1. Odontogenic infection in maxillofacial region
กลุ่มงานทันตกรรม รพ.วานรนิวาส

2. Infection in oral and maxillofacial region
Odontogenic infection Necrotizing facciitis, frequently odontogenic source Osteomyelitis Osteoradionecrosis Bisphosphonate-relaed osteonecrosis Salivary grand infection Fungal & viral infection

3. Odontogenic infection

4. Dental infection => space infection

5. Dental infection => space infection

6. Host
Anatomical
factor
Microbial

9. Severity score= 1
Subperiosteal abscess

10. Low severity
Severity score= 1
Vestibular abscess

11. Low severity Severity score= 1 Canine space abscess
ระวังPeriorbital!!!

12. Low severity
Severity score= 1
Buccal space abscess

13. Limited mouth opening ( 1cm)
Severity score= 2
Submasseteric space
Pterygomandibular space
Temporal space
Limited mouth opening ( 1cm)

14. Severity score= 2 Submental space infection
Submandibular space abscess

15. Ludwig’s angina Rapidly obstruct upper airway
Involvement submandibular spaces bilaterally ,submental space,sublingual
Rapid spread to lateral pharyngeal / retropharyngeal space
Rapidly obstruct upper airway

16. Severity score= 3

17. Severity score= 4
Danger space, Mediasternum

18. The most frequent cause of death in reported cases of odontogenic infection is Airway Obstraction
Clinical apparent partial air way obstruction with lowO2sat => secure airway

19. Management of odontogenic infection
Step 1.Determine the severity of infection ---Anatomical location ---Rate of progression : Inoculation,Cellulitis,Abscess ---Air way compromise

20. Chronic renal failure* Malnutrition Alcoholism End-stage AIDS
Step 2. Evaluated host defend
DM*
Steroid therapy
Organ transplants
Malignancy
Chemotherapy
Chronic renal failure*
Malnutrition
Alcoholism
End-stage AIDS

21. Step 3.Decide on setting care
-Refer > Severe score 2
IPD : score 1, mild score 2
fever, dehydration, control host disease
OPD : mild score 1-2
follow up in *few days
(7 days may be too long)

22. Step 4.Treat surgically
Mild root canal treatment or Tooth extraction ?
Surgical drain (intraoral or extraoral)
--If drain inserted,
drains should be discontinued
when drainage cease <72hrs
--Irrigate with NSS daily

23. Stage of Infection

24. Early incision and drainage aborts the spread of infection into deeper and more critical anatomic space, even when it is in the cellulitis stage
Williams and Guralnick N Engl J med 1943
Flyn TR, AAOMS 1999
แต่ถ้าแก่มากๆหรือในเด็กถ้าไม่ได้บวมมากก็สามารถชะลอไปก่อนได้

26. Step 5. support medically
Control fever& adequate hydration

27. Step 6. Choose antibiotic therapy
Usual Odontogenic infection :
70%= gram(+)cocci :Streptococus sp.
30% = anaerobic : gram (-) rod , Bacteroid sp, prevotella, prophyromonas, fusobacterium, Klebsiella
Step 7.Administer the antibiotics

28. Usual Odontogenic infection

29. In thailand เก็บclindamycin ไว้กรณี severe infection
รพ.ศูนย์ต่างๆพบว่าการรักษาคนไข้ในประเทศไทย
IV FOR ODONTOGENIC INFECTION
1st line drug : PGS + Metronidazole
or 1st gen cephalosporin+Metronidazole กรณีมีStaphlylococus(skin)
เก็บclindamycin ไว้กรณี severe infection

33. Culture& sensitivity testing
Expensive&time consumimg!!
Can be dalayed for as mush as 2 weeks
When dealing with
Unusual Infection **subjected to multiple course of antibiotics
DM : Klebsiella pneumoniae
HIV/AIDS :Mycobacteria
IV Drug abusers : Staphylococus aureus
Gram stain?cheap screen!!

34. Step 8.Evaluated the patient frequenly
No fever 1-2 days, การบวมลดลง, การปวดลดลง,รับประทานข้าวได้ เปลี่ยนเป็นยากินและ D/S ได้ นัด F/U

35. Step 1.Determine the severity of infection
Step 2. Evaluated host defend
Step 3.Decide on setting care
Step 4.Treat surgically
Step 5. support medically
Step 6. Choose antibiotic therapy
Step 7.Administer the antibiotics
Step 8.Evaluated the patient frequenly