SPREAD OF

SPREAD OF ORAL
ORAL
INFECTIONS
INFECTIONS

Dr. S.PRADEEP SANKAR

 INTRODUCTION
 Oral cavity consist of many microbes.

 Infection occurs due to 3 factors i.e the interaction of

the host, organism & the environment.

 In healthy state - balance exists among these 3

factors, when the balance lost disease occurs.
 Spread of infection via
• Lymphatics,
• Blood &
• Directly through the tissue

 Infection spread depends on

• Virulence of organism,
• Patient health ,
• Anatomic site of the infection ,
• Patient immune mechanism.
INFECTION PRESENCE DETERMINED
BASED ON
LOCAL AND SYSTEMIC FACTORS.
SYSTEMIC FACTORS

LOCAL FACTORS
• Pain , • Toxic apperance,
• Swelling, • Fever,
• Restriction of • Lymphadenopathy,
movement, • Malaise &
• Surface erythema & • WBC count
• Pus formation.
 Cellulitis
Phlegmon[cellulitis]
 Cellulitis - diffuse inflammation of soft tissue, not
confined to one area.

 Cellulitis of face and neck most commonly results from

Dental infections like
• Apical abscess
• Osteomyelitis
• Periodontal infection.
• Pericoronal infection[pericoronitis].
 cellulitis may occur due to tooth extraction
[infection either with an infected needle (or)
through an infected area (or) following jaw
fracture]

 Improper management of cellulitis leads to

• sepsis,
• airway obstruction,
• central nervous system involvement &
• mortality.
 ETIOLOGY
Alpha hemolytic streptococci
PRODUCES

streptokinase & hyaluronidase

break down fibrin,
connective tissue ground substance &
cellular debris
thus facilitating rapid spread of INFECTION
 CLINICAL FEATURES
 Elevated temperature
 Leukocytosis.
 Swelling is painful , firm , & happens due to
inflammatory edema.
 Inflammed skin shows orange pale appearance &
even purplish sometimes regional lymphadenitis is
usually present.
 Maxillary Infection perforate the outer cortical layer of
bone, above the buccinators attachment and, cause
swelling of upper half of face.

 Mandibular Infection perforates the outer cortical plates,

below the buccinators attachment, there is a diffuse
swelling of the lower half of the face.

 Cellulitis Extension towards eye is a potentially serious

complication because of cavernous sinus thrombosis

 Spread of cervical tissue can cause respiratory discomfort

 LABORATORY FINDINGS

Erythrocyte sedimentation rate

(ESR)
 & WBC counts are raised.
 Histological features
 Diffuse exudation of polymorphonuclear leukocyte
and occasional lymphocytes seen.
 Treatment
 Antibiotics for aerobic & anaerobic microbes

 To avoid spread of infection, patient advised not to

massage the affected area with any medication.

 Other drugs
Flucloxacillin
oral phenoxymethylpenicillin
intravenous benzylpenicillin,
ampicillin/amoxicillin
 Prognosis

 Antibiotic therapy provides complete

resolution of cellulitis.
 Untreated Cellulitis can occasionally lead to
(gangrene), (bacteremia) ,(sepsis).
Phlegmon[cellulitis]
 Diffuse inflammation ,Dental infections rarely tooth
extraction
 Alpha hemolytic streptococci
 Swelling is painful , firm , & happens due to
inflammatory edema. orange pale appearance..
 Maxillary -swelling of upper half of the face.
Mandible-lower half of the face.
 ESR,WBC raised. Polymorph nuclear leukocyte and
occasional lymphocytes seen.
 Antibiotic therapy. Untreated- (gangrene),
(bacteremia) ,(sepsis).