Orofacial Infections in Children Pedo
Content
OROFACIAL
INFECTION
IN
CHILDREN
www.FourthMolar.com
INTRODUCTION
Intact dentition ,periodontal structure & oral mucous
membrane
constitute first line of resistant within oral cavity
against the invasion of microorganism in to the body.
The oral cavity is constantly flooded with microorg. in
salivary fluid environment, but they remain nonpathogenic.
Thus dynamic balance b/w host & resistant factors
are responsible for non-pathogenic state in healthy
individual.
www.FourthMolar.com
PROGRESS OF INFECTION
May spread owing the wide marrow space
May involve buds of permanent teeth, as in brown
discoloration of enamel produced in chronic
infection (Turner ’s hypoplasia)
Can also cause complete destruction of
permanent tooth germs.
May reach growth centre of jaw.
May produce cellulitis & abscess formation.
www.FourthMolar.com
FACTORS INFLUENCING THE
SPREAD OF INFECTION
State of microorganism
Host & its environment
Disturbance to the delicate balance
b/w oral microflora & host resistant
Anatomical factors
www.FourthMolar.com
COMMON MENIFESTATION OF
INFECTION
Fever
General malaise, nausea & vomiting
Increase in white blood count, especially neutrophil
Dehydration due to loss of water
Other signs & symptoms of systemic involvement.
ection of oral mucosa in children may be
used by bacteria, viruses, fungi or protoz
www.FourthMolar.com
BACTERIAL INFECTION
1.SCARLET FEVER
ETIOLOGY:
Group A beta hemolytic
streptococci
C/F:
Occurs mainly during winter months
White coated tongue with red, hyperemic,
edematous,
fungiform papillae (STRAWBERRY TONGUE)
Manifest with fever, headache, delirium,
tonsillitis,
www.FourthMolar.com
TREATMENT:
Antibiotic such as penicillin.
If bact. are resistant to Penicillin, then
Erythromycin or Tetracycline are
drugs of choice.
www.FourthMolar.com
2.ERYSIPELAS
ETIOLOGY: Streptococcus
C/F:
Fever, malaise, vomiting
Skin lesion on face, extremities, genital &
periumblical region
The face, if involved, has red, tender inflammation of
the cheeks &
bridge of nose (BUTTERFLY TYPE)
TREATMENT:
Penicillin is the drug of choice & if sensitive to
Penicillin,
Erythromycin can be given.
www.FourthMolar.com
3.TUBERCULOSIS
ETIOLOGY: Mycobacterium tuberculosis
C/F:
Tubercular sinus usually arise from tuberculous
lymphadenitis affecting
submandibular & cervical lymph nodes.
Stage of development include lymphadenitis,
periadenitis, cold abscess &
sinus formation.
Enlarged lymph nodes with discharging sinus.
Tubercular lesion of oral cavity occur at the tongue,
palate & lips.
The lesion is an irregular ulcer &is very painful.
TREATMENT:
Excision of sinus and lymph nodes along with a
complete anti-tubercular
therapy.
www.FourthMolar.com
4.SYPHILIS
ETIOLOGY: Treponema pallidum
C/F:
Congenital syphilis is transmitted to the infant from infected
mother.
They manifest a great variety of lesions, including frontal
bossing, short maxilla,
saddle nose & mulberry molars.
The pathognomonic features of the disease is the
Hutchison’s Triad, which
include hypoplasia of incisor and molar teeth, eighth nerve
deafness and
interstitial keratitis.
TREATMENT:
Benzathine penicillin – 2.4 million units i.m.
Aqueous crystalline penicillin
Tetracycline hydrochloride – 250 mg orally q.i.d.
Erythromycin – 250 mg q.i.d.
www.FourthMolar.com
5.TULAREMIA (RABBIT FEVER)
Caused by Pasteurella tularensis after
contact with
infected wild rodents.
