This document summarizes various infections of the pulp, periapical tissues, and jaw bones: pulpitis causes inflammation of the pulp due to irritants like caries; dentoalveolar abscesses develop at tooth roots from pulp infections; Ludwig's angina is a life-threatening bilateral infection of sublingual and submandibular spaces often from dental infections; osteomyelitis is bone inflammation usually from mixed infections that requires medical and surgical treatment; and Actinomycosis is a chronic granulomatous infection caused by Actinomyces bacteria often related to dental procedures.

1. Infections of Pulp, Periapical
tissues, and jaw Bones

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Pulpitis
Dentoalveolar abscess
Ludwig’s angina
Osteomyelitis of jaw
Actinomycosis.

3. Pulpitis
• Inflammation of pulp.
• Follow exposure to range of irritants like
thermal, chemical, mechanical.
• Dental caries is commonest cause of pulpal
necrosis
• Others include accidental trauma,
instrumentation,

4. Pulpitis and its possible outcomes
Irritant
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Pulpal inflammation
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Acute pulpitis
Chronic pulpitis
Pulpal necrosis
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Infection of periodontal membrane
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Acute periapical periodontitis
Chronic periapical periodontitis
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Dentoalveolar abscess ←
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Cellulitis,-- Osteomyelitis
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Periapical granuloma or Cyst

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Pulpitis following dental caries
Pulpitis through an open cavity
Pulpitis through the apical foramen
Pulpal necrosis

6. Microbiology
• Overall the related micro flora is similar to
that isolated from necrotic pulps.
• Part of normal flora, obligate anaerobes,
facultative anaerobes.

7. Bacteria isolated from necrotic pulps
Obligate Anaerobes
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Peptostreptococcus
Veillonella
Eubacterium
Propionibacterium
Arachnia
Porphyromonas
Prevotella
Fusobacterium
Campylobacter
Wolinella
Facultative Anaerobes
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Lactobacillus
Eikenella
Streptococcus
Capnocytophaga

8. Dentoalveolar abscesses
• Common infection
• Develops typically at apices of roots of teeth.
• Infection most commonly arises via the pulp
chamber
• Endogenous usually caused by mixture of
bacteria.

9. Diagnosis
• Specimen collection - most imp.
• Method – aspiration with syringe and needle
(anaerobes)
• Gram stain and Z-N stain
• Culture- both aerobic and anaerobic
separately
• Imaging -

10. TREATMENT
• Aim- to establish the drainage of pus
• Antibiotics- useful adjuncts
- local instillation
- anti aerobic and anti anaerobic

11. Ludwig’s angina
• Life threatening infection.
• Bilateral infection of sublingual and
submandibular spaces.
• Infection of fascial tissue covering glands
• Rare but serious – Mortality is close to 100%
• Cause – dental infection in 90% cases

12. Micobiology
• Mixed type.
• Oral commensals - Anaeorobic gram negative
and anaerobic streptococci commonly
isolated.
• Staph, Strepto, Enterobacteria.

13. Key clinical features
• Brawny edema with elevated tongue, airway
obstruction and very little pus.

14. Treatment
• Maintenance of airway is of paramount
interest in management
• AIRWAY
• BREATHING
• CIRCULATION
• REMOVE SOURCE OF INFECTION – antibiotics

15. Osteomyelitis of jaw
• Uncommon now
• Definition- inflammation of medullary cavity
of bone spreading to involve cortical bone
and periosteum
• Acute or Chronic
• Commoner in Mandible than in Maxilla.
MIXED infection

16. Etiology and Risk factors
• Seen in immunocompromised, diabetes,
agranulocytosis
• Reduced vascularity of bone(Pagets disease)
• Mixed infection.
• Requires both medical and surgical treatment

17. Clinical Features
• Early acute suppurative –
- intense pain,
- high fever,
- swelling
- paresthesia or anesthesia of
mental nerve

18. c/f
• Chronic - established suppurative lesion,
sinus, deep pain, fever, teeth tender and
loose, lymph node enlargement.
• Cellulitis of cheek and trismus.

19. Microbiology
• Staphylococci
• Anaerobic G –ve rods
• Anaerobic G +ve cocci ( Streptococci)

20. DIAGNOSIS AND TREATMENT
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Specimen - pus
CULTURE
ANTIBIOTIC SENSITIVITY TESTS
Medical and surgical management
Drainage of pus, debridement, surgical
reconstruction

21. Actinomycosis
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Chronic granulomatous infection
Endogenous infection
Swelling at angle of jaw.
Cervico-facial region – commonest type
Risk factors – trauma, dental extraction, ID.

22. Microiology
• A.israeli – commonest actinomyectes causing
infection, A. naeslundii
• Others are Haemophyllus spp, Actinobacillus
actinomycetemcomitans
• Obligate Anaerobes

23. c/f
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Common in young people, males.
Presents as swelling at angle of lower jaw.
Multiple draining sinuses
Dental focus of infection

24. Lab diagnosis
• Specimen- aspirate clean, non contaminated
• Gram stain – gram positive long branching
filamentous
• Anaerobic culture
• Sulphur granules – particles seen in pus,
aggregates of actinomyeces filaments
• Sunray appearance - Gram stain and H& E
STAIN

25. Management
• Surgical drainage
• Extraction of dental focus of ifection.
• Long term administration of antibiotics
( penicillin)

26. To summarize
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Pulpitis
Dentoalveolar abscess
Ludwig’s angina
Osteomyelitis of jaw
Actinomycosis.