Overview    General symptoms of inflammation   Clinical manifestations of inflammation    Differential diagnosis    Causes    Spectrum of bacterial therapy    Prevalence of different abscesses    Classification of abscesses      

• Overview    General symptoms of inflammation   Clinical manifestations of inflammation    Differential diagnosis    Causes    Spectrum of bacterial therapy    Prevalence of different abscesses    Classification of abscesses      

Inflammation is a defence reaction of the organism to local injuries of any type, to infection. Infection is a pathological state resulting from the invasion of the body by pathogenic microorganisms and their proliferation within the organism.

• Inflammation is a defence reaction of the organism to local injuries of any type, to infection. Infection is a pathological state resulting from the invasion of the body by pathogenic microorganisms and their proliferation within the organism.

Non odontogenic

• Non odontogenic

• Odontogenic

1. Fufuruncle

• 1. Fufuruncle

• 2. Anthrex

• 3. erysipelas

• 4. Sibir canker

• 5. Noma (gangrenuos stomstitis)

Infected fracture

• Infected fracture

• Infected soft tissue wounds or tumors

• Infection by foreign bodies

• Infection after injection

• Inflammatory of skin or mucosal membrane disorders

• Haematogeneous or lymphogeneious spreading

1. Acute odontogenic periostitis

• 1. Acute odontogenic periostitis

• 2. Acute osteomyelitis of jaws

• 3. Odontogenic abcsesses

• 4. Odontogenic phlegmonas

• 5. Odontogenic lymfadinitis

Heat

• Heat

• Redness

• Tumor (oedema)

• Loss of function (trismus, difficult to swollow speech)

• Additional: leucocytosis and CRP increasis

CRP (C-reactive protein) is synthesised in the liver. It is one of the chemical mediators of inflammation and its serum level increases faster and to higher levels than that of any other parameters in acute infectious and non-infectious inflammation.

• CRP (C-reactive protein) is synthesised in the liver. It is one of the chemical mediators of inflammation and its serum level increases faster and to higher levels than that of any other parameters in acute infectious and non-infectious inflammation.

• Therefore, CRP belongs to the group of acute-phase proteins. These are blood lipids the concentration of which increases in the course of inflammatory diseases.

• CRP binds to invading foreign substances and activates important steps of the immune system with macrophages and the complement system. Due to its relatively short half-life of 24 hours, changes in CRP concentration indicate changes in the inflammatory process.

1.Presence of causal teeth

• 1.Presence of causal teeth

• 2. Smoothness of a transitive fold

• 3. Fluctuation of a transitive fold

• 4. Painful percussion of causal tooth

• Increases of temperature up to 38 гр

• Dysfunctions: opening of a mouth, chewing, speech, swallowing.

1. Odontogenig osteomylitis

• 1. Odontogenig osteomylitis

• 2. Traumatic osteomylitis

• 3. Hematogen osteomylitits

1. The infectious-embolic theory

• 1. The infectious-embolic theory

• Infringements innervation of jaws

• The theory a sensitization

1. Acute

• 1. Acute

• 2. under acute

• 3. chronic

1 Looseness of a causal tooth

• 1 Looseness of a causal tooth

• Infringement of function: opening of a mouth, chewing, speeches and swallowing

• Mobility of a several teeth

• Smoothness of a transitive fold from two sides.

• Rise in temperature of a body up to 41 гр.

• Fever

Elimination of cause (causal teeth extraction)

• Elimination of cause (causal teeth extraction)

• Incision

• discharge of pus

• Spreading of the abcsses cavity

• Osteoperforation of injure bone

• drainage of the pus cavity

• Facultative antibiotic treatment

1. Superficial located

• 1. Superficial located

• 2. middle deep located

• 3. deep located

submucous abscess, smooth vestibule Localized collection of pus an a cavity caused by necrosis of tissue due to bacterial infection

• submucous abscess, smooth vestibule Localized collection of pus an a cavity caused by necrosis of tissue due to bacterial infection

• Demarcation by abscess mambrane (granulation tissue)

• Firm elastic consestence

• Fluctuation can be palpated only in superficial abscesses

Oedematous swelling of the ocular region in abscess of the canine fossa concomitant oedema of the upper lip in submucous abscess in region 11 accumulation of fluid in tissue

• Oedematous swelling of the ocular region in abscess of the canine fossa concomitant oedema of the upper lip in submucous abscess in region 11 accumulation of fluid in tissue

• classic sign of any acute inflammation (tumour) soft and elastic on palpation. Due to the anatomical situation in the maxillofacial region, the typical fluctuation of an abscess is absent in the majority of cases or only rarely identifiable

swelling caused by neoplasms (sarcomas, malignant lymphomas, carcinomas)

• swelling caused by neoplasms (sarcomas, malignant lymphomas, carcinomas)

• salivary gland diseases

diffusely spreading inflammation between superficial tissue levels (without being limited to them)

• diffusely spreading inflammation between superficial tissue levels (without being limited to them)

• No demarcation

• infection by highly virulent bacteria (release of lytic enzymes)

• impaired defence mechanisms of the organism serous-purulent and necrotising inflammation

• serous-purulent and necrotising inflammation

• firm to hard on palpation

In 92-94% of the cases, infections in the oro-maxillofacial region are of odontogenic origin

• In 92-94% of the cases, infections in the oro-maxillofacial region are of odontogenic origin

• Periapical periodontitis

• Infection after teeth extraction

• difficult dentition (pericoronitis)

• Marginal priodontitis

• infected retained root fragments

Odontogenic infections are always caused by a mixed flora of aerobic and anaerobic bacteria.

• Odontogenic infections are always caused by a mixed flora of aerobic and anaerobic bacteria.

• The count of anaerobic bacteria always outnumbers that of aerobic bacteria (at least by 102).

• Pure anaerobic mixed infections also occur. Anaerobic bacteria play a predominant role in the generation and spreading of odontogenic soft tissue infections. Infection by clostridia as well as mixed infections by yeasts and bacteria may occur 

The following statement that Galen made almost 2,000 years ago - "ubi pus, ibi evacua" (if there is pus, remove it) which is still valid in the era of antibiotics could be considered the clinical conclusion from the abscess pathophysiology explained above. Therefore, incision and drainage are the primary therapy of an phlegmonas

• The following statement that Galen made almost 2,000 years ago - "ubi pus, ibi evacua" (if there is pus, remove it) which is still valid in the era of antibiotics could be considered the clinical conclusion from the abscess pathophysiology explained above. Therefore, incision and drainage are the primary therapy of an phlegmonas

Incision of an abscess is advisable, possibly by a sufficiently wide incision at the maximum point of the swelling.

• Incision of an abscess is advisable, possibly by a sufficiently wide incision at the maximum point of the swelling.

• Obtain sufficient discharge of pus with the incision. Prepare for drainage of the purulent exudate

• In smaller abscesses, it is usually sufficient to insert a Iodoform gauze packing strip for 2-3 days; extensive abscess cavities are drained through a tube that is fixed in place with sutures

rinsing of the abscess

• rinsing of the abscess

• Culture and antibiotic sensitivity testing

• Antibiotics for parenteral therapy Infections are classified as mild, moderate or severe infections. Differential surgical and antibiotic treatment is indicated according to the extension tendency and severity grade of infection as well as the general condition of the patient.