The spread of odontogenic infections

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1. Odontogenic Infection is derived from the following sources:

a) pulpal or periapical

b) pericoronal

c) periodontal

d) post-operative or post-traumatic

2. Stages
a) The primary infection: The odontogenic infection is very often confined to the tooth itself. This is manifested as an acutely painful tooth, most often with an obvious etiology.
b) The secondary infection: Here the infection has progressed to involve the supporting structures of the tooth: the periapex, the periodontal ligament and the adjacent bone.
Spread of an odontogenic infection is a function of many microbiological, enzymatic, biochemical and anatomical factors. Although bone destruction and soft tissue invasion are both part of an advancing infection, they are the results of very different biochemical events. Despite this variety of mechanisms, the patterns of spread of odontogenic infections is relatively predictable. Thus is a function of the relatively constant anatomy of the circumoral musculature and osseous structures.
c) The tertiary infection: The infection has progressed through bone and has now ruptured into the circumalveolar soft tissue. Thus we have involvement of the facial and oral spaces.

d) The quaternary infection: In the event of a particularly virulent organism or a susceptible host the infection is now involving the adjacent deep spaces of the head and neck.

3. Diagnosis is based on:
a) history

b) examination

c) radiographs

d) laboratory investigation

4. Severity of an infection is determined by evaluation of certain considerations:
a) Systemic considerations

1. acute toxic effects of infects of infection

2. underlying medical condition
b) Local considerations

1. underlying dental condition (etiology)

2. pain

3. swelling

4. local spread

5. trismus

6. odynophagia

7. dysphagia

8. dyspnea
5. Treatment is thus mobilized to respond to the specific situation and displays the following spectrum:
a) do nothing

b) analgesics +/- local anaesthetics

c) analgesics and antibiotics

d) pulpectomy (root canal)

e) extraction

f) incision and drainage

g) admission to IV therapy and OR

h) emergency airway +/- OR

6. Needless to say each situation requires individual judgement. There are certain situations that demand more serious consideration:
a) significant trismus

b) significant odynophagia

c) dysphagia

d) dyspnea

e) elevation of the tongue

f) deviation of the uvula

g) bilateral swelling

h) rapid, severe swelling

i) chest, pain

k) obvious systemic toxicity

l) eye signs

m) clouding of consciousness

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