34: Dentoalveolar infections

Chapter 34 Dentoalveolar infections

Dentoalveolar infections can be defined as pus-producing (or pyogenic) infections associated with the teeth and surrounding supporting structures, such as the periodontium and the alveolar bone. Other terms for these conditions include periapical abscess, apical abscess, chronic periapical dental infection, dental pyogenic infection, periapical periodontitis and dentoalveolar abscess. The clinical presentation of dentoalveolar infections depends on the virulence of the causative microorganisms, the local and systemic defence mechanisms of the host, and the anatomical features of the region. Depending on the interactions of these factors, the resulting infection may present as:

Dentoalveolar abscess

A dentoalveolar abscess usually develops by the extension of the initial carious lesion into dentine, and spread of bacteria to the pulp via the dentinal tubules (Figs 34.1 and 34.2). The pulp responds to infection either by rapid acute inflammation involving the whole pulp, which quickly becomes necrosed, or by development of a chronic localized abscess with most of the pulp remaining viable. Other ways in which microbes reach the pulp are:

Sequelae

Once pus formation occurs, it may remain localized at the root apex and develop into either an acute or a chronic abscess, develop into a focal osteomyelitis, or spread into the surrounding tissues (Figs 34.2 and 34.3).

Direct spread

2. Spread may occur into the adjacent fascial spaces, following the path of least resistance; such spread is dependent on the anatomical relation of the original abscess to the adjacent tissues (Table 34.1). Infection via fascial planes often spreads rapidly and for some distance from the original abscess site, and occasionally may cause severe respiratory distress as a result of occlusion of the airway by oedema (e.g. Ludwig’s angina).

Table 34.1 Sites of contiguous spread of dentoalveolar infection (see also Fig. 34.3)

Site of spread Maxillary teeth Mandibular teeth
Palate Palatal roots of premolars and molars; also lateral incisors with a palatally curved root
Buccal space Canines, premolars and molars Canines, premolars and molars
Infraorbital/periorbital region Canines mainly
Maxillary sinus Canines, premolars and molars
Upper lip Central and lateral incisors
Masseteric space, pterygomandibular space, lateral pharyngeal space Lower third molars
Lower lip Incisors and canines
Submandibular space Root apices below insertion of mylohyoid – usually molars but can also be premolars
Submental space Incisors and canines
Sublingual space   Root apices above mylohyoid/geniohyoid – usually incisors, canines and premolars; rarely molars

Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 34: Dentoalveolar infections
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