Lec5

-infections are either superficial (gingiva, periodontitis

or tissue pericoronitis ) or deep (bone)

-periapical infection route is either:

1-sub periosteal abscess
2-sub mucosal abscess
3-under vestibule: a)facial abscess b)cellulitis
-Q, sequalae of pulpitis or dental caries:
granuloma, abscess , cyst
-granuloma could be a cyst due to proliferation of
epithelial rest of Malassez
-thrombosis + embolism = cutting blood supply
-osteomyelitis = infection + cutting blood supply
-cellulitis: diffuse acute inflammation which cause
sever pain, redness hotness and swelling (hotness and
redness of the overlying skin, and diffuse and brawny
swelling and fever to the patient)
-brawny = hard soft tissue
-muscles and fibres are attached by cementing
substance (hyaluronic acid and fibrin)
-GR, cellulitis can diffuse:
due to the Prescence of strept which produce
hyaluronidase and fibrinolysin enzymes which dissolve
the cementing substance
-treatment of cellulitis:
1-surgical drainage
2-antibiotic
3-removal of cause
-Ludwig’s angina (VII):
1-bilateral, symmetrical which involves sublingual,
submandibular and submental spaces
2-happens at L7and L8 because their roots extend
below the mylohyoid level
3-acute condition: a)swelling b)sever pain c)hotness
d)redness
4-treatment: hospitalization (massive dosage of
antibiotics)
-cavernous sinus thrombosis (VII):
1- acute 2-eye manifestation (eye swelling=proptosis)
3-mostly appears in upper central and lateral
4-the microorganism is mixed but mainly strept
-emissary veins are valveless
-Q, what are the cavernous sinus thrombosis
complications?
1-brain abscess 2-meningitis
-Maxillary sinusitis:

Acute Chronic
Moderate sever pain Vague pain
Foul odour Foul odour
The pain inc. when the Polyps Prescence
patient bend bec, the pus (squamous metaplasia)
moves with gravity and
apply pressure on the
nerve
 Measure fluid level by Appears cloudy in x-ray
changing the head
position
-X-ray: occipito-mental view / sinus view / Water view
(scientist name)
-Dry socket =alveolar osteitis
-normally the lamina dura in x-ray is found but in dry
socket (persistent lamina dura)
-dry socket case:
a patient with severe pain after 3-4 days of extraction
-can be caused because of :
1)patient’s diseases:
a)diabetes
b)haemophilia
c)Paget’s disease (thick bone)
2) a patient didn’t follow instruction
3)odonto-iatrogenic:
a)using large amount of anaesthesia
b)traumatic extraction
c)excessive curettage
d)working for a long time

-GR, all inflammatory bone diseases are mandibular

1)mandible has dense bone
2)poor blood supply (one artery), not as the maxilla
which has collateral circulation
-osteomyelitis (VII): inflammation of bone and bone
marrow characterized by cutting of blood supply and
infection
-dead bone = empty lacuna
-Histopathology in all acute and chronic

Acute Chronic
Dead bone Dead bone
PMLs Lymphocytes+ plasma
cells
Pus Fibrosis
Many reversal lines
(isolate the old bone from
the new bone)

-Acute:
1)more in children, more in males
2)redness, hotness , sever pain , swelling
-x-ray: 14-21 days vague radiolucency and
unremarkable
-the pores where pus exit called cloacae
-chronic in x-ray appears more radiopaque due to
calcification of dead bone (dystrophic calcification)
-complications of chronic:
1-numbness of libs and looseness of teeth
2-can cause fracture of bone
3-trismus of upper jaw (inability to open the mouth)

chronic:
1)chronic suppurative:
-looseness of teeth
-numbness of lips
-less fever
-less pain
-jaw fracture
-trismus
- cloacae
-sequestrum
-involucrum
-x-ray: moth eaten appearance/ worm eaten

2-focal sclerosing (condensing):

-mild stimulation for long standing time
-localized
-source of infection can be traced
-no root resorption
-x-ray: radiopaque not surrounded by radiolucent
margin

3-diffuse sclerosing
-periodontitis
-diffused
-old age more
-looseness of teeth
-resection of gum
-foul odour
-histopathology: mosaic appearance
-panorama x-ray: cotton wool appearance
4-Garre’s
-no pus
-more in young age
-occlusal x-ray: onion skin appearance

-all osteomyelitis are more in children except:

1-diffuse (old age)
2-chronic suppurative (maybe in old or young)