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FUNDAMENTAL PRINCIPLES OF TREATMENT OF INFECTION-

ORAL SURGERY LECTURE NOTE

Sumdili  11:24 AM Oral Surgery Paediatric Dentistry 

In order to treat an acute dent alveolar infection as well as a fascial space ascess correctly!

t"e following are considered asolutely necessary:

•   #a$e a detailed medical "istory from t"e patient%

•  Drainage of pus! w"en its presence in tissues is estalis"ed%

 #"is is ac"ieved &1' y way of t"e root canal! &2' wit" an intraoral incision! &(' wit" an

e)traoral incision! and &4' t"roug" t"e alveolus of t"e e)traction% *it"out evacuation of pus!

t"at is wit" administration of antiiotics alone! t"e infection will not resolve%

•  Drilling of t"e responsile toot" during t"e initial p"ase of in+ammation! to drain e)udate

t"roug" t"e root canal! toget"er wit" "eat t"erapy% In t"is way! spread of in+ammation is

avoided and t"e patient is relieved of t"e pain% Drainage may also e performed wit"

trep"ination of t"e uccal one! w"en t"e root canal is inaccessile%

•  Antisepsis of t"e area wit" an antiseptic solution efore t"e incision%

•  Anest"esia of t"e area w"ere incision and drainage of t"e ascess are to e performed! wit"

t"e loc$ tec"ni,ue toget"er wit" perip"eral in-ltration anest"esia at some distance from

t"e in+amed area! in order to avoid t"e ris$ of e)isting microes spreading into deep tissues%

•  Planning of t"e incision so t"at:

. In/ury of ducts &*"arton! Stensen' and large vessels and nerves is avoided%

. Su0cient drainage is allowed% #"e incision is performed super-cially! at t"e lowest point of 

t"e accumulation! to avoid pain and facilitate evacuation of pus under gravity%

. #"e incision is not performed in areas t"at are noticeale! for est"etic reasons if possile!

it is performed intraorally%

•  Incision and drainage of t"e ascess s"ould e performed at t"e appropriate time% #"is is

w"en t"e pus "as accumulated in t"e soft tissues and +uctuates during palpation! t"at is

w"en pressed etween t"e t"um and middle -nger! t"ere is a waveli$e

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Incision for drainage of a sublingual abscess. The incision is performed parallel to the

submandibular duct and the lingual nerve

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Incision for drainage of a palatal abscess, parallel to the greater palatine vessels

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Incisions for drainage of a submandibular or parotid (a), and a submasseteric (b) abscess.

During cutaneous incisions, the course of the facial artery and vein must be taken into

consideration (a), as well as that of the facial nerve (b)

movement of t"e +uid inside t"e ascess% If t"e incision is premature! t"ere is usually a

small amountof leeding! no pain relief for t"e patient and t"e edema does not suside%

•   #"e e)act locali3ation of pus in t"e soft tissues &if t"ere is no +uctuation present' and t"e

incision for drainage must e performed after interpretation of certain data for e)ample!

ascertaining t"e softest point of swelling during palpation! redness of t"e s$in or mucosa!

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and t"e most painful point to pressure% #"is area indicates w"ere t"e super-cial incision wit"

a scalpel is to e made% If t"ere is no indication of accumulation of pus to egin wit"! "ot

intraoral rinses wit" c"amomile are recommended to speed up development of t"e ascess

and toensure t"at t"e ascess is mature%

•  Avoid t"e application of "ot compresses e)traorally! ecause t"is entails an increased ris$ of 

evacuation of pus towards t"e s$in &spontaneous drainage'

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Supercial incisions on the skin (a) and on the mucosa of the oral cavity (b)

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fact t"at it ta$es time to otain t"e results from a culture sample% 7ecause t"e

microorganisms isolatedmost often in odontogenic infections are streptococci &aeroic and

anaeroic'! penicillin remains t"e antiiotic of c"oice for treatment%

Diagrammatic illustrations showing the incision of an intraoral abscess and the

placement of a hemostat to facilitate the drainage of pus

Diagrammatic illustrations s"owing t"e placement of a ruer drain in t"e cavity and

staili3ation wit" a suture on one lip of t"e incision%

Treatment of Infection in "ellular Stage

In t"is stage! treatment of t"e infection depends on t"e location of e)isting pus% 8ocali3ation!

as already mentioned! may e intraalveolar! superiosteal! sumucosal or sucutaneous%

5ac" of t"ese cases is discussed in ne)t posts