Septicemia and craniofacial thrombophlebitis of dental origin.
- 1. Septicemia of oral-dental origin::
1.1. Definition
Septicemia is a general infection caused by the constant or temporary presence in the blood of pathogenic bacteria and their poison (Reilly).
- It is therefore a generalized infectious state, due to the dissemination of a pathogenic agent, throughout the organism via the blood.
- Septicemia of dental origin corresponds to repeated discharges from an initial oral-dental septic focus and can create multiple + apparent secondary foci.
- On the other hand, bacteremia is the temporary presence of bacteria in the blood.
- 1.2. Etiopathogenesis
* The following causes can be considered:
– an oral-dental infectious focus
– trauma (open wound, etc.)
– a septic therapeutic procedure (e.g.: local anesthesia at the level of an infected site).
* It is necessary to emphasize the notion of virulence of the germ, predisposition of the terrain (age, comorbidity, etc.) and the diffusion mechanism.
* According to Reilly: the link between the initial focus and the disease is thrombophlebitis.
Microbial toxins trigger neuro-vegetative irritation phenomena leading to venous parietal lesions promoting thrombus formation:
Hence three possibilities:
° the thrombus distills the germs 🡪pure septicemia
° septic emboli seed the body 🡪this is septic-pyohemia.
° the thrombus spreads like an oil stain 🡪 cervicofacial thrombophlebitis.
- 1.3. Bacteriology:
All germs can be pathogenic; streptococci and staphylococci predominate.
- 1.4. Clinical aspects
1.4.1. The acute form is abrupt and rare:
* All systems are affected with signs of:
– hypo or hyperthermia – dyspnea – albuminuria – anuria – delirium – drowsiness – cardiovascular collapse* – multiple hemorrhages – diarrhea – vomiting – subicterus.
* The cause is not always obvious.
* Death occurs rapidly due to cardiovascular collapse* and coma.
- Cardiovascular collapse: A set of symptoms with a sudden onset associated with coldness of the extremities and a state of considerable prostration accompanied by profuse sweating, cyanosis (blue-grey colouring of the skin and mucous membranes), a rapid pulse which is sometimes uncontrollable, a drop in blood pressure with a maximum (systolic) figure of less than 8 cm of mercury.
1.4.2. The acute form is often progressive:
* Local infectious signs are exacerbated.
* General signs intensify: general malaise – intense shivering that can last an hour – temperature at 40° – rapid pulse.
* The septic state then occurs: – patient prostrate – variable temperature – dry tongue – rare urine – existence of hepatosplenomegaly.
* It’s necessary :
– SEARCH FOR THE INFECTIOUS SOURCE
– PERFORM A BLOOD CULTURE AND AN ANTIBIOGRAM
* The evolution before the era of antibiotics was towards death in a picture of toxi-infection.
* Currently, the prognosis is better but early treatment is necessary.
- 2. Septico-pyohemia
2.1. Definition
Generalized infectious state due to a pyogenic microbe and characterized by the presence of secondary suppurative foci.
2.2. Clinic
The clinical signs overlap with those of septicemia, but here it is necessary to look for secondary infectious foci at each hyperthermic peak.
Septicemia and craniofacial thrombophlebitis of dental origin.
3. Thrombophlebitis
3.1. Definition
– If septicemia always has a phlebitic focus at its origin, the reverse is not true.
- It is their locations that make them unique.
– Thrombophlebitis is the formation of a clot in the lumen of a vein associated with inflammation of the venous wall.
– Resulting in a stoppage of blood flow in the obstructed vein and vascular hyperpressure upstream of the clot.
- Can be superficial or deep.
3.2. Bacteriology
The most commonly found are streptococcus and staphylococcus, but in fact any germ can be responsible.
3.3. Clinical aspects
we distinguish
3.3.1. Exocranial thrombophlebitis:
3.3.1.1. Thrombophlebitis of the facial vein and ophthalmic vein
After an infectious episode, appearance:
– a white, soft, painless edema which subsequently becomes inflammatory (red and painful)
– it extends towards the inner corner of the eye and the hemiface
– delicate palpation allows the indurated cord of the facial vein to be found.
Extension to the ophthalmic vein is done with:
– edema of the upper then lower eyelid
– chemosis
– exophthalmos
– visual acuity and eye mobility remain unaffected
The general signs are severe:
– hyperthermia at 40°
– intense and prolonged chills
– meningeal signs (vomiting or stiff neck)
EXTREME EMERGENCY
3.3.1.2. Thrombophlebitis of the frontal vein
– repeated scalp abscesses
– cord hardened on palpation
3.3.1.3. Pterygoid thrombophlebitis
– less clear signs (deep veins)
- look for edema: temporal, malar, anterior pillar of the veil, pharynx.
EXTREME EMERGENCY
3.3.2. Endocranial thrombophlebitis
EXTREME EMERGENCY
3.3.2.1. Cavernous sinus thrombophlebitis*:
– Follows on from previous ones
– Worsening of ophthalmic signs (venous stasis)
– Signs of nerve compression
– Signs of meningeal irritation 🡪 lumbar puncture (LP) to confirm the diagnosis .
* The cavernous sinus is a large vein located at the base of the skull, behind the eyes. This vein drains blood from the veins in the face.
3.3.2.2. Other sinuses:
* Lateral: edema and mastoid pain
* Upper longitudinal:
– signs of venous stasis on the scalp and forehead
– intracranial hypertension
– neurological signs (epilepsy, hemiplegia, etc.).
Septicemia and craniofacial thrombophlebitis of dental origin.
- 4. Treatment
- Early and massive antibiotic therapy for at least 15 days with antibiogram and blood culture (particularly during thermal peaks).
- Heparin anticoagulants then antivitamin K
- Sedatives
- Removal of the causal tooth
Septicemia and craniofacial thrombophlebitis of dental origin.
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.