Odontogenic infection

Under the heading of odontogenic infections (Greek: ὀδούς Odous " the tooth" and γὲνεσις genesis " origin " and Latin īnficere " infect ", "poison", literally " put in " ) are from the tooth or the periodontium ( periodontal ) outgoing inflammation understood, which has become a Kieferabszess or periodontal abscess - can develop - some with Wangenödem.

Causes

The most common cause of odontogenic infection is the tiefkariöse tooth in which the pulp pathogenic germs have infected. This leads to a pulpitis and in the further course of untreated to a devitalization (death ) of the tooth. In consequence, a periapical inflammation, apical periodontitis, develop, among which inflammation in the apical area of a tooth is to be understood. This may be limited to the specific region, but spread further in rare cases lymphogenem or hematogenous routes.

The two most common causes of odontogenic infection periodontal origin ( marginal periodontitis ). This results in a gingival abscess, periodontal abscess or an abscess may develop a perikoronaler.

Causative pathogens

It is in odontogenic infections almost always polymicrobial infections caused by anaerobic and aerobic bacteria. Mostly you will find Peptostreptococci, Streptococcus mutans, Capnocytophaga gingivalis, Eikenella corrodens, Staphylococcus aureus, Bacteroides species ( especially Bacteroides forsythus ) nucleatum, Prevotella intermedia, Fusobacterium, Actinobazillen, actinomycetes Borrelia, Veillonella parvula, Porphyromonas gingivalis, Campylobacter rectus, and others. The accompanying flora allows conclusions to odontogenic infections in systemic diseases.

Diagnosis and symptoms

Odontgene infections are painful in the acute state. If a tooth is the cause, he often reacts with pain on percussion, with increasing pain in the recumbent position of the patient, with pain increasing in heat and pain relief when cold. The tooth in question can be loosened and elongated. The inflammation can lead to a parulis ( " thick cheek" ) and lymphadenitis. The affected lymph nodes - usually submandibular - are swollen and painful on palpation. Radiologically osteolytic processes, periodontal bone loss, periapical translucency and / or an extension of the Periodontalspalts can be diagnosed.

Complications

Proceeds odontogenic inflammation, may form an abscess, an encapsulated collection of pus, resulting from inflammatory Gewebseinschmelzung from the osteomyelitis. Due to the vacuum pressure, the pus is looking for a relief path to the outside. This in turn creates first a painful tension of the relatively resistant periosteum before the fistulous pus breaks through the periosteum and the surrounding soft tissue.

Hence the purulent odontogenic inflammation can Phlegmonosum continue to develop, which can develop in a spread cranially to a meningitis or brain abscess one, both of which can be life-threatening. From a periapical osteitis or a periodontal infection on upper molars an odontogenic sinusitis may develop ( sinusitis ), which accounts for about 20 % of sinusitis. Here, the inflammatory exudate breaks through the maxillary sinus floor through the maxillary sinus. From there, the inflammation ( frontal sinuses, ethmoid, sphenoid sinus ) can be more sinuses spread.

In a spread caudally can be a mediastinitis result. At risk are patients with valvular heart disease and prosthetic heart valves or a status after rheumatic or bacterial endocarditis. In general, however, such infections remain localized.

From an odontogenic inflammation is also an extensive osteomyelitis may develop. Due to the small vessels inflammation and trophic bone may be destroyed. Also, a sequestrum is possible. Radiographically fall on cloudy, poorly demarcated osteolytic and sclerotic changes in part still preserved bone structure.

With participation of the area around the inferior alveolar nerve can cause paresthesias occur ( Vincent- symptom).

Therapy

Firstly, an attempt is made to treat the cause, which means the endodontic treatment of a tooth infection emanating. This access is initially set to the root canal system ( trepanation ). Then the channels with hand files or mechanically driven rotary instruments are flared ( " processed "). This necrotic pulp tissue is removed on the one hand and at the same time created an outflow to the outside, can escape through the Pus and gases. There is a rinsing of the root canal.

Secondly, the abscess is wide open under local anesthesia through an incision to allow the pus a further outflow ( Ubi pus ibi evacua - "Where is pus, there deflate him," Hippocrates of Kos). Then, a drainage for one to two days in the form of a gauze strip is inserted. A stab incision is not enough there to provide sufficient drainage. In the incision and the periosteum must be severed. The latter can be painful despite local anesthesia because the local anesthetic in the inflamed area restricted acts ( acidic environment ).

In periodontal cause one cleaning the gingival pockets, including where appropriate debridement, also followed by an opening of the abscess. If the periodontal inflammation have spread to the pulp, endodontic treatment of the tooth joins.

Other therapeutic measures, such as extraction of the tooth, a root resection or periodontal measures take place until after the acute inflammation.

There is no antibiotics usually Except for the mentioned risk patients. In high-risk patients antibiotic prophylaxis by means of a β -lactam antibiotic is indicated. In extensive odontogenic infections with tendency to spread a simultaneous antibiotic therapy is recommended. The bacterial spectrum is covered by modern broad-spectrum antibiotics such as amoxicillin, cephalosporins, or clindamycin.

Also anti-inflammatory drugs are not usually displayed. The accompanying edema disappears rapidly after the removal of the cause. Cooling compresses can speed up the decongestion.

Differential Diagnosis

The differential diagnosis should exclude particular by means of X-ray diagnostics super infected cysts and tumors.