Spread Of Oral Infection Important Question And Answers

Spread Of Oral Infection

Question.1. Write note on cellulitis.
Or
Write short note on cellulitis.

Answer. It is also known as phlegmon.

Cellulitis is defined as an acute edematous purulent inflammatory process which spreads diffusely through different tissue spaces or facial planes.

Clinical Features

• There is widespread swelling, redness, and pain without efiite localization.
• Soft tissue swelling is fim and browny.
• When cellulitis involves the superficial tissue spaces, the overlying skin appears purplish.
• Fever, chills leukocytosis are often present which make the patient slightly ill.
• Regional lymphadenopathy often develops.
• Some lesions resolve completely however in other cases pus discharging intraoral or extraoral sinuses may develop.
• If maxillary tooth is involved there may be redness of eye.

Read And Learn More: Oral Pathology Question And Answers

Histopathology

• There is collection of large amount of firin and serum fluid as well as tissue.
• Acute inflammatory cell infiltration by PMNs and occasionally lymphocytes.
• Formation of sinus tracts over skin or mucosal surfaces.
• Pus may develop in the later stages of the disease.

Treatment

• Bacteriological examination of exudates or pus.
• Drainage of pus is carried out.
• Antibiotic therapy
• Elimination of primary source of inflammation.

 

Question.2. Write short note on Ludwig’s angina.

Or
Describe in brief Ludwig’s angina.

Answer. Ludwig’s angina is an acute toxic cellulitis begin in submandibular space and secondarily involving sublingual and submental spaces as well.

Etiology

• Dentoalveolar abscess in relation to mandibular 2nd or 3rd molar.
• Deep periodontal abscess or pocket.
• Pericoronal infection in relation to mandibular 3rd molar.
• Osteomyelitis.
• Injection of contaminated needle.
• Traumatic injuries: Fracture of mandible if infected or contaminated.
• Deep laceration or penetrating injury.

Rare Causes

• Sublingual sialadenitis
• Submandibular sialadenitis.
• Purulent tonsillitis.

Bacteriology

• Main microorganism is streptococci
• Others are staphylococci, gram­negative (E.coli and Pseudomonas), anaerobes, bacteroids and peptostreptococcus.

Clinical Features

• It produces a board-like swelling of floor of mouth and consequent elevation of tongue.
• The swelling is fim, painful and diffuse showing no evidence of localization.
• There is difficulty in eating, swallowing and breathing.
• Patient has high fever, rapid pulse, and fast respiration.
• Moderate leukocytosis is present.
• The swelling may spread to the neck with development of edema glotts.

Laboratory Findings

• Streptococci are invariably seen.
• Fusiform bacilli and spiral forms, various staphylococci,diphtheroids and other microorganisms are cultured.
• It is a nonspecific mixed infection.

Complication

• Asphyxia: Due to edema of glotts.
• Septicemia and cavernous sinus thrombosis.
• Mediastinitis.
• Meningitis
• Brain abscess.
• Death.
  (The most common cause of death is as asphyxia).

Treatment

• Early diagnosis.
• Maintenance of patient airway.
• Intense and prolonged antibiotic therapy.
• Extraction of offending teeth.
• Surgical drainage of facial space.

 

Question.3. Write short note on focus of infection.
Or
Write short note on focus of infection and focal infection.

Answer. Focus of infection refers to “the circumscribed area of tissue which is infected with exogenous pathogenic microorganisms and is located near mucous or cutaneous surface”. By Billings

• As there is local or general infection which is caused by dissemination of microorganisms or toxic products from focus of infection this lead to focal infection.
• Foci may be primary or secondary. Primary foci usually are located in tissues communicating with a mucous or cutaneous surface.
• Secondary foci are the direct result of infections from other foci through contiguous tissues or at a distance through the bloodstream or lymph channels.

Mechanism Of Focal Infection

Two of the accepted mechanisms are:

• Metastasis of microorganisms from an infected focus by hematogenous or lymphogenous spread.
• Toxins or toxic products may be carried through the blood or lymphatic channels froma focus to a distant site where they may incite a hypersensitive reaction in the tissues.

