Written by - Dr.Urusa I Inamdar

An odontogenic infection is an infection of the alveolus,jaws, or face that originates from a tooth or from its supporting structures and is one of the most frequently encountered infections.

Causes

• dental caries
• deep fillings
• failed root canal treatment
• periodontal disease
• pericoronitis

Localised and spreading of odontogenic infection

infections have the potential to spread to other areas of the maxillofacial region and beyond through tissue planes and bloodstream.

A spreading odontogenic infection presents with varying degrees of facial swelling , trismus and pain , and can be life threatening.

Signs and symptoms

• pain in the oral cavity and jaws
• Swelling
• mobile tooth
• tenderness on biting or tapping on the affected tooth
• Pain on Palpation of the surrounding gum
• spontaneous drainage of pus

Red Flag suggestive of

• Difficulty in speaking , swallowing and breathing
• Dehydration
• Trismus
• Pyrexia
• Raised tongue and floor of the mouth , drooling
• Tachycardia and tachypnoae
• Hypotension
• Increased white blood cell count
• Lymphadenopathy
• Periorbital cellulitis

Clinical presentation

• Dentoalveolar infection– swelling of the alveolar ridge with periodontal, periapical and subperiosteal abscess.
• Submental space infection– firm midline swelling beneath the chin, caused by infection from the mandibular incisor.
• Submandibular space infection– swelling of the Submandibular triangle of the neck around the angle of the mandible, caused by mandibular molars infection.
• Sublingual space infection– swelling of the floor of the mouth with possible elevation of the tongue and dysphagia.
• Retro pharyngeal space infection– stiff neck, sore throat, dysphagia and raspy voice, caused by the infections of the molars. It has high potential to spread to the mediastinum.
• Buccal space infection– swelling of the cheek caused by infection of premolars and molars.
• Masticator space infection– swelling on either side of the mandibular ramus, caused by infection of the mandibular third molars. Trismus is present.
• Canine space infection– swelling of the anterior cheek with loss of the nasolabial fold and possible extension to the infraorbital region.

Complications of odontogenic Infections

• respirtory obstruction
• Sepsis
• Endocarditis
• Pericarditis
• Necrotising fascitis
• descending mediastinitis
• spondylitis
• brain abscess
• cavernous sinus thrombosis
• thoracic empyema
• pleuropulmonary suppuration
• aspiration pneumonia
• pneumothorax
• mandibular or Cervical osteomyelitis
• abscess of the carotid sheath and jugular thrombophlebitis
• hematogenous dissemination to distant organs and coagulation abnormalities.

References

• Ogle OE . Odontogenic Infections. Dent Clin North Am.
• gskpro.com ( Understanding Odontogenic Infections and its complications )
• Shafer’s Textbook of Oral Pathology ( 7th edition )