Cellulitis is an acute and edematous inflammatory infection that spreads into the facial tissues. Its etiology is Staphylococcus aureus, α-hemolytic streptococci, Haemophilus influenza type B and less often Gram-negative and anaerobic microorganisms. The source of infection is usually odontogenic but it can be sinus, skin or glandular in origin. Systemic complications include sepsis and dehydration. Maxillary cellulitis can lead to CNS involvement (meningitis, brain abscess) and cavernous sinus thrombosis. Mandibular cellulitis can lead to the spread of swelling to the submandibular, sublingual, submental spaces (Ludwig angina), fascial planes, nerves and blood vessels resulting in airway obstruction and restricted swallowing.
If the child is febrile, dehydrated, exhibits chills or if there is suborbital or submandibular swelling he/she should be admitted to the hospital for observation, IV hydration and antibiotics. The offending tooth should be extracted when the patient can tolerate the procedure.
An alveolar abscess is an accumulation of purulent material around the apex of a nonvital tooth as a result of pulpal necrosis. Clinical symptoms include a thickened periodontal membrane leading to sensitivity to percussion and movement, and swelling of the surrounding tissues. The patient may exhibit mild fever.
Antibiotics relieve acute symptoms. Drainage of the infection via pulpectomy or extraction provides additional pain relief. A regimen of antibiotics may be needed preoperatively to establish effective pain control. If left untreated the pus follows the path of least resistance forming an intraoral or extraoral abscess or sinus tract. Once the infection reaches this stage treatment can be initiated without prescribing antibiotics.
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