Chapter 9

Odontogenic Infections
9
F. D. Fragiskos

In order to understand how odontogenic then the cellular factors are triggered
infections are treated, the dentist must be (exudative or cellular phase). The inf
familiar with the ter- minology concerning lammation finally resolves and the
infection and the pathophysiol- ogy of inf destroyed tissues are repaired. On the
lammation, which are described below. other hand, chronic inf lammation is
Inoculation is characterized by the entry characterized by factors of reparation and
of patho- genic microbes into the body healing. Therefore, while acute inf lam-
without disease occur- ring. mation is exudative, chronic inf lammation
An infection involves the proliferation of is produc- tive (exudative and reparative).
microbes resulting in triggering of the Understanding the differences between
defense mechanism, a process these types of inf lammation is important
manifesting as inf lammation. for therapeutic treat- ment.
Inf lammation is the localized reaction of
vascular and connective tissue of the body Serous Phase. This is a procedure that lasts
to an irritant, result- ing in the approxi- mately 36 h, and is characterized
development of an exudate rich in proteins by local inf lamma- tory edema,
and cells. This reaction is protective and hyperemia or redness with elevated tem-
aims at limit- ing or eliminating the irritant perature, and pain. Serous exudate is
with various procedures while the observed at this stage, which contains
mechanism of tissue repair is triggered. proteins and rarely polymor- phonuclear
De- pending on the duration and severity, leukocytes.
inf lammation is distinguished as acute,
subacute or chronic. Cellular Phase. This is the progression of the
serous phase.
It is characterized by
Acute Inflammation. This is characterized by massive accumulation of
polymorphonuclear leukocytes, especially
rapid progression and is associated with neutrophil granulocytes, leading to pus
typical signs and symptoms. If it does not formation. If pus forms in a newly
regress completely, it may become developed cavity, it is called an abscess. If
it develops in a cavity that already exists,
subacute or chronic. e.g., the maxil- lary sinus, it is called an
empyema.
Subacute Inflammation. This is considered a
transi- tion phase between acute and Reparative Phase. During inf lammation, the
chronic inf lammation. repara- tive phenomena begin almost
immediately after inoc- ulation. With the
Chronic Inflammation. This procedure reparative mechanism of inf lamma- tion,
presents a prolonged time frame with the products of the acute inf lammatory
slight clinical symptoms and is reaction are removed and reparation of the
characterized mainly by the development destroyed tissues follows. Repair is
of connective tissue. achieved with development of gran-
Inf lammation may be caused by, ulation tissue, which is converted to fibrous
among other things, microbes, physical connec- tive tissue, whose development
and chemical factors, heat, and irradiation. ensures the return of the region to normal.
Regardless of the type of irritant and the
location of the defect, the manifestation of
inf lammation is typi-
cal and is characterized by the following clinical signs
and symptoms: rubor (redness), calor (pain), and functio laesa (loss of function).
(heat), tumor (swelling or edema), dolor
 The natural progression of inf 9.1
lammation is distin- guished into various Infections of the Orofacial Region
phases. Initially vascular reac- tions with
exudate are observed (serous phase),
and The majority (i.e., 9095%) of infections
that manifest in the orofacial region are
odontogenic. Of these, ap- proximately
70% present as periapical inf lammation,