THE SPREAD OF DENTAL

INFECTION
The Spread Of Dental Infection

Arise trough :
 Pulpal and Periapical disease

 Periodontal Disease
 Dental Plaque
( A complex mass comprising bacteria, their products host-derived material,
and food debris which adheres to teeth)

At the enamel surface At the gingival margin

inflammation of the pulpal Inflammation of the periodontal

tissues

pulpal and periapical disease Periodontal disease

 PULPAL AND PERIAPICAL
DISEASE
 DENTAL CARIES
Bacteria on plaque  enamel surface  elaborate acidic
acid proteolytic products  demineralize the surface,
digest the organic matrix  decay

Caries enamel  dentin  pulp  tooth destroyed

If left untreated  the pulpal canal  adjacent soft tissues 

initiate a painful and destructive inflammatory reaction  spread
into the marrow spaces of the bone  soft tissues and muscles of
the face and neck
 PULPITIS
Noxious stimuli (mechanical damage, thermal
injury, chemical irritation, bacterial effects)
degranulation of mast cell, decreased
nutrient flow, cellular damage  release of
inflammatory mediators (histamin, bradikynin,
neurokinins, neuropeptides, prostaglandin) 
vasodilation, increased blood inflow,
vascular leakage with edema 
active dilation of the arterioles 
increased pulpal pressure + accumulation
of mediators  vessel damage + pulpal
inflammation + tissue necrosis  spread
to apical portion of the pulp
reversible
Pulpitis
(acute, chronic) irreversible
 Reversible pulpitis
Pulpal inflammation, the tissue is capable of
returning to a normal state of health

Clinical features :
- Sudden mild to moderate pain of short duration

- Cold stimuli : ice, beverages, cold air

- Sweet or sour foods and beverages

- Does not occur without stimuli

- Subsides within seconds

- If progressed  irreversible affected
 IRREVERSIBLE PULPITIS
Pulpal inflammation in higher level, the pulpal
damage beyond the point of recovery

Clinical features :
- sharp, severe pain upon thermal stimulation

- The pain continuous after stimulus is removed

- The pain spontanious or continuous,

exacerbated when lies down
- Increases in intensity
 CHRONIC HYPERPLASTIC
PULPITIS (PULP POLYP)
 In children and young adults  large
exposures of the pulp  entire dentinal
roof often missing
 Mechanical irritation + Bacterial invasion
 Chronic inflammation produces
hyperplastic granulation tissue that
extrudes from the chamber Fills dentinal
defect
 Periapical abscess
The accumulation of acute inflammatory cells at
the apex of non vital tooth.

Abscess formation may arise of a chronic

periapical inflammatory lesion, acute
exacerbation, initial periapical pathosis

The source of infection : pulpal necrosis

trauma related
high occlusal contact
Clinical Features :

 Tenderness
 Pain, sensitive to percussion
 Extrusion of the tooth
 Swelling of the tissues
 Does not respond to cold or electric pulp
testing
 Headache, malaise, fever, chills
 With progression, the purulence
- may extend through the medullary spaces
away from the apical area
osteomyelitis
- May perforate the cortex and spread
diffusely trough the overlying soft tissue 
cellulitis
 Osteomyelitis
 An inflammatory process within medullary (trabecular) bone that
involves the marrow spaces

 Acute osteomyelitis : rapidly destructive inflammatory process

within trabecular bone and bone marrow consists of granulation
tissue, purulent exudates and sequestra

 Caused by direct extension of untreated periapical abscess

 Clinical features: - intense pain physically ill

- pyrexia, malaise
 Cellulitis
If an abscess is not able to establish drainage
through the surface of the skin or into the oral
cavity, it may spread diffusely through fascial
planes of the soft tissue  cellulitis

A painful swelling of the soft tissue of the mouth

and face resulting from a diffuse spreading of
purulent exudate along the fascial planes that
separate the muscle bundles
Ludwig’s Angina/ phlegmon

A cellulitis involving fascial spaces

between muscles and other structures of
the posterior floor of the mouth that
compromise the air way
Clinical features :
- Swelling of the floor of the mouth, tongue
and submandibular region
- Involvement of the sublingual space 
elevation, posterior enlargement, and
protrusion of the tongue (woody tongue)
- Submandibular space spread
enlargement and tenderness of the neck
above of the hyoid bone (bull neck)
- Pain in the neck and floor of mouth
- Dysphagia,dysphonia, dysarthria, drooling,
sore throat
- Lateral pharyngeal space involvement 
respiratory obstruction secondary to
laryngeal edema
- Tachypnea, dyspnea, tachycardia, stridor,
restlessness
- Fever, chills, leukocytosis
 Cavernous sinus thrombosis
 Edematous periorbital enlargement with involvement of
the eyelids and conjunctiva

 Clinical features :
- Protrusion and fixation of the eyeball
- Indurations and swelling of the adjacent fore head and
nose
- Pupil dilation, lacrimation,photopobia, loss of vision
- Pain over the eye and the trigeminal nerve
- Fever, chills, sweating, tachycardia, nausea, vomitus
- With progression central nervous system involvement
developed
- meningitis, tachypnea, irregular breathing, stiffening of
the neck, deepening stupor (advanced toxemia and
meningeal involvement)
- Occasionally  brain abscesses
thank you…