Dental Infections


PERIAPICAL ABSCESS

Diagnosis

  1. Most common dental infection, also known as acute alveolar abscess
  2. Very painful because periodontal ligaments create closed space
  3. Localized infection may spread, manifested by cellulitis or edema in the contiguous spaces of the head and neck  fascial planes and deep spaces mediastinum
  4. Healthy individuals under normal circumstances

Therapeutics

See also Dental Pain

  1. Fluctuant periapical abscesses
INFECTION AFTER ROOT CANAL
  1. Pain following root canal
  2. Extreme pain from pus in space formed by periodontal ligament
  3. Extrusion of tooth from pus and gas
  4. Treatment open canal by dental professional
  5. Treat with oral Abx ( penicillin V or erythromycin or clindamycin)
ODONTOGENIC INFECTIONS
  1. Buccal Space
  2. Infraorbital Space
  3. Orbital Space
  4. Vestibular Space
  5. Subperiosteal Space
  6. Submandibular Space
  7. Sublingual Space
  8. Submental Space
  9. Ludwig's Angina
  10. Masticator Space
  11. Submasseteric Space
  12. Pterygomandibular Space
  13. Temporal Space
  14. Lateral Pharyngeal Space
  15. Retropharyngeal Space
RETROPHARYNGEAL SPACE INFECTIONS 

Diagnosis

  1. Located b/t deep cervical & prevertebral fascia
  2. More commonly seen in children
  3. Untreated can be fatal due to airway compromise or rapid spread to CNS
  4. Typically present with facial swelling
  5. Similar presentations in patients with subcutaneous cysts, abscesses, or sinusitis
  6. CT scan very useful for delineation

MASTICATOR SPACE INFECTION

Diagnosis:

  1. One of the most common space infections
  2. Bordered by internal pterygoid muscle, masseter muscle, & superficial and deep temporal pouches
  3. Infections can extend both very high up or low into mandible  some erode into lower neck
  4. Characteristic sign of masticator space infection (and any disorder that irritates the internal pterygoid or masseter muscles)  trismus (inability to open mouth w/o pain)
  5. Trismus limits ability to examine pharynx & diagnose infections in retropharyngeal space
  6. CT scan useful to R/O retropharyngeal space infection
  7. Ludwig's angina

Treatment

  1. IV abx to cover oral flora, anaerobes i.e. clindamycin 600mg IV q6-8hr
  2. Urgent OMFs consult for drainage
  3. Tracheotomy may be necessary if airway compromised
  4. Patients will require hospitalization

 

IATROGENIC PERIODONTAL INFECTION

Diagnosis

  1. May be spread during extraction of an extremely impacted 3rd molar
  2. May spread into neck & mediastinum