Odontogenic infections
are frequent in pediatric population. In many cases that
have been reported, acute infection of the oral cavity occurs because of
neglected dental caries. Early management and recognition of orofacial
infections in children is crucial to prevent systemic involvement [8]. In this regard, the prevalence
of orofacial cellulitis has increased in the past decades. Orofacial cellulitis
of odontogenic origin in children is like that in adults; however, pediatric
patients require special considerations due to their acute course resulting
from the easy dissemination of the infection.
Despite numerous caries preventive programs, children in poor socioeconomic
groups remain greatly affected.
In a retrospective study by Al-Malik et al,
Odontogenic infection was found to commonly involved the primary posterior
teeth (84%) with the most affected tooth being the primary first molar (34%),
followed by the primary second molar (31%). The mandibular primary posterior
teeth were more commonly affected than the maxillary primary posterior teeth
(54.4% versus 45.6%). Extra-oral swelling was seen in 64% of patients [4]. In
our case, the patient had presented with a grossly decayed primary first and
second molar, which was the source of infection that had progressed to
cellulitis.
The classic presentation of rubor
(redness), dolor (pain), tumor (swelling), calor (heat) are the hallmarks of
cellulitis. The spectrum of severity ranges from localized erythema in a
healwel patient to the rapidly spreading erythema and fulminant sepsis seen
with necrotizing fasciitis in immunocompromised patients. Timing and evolution
of the findings may differentiate cellulitis from some of the common mimics
with more chronic clinical course. In
addition to pain, such infections can cause
acute abscess related to deciduous teeth, potentially leading to serious
sequelae such as recurrent fever, brain abscesses, and orbital cellulitis [9]. Complete and detailed history of the
patient combined with results of the physical examination is usually sufficient
to make a diagnosis of cellulitis.
Trismus seen in such patients are
suggestive of serious orofacial infections. Mouth opening with less than 20 mm
or more in a short period of time, with severe pain, is a sign of involvement
of the the peri mandibular anatomical spaces by the infection. If the
cellulitis is of odontogenic origin, the location of the swelling depends on
whether the offending tooth is maxillary or mandibular. Due to the diffuse
spread of the infection, the offending tooth is difficult to localize. If the
tooth is maxillary, the infection involves the canine or buccal space whereas;
if the tooth is mandibular, the swelling likely involves the submandibular,
sublingual, and buccal spaces.
In our case, maxillary primary molars were involved so it is likely that
infection had involved the buccal and canine spaces.
Odontogenic infections
tend to be mixed (aerobic and anaerobic bacteria). The most common
microorganisms involved are facultative Gram-positive aerobic organisms like
Streptococcus and Gram-negative organisms such as Prevotella, Porphyromonas
and Fusobacterium [10]. Acosta et al reported that the most common
bacterial species involved in odontogenic infections were Streptococcus
mutans (24.5%), Porphyromonas endodontalis (18.2%), Porphyromonas
gingivalis (23.6) and the most relevant causative agents are Streptococcus
salivarius (10.1%) and Streptococcus sanguis (8.2%) [11,12].
Antibiotic therapy is the first-line
treatment for orofacial infections. However, antimicrobial treatment is not
always sufficient. Removal of the offending agent leads to complete resolution
of the infection. Once the acute odontogenic infection has subsided, the
involved tooth should be immediately be treated whether it necessitates
endodontic treatment or complete removal of the tooth [13]. In our case,
hospitalization was not required since the patient did not exhibit any active
signs of infection or sepsis, Fever higher than 38°, vomiting and she was
afebrile, alert at the time of presentation.
Moreover, chronic abscesses often damage the underlying developing
permanent tooth bud. Infection of dental origin is one of the most common
diseases of the orofacial region. Dentists must understand that this condition
may initially present as a simple infection, but that it requires appropriate
and early management to thwart any unwanted complications later.
