Odontogenic infection has been affecting human across the globe since history unknown. Even today, when medical science and biomedical engineering have been revolutionizing the treatment procedures in almost all sectors, researchers and experts have not succeeded in eliminating odontogenic infections. The pyogenic orofascial infections are usually odontogenic in origin, which range from periapical abscesses to superficial and deep infections in the neck. If not treated in time, these infections spread into the adjoining fascial spaces like masseteric, sublingual, submandibular, temporal, buccal, canine and parapharyngeal areas and may lead to other complications. Hence, diagnosis of the odontogenic infections and proper therapy is important.
What is Odontogenic Infection?
Odontogenic is a medical term for tissues that gives origin to teeth. It is always caused by bacteria. Odontogenic infection is a complicated dental problem that originates within a tooth or in the adjacent tissues that hold the tooth. Microflora residing in the oral cavity normally instigates odontogenic infections. The infection may remain localized or spread into other teeth in the mouth. It generates higher level of pain and discomfort which sometimes seem unbearable. Odontogenic infections can spread beyond upper part of gum and result in life-threatening complications, such as infections in the deep fascial spaces of the head and neck.
Signs and Symptoms of Odontogenic Infections
Symptoms of odontogenic infections typically include pain in the affected area, swelling and redness of the mouth. The infected teeth become very sensitive to pressure and cold. In an advanced stage, the patient suffering from odontogenic infection can experience other complications like –
- Difficulty in swallowing
- Difficulty in opening the mouth.
If the issues are not treated at the first instance, the infection can spread rapidly in other parts of the mouth through the bone and can even damage adjacent teeth. The signs related to orthodontic infection include the following –
- Deep cavities in one or more teeth
- Inflammation of gum
- Oral swelling
- Tenderness in the affected areas
- Pus drainage
- Limited ability to open the mouth.
The infection can spread beyond the mouth and bone through the bloodstream to other areas of the body where it can cause severe damage.
Microbial Etiology of Odontogenic Infection
As with any other types of infection in the body, odontogenic infections usually occur as a result of normal endogenous flora. The mouth harbors almost 400 different types of bacteria, both aerobes and anaerobes. The aerobic or facultative anaerobic bacteria normally belong to Streptococcus species. The anaerobic bacteria make up most of the mouth's flora. The predominant bacteria in the mouth are the Anaerobic Streptococcus, Bacteroides, and Fusobacterium.
Recent studies have shown that Streptococcus is the most infectious bacterium and primarily responsible for odontogenic infections. The anaerobic bacteria come next which are also responsible for odontogenic infections in large number patients. Then, there are innumerable other patients with multiple organisms growing in their mouth from the infection.
Majority of odontogenic infections result primarily from the formation of dental plaque. Once pathogenic bacteria establish, they can cause local as also extensive complications including the following –
- Bacterial Endocarditis
- Mediastinal infection
- Infection of orthopedic or other prostheses
- Cavernous sinus infection
- Brain abscess
Causes of Odontogenic Infection
The primary cause of odontogenic infections is the premature death of the cells in the pulp of the tooth, which is followed by bacterial incursion through the chamber of pulp into the tissues deeper into that chamber. This premature death of cells is called Necrosis, which is the result of deep rooted carries in the tooth. When bacterial infection intensifies further, blood vessels in the infected areas are dilated (vasodilation) and fluid is accumulated in the cavity (edema) creating abnormal pressure on the tooth. As the rigid wall of the tooth prevents swelling, pain intensifies further. If untreated at that condition, the condition leads to strangulation of the blood supply leading to further necrosis. The dead tissues then become a perfect place for further bacterial invasion, which then infects the bone tissues. Once the bacteria affect the bone, the infection spreads likewise in all directions until a cortical plate comes upon. By that time, the patient experiences sufficient pain inducing him or her to go under treatment.
Spread of Odontogenic Infection
If proper treatment procedure for odontogenic infection is not adopted in time, the infection may become severe and spread to other parts in the mouth. The infection spreads from the apex of the tooth to the bone depending on the overlying bone thickness and the relationship of the bone (perforation site) with the muscle attachments of the jaws. If treatment is not taken, this type of infection destroys the cortical soft plate of bone starting from the one that is thinnest and nearest to the ones that are away and also infects the overlying soft tissue. Where the root apex is located centrally, the infection destroys the thinnest bone first. In the maxilla, the thinner bone is located in the labial-buccal side, whereas the palatal cortex is comparatively thicker. Hence, infection erodes labial-buccal side at first.
Once the odontogenic infection perforates the bone, then the local muscle attachments control the specific position of its appearance in the soft tissue. Infection then attacks the labial bone, producing a vestibular abscess. This is seen as a small pouch of fluid in the soft tissue covering the affected tooth. If treatment is still unavailable, a rupture of the abscess occurs, establishing the infection in sinus region.
If the odontogenic infection punctures the bone just above the muscle parts, the infection spreads through the fascial space also. In case the infection spreads through the fascial space, the chance for severe infections with fast spread of the infection to other areas is possible.
Diagnosis of Odontogenic Infection
The disease is diagnosed by observational study primarily. However, the expert may advice for X-ray to understand the current condition of the affected teeth and extent of odontogenic infections.
Management of Odontogenic Infection
In most of the situations, severity of the pain would not allow a patient to tolerate the infection for a long time. As a result, odontogenic infections are almost always treated at an early stage. They may become serious in patients who have some weak defense due to diabetes or immunosuppression. Careful and regular assessment of the patient's defenses is an important part of the patient's overall evaluation. Patients with some sort of pain and dysplasia due to odontogenic infections are poorly hydrated, and exhausted. Care needs to be taken to provide proper painkillers, nutrition and hydration.
In case of acute dental plaque that causes considerable pain or swelling, the doctor may operate the affected teeth and prescribe antibiotics. However, if the odontogenic infections are too intensive and have affected facial muscles, hospitalization of the patient may be required. Doctors initially apply painkillers to diminish the pain, and relieve the signs and symptoms. In the next level, a doctor's attention remains in arresting further enhancement of the infections, which he does by undertaking the operation and applying an antibiotic. The location of odontogenic infections determines the treatment options, which may include root canal treatment, periodontal treatment, or extraction of the tooth.
Prevention of Odontogenic Infection
Maintaining dental hygiene is the key to prevent odontogenic infections. Regular brushing and flossing, accompanied with periodical checkup can minimize the risk of this problem. In spite of all protections, if cavity is detected, it is feasible to take treatment immediately for preventing further damages.
Odontogenic infection should not be taken lightly. Once, a tooth is infected, it is feasible to visit a dentist without looking for home-remedy. Only expert doctors, right diagnosis and early treatment can reduce severity of the disease. Untreated infections can even lead to life threatening diseases or complications, as there remains a severe chance of spreading of the infections through circulatory system.