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The Normal Flora Oral cavity provides an environment
favorable to microorganism growth Flora of children is similar to adults Bacterial counts range 10,000,000
10,000,000,000 organisms/ml of saliva Modifies microbial population
Age, anatomic relationship, eruption of teeth,presence of decayed teeth, diet, oral hygiene,antibiotic therapy, systemic disease, cancertherapy
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NOT all residents of oral flora arepathogens
Progression of initiating infection (byoral streptococci) predominance of oralanaerobes occursPeriodontal infectionsare polymicrobial
Infections fromnonodontegeniccauses (facial trauma,
surgical manipulation,tonsillitis)Staph.aureusStreptococcus spp.
Infections originatingsolely from dentalperiapical tissues
anareobic
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Pattern of toothdecay affectingmainly the primary
upper incisors andfrequently theupper and lowerprimary molars
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Practice of puttingthe child to bed witha nursing bottle
filled with sugar-containing drink(milk, juice,softdrink)
Can destroys entireprimary dentition asit erupts
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Extension of microorganismthrouroot apex
leads to formationof abscessRadiographicevidence of bone
destruction 7-14days
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Indications that toothhas becomeabscessed:
Sensitivity to heatstimulus (relieved bycold)
Sensitivity topercussion
Tenderness to fingerpressure on thealveolar process
Chronic abscess Looseness of tooth Suppuration from
draining sinus tracksor gingival crevice Radiolucency on
radiographscellulitis swollenface, pain, fever andmalaise
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Prevalent in allages
Severe in diabetics,
compromised hostsPoor oral hygiene
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Severe infectionProgresses yearsbefore recognition
Hypertrophiedgingivae
purulent discharge Painless
Localizedperiodontal hygieneMeticulous oralhygiene
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Localized to the molar &incisor regionsDeep gingival pocketing &severe bone resorption, inotherwise healthy childrenEtiology: gram negativeanaerobe
A.actinomycetemcomitans
Tetracyline + periodontalsurgery
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Trench mouth,Vincents infectionCaused by fusiform
bacilli andspirochetesFrank ulceration attips of interdental
papillae (+)spontaneousbleeding
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Pseudomembranous necrotic exudatealong marginal gingivae & interdentalpapillae
Pain, foul breath & taste, thick ropy saliva,malaise, occasional fever
Therapy: Penicillin Localized gingival curettage oral rinse with 0.5% hydrogen peroxide or
0.12% Chlorhexidine
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Impaction of microorganism &debris under the softtissue overlying the
crown of a tooth(often mandibular 3 rd molar)Polymicrobial
Prevotella,Porphyromonas spp.,Treponema denticola,Streptococcus milleri )
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Lower 3 rd molars lie in proximity to the pterygomandibular space ( a portion of
the masticator space)Infection spreads to masticator space
Trismus
Deep parapharyngeal space involvement
Therapy: local I&D, extraction of offending toothPenicillin, hospitalization (in presence of fever and trismus)
Resolution expected < 7days
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Most commonFiery-red 2-to-3 mmwide linear band of
inflammation of gingivaCandida spp., maybe a possible cause
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HSV1 commonly manifests as herpeticgingivostomatitis direct contact with people who have
draining lesions asymptomatic carriers incidence: 2-4 yrs.old
infants protected by maternal antibodies
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Incubation period: 6 days
Small vesicles
Coalesce to form larger lesionsSevere cases: lip, gingivae, oralmucosa, pharynx
Healing: 1-2 wksGradual crusting
Re-epithelization
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Latency: Continue throughout life Reactivation triggered by
Actinic radiationEmotional/physical stress
Recurrent disease: Vesicles along mucocutanoeus border
Painfuly for 2 days crusting & complete healingin 7-8 days Up to 50% adults suffer
Unaware of recurrent cold sores, thereby transmitthe disease
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Odontogenicinfection of primarymolars
Superficial spreadof cellulitis thatfollows theplatysma muscles
cheek neck anterior chest wallGroup Astreptococci
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