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
-
If the tooth apex is closer to the buccal/labial bone cortex = swelling will be visible buccally (i.e anterior aspect of the teeth)
-
If the tooth is closer to the palatal/lingual bone cortex = there will be palatal/lingual swelling (i.e posterior aspect of the teeth)
​​
Root length
-
The root length determined whether the swelling will present intra-orally or extra-orally
-
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)
-
Teeth with short roots in relation to the muscle attachment will show as an intra-oral swelling (i.e lump inside the mouth)