Ingestion of contaminated meat may be
responsible for
oro-pharyngeal type of Tularemia in which
symptoms
are necrotic mouth ulcer in oral mucosa
and pharynx
with generalized stomatitis and cervical
lymphadenopathy.
www.FourthMolar.com
VIRAL INFECTIONS
1. HERPETIC STOMATITIS
ETIOLOGY: Herpes simplex virus (HSV)
type 1
C/F:
Incubation period 4-7 days
Multiple mouth ulcers
Diffuse gingivitis
Cervical lymphadenitis
Fever, malaise, irritability, anorexia
INCIDENCE:
common in poor areas and children
www.FourthMolar.com
MANAGEMENT:
Soft diet and adequate food intake
Anti-pyretic/Analgesic (Paracetamol
elixir)
Local anti-septic (chlorhexidine)
www.FourthMolar.com
2. HERPANGINA
ETIOLOGY: Coxsackie A virus
C/F:
Mild sore throat, fever, headache
Small ulcers or vesicular lesions present on anterior
faucial pillars,
hard and soft palate and tongue
INCIDENCE: Uncommon out breaks are seen among
young children
MANAGEMENT:
Clinical diagnosis
Serology (Theoretically) is confirmatory
Symptomatic Treatment
www.FourthMolar.com
4. HERPES ZOSTER (SHINGLES)
CAUSATIVE ORGANISM : Varicella Zoster virus, latent in
sensory
ganglion
C/F :
Unilateral pain
Rash and oral vesicles, then ulcers
Vesicular lesion develops within the peripheral
distribution of branch of
trigeminal nerve
INCIDENCE : Mainly affect elderly or
immunocompromised host
MANAGEMENT :
Analgesic
Acyclovir
www.FourthMolar.com
3. CHICKEN POX
CAUSATIVE ORGANISM : Herpes Varicella Zoster
virus
C/F :
Incubation period 14-21 days
Fever, headache, nasopharyngitis, anorexia
Maculopapular rash or vesicular lesion appear first
on skin of trunk
and spread to extremities and face
Oral lesion may occur in buccal mucosa, palate and
pharynx
Cervical lymphadenitis
INCIDENCE :
Most prevalent in winter and spring months
www.FourthMolar.com
MANAGEMENT:
Clinical diagnosis
Rising antibody titer is confirmatory
Symptomatic care :- Immunoglobulin or Acyclovir in
immunocompromised individuals
www.FourthMolar.com
5. KOPLIK’S SPOT
CAUSATIVE ORGANISM : Rubeola viral
infections (Measles)
C/F:
It is a one of the initial oral manifestation of
Rubeola viral
infection
It is an acute contagious disease
characterized by bluish
white irregular lesion surrounded by red
margins usually
present on buccal mucosa which disappears
within 4 – 5
days
It is followed by
fever, malaise ,coughing,
www.FourthMolar.com
MANAGEMENT :
Bed rest
Symptomatic
treatment
www.FourthMolar.com
6. MUMPS (EPIDEMIC PAROTITIS)
CAUSATIVE ORGANISM : paramyxo virus
C/F :
Children below age of 15 yrs
Bilateral painful enlargement of Parotid gland
Associated complains – fever, headache, vomiting
COMPLICATION : orchitis, pancreatitis, meningitis, myocarditis,
epididymitis
MANAGEMENT :
Most of the cases are self limiting
Prevention with live attenuated vaccine-MMR vaccine
Symptomatic treatment is given to control pain and swelling
www.FourthMolar.com
7. INFECTIOUS MONONUCLEOSIS
CAUSATIVE ORGANISM : Epstein – Barr virus
C/F :
Children 2-10 yrs of age
Oral ulceration and petechial hemorrhage at hard and soft
palate junction
Enlargement of lymph nodes and fever
Malaise, sore throat, peri-orbital swelling, skin rash
MANAGEMENT :
Symptomatic treatment
Analgesic
Soft diet and fluid intake
www.FourthMolar.com
8. HAND, FOOT AND MOUTH DISEASE
CAUATIVE ORGANISM : Coxsackie A16 virus
C/F:
Manifested by fever, nausea, vomiting, malaise & ulcerative
lesions on oral mucosa
& pharynx.
