PENDAHULUAN
Cellulitis adalah infeksi bakteri yang menyebar dibawah kulit. Ini biasanya disebabkan oleh bakteri : Streptococcus (pneomoniae) , Staphylococcus (aureus) , Escherichia.Anaerobes : Fusobacterium , Peptostrept. Previously , the bacterium Haemophilus influenzae type B (Hib) adalah penyebab celulitis utama pada anak-anak
CELLULITIS
Kata "cellulitis" berarti "radang sel." Specifically, cellulitings refers to an infection of the tissue just below the skin surface. Skin is the first defense against invading bacteria and other microbes. An infection can occur when this normally strong barrier is damaged due to surgery, injury, or a burn. Usually, the immune system kills any invading bacteria, but sometimes the bacteria are able to grow and cause an infection.
CELLULITIS
Disease-causing bacteria release proteins called enzymes which cause tissue damage. The body's reaction to damage is inflammation which is characterized by pain, redness, heat, and swelling. Cellulitis most often occurs on the face, neck, and legs.
CELLULITIS VS ABSCESS
CELULITIS:
-Diffuse
-Erithematous submucous/subcutaneous
-Streptococcus> Staphylococcus
-Enzimes: Streptokinase, hyaluronidase and streptodornase
-Cause: Break down fibrin and connective tissue= rapid spread
ABSCESS
- A thick wall cavity
- Containing pus
- Staphylococcus: enzyme coagulase
- Cause: fibrin deposition= wall formation
- Orbital cellulitis
A very serious infection, called orbital cellulitis, occurs when bacteria enter and infect the tissues surrounding the eye.
In 50-70% of all cases of orbital cellulitis, the infection spreads to the eye(s) from the sinuses or the upper respiratory tract (nose and throat).
25% of orbital infections occur after surgery on the face(incl. Dental Surgery)
Other sources of orbital infection include a direct infection from an eye injury, from a dental or throat infection, and through the bloodstream.
TANDA-TANDA KLINIS DAN GEJALA
- Swelling
- kemererahan
- sakit
- Post pencabutan gigi 11,12,13 with chronical infection
TANDA-TANDA KLINIS DAN GEJALA
HIGH RISK CELLULITIS
Pasien yang memiliki resiko tinggi terkena celulitis adalah mereka yang mengidap underlying disease (seperti cancer, diabetes, and kelainan ginjal), dalam terapi steroid, penurunan sistem kekebalan tubuh (disebabkan AIDS, organ transplant, etc.), have been api,terkena gigitan serangga, have reduced blood circulation to limbs, atau have had a leg vein removed for coronary bypass surgery.
Faktor resiko yang lainnya adalah :
1. Masalah pada sistem lympa
2. ISPA ( infesi salaran pernafasan atas)
3. Infeksi pada gigi dan telinga bagian tengah
CARACTERISTIC SIGN
Ciri-ciri gejala dari cellulitis orbitare adalah sakit pada mata, kemerahan, swelling, warmth, and tenderness. Mata menonjol keluar dan sulit dibuka atau tidak bisa digerakkan.
CELLULITIS
Kata "cellulitis" berarti "radang sel." Specifically, cellulitings refers to an infection of the tissue just below the skin surface. Skin is the first defense against invading bacteria and other microbes. An infection can occur when this normally strong barrier is damaged due to surgery, injury, or a burn. Usually, the immune system kills any invading bacteria, but sometimes the bacteria are able to grow and cause an infection.
CELLULITIS
Disease-causing bacteria release proteins called enzymes which cause tissue damage. The body's reaction to damage is inflammation which is characterized by pain, redness, heat, and swelling. Cellulitis most often occurs on the face, neck, and legs.
CELLULITIS VS ABSCESS
CELULITIS:
-Diffuse
-Erithematous submucous/subcutaneous
-Streptococcus> Staphylococcus
-Enzimes: Streptokinase, hyaluronidase and streptodornase
-Cause: Break down fibrin and connective tissue= rapid spread
ABSCESS
- A thick wall cavity
- Containing pus
- Staphylococcus: enzyme coagulase
- Cause: fibrin deposition= wall formation
- Orbital cellulitis
A very serious infection, called orbital cellulitis, occurs when bacteria enter and infect the tissues surrounding the eye.
In 50-70% of all cases of orbital cellulitis, the infection spreads to the eye(s) from the sinuses or the upper respiratory tract (nose and throat).
25% of orbital infections occur after surgery on the face(incl. Dental Surgery)
Other sources of orbital infection include a direct infection from an eye injury, from a dental or throat infection, and through the bloodstream.
