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In The Name
Of God
Dentoalveolar infection in
pediatric patients
Dr Sara Maleki Kambakhsh
D.D.S M.Sc Pedodontist
Assistant professor of Qazvin University of Medical Science
CONTENT
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Introduction of dental decay
Incidence and prevalence
Dentoalveolar infection
Treatment modalities
Recommendations
Dental caries
 Dental caries is the single most common chronic childhood
disease (may 2000.AAPD)
 Dental caries is five times more common than asthma and
seven times more common than hay fever
 Dental caries is not self-limiting, like the common cold, nor
amenable to treatment with a simple course of antibiotics, like
an ear infections
 dental care is the most prevalent unmet health need
among children
 many variables contribute to the spread of the disease
and thwart our efforts to eliminate this major health
problem
• ECC ( early childhood caries )
presence of one or more decayed (noncavitated or
cavitated), missing (as a result of caries), or filled tooth
surfaces in any primary tooth in a child 71 months of age or
younger
• SECC ( sever ECC, nursing caries, baby battle tooth
decay )
in children younger than 3 years of age, any sign of
smooth-surface caries is indicative of severe early
childhood caries
Etiology of dental caries
• Is an infectious and communicable disease and that
multiple factors influence the initiation and progression of
the disease
 host (tooth in the oral environment)
 a dietary substrate,
 and acid uric bacteria
 The saliva (viscosity / salivary flow )
 And individual factors ( genetic) (anatomy and
morphology)
host (tooth in the oral environment)
• Oral hygiene
• Critical PH (5.5/ 6.2)
• Primary dentition
Microorganisms(cariogenic bacteria)
• S. mutans ,S.sobrinus and lactobacilli
• Window of infectivity
• Vertical and horizontal transmission
nutrition
 Brest feeding (At once )
 Bottle feeding
 snacks
Odontogenic infection have three major
origins
Periapical ( 70%)
Periodontal (20%)
Pericronitis (10%)
Odontogenic Infections
 Classic signs and symptoms of infection
include redness, pain, swelling,
and local and systemic temperature increases
 The virulence of the microorganisms and the ability of the tissues to
react to the infection probably determine whether the infection will
be acute or chronic
the Importance in pediatric patients:
 Dentoalveolar infections can progress rapidly especially
in pediatric patient.
 Children are susceptible to becoming dehydrated and
systemically ill from what may appear to be a relatively
minor infection (as a result of his or her refusal to take
fluids because of oral pain)
 Because of wider marrow spaces in the child, an odontogenic
infection can rapidly spread through the bone, and the
surrounding tissue is less able to wall off the process
 Most odontogenic infections in the child are not serious and
can be easily managed with pulp therapy or removal of the
involved tooth
Criteria for referral to a
specialist
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Rapidly progressive infection (cellulitis)
Difficulty in breathing
Difficulty in swallowing
Facial space involvement
Elevated temperature (greater than 101F)
Severe jaw truisms (less than 10 mm)
Toxic appearance
Compromised host defense
Acute alveolar abscess
• The tooth is sensitive to percussion
and movement, and the patient may
have a slight fever
• The acute symptoms of an alveolar abscess can be relieved
by using antibiotic therapy and establishment of drainage
• antibiotic therapy is not always necessary
(effective pain control)
Warm saline
Chronic alveolar abscess
 characterized by less soreness, is often a
better-defined radiographic lesion
 The patient will likely have some lymphadenopathy
 Draining fistulas are also frequently associated with chronic alveolar
abscesses
 antibiotic therapy is unnecessary except in patients with an
overriding systemic problem (e.g., patients susceptible to subacute
bacterial endocarditis, patients with organ transplants, or those who
are immunodeficient)
CELLULITIS
 Cellulitis is a diffuse type of infection
of the soft tissues that may be caused
by a pulpless primary or permanent tooth
 It often causes considerable swelling of the face or neck,
and the tissue appears discolored
 Cellulitis is a very serious infection. It can be
lifethreatening and is a potential complication of all acute
dental infections
• The child appears acutely ill and may have an alarmingly high
temperature with malaise and lethargy
 If a maxillary tooth is the problem, the swelling and redness may
involve the eye
 If cellulitis is treated too late, serious complications, such as
involvement of the central nervous system or a cavernous sinus
thrombosis, could occur
• If the infection involves the submandibular, sublingual, and
submental spaces, it is called Ludwig angina. In this condition the
tongue and floor of the mouth become elevated to the extent that the
patient's airway is obstructed and swallowing is impossible
Bacteria Responsible for Odontogenic
Infection
Aerobic bacteria(25%)
Gram-positive Cocci
Streptococcus
Anaerobic bacteria(75%)
Gram-positive Cocci
Streptococcus,
Peptostreptococcus
Gram-negative Bacilli
Prevotella, porphyromonas
fusobacterium
Select antibiotic
• Causative organisms based on history
• Host defense history
• Allergy history
• Previous drug history
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Penicillin vk
Amoxicillin
Clindamycin
Metronidazole
Adequate length of time
• Improvement in symptoms: within 2 days
• Reasonably asymptomatic: within 4 or 5 days
• At least 2 days after the symptoms disappear
• Usual prescription should be written for 6-7 days