1. Infection and Inflammation/ odontogenic infection/ 4 stages of clinical progression of odontogenic infection/ spreading of odontogenic infection

manifesting as Infammation prolferation of microbes triggers the body's defonse mechanisms, which is a process

INFECTION

localized reaction of the vascular and connective tissues of the body to an irritant resuting in the development of an exudato that is rich in protein & cells

INFLAMMATION

- characterized by rapid progression

⁃ if it does not regress completely: it may develop to subacute or chronic inflarnmation

Acute inflammation

transition phase between acute & chronic inflammation

Subacute inflammation

presents a prolonged time frame with slight clinical symptoms

Chronic inflammation

characterized mainly by the development of connective tissue

Chronic inflammation

lasts approximately 36 hours

Serous phase

characterized by local edema, erythema with elevated temperature, and pain

Serous phase

serous exudate is present which usually contains proteins

Serous phase

progression of the serous phase

Cellular phase

exudates contains massive accumulation of polymorphonuclear leukocytes

Cellular phase

leading to the formation of pus

Cellular phase

if pus forms in a nowly developed cavity

abscess

if pus forms in a cavity that already exists

empyema

begins immediately after inoculation (entry of pathologic microbes into the body even ir the absence of disease)

Reparative phase

products of the acute inflamnmatory reaction are eliminated & followed by the reparatior of the destroyed tissue

Reparative phase

repair is achieved with the development of granulation tissue, which is then convertec to fibrous connective tissue that ensures the return of the affected area to normal function

Reparative phase

redness /erythema

RUBOR

sign which affects the surrounding tissues due to the vasodilatation effect of inflammation

RUBOR

1st sign which affects the surrounding tissues due to the vasodilatation effect of inflammation

RUBOR

swelling /edema

TUMOR

sign that is caused by pus accumulation & leakage of plasma into the interstitial fluid at the affected site resulting in edema

TUMOR

heat/ warmth

CALOR

3rd sign that is brought about by accelerated local metabolism

CALOR

pain

DOLOR

4th sign that results from prossure on the sensory nerve which is caused by edema or infection

DOLOR

loss of function

FUNCTIO LAESA

5th sign that is attributed to problems with

• mastication moderate to severe trismus

• dysphagia

• respiratory impairment

FUNCTIO LAESA

difficulty in swallowing

dysphagia

such as dyspnea or difficulty in breathing

respiratory impairment

jaw's limited or restricted range of motion characterized by a progressive reduction in mouth opening

Trismus

maximum interincisal opening is 20-30 mm

mild trismus

maximum interincisal opening is 10- 20 mm

moderate trismus

maximum interincisal opening is < 10 mm

severe trismus

refers to infection that has a characteristic flora which arises from the teeth, spreads beyond the teeth to the alveolar process, and then to the deeper tissues & spaces of the face, oral cavity. head, & neck areas

ODONTOGENIC INFECTIONS

well-localized infection that requires minimal treatment

low-grade infection

life-threatening infection that affects the deep fascial spaces of the head & neck

high-grade infection

which can grow in the presence or absence of oxygen

streptococcus milleri group

most common; as a result of pulpal necrosis from deep caries formation

PERIAPICAL ORIGIN

as a result of deep periodontal pocket formation

PERIODONTAL ORIGIN

occurs during the 1st- 3rd day when the invading bacterin are just beginning to colonize the host resulting in edema which is the hallmark of the inoculation stage

INOCULATION STAGE

Treatment of inoculation stage

may be performed by the removal of the odontogenic cause with or without supportive antibiotic therapy

occurs on the 1st - 5th day when the infecting mixed flora stimulates an intense inflammatory response which makes it the most severe presentation of an infection

CELLULITIS STAGE

Treatment of cellulitis stage

requires the removal of the dental cause of the problem, including incision & drainage (| & D) with supportive antibiotic therapy

erythematous, hot, swollen skin with irregular & indistinct margins which fade into the surrounding skin that affect the deeper dermis and subcutaneous tissues

Cellulitis

occurs on the 4th-10th day after the onset of swelling whon anaorobic bactoria begin to predominate and serves as a sign of increasing host resistance to infection

ABSCESS STAGE

Treatment of abcess stage

requires the removal of the dental cause of the problemn, including incision and drainage (1 & D) with supportive antibiotic therapy

a wave-like motion of fluid collected in a cavity which indicates pus accumulation in the center of an indurated area.

