Tema 11

1. Cellulite - is the first stage in the evolution septic process, presupurativ stage, reversible. It is
characterized by pronounced vasodilatation, serous exudate, leukocyte growth and cellular
infiltration of tissues.

Abscess - is circumscribed suppurative form a collection containing pus.

Phlegmon - is as diffuse suppurative processes. It is characterized by the absence of limited

collections and tend invaded extensive septic process, it infiltrates the tissues, septic thrombosis
vascular necrosis followed by gas bubbles due to the action of anaerobic germs.

2. Cellulite acute is the first stage in the evolution of acute septic-stage process presupurativ
reversible. It is characterized by:
- Pronounced vasodilation,
-serous exudate-,
- Increase leukocyte
- Infiltrated cellular tissue.
Exudate proteins are infiltrating tissue edema.
-clinical:
local congestion,
painful swelling localized infiltrate in the right causal factor,
overall condition is slightly altered,
moderate fever,
chills.

Acute Cellulitis is reversible, either spontaneously or after appropriate treatment, it can become
chronic in cases where the infection progresses from start slow due to low virulence of germs or
after unfair treatment.

Cellulite chronic is characterized by a chronic infiltrate dominated by capillary congestion, diffuse

bleeding and conjunctiva reaction network around which there are many polynuclear.

Sometimes there is a small cavity containing pus surrounded by a thin layer of granulation tissue,
all embedded in a table sclerosis.

clinical picture:

- Present infiltrate less painful, without changing skin

- Is this a limited collection, possibly fistulizing surrounded by hardened skin mobile

 - The existence of uni cord leading to tooth stronger causal.

- Overall condition is not altered.

3. Determinants factors:
- Dental-periodontal lesions - frequency - gangrene pulp, periodontal deep periodontal pockets,
tooth fractures, tooth eruption temporary and permanent damaged.
- Injuries - broken jaw.
- Osteomyelitis jaw - and soft parts - perimaxilara.
- Infected salivary lithiasis
-Tumors - cysts - overgrowth -
- Boil the head, neck.
- Complications of loco-regional anesthesia.
- Complications of tooth extraction, scrap, traumatic.
- Complications of various methods of dental treatment (fillings, pulp gangrene, stopping)

Contributing factors:
- Alcoholism
- Diabetes mellitus
- The use of narcotic substances
- Systemic Diseases

4. pathogenic mechanisms of dissemination of infection in the soft parts

 transosseous path:

-periapical infection gradually diffuses throughout the channels that expands Hawers (stage endosseous(

Such cross-infection in the jaw bone and periosteum get that at first he takes off (subperiosteal phase)
and then it erodes, opening their way perimaxilare soft tissues (submucosis suppuration stage or
broadcast in lodges perimaxilare(

 Way submucosis:

-infection develops at a pioreice bags under the hood or between the mucosal lining and bone.

-lining is off, the superficial localized suppurative process, having even the possibility of spontaneous
opening.
 Way lymphatic and venous

-infection diffuses through the lymph vessels, lymph nodes located in the veins realizing perimaxilari or
flebo-phlegmonous seeding.

 direct path

-is encountered in suppuration which cause punctures as tanks, presence of foreign bodies

5. General clinical symptoms:

-fever,
-headache,
- Loss of work capacity,
-weakness,
-insomnia.
-loss of appetite,
- Loss of work capacity.
Divine patient pale face.
Mucosa of the lips, mouth and tongue becomes dry, pale or cyanotic. Pulse and respiration are
accelerated.
Fever up to 40 ° C and becomes permanent.
Abscesses and adeno-flegmoane to observe low-grade fever;
Anaerobic Flegmoanele causes euphoria, which leads to a false mood of general condition of the
patient.
Facial vein thrombosis symptoms, based cervical poisoning.
- patient's general condition is serious, and local symptoms were not pronounced, is a sign that
the infection is generalized resistance from trivial sip ronosticul body is difficult.

