Pathology of oral and dental infections

2021-02-02 12:00 AM

Swelling covering the grooves and indentations of the face, swelling more or less depending on the position of the teeth, the cause and toxicity of the bacteria, the shiny skin, the touch of heat

Inflammatory disease caused by teeth

Most facial infections are caused by decaying teeth, then progressing to rotten marrow or peri-apical inflammation acute or chronic, when there is pus at the tooth tip it exits in three ways: canal, periodontal membrane , the alveolar bone in this case pus can reach the jawbone. So, in the case of periodontitis or a wisdom tooth eruption accident, it can also enter the perineal and then penetrate the bone into the software, causing infection in loose tissue or osteomyelitis. For baby teeth, because the root is short, it rarely causes inflammation in the loose tissue.


Cells are loose connective tissue, and if inflamed, it diffuses into soft tissue, not limited to abces. Inflammation may be localized or spread throughout the tissue in the face. The cause is usually due to tooth marrow rot due to decay or trauma creating lesions around the root tip such as granulomas, abces, cysts ... or by inflammation around the crown of teeth at wisdom teeth, periodontitis, trauma. There is no special bacteria that causes cellulitis but all the common bacteria in the mouth such as staphylococci, streptococcus, coccyx, anaerobic bacteria. Cell tissue becomes inflamed when pus penetrates directly, or by bacterial toxins, or by infection spread through the lymph. May differentiate cluster and diffuse cellulitis.

Inflammation of celluloid tissue

The most common are acute, subacute, chronic and gangrene.

Acute inflammation:

Serum inflammation (inflammation of the succulent tissue) is the first stage of cellulitis, with circulatory disorders [vasoconstriction, vasodilation] and serosa.

Clinical symptoms:

Systemic symptoms are not clear.

Local symptoms: swelling covering the grooves and indentations on the face, swelling more or less depending on the position of the teeth, the cause and the toxicity of the bacteria, the shiny skin, the touch of heat, little redness, no pain, no printing dactylogram.


Determination: based on a history of toothache ...

Distinguishing: inflammation caused by nails, trauma due to foreign bodies penetrating the mucosa, osteitis, lymphadenitis ...

Progression: clears after a few days if the cause of the tooth is treated or goes into a purulent stage.

Treatment: Endodontic treatment to preserve teeth or extraction of teeth, depending on the patient's condition and each specific case.

Purulent [phlegmon]: (inflammatory tissue inflammation) as the disease progresses to this stage systemic and local symptoms become more pronounced.


Body as a whole: high fever, rapid pulse, headache [pus starts to gather, then less fever].

Spot: face swollen, red skin, hot palpable, constant pain, unable to open wide, bad breath. For lower jaw, when the cause is behind, the hardening of the jaw [trismus] becomes worse, the pain of loss of appetite, insomnia, and medicine will not help the state of collapse. At first, it was difficult to see the signs of wave shifting, indicating a pus accumulation.


Identification: based on a history of toothache, the location of the swelling is related to the cause of the tooth.

Distinguishing: in the lower jaw can be mistaken for an inflammation of the oral floor due to shutting off Wharton salivary tube, purulent follicle, lymphadenitis under the jaw. In the upper jaw area of ​​the canine inflammation spreading to the lower eyelid can be confused with cholecystitis.

Progression: When pus escapes through the skin or mucous membranes in the mouth, it will help but if the cause is not treated, it will return to the chronic stage. If the patient's state of collapse or strong bacterial toxins will cause more serious complications such as sepsis, diffuse inflammation, osteomyelitis ...

Treatment: Combine systemic and local treatment. Using high-dose antibiotics should use antibiotic to have an effective antibiotic, pay attention to improve the health. Addressing the cause of the tooth, in case of recurrence should be extracted as soon as possible. After extraction, although a part of the pus has escaped along the alveoli, part of the pus still remains, so it is necessary to incision to remove the pus. When the disease is prolonged or not in remission, pay attention to causes such as granulomatosis, osteomyelitis, due to the death of the pulp next to the tooth, or other causes of body weakness.

Subacute inflammation:

Occurs when the bacterial toxicity is weak, the infection progresses slowly, so the body has time to resist. There are two types:

Type one abces: after the period of serous inflammation, redness and swelling, sometimes bruising, palpation of heat, swelling with clear circular boundaries, in the middle of soft around hard there are signs of shifting, wobbly with regional sensation swelling that sticks to the bone. Open mouth is limited when the cause is the molar near the chewing muscle. Examination in the mouth and corner of the hallway is full, red mucous membranes are shiny, the cause of pain is little or just pulled out a few days. Without good treatment, pus will rupture, creating a deep indentation in the skin and sticking to the bone.

