Nonpyogenic Soft Tissue Odontogenic Infection
The causes and the course of the disease
Nonpyogenic soft tissue odontogenic infections, cellutitis, either are
caused by nonpyogenic bacteria or related to pre-pyogenic or post-pyogenic
infections. That is, the causative
bacteria may be non-pyogenic or the infection has not reached the pus-forming
or pus-pulling stage. Intraorally, the odontogenic infection may be originated
in one of the three sites: the root canals and the periapex of the pulpless teeth,
the gingival in periodontal disease, and the gingival operculum over an
In most of these situations a review of history and clinical
radiographic examination coupled with pulp testing usually clearly indicated
the diagnosis of dental infection.
The alveolar mucosa and gingival are the most frequent sites
of dental infection, but if the infection is permitted to spread, a collection
of the oral mucosal surfaces, as well as the overlying skin, may became
involved. Various degrees of swelling
indicate a hot, red tender to painful surface.
However, pus that has created and pulled near the surface of the swollen tissue imparts a yellowish white color to the central region of the swelling and gives the swelling rubbery and fluctuant to the touch.
Ludwig's angina is an unusual example of a reddish soft tissue infection
that is produced by a mixed infection of nonspecific microorganisms. In these cases, a nonpyogenic strain of streptococcus in almost
invariably presents. This condition
causes a sudden swelling of the floor of the mouth and also of the submental
and submaxillary spaces, often of such magnitude that obstruction of the air
way is threatened. In most of the
occasions, a very red, fairly firm, and painful swelling on the floor of the
mouth produces an elevation of the tongue.
The skin of the neck overlying the swollen submental and submaxillary
spaces are on most occasions also red and feels hot on palpation.
Cervical or intraoral actinomycosis is a specific infection that generally
also occurs as a tender reddish swelling.
The differential diagnosis
When a patient has a reddish painful swelling of the oral soft tissues
with an accompanying tender cervical lymphadenitis, the diagnosis of cellulitis
infection is reasonably certain. An
extreme high percentage of these infection is odontogenic in origin and for
this reason bacterial in etiology.
However, your dentist should also at least consider the unlikely possibilities
of actinomycosis, tuberculosis, and different fungal infections, such as
histoplasmosis, coccidioidmyscosis, and blastomycosis.
When a diagnosis of odontogenic infection has been established, the linked dental problem should be eliminated by root canal therapy, extraction, excision, or incision and drainage. In addition, we recommend concomitant
systemic administration of an appropriate antibiotic.
Patients with infections that are or may be come a threat to
their air way should be hospitalized so that any respiratory complication can be