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Odontogenic infection in maxillofacial region

Infection in oral and maxillofacial region

Odontogenic infection Necrotizing facciitis, frequently odontogenic sourceOsteomyelitisOsteoradionecrosis Bisphosphonate-relaed osteonecrosisSalivary grand infectionFungal & viral infection

Odontogenic infection

Dental infection => space infection

Dental infection => space infection

Host

Anatomicalfactor

Microbialfactor

Subperiosteal abscess Severityscore= 1

Low severity

Vestibular abscessSeverityscore= 1

Low severity

Canine space abscess

Severityscore= 1

ระวงPeriorbital!!!

Low severity

Buccal space abscessSeverityscore= 1

Submasseteric spacePterygomandibular spaceTemporal space

Limited mouth opening ( 1cm)

Severityscore= 2

Submandibular space abscess

Submental space infection

Severityscore= 2

Ludwig’s angina

Involvement submandibular spaces bilaterally ,submental space,sublingual

Rapid spread to lateral pharyngeal / retropharyngeal space

Rapidly obstruct upper airway

Severityscore= 3

Danger space, MediasternumSeverityscore= 4

The most frequent cause of death in reported cases of odontogenic infection is

Airway Obstraction

Clinical apparent partial air way obstruction with lowO2sat => secure airway

Management of odontogenic infection

Step 1.Determine the severity of infection

---Anatomical location---Rate of progression :

Inoculation,Cellulitis,Abscess

---Air way compromise

Step 2. Evaluated host defend

DM*Steroid therapyOrgan transplantsMalignancyChemotherapyChronic renal failure*MalnutritionAlcoholismEnd-stage AIDS

Step 3.Decide on setting care

-Refer > Severe score 2-IPD : score 1, mild score 2

fever, dehydration, control host disease-OPD : mild score 1-2

follow up in *few days (7 days may be too long)

Step 4.Treat surgically

Surgical drain (intraoral or extraoral)--If drain inserted,drains should be discontinuedwhen drainage cease <72hrs--Irrigate with NSS daily

Mild root canal treatment or Tooth extraction

?

Stage of Infection

Early incision and drainage aborts the spread of infection into deeper and more critical anatomic space, even when it is in the cellulitis stage

Williams and Guralnick N Engl J med 1943Flyn TR, AAOMS 1999

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Step 5. support medically

Control fever& adequate hydration

Step 6. Choose antibiotic therapy

Usual Odontogenic infection :

70%= gram(+)cocci :Streptococus sp.30% = anaerobic : gram (-) rod , Bacteroid sp, prevotella, prophyromonas, fusobacterium, Klebsiella

Step 7.Administer the antibiotics

Usual Odontogenic infection

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1st line drug : PGS + Metronidazole or 1st gen cephalosporin+Metronidazole กรณี)ม)Staphlylococus(skin)

เก�บclindamycin ไว�กรณี) severe infection

Culture& sensitivity testingExpensive&time consumimg!!Can be dalayed for as mush as 2 weeks

When dealing with

Unusual Infection **subjected to multiple course of antibiotics DM : Klebsiella pneumoniaeHIV/AIDS :MycobacteriaIV Drug abusers : Staphylococus aureus

Gram stain?cheap screen!!

Step 8.Evaluated the patient frequenly

No fever 1-2 days, การบวมลุ่ด็ลุ่ง, การปวด็ลุ่ด็ลุ่ง, รบประทัานข้�าวได็� เปลุ่)*ย์น

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• Step 1.Determine the severity of infection• Step 2. Evaluated host defend• Step 3.Decide on setting care• Step 4.Treat surgically• Step 5. support medically• Step 6. Choose antibiotic therapy • Step 7.Administer the antibiotics• Step 8.Evaluated the patient frequenly