Maculopapular rash on hands and feet
Oral lesions are found on buccal mucosa, palate and tongue.
These lesions being as small vesicles which rapidly rupture, but
heal within two
weeks.
www.FourthMolar.com
9. CAT SCRATCH FEVER
It is thought to be viral (Rickettesial) in
origin
Symptoms of these disease are malaise,
headache , fever
and lymphadenitis
It develops after a bite or scratch by a cat
He lesion heals spontaneously in 1-3
months
www.FourthMolar.com
FUNGAL INFECTIONS
1. CANDIDIAL MONILIASIS (THRUSH OR
ACUTE PSEUDOMEMBRANEOUS
CANDIDIOSIS)
ETIOLOGY:
It may be seen in healthy neonates, however when
oral micro flora is
disturbed by antibiotics, corticosteroids, or
xerostomia.
Oropharyngeal thrush occasionally complicates the
use of
corticosteroid inhalers.
Immune defect especially HIV infection,
immunosuppressive
treatment, leukemia, lymphoma, cancer and diabetic
predispose to
www.FourthMolar.com
thrush.
MANAGEMENT:
Antifungal such as Nystatine oral
suspension or pastilles,
amphotericin lozenges or miconazole gel or
fluconazol
tables are indicated
Chlorhexidine has some anti fungal activity
www.FourthMolar.com
2. ACTINOMYCOSIS
It can occur in children and may follow intra oral
trauma including
dental extraction
The organism spread through tissue and can cause
dysphagia if
submandibular region is involved
Abscess may rupture on to the skin and long term
antibiotic therapy
is required
Penicillin should be prescribed and maintained at
least two weeks
following clinical cure.
www.FourthMolar.com
SPECIFIC INFECTION
1.PERIAPICAL ABSCESS(ALVEOLAR
ABSCESS)
DEF:
It is a localized collection of pus in alveolar bone at root apex of
tooth, following
death of pulp.
ETIOPATHOGENESIS:
May occur as a result of trauma or mechanical or chemical
irritation.
Bacterial invasion in dead pulp is the main cause
Most common organism- streptococcus viridans
When inflammatory response may extend in to adjacent
periapical alveolar bone, it
will initiate necrosis of periapical tissue & diffuse rarefaction of
bone, leading to
formation of periapical abscess with symptoms of acute
inflammation.
www.FourthMolar.com
R/F:
Widening of periodontal ligament space
Loss of lamina dura
Diffuse area of rarefaction of bone at periapcal
region
MANAGEMENT:
Establish drainage
Antibiotic-penicillin
Analgesic
Warm saline mouth rinse
Endodontic treatment
www.FourthMolar.com
NOMA(CANCRUM ORIS)
Also called as GANGRENOUS STOMATITIS
PREDISPOSING FACTORS:
Occur in children who are undernourished &
debilitated from
infection such as diphtheria, dysentery, measles,
pneumonia, scarlet
fever, syphilis, tuberculosis & blood dyscrasias.
Extensive mechanical injury
Originates as specific infection by Vincent's
organisms
Miscellaneous factors-leukemia, sickle cell trait,
stress,
chemotherapeutic agent.
C/F:
Small ulceration of gingival mucosa which spreads
rapidly &
involves surroundingwww.FourthMolar.com
tissue of jaws, lips & cheeks
In advanced stage, there is blue-black discoloration of skin with
sloughing of tissue
MANAGEMENT:
Parenteral fluid should be given to correct dehydration and
electrolyte balance
Blood transfusion
Nutritious & easily digestable diet
Multivitamins with large doses of ascorbic acid, niacin & iron.
Antibiotic therapy-Penicillin or Sulfonamide
Warm saline solution irrigation & mouthwash to remove sloughed
tissue
Reconstructive surgery
www.FourthMolar.com
CELLULITIS
DEF:
Defined as a non-suppurative inflammation of
subcutaneous
tissue
extending
along
the
connective tissue planes & across the
intercellular
space
BACTERIOLOGY:
Alpha hemolytic streptococci which produce
enzyme like
streptokinase & hyaluronidase.
