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ETIOLOGY
1. Pulp disease. 2. Periodontal disease. 3. Secondarily infected cysts or odontomes. 4. Remaining root fragment. 5. Residual infection. 6. Pericoronal infection.
Bacteriology
Aerobic 7%
G +ve Cocci ( Strep, Staph) & G-ve cocci (Neisseria) G +ve rods (Corny ) & G-ve rods
Anaerobic 33%
G +ve Cocci ( Strep, Pseudo strep) & G-ve cocci(veiollonela) G +ve rods (Lacto, Actino ) & G-ve rods (Bacteriodes)
Mixed 60%
TYPES
ACUTE In the acute stage infection may remain intra bony or spread into soft tissues in following clinical forms: 1. Abscess:
1.Circumscribed collection of pus in a pathological tissue space. 2.Thick walled cavity containing pus. 3.Aerobes & anaerobes--- large accumulation of pus--- pointing & drainage.
Abscess
2. Cellulitis:
1.This is spreading infection of loose CT. 1.It is a diffuse, erythematous, mucosal or cutaneous infection. 2.It is result of streptococci & does not result in large accumulation of pus. 3.Streptococci produce streptokinase, hyaluronidase.
3.Fulminating infections:
1.Spread of infection in various primary spaces in the orofacial region. 2.Here secondary spaces along the pathway of least resistance are involved. 3.Spread of deep cervical spaces and beyond.
It is due to persistent irritation from chronic pulp or acute virulent infection, or less host resistance.
Etiology
CLINICAL FEATURES
Acute Peri Apical Abscess
1- History of previous pulpitis. 2- Carious or heavily filled tooth. 3- Tender and felt extruded in socket. 4- When pus has formed severe throbbing pain 5- sensitive to percussion. 6- Over lying gum may or may not be swollen
TREATMENT
Acute Peri Apical Abscess
pulp chamber.
CLINICAL FEATURES
Acute Dento Alveolar Abscess Pain depend on the stage of disease. Sub mucosal swelling (Intra Oral). Facial swelling (extra Oral). Fluctuation may come after few days.
Radiographic features
Acute Dento Alveolar Abscess
Little informative in acute phase except little widening of periodontal ligament. But previous pathology if present will be seen.
Treatment
Acute Dento Alveolar Abscess
When the irritation in the peri apical tissues persists either due to,
incomplete resolution In complete treatment of acute periodontitis or pulpitis leading to necrotic pulp a forgotten blow or massive fillings or unsuccessful R.C.T lead to chronic periodontitis.
Secondary spaces
MASTICATORY SPACES Masseteric. Pterygomandibular. Superficial & deep temporal.
CERVICAL SPACES
LUDWIG S ANGINA
Cervical Cellulitis
Principles of management
Determine the severity of infection Evaluate the state of patients host defense mechanism
Determine , whether treated by GDP or refer to specialist Appropriate antibiotic & their proper administration Treat infection surgically Diet & i-v fluids Evaluate pts frequently
Surgical Management