6. Local clinical symptoms: dura local swelling, color changes (pale, ruber) function changes, local
temperature.

Local clinical symptoms arise flegmoanelor abscesses and purulent process according to location:

-trismus,
-dysphagia,
- Embarrassment to the jaw and phonation,
-pain in tongue movement,
-exaggerated pain on opening the mouth.

7. Principles of diagnosis in infectious processes perimaxilare cause of tooth:

- Determining the severity of infection,
- The state of defense mechanisms,
- Competenze needed to perform surgery (outpatient, inpatient)
 - Surgical treatment
- Medication, follow
- Clinical treatment.

- Determining the severity of infection:

-depending on subjective clinical signs (pain) and objective swelling, congestion), --- how quickly
evolved phenomena,
-important funzionante disorders (trismus, dysphagia, torticollis)
-impaired general condition (fever, tachycardia, tachypnea, Adynamic, curvature).
, Is investigating potential treatments done on their own initiative or at the direction of a
healthcare professional.
- Determining the severity of infection,
locally-examination,
- history
- Functional disorders.

8. Abscess and phlegmon suborbital region.

Topography: in subcutaneous adipose tissue located between:

Superior: the lower edge of orbit
Inferior: bottom of the bag vestibular
Medial: lateral side of the nose
Side: zygomatic bone (malar)

etiology
- Outbreaks pus from the upper front teeth (canines, first premolars, incisive side,
rarelypremater second and central incisors)
- Trauma
- Cysts superinfection
- sinus
- Phlebitis, thrombophlebitis

Clinical:
Acute pain
tissue swelling infraorbitale region.
facial asymmetry

On examination:
-edema and hyperemia in the canine fossa region spreading to the side of the nose zygomatic
region, lower eyelid and upper lip
- Closed eyelid orbital fissure
- The angle of the mouth on the sick lies lower than the healthy side
 - Tip of nose to the healthy ranges
-Envelope nasolabial deleted on the affected side
-in severe cases, upper eyelid edema occurs

Probe to determine infiltrated hard, suddenly dolor, canine fossa If fluctuient the region lies
close to the mouth vestibule labyrinth determine plicii deletion.

evolution:
infra-orbital phlegmon usually appears as abscess complicated data region.
-pathology arises suddenly. With ferbra, pain in reguinea infiltrate, insomnia, loss of appetite,
headache.

complications
- Osteomyelitis edge infraorbitale and zygomatic bone.
- sinus
- Trombofletita angular vein
- Entering ethmoid sinus infection

treatment
Incision is performed more often endobucal or by skin
Exobucala incision is made in case its location close to the edge abscess infraorbitala
wound drainage
Indicate general treatment

9. Abscess and phlegmon temporal region.

- Location of the lodge infection process time.
Lodge is the lateral temporal and pair, consisting of all the soft parts covering the lateral region
of depressed cranial vault-temporal fossa.

Temporal region include:

skin
subcutaneous tissues,
temporal muscle,
periosteum,
skeletal plan.
Purulent collection may be localizatàmtre muscle and skin or between muscles and bones.

etiology:
- Dentoparodontale processes, especially upper molars starting point;
- Bites diverse nature of temporal region;
-foreign body retention time in the region;
- Spread of infection from the neighborhood lodges.
 symptoms
-Overall status can be influenced
- Patients have fever, chills, malaise.

local
- Swelling in the temporal region,
-congested skin, smooth, shiny;
- Currently edema region.
Palpation is painful, highlights and deep infiltration if fluctuant collections for those superficial
(located between muscle and skin).

differential Diagnosis
Will be to:
- Puncture wound of the temporal region, are usually accompanied by edema
marked, it shows the characters of purulent collections;
- Infratemporale fossa abscess is usually located lower in comparison with
temporal, local and general symptoms is more severe;
- Temporal tumors are moving much slower, it shows signs
inflammation.

treatment
Surgical treatment consisted of incision and drainage.
- The incision will be made at the lowest pole of pus formation - vertical or slightly oblique
descent, in order to avoid damage to blood vessels and nerves in depth.
- Penetrate inside a pension collection between muscle and skin or between muscles and
bones.
- Drainage is made with a razor drain for 24-48 hours.

