Infeksi non odontogenik

pada jaringan keras gigi

Dwi Kurniawati, MPH

Infeksi rongga mulut

Disebabkan oleh mikroorganisme patogen
bakteri, virus, jamur, mikroorganisme
seperti virus, protozoa, dll
Dibagi 2:
1.Odontogenik
2.Non odontogenik

Mekanisme infeksi
Infeksi berhubungan dg ketidakseimbangan
antara host-mikroorganisme-lingkungan
Keparahan infeksi tgt dari:
Virulensi organisme
Integritas dan mekanisme pertahanan tubuh
penderita
Faktor anatomis dan struktural

Infeksi non odontogenik RM

Infeksi yang terjadi penyebabnya bukan
berasal dari gigi
Ex:
pada daerah maxilla : infeksi sinus
maksilaris, infeksi telinga
Pada daerah mandibula: osteomielistis
Infeksi yang terjadi di rongga mulut karena
penyakit sistemik

Trauma
Radioterapi
Chemotherapy mucositis
Salivary gland infections common in
patients with dehydration
Lymph node abscess
Post operative infections

 Mikroorganisme penyebab infeksi non

odontogenik berbeda dengan infeksi
odontogenik
Antara lain:

Herpes simplex virus

Gonococcus
Treponema pallidum
Fungal infections with Candida, Aspergillus
are common in patients with HIV infections.

OSTEOMYELITIS

Definition
Etiology
Classification
Pathogenesis
Symptoms

Definition
The word osteomyelitis originates
from the ancient Greek words:
osteon (bone)
muelinos (marrow)
Meaning inflammation of medullary
portion of the bone caused by
infection.

This disease is now rare due to the

value of antibiotics and early treatment
but the importance of predisposing
factors such as:

Poor nutrition
Untreated dental diseases
Impaired immunity
Exposure to radiation

It is quite rare but seen particularly

in those patients whose defense
against infection is compromised
because of local or systemic
factors.

Etiology
There are many various causes of
osteomyelitis:
1.Acute periapical infection
2.Pericoronitis
3.Acute periodontal lesions (postsurgical)
4.Trauma-fractures and extraction of teeth
5.Acute infection of the maxillary sinus
6.Infection from skin(boils-skin abcess)
7.Middle ear infections
8.Haematogenic origin
9.Vascular Insufficiency

Osteomyelitis of the jaws induced

by hematogenous spread has
become rare since the introduction
of antibiotics; however, in regions
of limited medical access these
forms may still be noted.

Classifications

Pathogenesis

For osteomyelitis to occur

exudate must spread through
the cancellous spaces of the
bone producing thrombosis of
the nutrient vessels with
ischemia, infarction, and
sequester formation.

 In most incidences periapical and periodontal

infections are localized by a protective pyogenic
membrane or soft tissue abscess wall which
serves as a certain barrier.
This condition represents a carefully balanced
equilibrium between microorganisms and host
resistance preventing further spreading of the
infection. If the causative bacteria are sufficient
in number and virulence, this barrier can be
destroyed. Furthermore, permanent or
temporary reduction of host resistance factors
for various reasons mentioned previously
facilitate deep bone invasion by microorganisms.

 Bacterial invasion induces a cascade of

inflammatory host responses causing hyperemia,
increased capillary permeability, and local
inflammation.
Proteolytic enzymes are released during this
immunological reaction creating tissue necrosis,
which further progresses as destruction of
bacteria and vascular thrombosis ensue.

 Accumulation of pus inside the medullary

cavity, consisting of necrotic tissue and
dead bacteria within white blood cells,
increases intramedullary pressure. This
leads to vascular collapse, venous stasis,
thrombosis, and hence local ischemia.
Pus travels through the haversian and
nutrient canals and accumulates beneath
the periosteum, elevating it from the
cortical bone and thereby further reducing
the vascular supply

Chronification of bone infection

The chronification of the disease reflects the
inability of the host to eradicate the pathogen due
to lack of treatment or inadequate treatment,
resulting in failure to reestablish the carefully
balanced equilibrium between host factors and
pathogens found in a healthy oral environment.
After the acute inflammatory process occurs and
local blood supply is compromised, necrosis of
the endosteal bone takes place. The bone
fragments die and become sequestra.

 Chronic osteomyelitis at the molar region

and region of first premolar of the left side
of the mandible

 Osteomyelitis is a rare problem in the

maxilla because it has predominantly
cancellous alveolar bone with a thin cortex
and a rich plexiform blood supply.

Diagnosis

Clinical Picture
X-ray
Complete blood count
Erythrocyte sedimentation rate
Needle aspiration or bone biopsy
Radionuclide bone scans
CAT scans
MRI
Ultrasound
C-reactive Protein

Sign n symptoms

Symptoms of Acute Osteomyelitis

Severe pain
Tenderness in the affected area
Swelling in the affected area
Regional lymphadenopathy
If the infection involves the mandibular canal near premolar region, a
paresthesia of the lip is common.
Problem opening jaw (trismus)
An important symptom is a developing numbness over the chin as a
result of mental nerve involvement.
Percussion is painful over involved teeth
Some teeth involved can become loose and mobile
Puss discharges
A fetid oral odor caused by anaerobic pyogenic bacteria
Fever (sub-febrile) and weakness

On Radiographs:
Can be seen on x-ray only after 1-3 weeks
The typical feature is a rarefying of the bone.
This may extend through a large area of bone,
involving the inferior dental canal and lower cortex
of the mandible.
Decreased density of trabeculae
Multiple small radiolucent areas become apparent
Sequestra - irregular calcified areas separate from
remaining bone.

Chronic Osteomyelitis
Clinical features
Clinical course lasting over a month.
Painful exacerbations and swelling are always
present, although this is likely to be less severe
than in the acute form.
Preservation of mental and labial sensation
One or more soft tissue sinuses are typically
present, draining pus. The affected bone may
become enlarged owing to periosteal reaction.

A- Patient with a clinically extensive secondary chronic osteomyelitis of the

frontal region with multiple fistula and abscess formations. The patient was
treated with i.v. bisphosphonates for metastatic breast cancer.
B- CT scan corresponding to a: The bone and periosteal reaction is not as
strong as would have been expected from the clinical picture and compared
with cases of secondary osteomyelitis of the mandible with no underlying
bone pathology.

Management

Kontrol etiologi dan faktor predisposisi.

Perbaiki keadaan umum.
Istirahat total.
Diet teratur.
Konsumsi antibiotik dan analgesik dosis tinggi.
Incisi abses supaya tekanan nanah berkurang
pada tulang.
squesterektomi

Terimakasih