Spreading Dental Infections

Clinical Features of Infection

For all infections of dental origin, there should be an identifiable cause e.g. A partially erupted lower wisdom tooth or a non-vital tooth.

Local Features:

¨ Pain

¨ Swelling

¨ Redness

¨ Heat of inflammation

¨ Suppuration

¨ Swelling caused by oedema, cellular infiltrate and pus

¨ Trismus if the muscles of mastication are involved

¨ Dysphagia

Systemic Features:

¨ Temperature above 37.0⁰C

¨ Raised pulse and respiratory rates

¨ Regional lymphadenopathy

¨ Malaise and pallor

Patterns of Presentation

¨ A collection of pus is called an abscess

¨ The infection is confined largely to the mouth, with the swelling centred close to the cause

¨ Fluctuant swelling

¨ Degree of systemic disturbance is often slight

1. Cellulitis is where there is no significant localisation of pus

2. The overlying skin is swollen and oedematous, pitting may occur

3. No true fluctuance

4. Progressive spread to involve adjacent spaces, cross the midline and down the neck

5. Often systemic features are present

¨ Less oedema, and infection is more deeply placed than that of oedema

¨ Less inflammation

¨ Clinical signs and symptoms depend upon the spaces involved

¨ Trismus/pain on swallowing/raising of floor of mouth and tongue

General Ideas

¨ Lower 1+2 – mentalis attached above apices – thus not into labial sulcus, but chin point or submental space

¨ Lower 4+5 – buccal sulcus (apices above muscle attachments)

¨ Lower 6,7+8 – buccal plate very thick, depends on length of roots and attachment of Mylohyoid

i.e. apices above mylohyoid (6) – sublingual space (superficial)

apices below mylohyoid (7/8) – submandibular space (deep)

**2 spaces communicate**

· Upper 1 – long roots to nasal cavity

· Upper 2 – palatal

· Upper 3 – long roots to infra-orbtial * cav.sinus thrombosis risk *

· Upper 4,5,6+7 – buccal sulcus

**Children – Have low attachment of buccinator –thus facial swelling as apices above attachment (so not buccal sulcus)