These enzyme breakdown fibrin, conn. tissue
ground substance
& cellular debris, thus
facilitating the rapid spread of bacterial invaders.
C/F:
Diffuse swelling, redness & pain
Presence of tenderness on palpation
Tissue are grosslywww.FourthMolar.com
edematous & there is marked
MANAGEMENT:
Surgical incision & drainage-It is
perforated when
presence of pus is
diagnosed
Extraction of offending tooth
Specific antibiotic coverage
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LUDWIG’S ANGINA
DEF:
Defined as a overwhelming, rapidly spreading, septic cellulitis,
involving
submandibular, sublingual & submental space bilaterally
ETIOLOGY:
Odontogenic infection-Extension of infection from mand. Second
& third molar
teeth in to the floor of mouth
Trauma-Oral soft tissue laceration & punctured wounds of oral
floor
Submand. gland sialadenitis & infected malignancy
Salivary calculi
Osteomyelitis in compound mand. fracture
BACTERIOLOGY:
Most common-streptococci
Other microorg-Alpha hemolytic streptococci, bacteriodes,
klebsella, fusiform bacilli
& E-colli.
C/F:
Diffuse painful swelling with no signs of localization
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Floor of mouth appears erythematous
& edematous
FATAL COMPLICATION:
Resp. Obstruction
Gen. Septicemia
Erosion of carotid artery
Cavernous sinus thrombosis
Brain abscess
Meningitis
MANAGEMENT:
Intense & prolonged antibiotic therapy-Penicillin IM or IV.
Incision & drainage.
Supportive therapy-Parenteral hydration, high protein diet & vitamin
supplements.
Extraction of offending tooth.
www.FourthMolar.com
ACUTE OSTEOMYELITIS IN INFANTS
(OSTEOMYELITIS MAXILLARIS
NEONATORUM)
It is a rare type of osteomyelitis seen in infants
few weeks after
birth which commonly involves maxilla.
ETIOLOGY:
Infection is caused by staphylococcus aureus
These microorg. are believed to enter wounds
during delivery
when finger is inserted in to child’s mouth &
mucosa scratch or
later through injuries of oral mucosa made by
sucking foreign
object.
The disease may be caused by infection from
infants nose
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Hematogenous invasion
by streptococci or
TREATMENT:
Antibiotic- Penicillin IV
If bact. are penicillin resistant then other
antibiotic such as
Erythromycin or Tetracycline should be given
initially.
Intra oral incision should be made if there is
indication of
subperiosteal or palatal abscess
Later sequestrectomy or removal of dead tooth
germ.
www.FourthMolar.com
CHRONIC OSTEOMYELITIS IN CHILDREN
It is usually secondary to an acute osteomyelitis
C/F:
Dull boring pain in jaw with h/o chronic discharge in oral cavity or
in the face.
Regional lymph nodes may be enlarged.
Multiple draining sinus
R/F:
Moth eaten appearance
Presence of chronic sequestrum
Mottling of adjacent trabecular bone
TREATMENT :
Long term antibiotic therapy
Sequestrectomy (removal of sequestrum) & saucerization
(removal of bony cavity)
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GARRE’S OSTEOMYELITIS OF
MANDIBLE
(PROLIFERATIVE
PERIOSTITIS)
It is a non-supportive process in which there is
peripheral
subperiosteal bone deposition
Caused by mild irritation & infection.
It was first described by CARL GARRE in 1893
C/F:
Dis. most commonly affect children & young adults
In jaw, mandible is most commonly affected than
maxilla, which
commonly occur at inferior border of mandible , in
first molar
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region.
MANAGEMENT:
Removal of infected tooth
Curettage of socket
Surgical recontour of cortical expansion of
jaw only in
case of asymmetry
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REFERENCES:
TEXTBOOK OF PEDODONTICS:
BY SHOBHA TONDON
CLINICAL PEDODONTICS:
BY SIDNEY B. FINN
PAEDIATRIC DENTISTRY:
BY RICHARD R. WELBURY
ORAL & MAXILLOFACIAL SURGERY:
BY DANIAL M. LASKIN
www.FourthMolar.com
INFECTION
IN
CHILDREN
www.FourthMolar.com
INTRODUCTION
Intact dentition ,periodontal structure & oral mucous
membrane
constitute first line of resistant within oral cavity
against the invasion of microorganism in to the body.