TANDA-TANDA KLINIS DAN GEJALA
- Swelling
- kemererahan
- sakit
- Post pencabutan gigi 11,12,13 with chronical infection
TANDA-TANDA KLINIS DAN GEJALAHIGH RISK CELLULITIS
Pasien yang memiliki resiko tinggi terkena celulitis adalah mereka yang mengidap underlying disease (seperti cancer, diabetes, and kelainan ginjal), dalam terapi steroid, penurunan sistem kekebalan tubuh (disebabkan AIDS, organ transplant, etc.), have been api,terkena gigitan serangga, have reduced blood circulation to limbs, atau have had a leg vein removed for coronary bypass surgery.
Faktor resiko yang lainnya adalah :
1. Masalah pada sistem lympa
2. ISPA ( infesi salaran pernafasan atas)
3. Infeksi pada gigi dan telinga bagian tengah
CARACTERISTIC SIGN
Ciri-ciri gejala dari cellulitis orbitare adalah sakit pada mata, kemerahan, swelling, warmth, and tenderness. Mata menonjol keluar dan sulit dibuka atau tidak bisa digerakkan.
gangguan penglihatan sementara, keluar nanah dari mata, chills, demam, sakit kepala, mual, and sakit pada seluruh tubuh.
Cellulitis in Dentistry
SOURCES:
Odontogenic infection: Buccal space, Infraorbital space, Canine fossa
Odontogenic infection: maxillary sinusitis
Maxillary osteomyelitis
Dental work: Dental extraction
INTRAORAL EXEMINATION
Teeth
Cellulitis in Dentistry
SOURCES:
Odontogenic infection: Buccal space, Infraorbital space, Canine fossa
Odontogenic infection: maxillary sinusitis
Maxillary osteomyelitis
Dental work: Dental extraction
INTRAORAL EXEMINATION
Teeth
- Colour
- Vital sign Etc
GINGIVA
- Redness
- Swelling.Etc
INTRAORAL EXEMINATION
TEETH
- Colour
- Vital sign.Etc
GINGIVA
- Redness
- Swelling.Etc
Dental Radiography
- Tooth involvment
- Bone destruction
- Radiolucency
- Border
- Periapical lesion
- Dental Radiography
- Tooth involvment
- Bone destruction
- Radiolucency
- Border
- Periapical lesion
Important spaces related to
odontogenic orbital cellulitis
Buccal space abscess
Canine space abscess
Severity of facial infection due to anatomic space
- Vital sign Etc
GINGIVA
- Redness
- Swelling.Etc
INTRAORAL EXEMINATION
TEETH
- Colour
- Vital sign.Etc
GINGIVA
- Redness
- Swelling.Etc
Dental Radiography
- Tooth involvment
- Bone destruction
- Radiolucency
- Border
- Periapical lesion
- Dental Radiography
- Tooth involvment
- Bone destruction
- Radiolucency
- Border
- Periapical lesion
Important spaces related to
odontogenic orbital cellulitis
Buccal space abscess
Canine space abscess
Severity of facial infection due to anatomic space
TREATMENT in General
Persons at high risk for severe cellulitis will probably be hospitalized for treatment and monitoring.
Antibiotics : intravenously to patients with severe cellulitis.
Complications such as deep infection, or bone or joint infections, might require surgical drainage and a longer course of antibiotic treatment.
Extensive tissue destruction may require plastic surgery to repair.
In cases of orbital cellulitis caused by a sinus infection, surgery may be required to drain the sinuses.
TREATMENT
A normally healthy person is usually not hospitalized for mild or moderate cellulitis.
General treatment measures include elevation of the infected area, rest, and application of warm, moist compresses to the infected area.
The doctor will want to see the patient again to make sure that the antibiotic treatment is effective in stopping the infection(monitoring).
TREATMENT
ANTIBIOTIC THERAPY : usually responds well without surgical drainage
Use Broad spectrum antibiotics
Cefalosporin
Amoxillin+Clavulanat
Metronidazole or Clindamycin : anaerob
Dexamethasone to prevent swelling
Provides rapid bactericidal activity against both Streptococci and anaerobs
PROGNOSIS
Over 90% are cured after 7-10 days of antibiotic treatment.
Serious complications include blood poisoning (bacteria growing in the blood stream), meningitis (brain and spinal cord infection), tissue death (necrosis), and/or lymphangitis (infection of the lymph vessels).
Persons at high risk for severe cellulitis will probably be hospitalized for treatment and monitoring.
Antibiotics : intravenously to patients with severe cellulitis.
Complications such as deep infection, or bone or joint infections, might require surgical drainage and a longer course of antibiotic treatment.