Fluctuance

infection can spread equally in all directions or preferentially along the path of least resistance

Thickness of the bone overlying the tooth apex

infection spreads through cancellous bone until it reaches the cortical plate: infection wil erode through the bone & invade the soft tissues in the presence of a thin cortical plate

Thickness of the bone overlying the tooth apex

most infections erode through the lingual cortical plate

Maxillary teeth

most infections erode through the lingual cortical plate

mandibular teet

relative position or placement determines fascial space involvement

Relationship of point of bone perforation site to muscle attachment of the maxilla & mandible

results in the infection of the vestibular

space

tooth apex is lower than the muscle attachment

results in the infection of the adjacent fascial space

tooth apex is higher than the muscle attachment

by direct continuity:; spreads from cell to cell, by means of secretion, through the tissues, or by the path of least resistance through the spaces of the head & neck

SPREADING PER CONTINUITATEM

from the skin or mucosa to the regional lymph nodes

SPREADING THROUGH THE LYMPHATIC SYSTEM

infectious agents travel through the bloodstream or via blood circulating through the body

SPREADING THROUGH THE VASCULAR SYSTEM

presence of bacteria in blood and is the means by which local infections spread to distant organs

BACTEREMIA

occurs when defense mechanisms of the body effectively eliminate small quantities of bacteria resulting in the absence of clinical signs & symptoms

ASYMPTOMATIC BACTEREMIA

occurs in normal, healthy individuals where infection may occur at a distant site after manipulative procedures

SYMPTOMATIC BACTEREMIA

SYMPTOMATIC BACTEREMIA

vigorous chewing

oral prophylaxis

tooth extraction

needle punctures

drug infusions

catheter insertions

surgery

signs & symptoms of bacterimia

• fever

• chills

• rigors (shivering)

• diaphoresis (sweating)

rapidly, progressing, life-threatening infection that can arise from systemic infections throughout the body leading to a severe inflammatory response syndrome (SIRS)

SEPSIS / SEPTICEMIA

characterized by the presence of SIRS criteria with evidence of infection

SEPSIS / SEPTICEMIA

Sign and symptoms of sepsis/septicemia

fever or hypothermia

leukocytosis

tachypnea

tachycardia

hypotension

confusion

reduced vascular tone

organ dysfunction

represents a widespread inflammatory response to a variety of severe clinical insults

SIRS (Severe Inflammatory Response Syndrome)

its criteria is recognized by the presence of > 2 of the following: elevated body temperature; rapid heart rate; increased respiratory rate, and leukocytosis (increase in the number of white blood cells in the blood)

SIRS (Severe Inflammatory Response Syndrome)

serious condition that can cause multiple organ dysfunction and death due to a drop in arterial blood pressure with a rosultant decrease in offective blood flow to the vital organs

SEVERE SEPSIS

characterized by the presence of sepsis criteria with evidence of organ dysfunction

SEVERE SEPSIS

Sugn and symptoms of severe sepsis

hypotension

hypoxemia

oliguria

metabolic acidosis

thrombocytopenia

confusion

disseminatod intravascular cascade or DIC

low oxygen in the blood

hypoxemia

decreased urine output

oliguria

pathologic, widesproad activation of the blood clotting cascade

disseminatod intravascular cascade or DIC

potentially fatal condition that results in multiple organ failure and death due to a drop in arterial blood pressure with a resultant decrease in effective blood flow to the vital organs despite adequate supply of fluids

SEPTIC SHOCK

characterized by the presence of severe sopsis criteria with evidence of persistent signs of organ dysfunction & hypotension

SEPTIC SHOCK

Sign and symptoms of septic shock

• myocardial depression

• altered vasculature

• metabolic acidosis altered organ perfusion

• imbalance in oxygen delivery and consumption

• hemodynamic alterations such as hyperdynamic state ( warm shock") showing high cardiac output

• hypodynamic state (*cold shock*) exhibiting low cardiac output

progressive impairment of  >/= organ systems from an uncontrolled inflammatory response to a severe illness or injury

MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)

characterized by altered function of multiple organ systems where intervention is needed in order to sustain life

MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)

Sign and symptoms of Multiple organ disfucntio

• combination of cardiovascular

• pulmonary

• renal

• hepatic neurological

• gastrointestinal

• integumentary

• hematologic system dysfunction