The oral cavity is constantly flooded with microorg. in
salivary fluid environment, but they remain nonpathogenic.
Thus dynamic balance b/w host & resistant factors
are responsible for non-pathogenic state in healthy
individual.
www.FourthMolar.com
PROGRESS OF INFECTION
May spread owing the wide marrow space
May involve buds of permanent teeth, as in brown
discoloration of enamel produced in chronic
infection (Turner ’s hypoplasia)
Can also cause complete destruction of
permanent tooth germs.
May reach growth centre of jaw.
May produce cellulitis & abscess formation.
www.FourthMolar.com
FACTORS INFLUENCING THE
SPREAD OF INFECTION
State of microorganism
Host & its environment
Disturbance to the delicate balance
b/w oral microflora & host resistant
Anatomical factors
www.FourthMolar.com
COMMON MENIFESTATION OF
INFECTION
Fever
General malaise, nausea & vomiting
Increase in white blood count, especially neutrophil
Dehydration due to loss of water
Other signs & symptoms of systemic involvement.
ection of oral mucosa in children may be
used by bacteria, viruses, fungi or protoz
www.FourthMolar.com
BACTERIAL INFECTION
1.SCARLET FEVER
ETIOLOGY:
Group A beta hemolytic
streptococci
C/F:
Occurs mainly during winter months
White coated tongue with red, hyperemic,
edematous,
fungiform papillae (STRAWBERRY TONGUE)
Manifest with fever, headache, delirium,
tonsillitis,
www.FourthMolar.com
TREATMENT:
Antibiotic such as penicillin.
If bact. are resistant to Penicillin, then
Erythromycin or Tetracycline are
drugs of choice.
www.FourthMolar.com
2.ERYSIPELAS
ETIOLOGY: Streptococcus
C/F:
Fever, malaise, vomiting
Skin lesion on face, extremities, genital &
periumblical region
The face, if involved, has red, tender inflammation of
the cheeks &
bridge of nose (BUTTERFLY TYPE)
TREATMENT:
Penicillin is the drug of choice & if sensitive to
Penicillin,
Erythromycin can be given.
www.FourthMolar.com
3.TUBERCULOSIS
ETIOLOGY: Mycobacterium tuberculosis
C/F:
Tubercular sinus usually arise from tuberculous
lymphadenitis affecting
submandibular & cervical lymph nodes.
Stage of development include lymphadenitis,
periadenitis, cold abscess &
sinus formation.
Enlarged lymph nodes with discharging sinus.
Tubercular lesion of oral cavity occur at the tongue,
palate & lips.
The lesion is an irregular ulcer &is very painful.
TREATMENT:
Excision of sinus and lymph nodes along with a
complete anti-tubercular
therapy.
www.FourthMolar.com
4.SYPHILIS
ETIOLOGY: Treponema pallidum
C/F:
Congenital syphilis is transmitted to the infant from infected
mother.
They manifest a great variety of lesions, including frontal
bossing, short maxilla,
saddle nose & mulberry molars.
The pathognomonic features of the disease is the
Hutchison’s Triad, which
include hypoplasia of incisor and molar teeth, eighth nerve
deafness and
interstitial keratitis.
TREATMENT:
Benzathine penicillin – 2.4 million units i.m.
Aqueous crystalline penicillin
Tetracycline hydrochloride – 250 mg orally q.i.d.
Erythromycin – 250 mg q.i.d.
www.FourthMolar.com
5.TULAREMIA (RABBIT FEVER)
Caused by Pasteurella tularensis after
contact with
infected wild rodents.