Oral Foci Of Infection

Various infections of the oral cavity may act as sources of infection and may be responsible for spread of microbes to a distant site causing metastases. The potential foci in the oral cavity include:

• Infected periapical lesions, particularly the chronic lesions,such as the periapical abscess., granuloma and cyst.
• Teeth with infected root canals are the potential sources of dissemination of microbes as well as their toxins.
• Periodontal disease following tooth extraction or dental manipulation is also signifiant focus of infection; particularly the tooth extraction is an important cause of bacteremia.

Impedance Of Oral Foci Of Infection

Oral foci of infection either cause or aggravate many systemic diseases. Most frequently encountered systemic diseases are:

• Arthritis: Arthritis of the rheumatoid type and rheumatic fever type. Which are manifested because of the occurrence of streptococcal infection in mouth.
  The causal microbe (Group A streptococci) may not be cultured from the joints and blood but the patients have a high titer of antibodies against these microbes.
  The presence of these antibodies suggests that tissue hypersensitivity reaction is the cause of inflammatory reactions that occur.
• Subacute bacterial endocarditis (infective endocarditis): Majority of these cases are related to oral infection and occur following tooth extraction.
  The close similarity between the causative agent of subacute bacterial endocarditis and the Streptococcus of viridAns group in the oral cavity, in the dental pulp and periapical lesions, and frequent occurrence of transient streptococcal bacteremia following tooth extraction are the indication that oral foci are the cause of this disease.
• Gastrointestinal diseases: It has been reported that constant swallowing of streptococci from mouth may lead to a variety of gastrointestinal diseases.
  Gastric and duodenal ulcers are related to oral foci of infection.
• Ocular diseases: In many ocular diseases, such as iritis, cyclitis, choroiditis, uveitis, etc. microbes associated with the teeth, oral cavity, tonsils, sinuses, etc. have been considered as primary foci of infection.
• Skin diseases: Such as some form of eczema and possibly urticaria can be related to oral foci of infection.
• Renal diseases: Streptococci, particularly S. hemolyticus present in dental root canals or periapical or gingival areas appears to have some relation with certain type of renal diseases and may play a role in causing renal diseases.

 

Question.4. Describe in detail on diseases of maxillary sinus.

Answer. Following are the diseases of maxillary sinus:

Classification

• Developmental:
  • Crouzon’s syndrome
  • Treacher Collins syndrome
  • Binder syndrome
• Inflammatory:
  • Maxillary sinusitis
  • Mucositis
  • Empyema
• Cyst:
  • Non­dental
    • Mucocele
    • Benign mucosal cyst of maxillary antrum
    • Surgical ciliated cyst
  • Dental:
    • Radicular cyst
    • Globulomaxillary cyst
    • Dentigerous cyst
    • Odontogenic keratocyst
• Benign tumor:
  • Osteoma
  • Ameloblastoma
  • Antral polyp
  • Antral papilloma
• Malignant tumor:
  • Squamous cell carcinoma
  • Metastatic carcinoma of maxillary sinus
  • Local malignant tumor invades maxillary sinus
• Due to trauma:
  • Fractured root
  • Sinus contusion
  • Blow out fracture
  • Isolated injury
  • Complex fracture
  • Oroantral fitula
  • Foreign bodies
• Calcifiation: Antrolith
• Miscellaneous
  • Fibrous dysplasia
  • Pseudotumor

Crouzon syndrome

It is also known as craniofacial dysostosis.

• Following are the features
• Frontal defect is present and cranium is brachycephalic.
• Maxilla and maxillary sinus remains hypoplastic.
• High arch palate is seen.
• Dental arch is V shaped
• Partial anodontia is present.

Treacher Collins syndrome

It is also known as mandibulofacial dysostosis.

• Maxillary sinus and malar bones are underdeveloped.
• Cheek bones are underdeveloped.
• Facial cleft is present.
• Palate is high arched
• Malformation of external ear is seen.

Binder Syndrome

• It leads to hypoplasia of middle third of face.
• Retrognathic maxilla
• Presence of maxillonasal dysplasia
• Hypoplastic maxillary and frontal sinus

Maxillary sinusitis

• Inflmmation of mucosa of maxillary sinus is known as
• maxillary sinusitis.
• It can be acute, sub­acute and chronic.

