ORO FACIAL INFECTION
INTRODUCTION
• Infections of Orofacial region, particularly those of
odontogenic origin are most common.
• These infections can be managed successfully
without any complications but if not treated these
can produce serious complications and can prove
fatal.
• Early recognition of orofacial infection, its cause
and quick appropriate therapy is essential.
• Proper knowledge of anatomy, anatomical
landmarks and vital structures of the face and neck
is necessary to predict pathways of spread of
infections and to drain these spaces.
Causes & Types of Infection
Odontogenic infection are infections that arise within
the jaw bones and can be classified on the basis of
etiology as :
1. Based on the origin of infection.
• Odontogenic
• Traumatic
• Pulp disease
• Implant surgery
• Periodontal disease
• From contaminated
• Infected cysts
needle punctures
• Remaining roots
• Salivary gland
• Residual infection
infections
• Pericoronal infection
2. Based on the causative organisms.
• Bacterial infections ( GRAM +VE & GRAM –VE )
• Fungal infections
• Viral infections
Types of infection
Acute
• Acute peri-apical abscess
• Acute periodontal abscess
• Cellulitis
Chronic
• Chronic abscess leading to fistulous tract or sinus
formation
SPREAD & PATHWAY OF ODONTOGENIC INFECTION
Invasion of the dental pulp by bacteria after decay of a tooth
Inflammation, edema and lack of collateral blood supply
Venous congestion or avascular necrosis
Reservoir for bacterial growth
Periodic egress of bacteria into surrounding alveolar bone
Periapical infection progress to other areas or spaces
Stages/Phases of Dento-alveolar Infections
• Peri-apical osteitis
• Intra-bony abscess
• Cellulitis
• Facial abscess
General Factors Affecting Spread of Infection
• Host resistance (BODY).
• Virulence of infecting organism.
• Bacterial quantity.
Body Resistance Depends On
• Humoral factors
• Cellular factors
• Humoral factors include polymorphonuclear
leukocytes, monocytes, lymphocytes and tissue
macrophages.
• Cellular factors involves immunoglobulins derived
from sensitized B- lymphocytes or plasma cells and
complement.
Local Factors Affecting Spread of Infections
• Anatomic location of the tooth
• Position of muscle and facial attachments
Intact Anatomical Barriers
• Alveolar bone
• Periosteium
• Adjacent muscles and fascia
Routes / Spread of Orofacial Infection
• By direct continuity through the tissues
• By lymphatics to regional lymph nodes
• By blood stream
Phases & Fate of Infection
If untreated or improperly treated, infections can lead to
• Focal osteomyelitis
• Widespread osteomyelitis
• Fistulous tract which may be
INTRAORAL/EXTRAORAL
• Intraoral or Extraoral cutaneous soft tissue abscess
• Cellulitis
• Bacteremia – septicemia
• Deep fascial space infection
• Ascending facial cerebral infection
Diagnosis of Infection
• History of toothache/headache with chills & fever.
• Previous history of soft or hard tissue trauma.
• History of localized swelling which may be tender.
• Enlarged lymph nodes.
• Extraoral & intraoral sinus tracts.
• Trismus.
• Dysphagia.
• Radiological examination.
• Other diagnostic aids.
Radiological Examination
Helpful in locating offending tooth or any other
underlying cause :
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IOPA
OPG
Lateral Oblique.
CT guided needle aspiration.
CT Scan.
MRI.