OROFACIAL BACTERIAL
INFECTIONS
Dr. Saleem Shaikh
INTRODUCTION
 Oral cavity contains a rich and diverse microflora
 Small alterations in the local environment can produce
microbial population changes that permit the development of
opportunistic infections involving bacterial species that are
usually regarded as non pathogenic.
 Strict anaerobes form the major proportion of microflora in
acute suppurative infections.
 Gram negative anaerobic bacteria are the most predominant
and in most cases the pathogens in such infections.
 Orofacial bacterial infections may present either as a
localized abscess or dif fuse cellulitis depending on the
virulence of bacteria, local anatomic structures and host
defense mechanisms.
 These may lead to septicaemia
 An abscess is hypertonic in relation to its surroundings and
pressure ef fects lead to bone resorption, in dentoalveolar
abscess perforation of the bone may spread the infection to
surrounding soft tissue which leads to cellulitis.
ANTIMICROBIAL SUSCEPTIBILIT Y
 Global emergence of antibiotic resistance is of great concern,
previously 3-4 % isolates showed penicillin resistance but now
38-42% show penicillin resistance.
 Molecular techniques have been developed to permit rapid
detection of penicillin resistance genes in pus specimens this
may prove to be very beneficial in clinical management if they
are more widely available.
 The emergence of beta lactamase producing bacteria is said
to be the most important cause for penicillin resistance.
 Clindamycin has shown extremely low incidence of resistance,
even in countries where it is frequently used.
ENDODONTIC INFECTION
 The presence of microorganisms in root canals prior to and
during treatment is widely studied.
 The microflora seen are very similar to that of acute dento
alveolar abcsess
 7-20 dif ferent species are frequently seen in the root canals –
Olsenella profusa, P. gingivalis, Dialister spp and anaerobic
streptococci.
 Enterococcus faecalis has been proposed to be associated
with endodontic failures.
 T. denticola has been implicated as the cause of
disseminating infection from the root canal to dif ferent
organs.
LATERAL PERIODONTAL ABSCESS
 It is associated with a vital pulp
 Develops usually as a result of blockage of in an established
periodontal pocket due to presence of a foreign object
 Pus discharge may be seen from the gingival margin
 Porphyromonas spp, Prevotella spp, fusobacterium spp,
actinomyces spp, capnocytophaga spp, haemolytic
streptococci are seen commonly
 Drainage and irrigation with an antiseptic mouthwash is
indicated.
 Antibiotic therapy is rarely required.
ACUTE DENTOALVEOLAR ABSCESS
 This is the most frequently occurring orofacial bacterial
infection.
 Develops usually due to spread of infection from the necrotic
pulp. It may also spread from the periodontal ligament or from
the blood vessels [anachoresis].
 It may also develop from a chronic lesion, the mechanism for
change from chronic to acute suppurative lesion are poorly
understood, it could be because of occurrence of specific
combination of bacteria or due to sudden provision of nutrients
via local tissue damage.
 Microflora is polymicrobial, streptococci group is predominant,
Porphyromonas spp, Prevotella spp, fusobacterium spp,
actinomyces spp, are also seen
 Drainage – antibiotics [amoxicillin, metronidazole, clindamycin]
CELLULITIS – LUDWIG’S ANGINA
 Dif fuse spread of infection in the soft tissues,
 Spread of infection to spaces of the face may lead to dif ficulty
in swallowing.
 Ludwig’s angina – involvement of sunmandibular, sublingual
and submental spaces bilaterally.
 Porphyromonas spp, Prevotella spp, fusobacterium spp,
actinomyces spp, capnocytophaga spp, haemolytic
streptococci are seen
 Immediate referral to a specialist is recommended,
hospitalization permits use of intravenous antibiotics.
 Initial treatment must include broad spectrum antibiotics –
ceftriaxone and metronidazole combination.
OSTEOMYELITIS
 It is infection and inflammation of the bone or bone marrow.
 May be acute or chronic
 Treatment is local debridement and topical anesthetic of
exposed areas.
 Clindamycin is the drug of choice due to its ability to achieve
therapeutic levels in the bone.
DRY SOCKET
Extremely painful form of alveolar osteitis.
Caused due to fibrinolysis of the blood clot.
Strict anaerobes have been implicated in this infection
Metronidazole is the drug of choice.
Pericoronitis
 Inflammation of soft tissues covering or immediately adjacent to
the crown of a partially erupted tooth.
 Prevotella intermedia, fusobacterium spp, anaerobic streptococci
are seen . Recent studies have shown A .actinomycetecomitans
also.
 Local irrigation, operculectomy
 Severe cases may require antibiotics – amoxicillin and
metronidazole.
Bacterial sialadenitis
Bacterial infection principally caused by staphylococcus aureus,
seen due to presence of underlying xerostomia.
Other bacteria may be haemophilus spp, eikenella corrodens,
prevotella spp.
Amoxicillin or erythromycin.
ANGULAR CHELITIS
 Inflammation which is localized to the angles of the mouth,
 Caused by staphylococcus aureus or candida spp either alone or
together.
 Staphylococci are seen commonly in dentate patients whereas candida is
seen more in patients with dentures or orthodontic appliances.
 The reservoir of staphylococcal infection is anterior part of the nose and
oral cavity for candida.
 Fusidic acid cream is used for stapylococcal infection. Miconazole cream
is used in uncertain cases as this is effective against both candida and
bacteria.
ACTINOMYCOSIS
Caused by actinomyces genus
Sulphur granules
A. Actinomycetemcomitans, Haemophilus spp, propionibacterium spp