Ingestion of contaminated meat may be
responsible for
oro-pharyngeal type of Tularemia in which
symptoms
are necrotic mouth ulcer in oral mucosa
and pharynx
with generalized stomatitis and cervical
lymphadenopathy.
www.FourthMolar.com
VIRAL INFECTIONS
1. HERPETIC STOMATITIS
ETIOLOGY: Herpes simplex virus (HSV)
type 1
C/F:
Incubation period 4-7 days
Multiple mouth ulcers
Diffuse gingivitis
Cervical lymphadenitis
Fever, malaise, irritability, anorexia
INCIDENCE:
common in poor areas and children
www.FourthMolar.com
MANAGEMENT:
Soft diet and adequate food intake
Anti-pyretic/Analgesic (Paracetamol
elixir)
Local anti-septic (chlorhexidine)
www.FourthMolar.com
2. HERPANGINA
ETIOLOGY: Coxsackie A virus
C/F:
Mild sore throat, fever, headache
Small ulcers or vesicular lesions present on anterior
faucial pillars,
hard and soft palate and tongue
INCIDENCE: Uncommon out breaks are seen among
young children
MANAGEMENT:
Clinical diagnosis
Serology (Theoretically) is confirmatory
Symptomatic Treatment
www.FourthMolar.com
4. HERPES ZOSTER (SHINGLES)
CAUSATIVE ORGANISM : Varicella Zoster virus, latent in
sensory
ganglion
C/F :
Unilateral pain
Rash and oral vesicles, then ulcers
Vesicular lesion develops within the peripheral
distribution of branch of
trigeminal nerve
INCIDENCE : Mainly affect elderly or
immunocompromised host
MANAGEMENT :
Analgesic
Acyclovir
www.FourthMolar.com
3. CHICKEN POX
CAUSATIVE ORGANISM : Herpes Varicella Zoster
virus
C/F :
Incubation period 14-21 days
Fever, headache, nasopharyngitis, anorexia
Maculopapular rash or vesicular lesion appear first
on skin of trunk
and spread to extremities and face
Oral lesion may occur in buccal mucosa, palate and
pharynx
Cervical lymphadenitis
INCIDENCE :
Most prevalent in winter and spring months
www.FourthMolar.com
MANAGEMENT:
Clinical diagnosis
Rising antibody titer is confirmatory
Symptomatic care :- Immunoglobulin or Acyclovir in
immunocompromised individuals
www.FourthMolar.com
5. KOPLIK’S SPOT
CAUSATIVE ORGANISM : Rubeola viral
infections (Measles)
C/F:
It is a one of the initial oral manifestation of
Rubeola viral
infection
It is an acute contagious disease
characterized by bluish
white irregular lesion surrounded by red
margins usually
present on buccal mucosa which disappears
within 4 – 5
days
It is followed by
fever, malaise ,coughing,
www.FourthMolar.com
MANAGEMENT :
Bed rest
Symptomatic
treatment
www.FourthMolar.com
6. MUMPS (EPIDEMIC PAROTITIS)
CAUSATIVE ORGANISM : paramyxo virus
C/F :
Children below age of 15 yrs
Bilateral painful enlargement of Parotid gland
Associated complains – fever, headache, vomiting
COMPLICATION : orchitis, pancreatitis, meningitis, myocarditis,
epididymitis
MANAGEMENT :
Most of the cases are self limiting
Prevention with live attenuated vaccine-MMR vaccine
Symptomatic treatment is given to control pain and swelling
www.FourthMolar.com
7. INFECTIOUS MONONUCLEOSIS
CAUSATIVE ORGANISM : Epstein – Barr virus
C/F :
Children 2-10 yrs of age
Oral ulceration and petechial hemorrhage at hard and soft
palate junction
Enlargement of lymph nodes and fever
Malaise, sore throat, peri-orbital swelling, skin rash
MANAGEMENT :
Symptomatic treatment
Analgesic
Soft diet and fluid intake
www.FourthMolar.com
8. HAND, FOOT AND MOUTH DISEASE
CAUATIVE ORGANISM : Coxsackie A16 virus
C/F:
Manifested by fever, nausea, vomiting, malaise & ulcerative
lesions on oral mucosa
& pharynx.
