Odontogenic infections

Abstract

In order to understand how odontogenic infections are treated, the dentist must be familiar with the terminology concerning infection and the pathophysiology of inflammation,which are described below. Inoculation is characterized by the entry of pathogenic microbes into the body without disease occurring. An infection involves the proliferation of microbes resulting in triggering of the defense mechanism, a process manifesting as inflammation. Inflammation is the localized reaction of vascular and connective tissue of the body to an irritant, resulting in the development of an exudate rich in proteins and cells. This reaction is protective and aims at limiting or eliminating the irritant with various procedures while the mechanism of tissue repair is triggered. Depending on the duration and severity, inflammation is distinguished as acute, subacute or chronic. Acute Inflammation. This is characterized by rapid progression and is associated with typical signs and symptoms. If it does not regress completely, it may become subacute or chronic. Subacute Inflammation. This is considered a transition phase between acute and chronic inflammation. Chronic Inflammation. This procedure presents a prolonged time frame with slight clinical symptoms and is characterized mainly by the development of connective tissue. Inflammation may be caused by, among other things, microbes, physical and chemical factors, heat, and irradiation. Regardless of the type of irritant and the location of the defect, the manifestation of inflammation is typical and is characterized by the following clinical signs and symptoms: rubor (redness), calor (heat), tumor (swelling or edema), dolor (pain), and functio laesa (loss of function). The natural progression of inflammation is distinguished into various phases. Initially vascular reactions with exudate are observed (serous phase), and then the cellular factors are triggered (exudative or cellular phase). The inflammation finally resolves and the destroyed tissues are repaired. On the other hand, chronic inflammation is characterized by factors of reparation and healing. Therefore, while acute inflammation is exudative, chronic inflammation is productive (exudative and reparative). Understanding the differences between these types of inflammation is important for therapeutic treatment. Serous Phase. This is a procedure that lasts approximately 36 h, and is characterized by local inflammatory edema, hyperemia or redness with elevated temperature, and pain. Serous exudate is observed at this stage, which contains proteins and rarely polymorphonuclear leukocytes. Cellular Phase. This is the progression of the serous phase. It is characterized by massive accumulation of polymorphonuclear leukocytes, especially neutrophil granulocytes, leading to pus formation. If pus forms in a newly developed cavity, it is called an abscess. If it develops in a cavity that already exists, e.g., the maxillary sinus, it is called an empyema. Reparative Phase. During inflammation, the reparative phenomena begin almost immediately after inoculation. With the reparative mechanism of inflammation, the products of the acute inflammatory reaction are removed and reparation of the destroyed tissues follows. Repair is achieved with development of granulation tissue, which is converted to fibrous connective tissue, whose development ensures the return of the region to normal. © Springer-Verlag Berlin Heidelberg 2007.