SPREAD OF THE ORAL INFECTION

Dr. Gaurav Salunkhe

Lecturer
Oral Pathology And Microbiology
 Introduction
• Infections involving the tooth and its supportive
structure are known as odontogenic infection, these
infections can arise either from gingival tissue or
periapical areas.
• Infections from gingival tissue involves the deeper
periodontal ligaments and alveolar bone.
• Periapical infection are often sequel of dental caries.
• Odontogenic infection spreads into the tissue spaces
situated between different planes of fascia such
infections into the tissue space are called as
“space infection “
• Common odontogenic infection in the oral
cavity
1. Pericoronitis
2. Periodontal abscess
3. Periapical abscess
4. Subperiosteal abscess
5. Osteomylitis
 Factors affecting the ability of spread of
infection are

 Type and virulence of organism

 General health of pateint

 Anatomical site of infection

• Space infection can be classified into
1. Maxillary space infection
2. Mandibular space infection
Depending upon the vicinity of the jaw bone.
 CELLULITIS

 If the abscess is not able to drain in the oral cavity or through the skin
surface it may spread through facial planes of the soft tissue.
 Cellulitis is a diffuse inflammation of soft tissues which is not
circumscribed or confined to one area, tends to spread through tissue
spaces and along facial planes.

 Causative organism ------ Streptococci

 Streptoccoci produce hyaluronidase and fibrinolysins which dissolves

hyaluronic acid and fiber, which are an intercellular substances.

 Cellulitis of face and neck most commonly results from dental infection ---
periapical abscess --- osteomyelitis ---- periodontal infection ----
pericoronitis
 Clinical Features:
• Large, diffuse, painful swelling of soft tissues,
tissues become firm and brawny
 Overlying skin is inflamed and shows purplish
appearance.
 Infection arising in maxillary area perforate
the outer cortical layer of bone and cause
swelling in the upper half of the face.
 Infection in the mandibular area results in
swelling on the lower half of the face, which
the spreads to cervical tissues to cause
respiratory discomfort.
 Chronic infection may become localized to
form a facial abscess, in such cases the
supportive material discharge to the surface.
 Fever, chill, leukocytosis are often seen.
 Treatment
• Surgical drainage with elimination of the
primary source of infection.

• Antibiotics

• Good diet

• Good amount of fluid intake

 Spread of Infection From Maxillary Teeth:

 Maxillary central and lateral incisor ----- labial, palatal abscess

or vestibular abscess

 Maxillary canine ------- canine space abscess , upper lip

 Maxillary premolars and molars ------ Buccal or palatal

abscess
 Spread of Infection From Mandibular Teeth
 Mandibular incisor --------- If the pus does not penetrates the muscle
attachment ---- labial or vestibular abscess ------ If the pus penetrates muscle
attachment ------- submental space is involved

 Mandibular premolars ------ vestibular abscess ------ lingual perforation ----

sublingual abscess

 Mandibular 1st molar ------- pus above the buccinator attachment -----
vestibular abscess ------- below buccinator attachment ----- buccal space
abscess ---- pus penetrates through lingual side ----- sublingual abscess
 Mandibular second molars ----- vestibular abscess ------ sublingual or
submandibular abscess

 Mandibular third molars ----- Submandibular ------ pterygomandibular ----

submasseteric abscess
 LUDWIG’S ANGINA
 Ludwig’s angina is an acute, potentially life threatening, toxic cellulitis
beginning usually in the submandibular space and secondarily involving
the sublingual and submental spaces.

