Acute Infections

1. Periapical osteitis – Localized inflammation of bone marrow spaces. Throbbing pain and tenderness to vertical percussion.

2. Phoenix abscess – Acute inflammation superimposed on a chronic lesion eg. cyst or granuloma

3. Pericoronitis – Infection of soft tissues (operculum) surrounding the crown of a partially erupted tooth

4. Folliculitis – Infection of follicle of developing 2ry teeth (spreads from 1ry predecessors)

5. Fistula – Abscess communicates with an epithelial surface

6. Ludwig’s angina – Rapidly spreading – septic cellulitis – involving submental, submandibular & sublingual spaces bilaterally

NB:

Primary fascial spaces: Adjacent to origin of infection

• Vestibular
• Sublingual, sub mandibular, submental
• Canine
• Buccal

Secondary fascial spaces:

• Pterygomandibular space
• Masseteric
• Superficial and deep temporal
• Infratemporal
• Masicator
• Lateral pharyngeal
• Retropharyngeal
• Prevertebral

Abscess	Cellulitis
Localized collection of pus	Inflammation of CT, non suppurative
Pocket with necrotic tissue, bacterial colonies and dead white cells	Warm, diffuse, erythematous, indurated tissue in infected area
Chronic	Acute
Localized pain	Severe and generalized pain
Well circumscribed	Diffuse
Fluctuant	Indurated
Anaerobic	Aerobic

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Chronic Infections

1. Chronic dento-alveolar abscess – Abscess from dental tissues spreads into alveolar bone. Sinus through alveolar bone onto mucosa near level of apex. Tender on percussion, no EPT response, Ice relieves pain, heat aggravates. Management: Drainage via pulp chamber/trephination, irrigate with H2O2 and normal saline, antibiotics

2. Condensing osteitis – Deposition of bone along existing trabeculae due to chronic irritation

3. Osteosclerosis – Deposit compact bone within trabecular area

4. Granuloma – mass of granulation tissue, consists of:

• Proliferating capillaries
• Fibroblasts
• Lymphocytes
• Plasma cells
• Macrophages
• Giant cells
• Collagen deposits – more pronounced at periphery

5. Periapical scar – Dense fibrous tissue. Scar forms after periapical inflammation resolves

6. Periostitis – Inflammation of periosteum (Vascular CT enveloping bones)

7. Hypercementosis – Excessive deposition of cementum

8. Osteomyelitis – Bone marrow infection

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Potentially fatal complications of oral infections

1. Intracanal spread by septic emboli

• Bacterial meningitis
• Brain abscess
• Cavernous sinus thrombosis

2. Mediastinitis

3. Bacteremia – detectable levels of bacteria in blood

4. Septicemia – Increased bacteria + toxins in blood

5. Septic shock – Septicemia, G-ve bacteria, inadequate perfusion of tissues

6. Necrotizing fasciitis

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In summary:

Untreated dental infections can lead to:

A) Local:

• Periapical abscess/granuloma
• Root resorption
• Cellulitis eg. Ludwig’s angina
• Osteomyelitis
• Osteosclerosis
• Trismus

B) Systemic (ascending):

• Cavernous sinus thrombosis
• Meningitis
• Extrusion of orbit

C) Systemic (descending):

• Mediastinitis
• Bacteremia
• Septicemia
• Septic shock
• Necrotising fasciitis