Infection spread via tissue spaces

Infection can spread via the blood, lymph and the tissue spaces. In dentistry, the most relevant tissue spaces are the:

• pterygomandibular space
• lateral pharyngeal space
• retropharyngeal space
• infratemporal fossa
• buccal space
• vestibular space
• sublingual space
• submandibular space
• submental space

Many of these spaces run into each other, allowing infection to spread from one space to another. For example, an infection from a wisdom tooth can spread to the pterygomandibular space and from there it can travel to the lateral pharyngeal space, then to the retropharyngeal space and even to the mediastinum.

Infection can also spread to the pterygomandibular space and lateral pharyngeal space from the infratemporal fossa.

Infection spread from maxillary teeth

Infections from the maxillary teeth can spread to the maxillary sinus, the canine fossa, palatal space, infratemporal fossa, buccal space and vestibular space. Infection will spread to the buccal space if the infection's path is outside the attachment of the buccinator muscle, but will spread to the vestibular space if the infection's path is inside the attachment of the buccinator muscle.

Infection can spread to the cavernous sinus from the infratemporal fossa and from the canine fossa. Infection in the cavernous sinus can lead to cavernous sinus thrombosis, which is potentially fatal.

Infection spread from mandibular teeth

Infections from mandibular teeth can spread to the vestibular and buccal space in the same way as from the maxillary teeth. Infection can also spread to the pterygomandibular space, sublingual space, submandibular space and submental space. The sublingual, submental and submandibular spaces can be referred collectively as the submandibular spaces.

Sometimes when an infection spreads to the submandibular spaces a life threatening condition called Ludwig's angina occurs. Angina is latin for strangle therefore this angina is referring to the sensation of being strangled caused by the swelling of the neck region. Tracheotomy is sometimes necessary to maintain the airway.

Pain as a Motivational Tool

Dr Feinstone motivates patient to comply promptly.

Drilling Technique

Dr Feinstone demonstrates a cavity preparation on the mandibular first molar.

Got to have a sense of purpose

From the movie The Dentist starring Corbin Bernsen as Dr Alan Feinstone.