- Dental pulp ----> root canal ----> peri-apical tissue
- Superficial periodontal tissue----> dispersed through Spongy bones----> outer cortical bone ----> spread in tissue space / exists through free mucous membrane.
Routes of spread of infection:
Intra-bony confined infections are serious but it becomes much more dangerous when it escapes out of the bone of the maxilla or mandible. (Why is this? this is because the spread is less restricted once it escapes out of the bony confinement)
- Lymphatic systems
- Blood stream
- Tissue –tissue
Amount and rapidity of spread of infection depends upon:
- Type and virulence of bacteria
- Health of patient
- Anatomy of the affected site
- Immunity of the patient.
CELLULITIS:
It is a diffuse inflammation of the soft tissues, which is not circumscribed or contained to a single area.
It spread through tissue space and facial planes.
Streptokinase, Hyaluronidase and Fibrinolysins etc( from the micro-organism) generally cause this reaction. Streptococci and Staphylococci are mostly responsible for cellulitis.
Apical infection or osteomyelitis even peri coronitis can result in cellulitis and trismus.
Infected needle or Jaw infections/a fracture can also cause cellulitis.
- Patient will be moderately ill
- Elevated temperature
- Leukocytosis
- Much of the swelling is due to inflammatory edema
- Superficial skin may have orange-peel / purplish appearance .regional
- lymphadenitis may be seen.
Infection in maxilla-->Infection above the buccinator attachment----> if near to the orbit ---->Inner Canthus of eye ----> cavernous sinus thrombosis.
Infection in mandible---->below the buccinators attachment----> diffuse swelling in the lower half of the face----> spread in the cervical region which often cause discomfort.
Typical facial cellulitis ----> infection tends to localize and abscess may forms.
TREATMENT :
- prophylactic antibiotics.
- Removal of the cause
- patient is asked not to massage the affected area- to avoid the spread of infection.
Proper treatment is decided upon the condition of the patient and if required even hospitalized.The most common is the breathlessness of the patients and may require artificial support along with heavy antibiotic therapy and I.V.
Culture sensitivity test must be done to confirm the action of the antibiotic without any delay of the treatment. Drainage if required must be performed to give relieve the patient from any discomfort but before that the patient must have a heavy dose of prophylactic antibiotic .If diagonalized earlier ,it can be well controlled.
