drainage and Surgical drainage and incisionincision

Surgical drainage and Surgical drainage and incisionincision

How to judge the pus formation?How to judge the pus formation?

Purposes of surgical drainage and incisionPurposes of surgical drainage and incision

Principles of surgical drainage and incisionPrinciples of surgical drainage and incision

How to judge the pus How to judge the pus formation?formation?

How to judge the pus How to judge the pus formation?formation?

Three Three stagesstages

InoculationInoculation

CellulitisCellulitis

AbscessAbscess

Duration--- Duration--- >5 days>5 days

Palpation---FluctuantPalpation---Fluctuant

Appearance---ReddenedAppearance---Reddened

Needle aspirationNeedle aspiration

B-ultrasoundB-ultrasound

CT CT

CharacteristicCharacteristic

Fluctuant examinationFluctuant examinationFluctuant examinationFluctuant examination

Purposes of surgical drainage & Purposes of surgical drainage & incisionincision

Purposes of surgical drainage & Purposes of surgical drainage & incisionincision

Rid the body of toxic purulent materialRid the body of toxic purulent material

Decompress the tissuesDecompress the tissues

Allowing better perfusion of blood containing antibiotics Allowing better perfusion of blood containing antibiotics

and defensive elements and defensive elements

Increased oxygenation of the infected areaIncreased oxygenation of the infected area

Infection in masseteric Infection in masseteric spacespace

Infection in masseteric Infection in masseteric spacespace

Infection in multi-spaceInfection in multi-spaceInfection in multi-spaceInfection in multi-space

Ludwig’s anginaLudwig’s angina

Principles of surgical drainage Principles of surgical drainage & incision& incision


Place the incision in an esthetically acceptablePlace the incision in an esthetically acceptable

Place the incision in a dependent position to Place the incision in a dependent position to

encourage drainage by gravityencourage drainage by gravity

Dissect bluntly through deeper tissues and explore all Dissect bluntly through deeper tissues and explore all

portions of the abscessportions of the abscess

Place a drain and stabilize it with suturesPlace a drain and stabilize it with sutures



Lesion tooth---Impacted toothLesion tooth---Impacted tooth

OsteomyelitisOsteomyelitis

Chronic stage Chronic stage Chronic stage Chronic stage

Surgical removal of the focusSurgical removal of the focus

ConclusionConclusionConclusionConclusion

The trait of Infection The trait of Infection

Odontogenic infectionOdontogenic infection

mutation of infectiousmutation of infectious

Diagnosis of the infectionDiagnosis of the infection

Diagnosis of the abscess formationDiagnosis of the abscess formation

The principles of the treatmentThe principles of the treatment

Infection in oral & maxillo-facial region

Thank youThank you

Health & Medicine

Pericoronitis