1- Caused by the oral normal inhabitant bacteria.
2- The bacteria are primarily: gram positive aerobic cocci, gram-positive anaerobic and gram-negative anaerobic.
3- The Odontogenic infections most commonly caused by polymicrobial origin.
4- The Odontogenic infections are caused mainly by:
Anaerobic 44%
Aerobic 6%
Mixed 50%
5- The Anaerobic gram-positive rods and anaerobic gram-negative cocci have little or no role in oral odontogenic infections.
6- The facultative S. Milleri group organisms can synthesize hyalurunidase, that allow spreading of infection the deeper connective tissue, initiating the cellulitis infections, the streptococci then produce the by-products that make a good environment, lowered tissue PH and release of essential nutrients, All make the anaerobic bacteria to grow there, and as the local oxidation reduction potential is lowered, the anaerobic bacteria predominate causing liquefaction necrosis of tissue by the collagenase the release, while the collagen break down and the invading WBC’s necrose & lyse, they form micro abscesses that may coalesce to form the clinical recognizable abscess.
So That: Each Oral Infection starts by cellulitis, is aerobic, whereas each one ends with chronic infection, is anaerobic.
7- Odontogenic infections includes 4 stages:
- Inoculation Stage: characterized by a soft mildly tender, doughy swelling, where the invaded streptococcus starts to colonize the host (in first 3 days).
- Cellulitis Stage: the swelling becomes harder, tenderer and red as the mixed flora starts to promote the inflammatory response. (3-5 days).
- Abscess Stage: when the anaerobic bacteria starts to predominate, causing the liquefied abscess.
- Resolution Stage: when the abscess drain through skin or mucosa of by surgery.
-----------------------------
- Complete History:
1- The patient chief complain should be recorded in patient's own words, ex: swelling, boiling gum or toothache.
2- Duration, onsite, time and rapidity of the infection.
3- Electing the patient's symptoms of infection, which are: pain, swelling(tumor), warmth(Salor), Redness(rubor) and loss of function(functio laesa)
4- The Patient then is asked about how does he feel in general, ex: fatigued, feverish, sick, weak and malaised.
5- Dentist should be aware of some cases that are refered from other physicians and cases of patients having self-treatment in home, that may cause unfavourable unexpected results.
6- The dentist must take the complete medical history of the patient.
- Physical Examination:
1- First of all the dentist should obtain the patient's vital signs, including tempreture, blood pressure, pulse rate and respiratory rate.
- The tempreture should be elevated slightly in cases of infection up to 38.3 C (101 F).
- The blood pressure should be elevated. in cases of pain and anxiety there is increased systolic blood pressure while there may be hypotention in cases of severe septic shock.
- The patients pulse rate should be slightly elevated, uncommonly up to 100 beat/min, but if elevated more than that, so aggressive treatment should be held for such a severe infection.
- Patients respiratory rate should be carefully observed to detect any partial or complete upper airway obstructions, the normal is 14-16 breath/min, while in mild to mederate infections in may reach 18 breath/min.
2- physical examination of the patients general appearance, if there is more than minor localized infection, there may be fatigue, feverishness and malaise. (Toxic Appearance).
3- physical Examination of the head and neck region for any swelling the underlying erythema.
4- open the patients mouth widely, as the patient to swallow and having deap breaths, to check for trismus 73%, dysphagia 78% and dyspnea 14%.
5- The dentist should have a good oral examination to detect the cause of infection.
6- Having A good Radiographic Image( intraoral periapical or extraoral panoramic ).
7- Complete the physical Examination by palpation of the swelling.
- If it's very soft, mildy tender, edematous swelling then it's in inoculation (Edema) stage. but,
- If it's slighter broadlike consistensy with reddish color, diffuse tender pain and diffuse borders then it's in cellulitis stage. but,
- If it's localized slightly tender swelling of flactuant consistensy and well-defined margins of swelling then it's in Abscess stage, where the body immune system has locally walled off infection.
-------------------------------
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2- The bacteria are primarily: gram positive aerobic cocci, gram-positive anaerobic and gram-negative anaerobic.