10. Canine fossa abscess region.

clinical picture:
-severe pain pulsating in infraorbitala region that may radiate into the eye and upper jaw teeth.

Physical examination:
-moderate facial asymmetry due to tissue inflammation infraorbital area,
-swelling of the lower eyelid.
Palpation of the anterior wall of the upper jaw causing pain.
Because of the lower eyelid edema is difficult to open your eyes.

Abscess opening technique of canine fossa

1. Anesthesia - local infiltration anesthesia.
2. Incision of the mucosa and periosteum along the upper jaw during inflammatory vestibule.
3. Evacuation of pus, working with antiseptic.
 4. Hemostasis and drain application.

11. Abscess zygomatic region.

etiology:

outbreaks of infection, tooth molars and premolars.

- Inflammatory and infectious skin

The zygomatic region-infected wounds

- Spread of infection from adjacent infraorbital, buccal, parotido-masseter, temporal.

Clinical:

- The patient had pain in the zygomatic region.

Physical examination:

Facial asymmetry due to infiltration in tissues.

The infiltrated skin is tense,

pain on palpation acauza - can detect a fluctuation and the propagation of the inflammatory process in
the jaw muscles.

Zygomatic abscess opening technique:

Gateway infectious process depends on the location:

Endobucal - if the infection is localized subperiosteal cihd

Exobucal - in the case when the infection is located superficially or in case of cellulite

Subperiosteal abscess opening technique of zygomatic

1. Anesthesia - local infiltration anesthesia.

2. Incision of the mucosa and periosteum along the upper jaw premolar vestibule until the molar region,
with delolarea zygomatic periosteum crestiei

3.indepartam soft tissues to create access until the outbreak festering with pus discharge then working
with antiseptic.

4. Hemostasis and drain application.

12. Abscess palate region.

etiology:

- Infections of teeth whose roots are oriented icisivul palate-lateral palatal roots of the first premolars
and molars.

-Abscesses that as a starting point lateral incisors are situatein previously palace, having an elongated

- The left posterior molars have rounded located in Santa palate, and can perform either the median line
or the edge of the gum.

Clinic:

- Acute apical periodontitis pain,

- Disfiguring swelling palate.

- Severe pain and is due to take off fibromucoasei palate caused by pus that has crossed bones.

- The exam is observable swelling which distorts the palate, with a diameter variazaintre 1 and 2 cm,
without exceeding the midline.

- Fibromucosis palate is red, relaxed.

- Swelling is relatively well defined edges,

- To touch - which is extremely painful - is charged fluctuant.

Differential diagnosis is made with:

- Jaw cysts become infected, but evolves slowly and does not disturb the patient unless they become
infected.

- Goma Lueta that, during the soft-mindedness, shows characteristic signs of the disease and causal;

- Tumors of the upper jaw evolution in vault

treatment:

-opening the abscess through a longitudinal incision, parallel palatine artery, closer to the midline.

- Excising a small portion of fibromucoasa (in slices of orange).

- Will be introduced for 24 hours a mesa iodoform to promote pus discharge and possibly hemostasis.

In palatal abscess gingival edge of evolution by side, you can simply take off the gum from the tooth
until collection package effusion.

Drainage will be asiguratín these cases with a squeegee.

13. Complications Lodges superficial suppuration.

1.tratamentul inappropriate surgery (incision parsimony or incorrectly placed, lack of sufficient or

effective drainage).

2. Own poor defense, lack of adequate medical treatment, dehydration.

3. Presence of foreign bodies which maintain suppurative process.

4. Incorrect administration of antibiotics without medical prescription compliance, or even refusing to

take antibiotics, oral candidiasis appearance etc.

It is possible that bacteria is not sensitive to antibiotics prescribed antibiotic or situation that requires
making an antimicrobial.

14.- Prevention of bacterial infections of the oral cavity.

-Proper Dental Care and gums

- Early treatment of affected teeth

-clearing other outbreaks

-brushing teeth morning and evening after meals.

- Use dental floss daily

- Regular dental checkups

- Avoid smoking