Etiology

• It is caused due to periapical infection of teeth.
• Due to oro-antral fitula
• By deep pocket
• Due to trauma of facial bones.
• Due to overpreparation of root canal which leads to guttpercha filing in sinus.
• If implant is placed too deep

Clinical Features

Acute

• Patient complains of pain in eyeball, cheek or frontal areas which is severe and is constant. Pain gets exaggerated by downward positioning of head.
• Nasal discharge is present which is watery in beginning of disease and later on becomes mucopurulent.
• There is presence of erythematous color and inflammation of mucosa of anterior nares.
• Presence of tenderness on palpation.

Sub-acute

• Symptoms are diminished.
• Presence of purulent discharge. Nasal voice is present.
• Patient is unable to sleep because of presence of cough.

Chronic

• Nasal obstruction and headache are the constant features.
• Low fever and tiredness is present.

Histopathology

• Maxillary sinus lining have acute inflammatory infiltrate.
• Edema of connective tissue is present.
• At times hemorrhage is also seen.

Treatment

• Removal of the cause.
• Antibiotics, analgesics and nasal decongestants should be given.

Mucositis

• Inflammation of mucosa of maxillary sinus is known as mucositis.
• It is caused by periodontal or periapical infection.
• Disease is asymptomatic.

Benign mucosal Cyst of maxillary antrum

• Occurs during 2nd and 3rd decades of life.
• Male predilection is present.
• Localized dull pain is present over antrum.
• Yellow flid discharge is seen from nose.
• Histology reveals presence of chronic inflammatory cells in connective tissue wall.

Postoperative Maxillary Cyst

• It occurs due to the entrapped epithelial lining of maxillary sinus in wound closure during Caldwell­Luc surgery.
• Occurs from 2nd to 7th decades of life.
• Pain and swelling is present over cheek or palate or face or alveolus.
• Pus discharge is present.
• Histopathology reveals presence of squamous metaplasia in pseudo-stratified columnar epithelium.
• Enucleation should be done.

Osteoma

• It occurs from 2nd to 4th decade of life.
• Male predilection is seen.
• Mainly asymptomatic but obstruct the ostium of sinus.
• It can expand to maxillary sinus and leads to swelling of hard palate.
• Surgical excision is done.

Antral Polyp

• Mucosa of the chronically inflamed sinus leads to the formation of irregular folds known as polyp.
• Seen in young adults.
• Pain in the nose and nasal obstruction is present.
• Saint’s triad is present, i.e. asthma, nasal and antral polyp, and aspirin sensitivity.
• Excision of polyp is done.

Squamous Cell Carcinoma

• Squamous cell carcinoma of maxillary sinus occurs from metaplastic epithelium of sinus lining.
• Occurs during 6th decade of life and male predilection is seen.
• Patient complains of pain over face, nasal obstruction and swelling.
• Ulceration is present over the hard palate.
• Both medial and lateral walls of the sinus are involved.
• Involvement of flor of the sinus leads to expansion of boney plates, swelling, mobility of teeth and severe pain.
• Histopathology reveals features of squamous cell carcinoma.

Oroantral Fistula

• It is an epithelialized pathological communication between oral cavity and maxillary sinus.
• It is caused by trauma to sinus, malignancies and osteomyelitis
• There is presence of tenderness over the maxilla especially in infraorbital region.
• Mild edema to cheek in infraorbital soft tissue.
• Ear ache­referred pain from antrum.
• On nose­red, shiny and swollen, mucous membrane, around osteum.
• Presence of pus or mucopurulent discharge in middle meatus.
• Oropharynx—mucopurulent discharge.
• Impairment of sense of smell.
• Foul smelling of mucopurulent discharge.
• Mild tenderness over infraorbital region.
• Closure of opening is done by surgical methods.

Antrolith

• It is the calcified mass present in the maxillary sinus.
• It can occur at any age
• Lesion is asymptomatic and at times nasal discharge is present which is blood-stained and nasal obstruction too is seen.
• Removal is done if lesion is symptomatic.