3- The Odontogenic infections most commonly caused by polymicrobial origin.
4- The Odontogenic infections are caused mainly by:
Anaerobic 44%
Aerobic 6%
Mixed 50%
5- The Anaerobic gram-positive rods and anaerobic gram-negative cocci have little or no role in oral odontogenic infections.
6- The facultative S. Milleri group organisms can synthesize hyalurunidase, that allow spreading of infection the deeper connective tissue, initiating the cellulitis infections, the streptococci then produce the by-products that make a good environment, lowered tissue PH and release of essential nutrients, All make the anaerobic bacteria to grow there, and as the local oxidation reduction potential is lowered, the anaerobic bacteria predominate causing liquefaction necrosis of tissue by the collagenase the release, while the collagen break down and the invading WBC’s necrose & lyse, they form micro abscesses that may coalesce to form the clinical recognizable abscess.
So That: Each Oral Infection starts by cellulitis, is aerobic, whereas each one ends with chronic infection, is anaerobic.
7- Odontogenic infections includes 4 stages:
- Inoculation Stage: characterized by a soft mildly tender, doughy swelling, where the invaded streptococcus starts to colonize the host (in first 3 days).
- Cellulitis Stage: the swelling becomes harder, tenderer and red as the mixed flora starts to promote the inflammatory response. (3-5 days).
- Abscess Stage: when the anaerobic bacteria starts to predominate, causing the liquefied abscess.
- Resolution Stage: when the abscess drain through skin or mucosa of by surgery.
-----------------------------
Principle 1: Determine the severity of the infection:
This is done by the good complete history and physical examination.- Complete History:
1- The patient chief complain should be recorded in patient's own words, ex: swelling, boiling gum or toothache.
2- Duration, onsite, time and rapidity of the infection.
3- Electing the patient's symptoms of infection, which are: pain, swelling(tumor), warmth(Salor), Redness(rubor) and loss of function(functio laesa)
4- The Patient then is asked about how does he feel in general, ex: fatigued, feverish, sick, weak and malaised.
5- Dentist should be aware of some cases that are refered from other physicians and cases of patients having self-treatment in home, that may cause unfavourable unexpected results.
6- The dentist must take the complete medical history of the patient.
- Physical Examination:
1- First of all the dentist should obtain the patient's vital signs, including tempreture, blood pressure, pulse rate and respiratory rate.
- The tempreture should be elevated slightly in cases of infection up to 38.3 C (101 F).
- The blood pressure should be elevated. in cases of pain and anxiety there is increased systolic blood pressure while there may be hypotention in cases of severe septic shock.
- The patients pulse rate should be slightly elevated, uncommonly up to 100 beat/min, but if elevated more than that, so aggressive treatment should be held for such a severe infection.
- Patients respiratory rate should be carefully observed to detect any partial or complete upper airway obstructions, the normal is 14-16 breath/min, while in mild to mederate infections in may reach 18 breath/min.
2- physical examination of the patients general appearance, if there is more than minor localized infection, there may be fatigue, feverishness and malaise. (Toxic Appearance).
3- physical Examination of the head and neck region for any swelling the underlying erythema.
4- open the patients mouth widely, as the patient to swallow and having deap breaths, to check for trismus 73%, dysphagia 78% and dyspnea 14%.
5- The dentist should have a good oral examination to detect the cause of infection.
6- Having A good Radiographic Image( intraoral periapical or extraoral panoramic ).
7- Complete the physical Examination by palpation of the swelling.
- If it's very soft, mildy tender, edematous swelling then it's in inoculation (Edema) stage. but,
- If it's slighter broadlike consistensy with reddish color, diffuse tender pain and diffuse borders then it's in cellulitis stage. but,
- If it's localized slightly tender swelling of flactuant consistensy and well-defined margins of swelling then it's in Abscess stage, where the body immune system has locally walled off infection.
-------------------------------
If You Have Any Other Useful information, Please Feedback us.
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..
Authored By,
:: World Of Dentistry :: TEAM
Would you tell us more about the antibiotic regimen in these cases?
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