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LECTURE
Abscesses of maxillo-lingual groove, palate,
hyoid ridge. Phlegmon:
submandibular, buccal,
masticator, retromandibular, submental are
as.Phlegmons of the floor of the mouth and
neck, putrefactive-necrotic angina
of Zhansul Ludwig, phlegmons and
abscesses of tongue. Etiology, pathogenesis,
clinic, diagnostics. Treatment,
complications, prevention.
Inflammation may spread
in three ways:
 1.
By passing through tissue
spaces and planes.
 2.
By way of the lymphatic
system.
 3.
By way of blood circulation.
Most Common Teeth and Associated
Periodontium Involved in Clinical Presentations
of Abscesses and Fistulae.
Maxillary vestibule
Maxillary central or lateral incisor, all surfaces, and roots.
Maxillary canine, all surfaces, and roots (short roots below levator anguli
oris).
Maxillary premolars, buccal surfaces, and roots.
Maxillary molars, buccal surfaces, or buccal roots (short roots below
buccinator).
Penetration of nasal floor
Maxillary central incisor, roots.
Maxillary canine, all surfaces, and root (long root above levator anguli oris).
Palate
Maxillary lateral incisor, lingual surfaces, and roots. Maxillary premolars,
lingual surfaces, and roots. Maxillary molars, lingual surfaces, or palatal
roots.
Perforation Into maxillary sinus
Maxillary molars, buccal surfaces, and buccal roots (long roots). Maxillary
molars, buccal surfaces, and buccal roots (long roots above buccinator).
Mandibular first and second molars, buccal surfaces, and buccal roots (long
roots below buccinator).
Mandibular vestibule
Mandibular incisors, all surfaces, and roots (short roots above mentalis).
Mandibular canine and premolars, all surfaces, and roots (all roots above
depressors).
Mandibular first and second molars, buccal surfaces, and roots (short roots
above buccinator).
Buccal space infection
Submandibular space
Most Common Teeth and Associated
Periodontium Involved in Clinical
Presentations of Abscesses and Fistulae.




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
Submental skin region
Mandibular incisors, roots (long roots below mentalis).
Sublingual region
Mandibular first molar, lingual surfaces, and roots (all roots
above mylohyoid). Mandibular second molar, lingual
surfaces, and roots (short roots above mylohyoid).
Submandibular skin region
Mandibular second molar, lingual surfaces, and roots (long
roots below mylohyoid). Mandibular third molars, all
surfaces, and roots (all roots below mylohyoid).
Surgical treatment of facial
space infection
Possible Space. Teeth, and Periodontium Involved With a Clinical
Presentation of Phlegmon from the Spread of Dental Infection.
SPREAD BY SPACES

The spaces of the head and neck can allow
the spread of infection from the teeth and
associated oral tissues because the
pathogens can travel within the fascial
planes, from one space near the infected
site to another distant space, by the
spread of the related inflammatory
exudate. When involved in infections, the
space can undergo phlegmon or abscess,
which can cause a change in the normal
proportions of the face.
Frontal section of the head and neck highlighting the
submandibular and sublingual spaces.
SPREAD BY LYMPHATICS

The lymphatics of the head and neck can
allow the spread of infection from the
teeth and associated oral tissues. This
occurs because the pathogens can travel
in the lymph through the lymphatics that
connect the series of nodes from the oral
cavity to other tissues or organs. Thus,
these pathogens can move from a primary
node near the infected site to a secondary
node at a distant site .
Superficial cervical lymph nodes
and associated structures.
Deep cervical lymph nodes and
associated structures.
SPREAD BY THE BLOOD
SYSTEM
 The
blood system of the head and
neck can allow the spread of
infection from the teeth and
associated oral tissues, because
pathogens can travel in the veins
and drain the infected oral site into
other tissues or organs. The spread
of dental infection by way of the
blood system can occur from
bacteremia or an infected thrombus.
Pathways of the internal jugular vein and facial
vein, as well as the location of the cavernous
venous sinus.
SPREAD TO THE PARANASAL
SINUSES

The paranasal sinuses of the skull can
become infected through the direct spread
of infection from the teeth and associated
oral tissues, resulting in a secondary
sinusitis. A perforation in the wall of the
sinus can also be caused by an infection.
Secondary sinusitis of dental origin occurs
mainly with the maxillary sinuses, since
the maxillary posterior teeth and
associated tissues are in close proximity to
these sinuses.
Lateral view of the skull and the
paranasal sinuses.
Dental abscess
An abscess is an accumulation of
pus. Pus is a thick fluid that
usually contains white blood
cells, dead tissue and bacteria
(germs). The usual cause of an
abscess is an infection with
bacteria. A dental abscess is an
infection in the centre of a tooth
which spreads through the tooth
to infect supporting bone and
other nearby tissues.
Dental abscess
 Dental
abscess is common. It may
develop as a complication of tooth
decay (caries), or from an infection
in the gums.
CAUSES
The cause of these infections is direct growth of the
bacteria from an existing cavity into the soft tissues
and bones of the face and neck.

An infected tooth that has not received
appropriate dental care can cause a dental
abscess to form. Poor oral hygiene, (such
as not brushing and flossing properly or
often enough) can cause cavities to form
in your teeth. The infection then may
spread to the gums and adjacent areas
and become a painful dental abscess.
Classification abscesses and
phlegmons of maxillofacial area:
 1.Abscesses
and phlegmons
maxilla region.
 2.Abscesses and phlegmons
mandible region.
 3.Abscesses and phlegmons
bottom oral cavity.
 4.Abscesses and phlegmons
tongue and of the neck.
of the
of the
of the
of the
Symptoms of a dental abscess
include:

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


Pain (toothache) which can quickly become
worse. It can be severe and throbbing.
Swelling of the gum which can be tender.
Swelling of the face. The skin over an abscess
may become red and inflamed.
The affected tooth may become tender to touch,
and may even become loose.
High temperature and feeling generally unwell.
In severe cases there may be spasm of the jaw
muscles with difficulty swallowing and/or
breathing.
PHYSICIAN DIAGNOSIS
A
doctor or dentist can determine by
physical examination if you have a
drainable abscess. X-rays of the
teeth may be necessary to show
small abscesses that are at the
deepest part of the tooth. Signs
observed by the doctor, including
nausea, vomiting, fever, chills, or
diarrhea, may indicate that the
infection has progressed to the point
where it is making your whole body
sick.
PHYSICIAN TREATMENT

The doctor may decide to cut open the
abscess and allow the pus to drain. Unless
the abscess ruptures on its own, this is
the only way that the infection can be
cured. People with dental abscesses are
typically prescribed pain relievers and, at
the discretion of the doctor, antibiotics to
fight the infection. An abscess that has
extended to the floor of the mouth or to
the neck may need to be drained in the
operating room under anesthesia.
Directions of cuts during treatment of
purulent processes in maxillofacial area.
Directions of cuts during treatment of
purulent processes in maxillofacial area.
Prognosis
If treated, the outlook is good. The pus
can usually be drained and the tooth can be
saved if it is not badly broken down.

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


If left untreated, complications may
develop which can include:
Spread of infection
The abscess may 'burst' onto the skin of the face,
or into the mouth. This may leave a sinus tract (a
channel) between a persistent focus of infection
and the skin or mouth which can discharge pus
from time to time.
Cavernous sinus thrombosis - a serious infection
and clotting of a blood vessel in the brain.
Sinusitis - spread of infection to the nearby sinus
in the face bone.
A dental cyst (fluid filled cavity) may develop.
Thank you for
attention
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