Extensive tissue destruction may require plastic surgery to repair.
In cases of orbital cellulitis caused by a sinus infection, surgery may be required to drain the sinuses.
TREATMENT
A normally healthy person is usually not hospitalized for mild or moderate cellulitis.
General treatment measures include elevation of the infected area, rest, and application of warm, moist compresses to the infected area.
The doctor will want to see the patient again to make sure that the antibiotic treatment is effective in stopping the infection(monitoring).
TREATMENT
ANTIBIOTIC THERAPY : usually responds well without surgical drainage
Use Broad spectrum antibiotics
Cefalosporin
Amoxillin+Clavulanat
Metronidazole or Clindamycin : anaerob
Dexamethasone to prevent swelling
Provides rapid bactericidal activity against both Streptococci and anaerobs
PROGNOSIS
Over 90% are cured after 7-10 days of antibiotic treatment.
Serious complications include blood poisoning (bacteria growing in the blood stream), meningitis (brain and spinal cord infection), tissue death (necrosis), and/or lymphangitis (infection of the lymph vessels).
GENERAL PREVENTION
Cellulitis may be prevented by wearing appropriate protective equipment during work and sports to avoid skin injury, cleaning cuts and skin injuries with antiseptic soap, keeping wounds clean and protected, watching wounds for signs of infection, taking the entire prescribed dose of antibiotic, and maintaining good general health.
Persons with diabetes should try to maintain good blood sugar control.
Cellulitis may be prevented by wearing appropriate protective equipment during work and sports to avoid skin injury, cleaning cuts and skin injuries with antiseptic soap, keeping wounds clean and protected, watching wounds for signs of infection, taking the entire prescribed dose of antibiotic, and maintaining good general health.
Persons with diabetes should try to maintain good blood sugar control.
CELLULITIS PREVENTION IN DENTAL SURGERY
Clinicians should not performe a tooth extraction when the patien in in the acute stage of maxillary sinus infection.
Do not perform surgery in acute inflamatory condition
Minimal trauma, well antisipate anatomical and topographic location at the roots
Good Antibiotic treatment, if needed
Be aware of immunodeficiency patien
Other preventions of cellulitis
Remove necrotic teeth
Well cavity filling
Well endo intra canal treatment
Well intacanal seal
Need corrective endo- terament?
Need surgical endodontic?
Surgical Endodontic-1
Large Periapical lesion
Need apicoectomy
Full mucoperiosteal incision
Surgical Endodontic-2
Full-thickness mucoperiosteal flap
Length of teeth
Apical location
Surgical Endodontic-3
Apical exposure
Good visibility and access to lesion and apex
Use low speed bur and well irigation
Surgical Endodontic-4
Curetage to remove necrotic tissue
Use uncutting instrument
Surgical Endodontic-5
Root end resection
ApicoectomiOne third of apex
Surgical Endodontic-6
Easy to root canal filling.
Well apical seal
Reasons to remove
Necrotic teeth
Focal infection
Direct spreading infectin to surround tissue
Secundair spreading
Clinicians should not performe a tooth extraction when the patien in in the acute stage of maxillary sinus infection.
Do not perform surgery in acute inflamatory condition
Minimal trauma, well antisipate anatomical and topographic location at the roots
Good Antibiotic treatment, if needed
Be aware of immunodeficiency patien
Other preventions of cellulitis
Remove necrotic teeth
Well cavity filling
Well endo intra canal treatment
Well intacanal seal
Need corrective endo- terament?
Need surgical endodontic?
Surgical Endodontic-1
Large Periapical lesion
Need apicoectomy
Full mucoperiosteal incision
Surgical Endodontic-2
Full-thickness mucoperiosteal flap
Length of teeth
Apical location
Surgical Endodontic-3
Apical exposure
Good visibility and access to lesion and apex
Use low speed bur and well irigation
Surgical Endodontic-4
Curetage to remove necrotic tissue
Use uncutting instrument
Surgical Endodontic-5
Root end resection
ApicoectomiOne third of apex
Surgical Endodontic-6
Easy to root canal filling.
Well apical seal
Reasons to remove
Necrotic teeth
Focal infection
Direct spreading infectin to surround tissue
Secundair spreading
DENTAL SURGERY CAUTIONS
Be aware of Immunodeficiency cases:
Diabetes mellitus
Chronic renal failure
Alkoholism/Chronic lever disease
Malnutrition
Aging
Leukemia
Others
Be aware of Immunodeficiency cases:
Diabetes mellitus
Chronic renal failure
Alkoholism/Chronic lever disease
Malnutrition
Aging
Leukemia
Others
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