 Dental infections account for 80% of ludwig’s angina

 The chief source of infection is from mandibular molar

 Other sources : submandibular gland sialadenitis, oral soft tissue

lacerations, intraoral and perioral piercing, gun shot wound, osteomyelitis
and jaw bone fractures
 Clinical features
• Massive swelling of the neck that often extend close
to clavicle .
• Elevation, posterior enlargement and protrusion of
tongue called as woody tongue.
• Enlargement and tenderness of the neck above the
level of hyoid bone - bull neck.
• Pain in the neck and floor of the mouth with limited
movement of the neck.
• Dysphagia, dysphonia, dysarthria, drooling and sore
throat.
• Involvement of the lateral pharyngeal space can
cause respiratory obstruction.
• Tachypnea
• Dyspnea
• Tachycardia
• Stridor- whistling sound during breath.
• Restlessness
• Patient needs to maintain erect position.
• Fever, chills, leukocytosis.
 Treatment
1. Maintenance of the airway
2. Incision and drainage
3. Antibiotics
4. Elimination of original focus of infection.
 CAVERNOUS SINUS THROMBOSIS
• It is a life threatening condition characterised by
formation of septic thrombi within the cavernous sinus
and its communicating branches.
• A blood clot blocks a vein that runs through a hollow
space underneath the brain and behind the eye sockets.
• Routes of spread of infections
1. External- veins of maxillary region of face drains into
cavernous sinus – any infection from upper lip, face,
eye.
2. Internal- upper and lower 3rd molars.
 Clinical features
• Edematous periorbital enlargement with
involvement of the eyelids and conjunctiva.
• Protusion and fixation of the eyeball.
• Induration and swelling of the forehead and
nose.
• Pupil dilatation, lacrimation, photophobia, and
loss of vision may occur.
• Pain over the eyelid along the ophthalmic nerve
distribution.
• Fever, chills, headache, sweating, techycardia,
nausea and vomiting can occur.
• With progression, signs of CNS involvement
develops. Meningitis, stiffing of the neck,
deepening stupor with or without delirium
indicates advance toxemia.
• Brain abscess may result.
 Treatment
1. Maintenance of the airway
2. Incision and drainage
3. Antibiotics
4. Anticoagulant therapy.
 MAXILLARY SINUSITIS
• It is an acute and chronic inflammation of the maxillary
sinus, which is often due to direct extension of dental
infection.
• Other conditions such as
1. Common cold
2. Exanthematous diseases
3. Local spread of infection from frontal and paranasal
sinuses
4. Traumatic injury to the sinus
Can result in sinusitis
• The common organisms are
1. Streptococcal pneumoniae
2. Hemophilus influenzae
3. Gram negative bacilli
4. Anerobic organism
5. Rhinovirus
6. Parainfluenza virus etc
• When maxillary sinusitis is secondary to dental
infection the organism associated with
sinusitis is same as that of the dental infection.
• Foreign bodies, tumours, granulomatous
infections may produce maxillary sinusitis.
•
 Acute maxillary sinusitis
• It can result from acute periapical abscess or
acute exacerbation of chronic inflammation.
• Mostly organism involved are
1. Streptococcal pneumoniae
2. Hemophilus influenzae
3. Moraxella catarrhalis
 Clinical features (acute)
• Can occur at any age.
• Pt. complains of pain, pressure and heaviness at the
affected side.
• Pressing over the maxilla increases the pain.
• Headache is the most common.
• Facial erythema, swelling, fever.
• Drainage of foul smelling mucopurulant material
into the nasal cavity and nasopharynx.
• Pain is exacerbated on bending position.
• Dull pain may be present on premolar and molar
region.
 Acute maxillary sinusitis
• Histologically:
• The lining of the maxillary sinus may show a
typical acute inflammatory infiltrate.
• Edema of connective tissue.
• Squamous metaplasia of the epithelium
occurs sometimes.
 Chronic maxillary sinusitis
• It may develop as the acute lesion subsides or it
may represent as a chronic lesion from the onset.
• Common predisposing factors are
1. URTI
2. Allergies
• Common organism
1. Steotococcus
2. Bacteroides
3. veillonella
 Clinical features (chronic)
• Repeated attacks.
• Pain and tenderness.
• Foul unilateral discharge.
• Cacosmia i.e. Fetid odour with bad taste in
mouth.
• Rarely antroliths can be seen in radiographs
• Histologically:
• The mucosa lining shows thickening and
development of numerous sinus ‘polyps’
• These polyps are hyperplastic granulation
tissue with lymphocytic and plasma cell
infiltration.
• Squamous metaplasia of the epithelium.
Diagnostic evaluation of maxillary sinus.

• Detailed medical & dental history.

• Clinical examination.
Inspection
Palpation
Percussion
Transillumination
• Radiographs .
• Ultrasound, CT scan, MRI.
• Endoscopy.
 Palpation
• Tapping of lateral wall of sinus over
prominence of cheek bone and palpation
intra-orally on lateral surface of maxilla
between canine fossa and zygomatic buttress.
 Transillumination
• It is done by placing a bright flash light or fiber
optic light against the mucosa on the palatal
or facial surface of the sinus and observing the
transmission of light through the sinus in the
darkroom.
 Radiographs
Intra-oral
• Periapical
• Occlusal
• Lateral
Extra-oral
• Panoramic
• Waters veiw
• Submentovertex
• PA veiw
 CT Scan &MRI
• Provides multiple sections at different planes
• High resolution
• Non-invasive techniques

Normal Pathology
 Ultrasound
• Introduced by LANDMAN in 1986
• Non-invasive
• Safe
• Quick
• Ultrasound waves are generated by probe.
 Endoscope
• Allows direct visualization in inaccessible
areas, such as maxillary moral roots that are
behind distobuccal root of maxillary 1st molar.
 Maxillary sinusitis
• TREATMENT-
1. Removal of the cause of the disease.
2. Nasal decongestant.
3. Antibiotics.
4. Analgesic
 Focal infection
• It can be localised or generalised infection,
caused by the dissemination of microorganism
or their toxic products.

• Oral focal infection has been related to

general health.
 Focal infection
• Mechanism:
1. Metastasis of microorganism from infected
focus either by hematogenous or
lymphogenous spread.
2. Toxins or toxic products may be carried
through blood stream or lymphatic channels
from focus to other sites.
 Role of Focal infection
• A variety of situation exist in the oral cavity
which may set up distant metastases such as.
1. Infected periapical lesion
2. Teeth with infected root canals
3. Periodontal disease.
 Significance of oral focal infection
• Oral foci of infection either cause or aggravate
many systemic diseases. Most commonly
1. Artheritis
2. Subacute bacterial endocarditis
3. GIT diseases
4. Ocular disease
5. Skin disease
6. Renal disease.
 Subacute bacterial endocarditis
• Close similarity between the etiologic agent of
the disease and the microorganism of the oral
cavity.
• Most common after tooth extraction.
• Transient bacteremia frequently follows tooth
extraction.
• Occurs within few weeks or moths post dental
extraction.