Professional Documents
Culture Documents
Presented By:
Gerald Volire DDS, B.Sc.D, DHSA, CDT, RDH, B.Sc.
geraldvoliere@yahoo.ca
11/10/2017 1
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
Principles of Management and Prevention of
Odontogenic Infections Part I
Introduction
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 3
Principles of Management and Prevention of
Odontogenic Infections Part I
Introduction
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 5
Principles of Management and Prevention of
Odontogenic Infections Part I
Outline
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 6
Principles of Management and Prevention of
Odontogenic Infections Part I
Outline
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 7
Principles of Management and Prevention of Odontogenic Infections Part I
Outline
PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 8
Principles of Management and Prevention of Odontogenic Infections Part I
Outline
PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 9
Principles of Management and Prevention of Odontogenic Infections Part I
Outline
PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 11
Principles of Management and Prevention of Odontogenic Infections Part I
Outline
PRINCIPLES OF PROPHYLAXIS AGAINST METASTATIC INFECTION
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 12
Ubi Pus, Ibi Evacua
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History
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Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
Incision of an abscess above a front tooth and insertion of a surgical drain
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MICROBIOLOGY OF ODONTOGENIC INFECTIONS
The bacteria that cause infection are most These bacteria are primarily
commonly part of the indigenous bacteria aerobic gram-positive cocci,
that normally live on or in the host
anaerobic gram-positive cocci, and
Odontogenic infections are no exception anaerobic gram-negative rods
because the bacteria that cause
odontogenic infections are part of the These bacteria cause a variety of
normal oral flora: common diseases, such as
Those that comprise the bacteria of plaque Dental caries
Those found on the mucosal surfaces
Gingivitis
Those found in the gingival sulcus
Periodontitis
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MICROBIOLOGY OF ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 21
MICROBIOLOGY OF ODONTOGENIC INFECTIONS
The anaerobic bacteria found in The Prevotella and Porphyromonas spp. are found
odontogenic infections include an even in about 75% of these
greater variety of species And Fusobacterium organisms are present in more
than 50%
Two main groups predominate
Of the anaerobic bacteria, several gram-positive
1. The anaerobic gram-positive cocci are cocci (i.e., anaerobic Streptococcus and
found in about 65% of cases Peptostreptococcus spp . ) and gramnegative rods
(i.e., Prevotella and Fusobacterium spp. )
These cocci are anaerobic Streptococcus Play a more important pathogenic role
and Peptostreptococcus The anaerobic gram-negative cocci and the
anaerobic gram-positive rods appear to have little
2. Oral gram-negative anaerobic rods are or no role in the cause of odontogenic infections
cultured in about three quarters of the Instead, they appear to be opportunistic organisms
infections
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MICROBIOLOGY OF ODONTOGENIC INFECTIONS
The method by which mixed aerobic and Metabolic by-products from the streptococci
anaerobic bacteria cause infections is then create a favorable environment for the
known with some certainty growth of anaerobes
The release of essential nutrients
After initial inoculation into the deeper
tissues Lowered pH in the tissues
Consumption of local oxygen supplies
The facultative S. milleri group organisms
can synthesize hyaluronidase The anaerobic bacteria are then able to grow,
and as the local oxidation-reduction potential is
Which allows the infecting organisms to lowered further
spread through connective tissues
The anaerobic bacteria predominate and cause
Initiating a cellulitis type of infection liquefaction necrosis of tissues by their
synthesis of collagenases
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 23
MICROBIOLOGY OF ODONTOGENIC INFECTIONS
As collagen is broken down and invading white blood cells necrose and lyse
Micro abscesses form and may coalesce into a clinically recognizable abscess
In the abscess stage, the anaerobic bacteria predominate
And may eventually become the only organisms found in culture
Early infections appearing initially as a cellulitis may be characterized as
aerobic streptococcal infections
And late, chronic abscesses may be characterized as anaerobic infections
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 24
MICROBIOLOGY OF ODONTOGENIC INFECTIONS
Clinically, this progression of the infecting flora from 3. At 5 to 7 days after the onset of swelling, the
aerobic to anaerobic
anaerobes begin to predominate
Seems to correlate with the type of swelling that can be
found in the infected region Causing a liquefied abscess in the center of the
Thus, odontogenic infections seem to pass through four swollen area
stages This is the abscess stage
1. In the first 3 days of symptoms, a soft, mildly tender,
doughy swelling represents the inoculation stage 4. When the abscess drains spontaneously
In which the invading streptococci are just beginning to
through skin or mucosa or it is surgically
colonize the host drained, the resolution stage begins
2. After 3 to 5 days, the swelling becomes hard, red, and As the immune system destroys the infecting
acutely tender bacteria
As the infecting mixed flora stimulates the intense
inflammatory response of the cellulitis stage And the processes of healing and repair ensue
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MICROBIOLOGY OF ODONTOGENIC
INFECTIONS
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
When the infection erodes through the cortical plate of the alveolar process,
it spreads into predictable anatomic locations
The location of the infection arising from a specific tooth is determined by the
following two major factors
The thickness of the bone overlying the apex of the tooth
The relationship of the site of perforation of bone to muscle attachments of
the maxilla and mandible
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 30
Figure I 5-1 demonstrates how infections perforate through bone into the overlying soft
tissue
In Figure I 5-1, A, the labial bone overlying the apex of the tooth is thin compared with the
bone on the palatal aspect of the tooth
Therefore, as the infectious process spreads, it goes into the labial soft tissues
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 32
In Figure 15-2, A, the infection has eroded through to the facial aspect of the tooth
And inferior to the attachment of the buccinator muscle
Which results in an infection that appears as a vestibular abscess
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
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Likewise, on occasion a long maxillary canine root allows infection to erode through the
bone superior to the insertion of the levator anguli oris muscle
And causes an infraorbital (canine) space infection
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
38
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
11/10/2017
NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
11/10/2017
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NATURAL HISORY OF PROGRESSION OF
ODONTOGENIC INFECTIONS
As long as the sinus tract continues to drain, the patient experiences no pain
Antibiotic administration usually stops the drainage of infected material
temporarily
But when the antibiotic course is over, the drainage recurs
Definitive treatment of a chronic sinus tract requires treatment of the original
causative problem
Which is usually a necrotic pulp
In such a case the necessary surgery is endodontic therapy or extraction of
the infected tooth
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 40
PRINCIPLES OF THERAPY OF ODONTOGENIC
INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 41
PRINCIPLES OF THERAPY OF ODONTOGENIC
INFECTIONS
Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University 11/10/2017 42
Principle 1: Determine Severity of Infection
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
The next step is eliciting the These signs and symptoms are the
patient's symptoms Latin terms
Dolor (pain)
Infections are actually a
severe inflammatory response Tumor (swelling)
Calor (warmth)
And the cardinal signs of
inflammation are clinically Rubor (erythema, redness)
easy to discern Functio laesa (loss of function)
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Complete History
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
Distinctions between
the inoculation,
cellulitis, and abscess
stages are typically in
duration, pain, size,
peripheral definition,
and consistency on
palpation, presence of
purulence, infecting
bacteria, and potential
danger (Table 15-3)
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Dr. Gerald Volire School & Hospital of Stomatology Wenzhou Medical University
Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Principle 1: Determine Severity of Infection
Physical Examination
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Bibliography
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