Variety of abces: also appear after serous inflammation but located in the corner of jaw and neck, finding abces very shallow and the surrounding skin is not hardy Then the pus cracks the skin, then appears abces in the vicinity and then pus cracks. There are cases where the cause of the teeth extracted and still appear abces is due to inflammation spread from place to place maintaining the probe.

Early treatment, good drainage incision will avoid this case.

Chronic inflammation:

Appears after acute or subacute inflammation. The inflamed area is not completely deflated, but gathered under the skin with a painless circular finger, which is mobile, but has a feeling of sticking to the bone, normal color. After a period of skin fissure, differentiating from tuberculosis lymphadenitis is that it does not stick to the bone and creates many long-healing probes [tuberculosis test, white biopsy is required].

Treating the cause teeth, incision sugar abces in the mouth to avoid scarring, if the pus probe takes a long time to curettage, pump, drain.

Gangrene inflammation:

This is an intermediate condition between inflammation of the congestion and diffuse inflammation, a stench of pus that is slightly concentrated in a cavity of loose cell tissue and necrotic fragments of the organization.

Symptoms: high fever, general fatigue, palpable mass in the face.

Progression: Insufficient or timely treatment becomes diffuse.

Treatment: deep, wide incision to drain well with antibiotics, improve physical condition.

Diffuse cellulitis

It is an inflammatory form with unlimited spreading nature and widespread necrosis of inflamed organizations. In the early days, there is no pus, pus does not gather immediately, but will be eliminated with necrotic tissue. The disease is common after acute arthritis, periodontitis or after difficult tooth extraction, sometimes after a jaw fracture or osteomyelitis.


In the first days, symptoms of the whole body were very severe, chills, high fever, rapid pulse, delirium, difficulty breathing, vomiting, diarrhea. The swelling depends on the location of the inflammatory area, the patient may die after day 2 or 3 of systemic intoxication.

If the pus is collected after day 5 or 6, then the skin will be drained by the skin being punctured due to necrosis or after the incision, the pus comes out with necrotic organs.

If healing, it takes quite a long time and leaves many serious sequelae such as thrombophlebitis, neighboring arthritis ...

Differential diagnosis with myelitis, cellulitis.


Mainly by surgery to open wide and many places to drain, remove the cause teeth, improve the health with high-dose antibiotics.

Osteomyelitis (osteomyelitis)

The jaw is inflamed for three reasons: the most common tooth cause because the canalicas enter the bone where there is no periosteal and protective lymphatic tissue, due to blood sugar [osteomyelitis] and less common is due to the approach as in periodontitis, inflammation around the teeth during wisdom tooth eruption, cellulitis ... because the jaw bone has a thick membrane to protect it very well. In addition to systemic diseases or jaw fractures are also favorable factors. The disease is common in the lower jaw because the lower tooth artery is located very close to the tip of the tooth [8 teeth 5] and is the terminal artery, so it is susceptible to root apical infections and infections that spread easily, unlike The jaw on the arteries is richer and not terminal so bacteria are difficult to concentrate and easily destroyed, but if the upper jaw is inflamed, it can be very severe and can spread quickly to the skull and facial bones, leaving it permanently damaged. There is no specific germ, but a combination of many bacteria.


High fever, chills, severe toothache spreading all over the jawbone, the cheeks swollen red, red skin, feeling the bones are thicker and pain, there are many loose teeth in the mouth with symptoms of arthritis , may have stiffness of the jaw.


Then the pus escapes through the hole in the skin or mucous membrane, now the overall condition looks better, but even after the tooth has been removed the swelling does not go away. Using a probe, follow the probe to feel the dead bone inside vibrate and only when it is withdrawn will the disease go into remission.


Extraction of the cause, but not extraction of neighboring teeth, even though it is shaky, give antibiotic a lot and a long time, coordinate sedation and improve the condition.

Incision abces avoid hole formation.

Watch for the dead bone when it is completely removed from the healthy bone.

Sinusitis caused by teeth

Is inflammation of the sinus mucosa but no bone damage, the reason for the lowest point of the sinus base is near the tip of the tooth 4,5,6 in case of large sinuses, from teeth 3 to 7,8. The base of the sinus is sometimes very low, lying between the root of the teeth, so that the infected teeth tip, the cyst, the infected tooth easily cause sinusitis. Upper jaw fractures that make blood stagnant in the sinuses are also causes of sinus inflammation.


Fainting, tired, sleepless. Visually, slightly swollen in the corresponding sinus area, press in pain, on a blurred sinus X-ray on the inflamed side due to the presence of inflammatory tissue or fluid accumulation in the sinuses, painful half-facial pain spreading to the lower eyelid pain Increasingly, until stinking pus escapes from the sore side nostril, the body is relieved. If the pus does not drain, some time later it will cause frontal sinusitis, osteomyelitis, or eye complications [neuritis of the eye, iritis], sinus thrombophlebitis or skin fissures.