Maculopapular rash on hands and feet
Oral lesions are found on buccal mucosa, palate and tongue.
These lesions being as small vesicles which rapidly rupture, but
heal within two
weeks.
www.FourthMolar.com
9. CAT SCRATCH FEVER
It is thought to be viral (Rickettesial) in
origin
Symptoms of these disease are malaise,
headache , fever
and lymphadenitis
It develops after a bite or scratch by a cat
He lesion heals spontaneously in 1-3
months
www.FourthMolar.com
FUNGAL INFECTIONS
1. CANDIDIAL MONILIASIS (THRUSH OR
ACUTE PSEUDOMEMBRANEOUS
CANDIDIOSIS)
ETIOLOGY:
It may be seen in healthy neonates, however when
oral micro flora is
disturbed by antibiotics, corticosteroids, or
xerostomia.
Oropharyngeal thrush occasionally complicates the
use of
corticosteroid inhalers.
Immune defect especially HIV infection,
immunosuppressive
treatment, leukemia, lymphoma, cancer and diabetic
predispose to
www.FourthMolar.com
thrush.
MANAGEMENT:
Antifungal such as Nystatine oral
suspension or pastilles,
amphotericin lozenges or miconazole gel or
fluconazol
tables are indicated
Chlorhexidine has some anti fungal activity
www.FourthMolar.com
2. ACTINOMYCOSIS
It can occur in children and may follow intra oral
trauma including
dental extraction
The organism spread through tissue and can cause
dysphagia if
submandibular region is involved
Abscess may rupture on to the skin and long term
antibiotic therapy
is required
Penicillin should be prescribed and maintained at
least two weeks
following clinical cure.
www.FourthMolar.com
SPECIFIC INFECTION
1.PERIAPICAL ABSCESS(ALVEOLAR
ABSCESS)
DEF:
It is a localized collection of pus in alveolar bone at root apex of
tooth, following
death of pulp.
ETIOPATHOGENESIS:
May occur as a result of trauma or mechanical or chemical
irritation.
Bacterial invasion in dead pulp is the main cause
Most common organism- streptococcus viridans
When inflammatory response may extend in to adjacent
periapical alveolar bone, it
will initiate necrosis of periapical tissue & diffuse rarefaction of
bone, leading to
formation of periapical abscess with symptoms of acute
inflammation.
www.FourthMolar.com
R/F:
Widening of periodontal ligament space
Loss of lamina dura
Diffuse area of rarefaction of bone at periapcal
region
MANAGEMENT:
Establish drainage
Antibiotic-penicillin
Analgesic
Warm saline mouth rinse
Endodontic treatment
www.FourthMolar.com
NOMA(CANCRUM ORIS)
Also called as GANGRENOUS STOMATITIS
PREDISPOSING FACTORS:
Occur in children who are undernourished &
debilitated from
infection such as diphtheria, dysentery, measles,
pneumonia, scarlet
fever, syphilis, tuberculosis & blood dyscrasias.
Extensive mechanical injury
Originates as specific infection by Vincent's
organisms
Miscellaneous factors-leukemia, sickle cell trait,
stress,
chemotherapeutic agent.
C/F:
Small ulceration of gingival mucosa which spreads
rapidly &
involves surroundingwww.FourthMolar.com
tissue of jaws, lips & cheeks
In advanced stage, there is blue-black discoloration of skin with
sloughing of tissue
MANAGEMENT:
Parenteral fluid should be given to correct dehydration and
electrolyte balance
Blood transfusion
Nutritious & easily digestable diet
Multivitamins with large doses of ascorbic acid, niacin & iron.
Antibiotic therapy-Penicillin or Sulfonamide
Warm saline solution irrigation & mouthwash to remove sloughed
tissue
Reconstructive surgery
www.FourthMolar.com
CELLULITIS
DEF:
Defined as a non-suppurative inflammation of
subcutaneous
tissue
extending
along
the
connective tissue planes & across the
intercellular
space
BACTERIOLOGY:
Alpha hemolytic streptococci which produce
enzyme like
streptokinase & hyaluronidase.
