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Mandibular Dental Infection Pathways

There are 4 main pathways of mandibular spread of infection which will be covered.

The 4 pathways are:

1. Buccal spread intra-orally

2. Buccal spread extra-orally

3. Lung spread through the cortex above mylohyoid muscle to the sublingual space, elevating the tongue

4. Lingual spread inferiorly beyond the mylohyoid muscle into submandibular space

There are 2 main factors which influence how the infection spreads:

the location of the tooth apex and the root length

Tooth apex

  • The tooth apex determines whether it will be buccal spread or lingual spread

  1. If the tooth apex is closer to the buccal/labial bone cortex = swelling will be visible buccally (i.e anterior aspect of the teeth)

  2. If the tooth is closer to the palatal/lingual bone cortex = there will be palatal/lingual swelling (i.e posterior aspect of the teeth)

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Root length

  • The root length determined whether the swelling will present intra-orally or extra-orally

  1. Teeth with long roots where the muscle attachment is below, on maxillary arch, or above, on mandibular arch = then the apex of the root will show as an extra-oral swelling (i.e big swollen cheek)

  2. Teeth with short roots in relation to the muscle attachment will show as an intra-oral swelling (i.e lump inside the mouth)

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