If the new sinuses become inflamed, the extraction of the tooth can heal the disease.

Roots entered the sinus, then find a way to remove if not to open the sinuses and curettage neoplastic mucosa.

Inflammation is not caused by teeth

The boil

It is an infection that destroys the hair-root organization because staphylocoque Doré invades through scratches on the skin, if it appears on the face, especially on the lips, it is very dangerous because there are many blood vessels. Severe swelling can develop if a young stinger is injected, presented with severe local and systemic symptoms that could lead to death from sinus thrombophlebitis.


Whole body: patient has high fever, weak pulse, difficulty breathing.

Spot: at first a small, hard pimple emerges, then the necrosis in the middle spreads gradually making the skin white. Necrotic skin with yellow pus oozing, in the middle is a yellow-green stinger.

Progression: on 8-9 days the stinger drifted out, at this time less skin disease gradually became purple.

Treatment: The boils on the side of the face are forbidden to use, only use high-dose antibiotics, apply hot compresses, carefully monitor and protect against crushing. In case of a rash on the face, reddening, stretching to the eyelids must be immediately resuscitated.


It is a necrotic ulcer of the jawbone and soft facial area. The cause is unknown, there is no specific bacteria, often appearing after severe debilitating diseases such as typhoid, dysentery, typhus fever, especially children after measles and poor oral hygiene.


Whole body: after the measles stopped, the fever began to return, the whole body was tired, pale, fast pulse, very poor general condition, especially bad breath, saliva flow.

Spot: starting as an ulcer in the gums that spreads quickly to nearby tissues, an ulcer to the skin then necrosis puncturing the lips, cheeks and bones, the process takes only 1-2 days as fast as running horses, lung teeth lay and drop many teeth at once.

Progression: no treatment gradually leads to death after 5-7 days due to sepsis or complications in the lung. Late treatment of necrotic jaw bone leaves behind functional and aesthetic sequelae.

Treatment: mainly using high-dose penicillin antibiotic, improving health with vitamins B1, C, sweet serum infusion, heart support, nutritional death along with oral hygiene with salt water pump several times. If there are loose teeth and necrotic bones, they are removed then plastic surgery.

Inflammation of the salivary glands

In the mouth there are many salivary glands, there are small glands scattered in the mouth such as the palate, the cheek mucosa, the lip mucosa, there are large glands such as parotid glands, sublingual, sub-jaw, but the most common is inflammation of the water glands. Ear foam.

The reason is that a decrease in saliva secretion makes common bacteria such as Streptococus, Staphylococus, Pheumococus easy to penetrate through the gland, rarely follow the blood sugar.


Purulent inflammation: enlargement of the gland starts, a rapid increase in fever, rapid pulse, fatigue. The site is full of signs of inflammation, natural pain that can spread to the neck and temples, hearing loss, difficult opening of the mouth, red erection of the stenon, a feeling of dry throat because the gland is no longer excreted, pressing against the skin The glandular area has finger imprints and pus discharge in the cavity of the salivary gland.

Necrotizing fasciitis: only in cases of exhaustion, shortness of breath, in the place of red, purple skin with ulcers, there are many necrotic lesions, in the gland there are palpable gas, there is a lot of pus coming out of the Stenon tube. .

Progress: without treatment, the gland becomes swollen and enlarged, pus is probed to the skin about 5,6 days then the disease gradually recedes, after a period of time naturally no longer detects, the gland becomes sclerotic. In necrotic inflammation will lead to facial nerve paralysis.

Differential diagnosis:

If inflammation of the glands of both sides: differentiated from mumps (the disease spreads to an epidemic, quickly cures, complications may be inflamed for the drainage or ovary, blood test with increased amiloase).

Unilateral gland inflammation: differentiated from osteoarthritis of the lower jaw (history of tooth disease, painful pressure on the bone, bone damage on film): with mastitis (history of ear disease); with lymphadenitis jaw angle [lower position, natural pain-free pain to the touch, no pus in Stenon's hole).

Treatment: squeeze pus by pressing your hand against the gland for 4-5 minutes / day.

Apply cold for 2-3 days.

Stenson catheter pump.

Give drugs to increase saliva secretion such as Pilocacpin.

Vitamins and antibiotics improve health and avoid superinfection.

In the form of necrotic disease requiring wide and early incision, the incision curves from the earlobe to the angle of the jaw and follows the margin under the lower jaw bone, if a multiple incision is required, the parallel incision of the facial nerve and Stenon tube is used latex drainage clamp.