These enzyme breakdown fibrin, conn. tissue
ground substance
& cellular debris, thus
facilitating the rapid spread of bacterial invaders.
C/F:
Diffuse swelling, redness & pain
Presence of tenderness on palpation
Tissue are grosslywww.FourthMolar.com
edematous & there is marked
MANAGEMENT:
Surgical incision & drainage-It is
perforated when
presence of pus is
diagnosed
Extraction of offending tooth
Specific antibiotic coverage
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LUDWIG’S ANGINA
DEF:
Defined as a overwhelming, rapidly spreading, septic cellulitis,
involving
submandibular, sublingual & submental space bilaterally
ETIOLOGY:
Odontogenic infection-Extension of infection from mand. Second
& third molar
teeth in to the floor of mouth
Trauma-Oral soft tissue laceration & punctured wounds of oral
floor
Submand. gland sialadenitis & infected malignancy
Salivary calculi
Osteomyelitis in compound mand. fracture
BACTERIOLOGY:
Most common-streptococci
Other microorg-Alpha hemolytic streptococci, bacteriodes,
klebsella, fusiform bacilli
& E-colli.
C/F:
Diffuse painful swelling with no signs of localization
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Floor of mouth appears erythematous
& edematous
FATAL COMPLICATION:
Resp. Obstruction
Gen. Septicemia
Erosion of carotid artery
Cavernous sinus thrombosis
Brain abscess
Meningitis
MANAGEMENT:
Intense & prolonged antibiotic therapy-Penicillin IM or IV.
Incision & drainage.
Supportive therapy-Parenteral hydration, high protein diet & vitamin
supplements.
Extraction of offending tooth.
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ACUTE OSTEOMYELITIS IN INFANTS
(OSTEOMYELITIS MAXILLARIS
NEONATORUM)
It is a rare type of osteomyelitis seen in infants
few weeks after
birth which commonly involves maxilla.
ETIOLOGY:
Infection is caused by staphylococcus aureus
These microorg. are believed to enter wounds
during delivery
when finger is inserted in to child’s mouth &
mucosa scratch or
later through injuries of oral mucosa made by
sucking foreign
object.
The disease may be caused by infection from
infants nose
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Hematogenous invasion
by streptococci or
TREATMENT:
Antibiotic- Penicillin IV
If bact. are penicillin resistant then other
antibiotic such as
Erythromycin or Tetracycline should be given
initially.
Intra oral incision should be made if there is
indication of
subperiosteal or palatal abscess
Later sequestrectomy or removal of dead tooth
germ.
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CHRONIC OSTEOMYELITIS IN CHILDREN
It is usually secondary to an acute osteomyelitis
C/F:
Dull boring pain in jaw with h/o chronic discharge in oral cavity or
in the face.
Regional lymph nodes may be enlarged.
Multiple draining sinus
R/F:
Moth eaten appearance
Presence of chronic sequestrum
Mottling of adjacent trabecular bone
TREATMENT :
Long term antibiotic therapy
Sequestrectomy (removal of sequestrum) & saucerization
(removal of bony cavity)
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GARRE’S OSTEOMYELITIS OF
MANDIBLE
(PROLIFERATIVE
PERIOSTITIS)
It is a non-supportive process in which there is
peripheral
subperiosteal bone deposition
Caused by mild irritation & infection.
It was first described by CARL GARRE in 1893
C/F:
Dis. most commonly affect children & young adults
In jaw, mandible is most commonly affected than
maxilla, which
commonly occur at inferior border of mandible , in
first molar
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region.
MANAGEMENT:
Removal of infected tooth
Curettage of socket
Surgical recontour of cortical expansion of
jaw only in
case of asymmetry
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REFERENCES:
TEXTBOOK OF PEDODONTICS:
BY SHOBHA TONDON
CLINICAL PEDODONTICS:
BY SIDNEY B. FINN
PAEDIATRIC DENTISTRY:
BY RICHARD R. WELBURY
ORAL & MAXILLOFACIAL SURGERY:
BY DANIAL M. LASKIN
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