Odontogenic abscess

1. Gastroepato

2. The patient's visit

3. Odontogenic abscess

The abscess is the collection of purulent material in a newly formed cavity where the body tends to circumscribe the lesion. It can develop from acute apical periodontitis or chronic periapical granuloma (due to exacerbation).
Primum movens: bacterial colonization at the apical level following:
- Pulp necrosis from dental caries
- Pulpal necrosis from periodontal disease
- Post traumatic pulp necrosis
- iatrogenic infections

Etiology

Odontogenic infections originate from corrective teeth or dental devices. They are the most frequent cause of inflammation of the mouth, of the lower third of the face and of the upper part of the neck. The primary focus is usually located in a dental root. Caries are the most common cause of odontogenic infections. After the enamel and dentin are destroyed, a pulp is produced that can propagate through the root canals to cause acute or chronic periodontitis. Hence the infection extends through the bone towards the soft tissues. Odontogenic infections can also be caused by wounds in the gums, infected gingival diverticula or systemic infections, by hematogenous route. In 90% of cases, the causative agents are staphylococci or streptococci, however any microorganism of the oral flora can cause an odontogenic infection. In addition to bacteria, in rare cases, these infections are caused by fungi.
Among the bacteria we remember:

Prevotella
-Porfiromonas
-Streptococci 70%
-Stafilococchi 5%
Bacterial synergy increases the severity of the infection

Clinical

Endosteal phase.

 The pain increases in intensity and acquires a dull, lacerating, sometimes pulsating character. Pain is often widespread and, therefore, it is more difficult to locate even if the percussion of the tooth and the alveolar apophysis continues to cause pain. Often, edema occurs in the lips, cheeks and gums. Subperitostive phase. When the abscess pierces the periosteum, this is stretched and causes a very intense pain, hardly bearable. The area surrounding the affected tooth is the site of intense inflammation; sometimes fever may appear.

Soft tissue phase.

 After the abscess has passed the periosteum and the pus has spread into the soft tissues, a very marked inflammation appears. The pain usually improves rapidly as soon as the tension of the periosteum is reduced. Soft tissues acquire a pasty consistency; sometimes the area is reddened and warm. If chewing muscles are also affected, the contracture of the mandible may occur. As you begin to reduce the flower giants, you can appreciate a floating mass.

Alveolar dento abscess

It is the most frequent among dental infections. It often originates from decayed teeth, more rarely appears as a result of a trauma in a devitalized tooth. Usually the abscess occurs acutely, even if the course may be chronic (for example if a causative people are not very virulent and the patient has an ox and immune defenses); in this case a granuloma can develop in the terminal part of the root, which can remain asymptomatic for years and then constitute an outbreak of infection for relapsing bacteraemia. Sometimes, when the immune defenses are reduced for any reason, these granulomas manifest themselves with sudden exacerbations.

Periodontal abscess

It is the second infection in terms of frequency. It originates at the level of an infected gingival diverticulum and causes a marginal periodontitis, which extends towards the alveolar apophysis. The gingiva of the affected tooth presents an important cupuliform dilatation which, when compressed, releases purulent material.

Other types of abscess

Vestibular abscess. Accumulation of purulent material at the level of the vestibular mucosa with local ¬flammation and possibility of fistulization.
Submandibular abscess. Located between the musculature of the floor of the mouth and the su¬perficial fascia of the neck or platysma.
Subslingual abscess. It is located between the mucosa of the floor of the mouth and the musculature that forms it. The abscesses of the floor of the mouth are also called Ludwig's angina.
Abscascascular abscess. It is located between the maxillary tuberosity and the pterygeal apophysis.

Therapy