Nonpyogenic Soft Tissue Odontogenic Infection
(Fatal Cellutitis)

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 erupting tooth.

The features

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.

The management

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 managed properly.