Odontogenic inflammation I. Pathology, pathophysiology, and microbiology of pyogenic inflammations.
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1 Odontogenic inflammation I. Pathology, pathophysiology, and microbiology of pyogenic inflammations.
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3 Histology of Actinomycosis
4 Odontogenic inflammation Dental inflammation Dental infections Odontogenic infections
5 Inflammation: the reaction of tissues to different types of irritation, involving the whole organism Local cell necrosis demarcation of damaged tissues - replacement Liberation of histamine and H-substances, activation of kinine-kallikrein system Accumulation of Prostaglandins Leukotoxin: increasing of permeability, leukocyte migration Necrosin: necrosis of tissues Pyrexin: fever
6 Provocative agents Physical irritation (cold, hot) Mechanical irritation Chemical agents Hetero proteins Auto proteins (autoimmunisation) Infective agents
7 Pathogenic agents (living agents) Bacteria, fungi, protozoa Virus Parasite, Rickettsia
8 Clinical features of inflammations calor, rubor, tumor, dolor (Celsus) Elevated temperature, redness, swelling, pain functio laesa (Galenus) Malfunction
9 Phases of inflammation 1. Accelerated blood circulation, acute hyperaemia (fluxio) 2. Decelerated blood circulation, capillary dilatation (peristasis, hyperaemia) Elevated permeability, Protein-exudation sticky capillary endothelium: emigration of leukocytes
10 3.a. Exsudative- infiltrative phase proteins, leukocytes Immunoglobulines phagocytosis Exudation stops, resorption healing
11 3.b. Proliferative infiltrative phase exudation proliferation: histiocytes lymphocytes plasma cells monocyte infiltration
12 3.a. or 3.b. Reasons Features of pathogenic agents Protective ability of the organism Humoral agents: modification of local reactions (prophlogistic, antiphlogistic)
13 Specific proliferativeinflammations Tuberculosis Syphilis AIDS Actinomycosis Tularaemia
14 Classification of inflammations Type of exudate: Serous Fibrinous Purulent Haemorrhagic Necrotic
15 Classification of inflammations Acute Chronic Subacute
16 Abscess Pus bonum et laudabile (Good and laudable pus) Circumscribed pus accumulation combined with tissue lyses Empyema: Pus accumulation in a preformed cavity Paranasalium (in the maxillary sinus) Chronic abscess: bordered by a 1-2 mm wide yellow pyogenic membrane Fistulization
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18 Changes in blood count in inflammations 1. Stage (neutrophil reaction): Leukocytosis Qualitative changes: ratio of neutrophils, stabs and early differentiated cells is elevated Ratio of eosinophils is decreased 2. Stage (monocytic protective): Number of monocytes increased Number of leukocytes and granulocytes decreased 3. Stage (lymphocytic healing): Ratio of lymphocytes elevated Number of leukocytes decreased more Early differentiated cells disappeared Number of eosinophils increased
19 Changes of blood count in dental inflammations NB: Changes are characteristic in extradental inflammations! Elevated sedimentation: 85% Leukocytosis: 60% Absence of Eosinophils : 50%
20 Microbiology of infections in the oral cavity 92-94% odontogenic origin Pathogenic agents: 70-80%: mainly anaerobe, mixed flora Components: Gram-positive + negative, obligate and facultative anaerobe bacteria Streptococci, Staphylococci relatively rarely
21 Microbiology Streptococcus (alfa-haemolyticus) Streptococcus pyogenes (n.normal Flora) Staphylococcus aureus (n.normal Flora) Neisseria Actinomyces genus Fusobacterium species Treponema microdentium
22 Therapy of infections Endodontic Endodontic + excochleation Endodontic + apicectomy Incision + endodontic + apicectomy Extraction Physiotherapy: laser (soft) US SW IR packing
23 Antibiotic therapy penicillin clindamycin metronidazol macrolid Aktil-Duo, Augmentin, Ciprobay, Dalacin C, Duomox, Klacid, Klion, Rovamycin, Pyassan
24 Packing /hydrotherapy/ Compress (cold): Decreasing of oedema Painkiller effect Wet pack Cream (fatty e.g.petrolatum) Wet cotton Plastic foil Dry cotton (thick) Fixing
25 Thank you for your attention
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