Origin and progression of Odontogenic Infection; Buccal space infection/abscess vs vestibular abscess

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Origin and progression of Odontogenic Infection; Buccal space infection/abscess vs vestibular abscess

Odontogenic infection are mainly originated from 

  1. Periapical 
  2. Peridontal

Periapical Origin:

The caries in the tooth as progress into the power cause pulpal necrosis and subsequent bacterial invasion into the periapical tissue.  This is the most common origin of odontogenic infection.

 Once the periapical tissue has become inoculated with bacteria and an active infection is established the infection spreads equally in all directions. The infection  spreads through the cancellous bone till it encounters a cortical plate.   If this cortical plate is thin the infection invades through the bone and into surrounding soft tissue.

 Periodontal origin: 

As a result of deep periodontal pockets this allows inoculation of bacteria into the underlying soft tissue  by penetration through the bone.

 Progression of infection:

When the infection penetrates through the cortical plate it spreads into predictable anatomic locations determined by two factors.

  1. Thickness of bone overlying the root Apex
  2.  relationship of the site of perforation of bone to muscle attachment of maxilla and mandible.

The infection will spread either Buccally  or or lingually/ palatally  where the overlying bone is thin so that infection is easy to perforate.

Click here to read Case of Buccal Space Infection In Dental Clinic; Examination, Diagnosis and Treatment Plan

Buccal space infection /abscess vs vestibular abscess

odontogenic-infection-buccal-space-infection

In figure A, since the overlying bone on the palatal aspect of the root is thin in the infection has  spread palatally.

 In figure B, since the overlying bone on the labial aspect of the root is thin the infection has  spread labially.

If the infection has eroded through to the facial aspect of the alveolar process and is inferior to the attachment of buccinator muscle which results in an infection that appears as a vestibular abscess.

 if the infection has eroded through  the bone superior to the attachment of buccinator  muscle it results as buccal space infection. 

if the infection has eroded through the bone superior to the attachment of the buccinator muscle and is expressed as an infection of the buccal space because the buccinator muscle separates the buccal and vestibular spaces

Buccal space infection /abscess vs vestibular abscess

odontogenic-infection-buccal-infection
Figure 16-2 Relationship of point of bone perforation to muscle attachment determines fascial space involved. A, When tooth apex is lower than
muscle attachment, vestibular abscess results. B, If apex is higher than muscle attachment, the adjacent fascial space is involved.

Similarly in the mandible, mylohyoid muscle determines whether the infection that drains lingually to sublingual space or to sub mandibular space.

If the infection is lingually superior to mylohyoid muscle, it is referred to as sublingual space infection.

If the infection is lingually below the mylohyoid muscle, it is referred to as sub mandibular space infection. 

Conclusion: The origin and spread of infection determines the anatomical location of the infection. 

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