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-anakCELLULITISKata "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.CELLULITISDisease-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 ABSCESSCELULITIS:-Diffuse-Erithematous submucous/subcutaneous-Streptococcus> Staphylococcus-Enzimes: Streptokinase, hyaluronidase and streptodornase-Cause: Break down fibrin and connective tissue= rapid spreadABSCESS- A thick wall cavity - Containing pus- Staphylococcus: enzyme coagulase- Cause: fibrin deposition= wall formation- Orbital cellulitisA 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 infectionTANDA-TANDA KLINIS DAN GEJALAHIGH RISK CELLULITISPasien 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 lympa2. ISPA ( infesi salaran pernafasan atas)3. Infeksi pada gigi dan telinga bagian tengahCARACTERISTIC SIGNCiri-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 DentistrySOURCES:Odontogenic infection: Buccal space, Infraorbital space, Canine fossaOdontogenic infection: maxillary sinusitisMaxillary osteomyelitisDental work: Dental extractionINTRAORAL EXEMINATION Teeth

- Colour- Vital sign EtcGINGIVA- Redness- Swelling.EtcINTRAORAL EXEMINATIONTEETH- Colour- Vital sign.EtcGINGIVA- Redness- Swelling.EtcDental Radiography- Tooth involvment- Bone destruction- Radiolucency- Border- Periapical lesion- Dental Radiography- Tooth involvment - Bone destruction- Radiolucency- Border- Periapical lesionImportant spaces related to odontogenic orbital cellulitisBuccal space abscessCanine space abscessSeverity of facial infection due to anatomic space

TREATMENT in GeneralPersons 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 drainageUse Broad spectrum antibioticsCefalosporin Amoxillin+Clavulanat Metronidazole or Clindamycin : anaerob Dexamethasone to prevent swelling Provides rapid bactericidal activity against both Streptococci and anaerobs PROGNOSISOver 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 PREVENTIONCellulitis 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 SURGERYClinicians 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 conditionMinimal trauma, well antisipate anatomical and topographic location at the rootsGood Antibiotic treatment, if neededBe aware of immunodeficiency patienOther preventions of cellulitis Remove necrotic teethWell cavity filling Well endo intra canal treatmentWell intacanal sealNeed corrective endo- terament? Need surgical endodontic?Surgical Endodontic-1Large Periapical lesionNeed apicoectomyFull mucoperiosteal incisionSurgical Endodontic-2Full-thickness mucoperiosteal flapLength of teethApical locationSurgical Endodontic-3Apical exposureGood visibility and access to lesion and apexUse low speed bur and well irigationSurgical Endodontic-4Curetage to remove necrotic tissueUse uncutting instrumentSurgical Endodontic-5Root end resectionApicoectomiOne third of apexSurgical Endodontic-6Easy to root canal filling.Well apical sealReasons to remove Necrotic teethFocal infectionDirect spreading infectin to surround tissueSecundair spreading

DENTAL SURGERY CAUTIONSBe aware of Immunodeficiency cases:Diabetes mellitusChronic renal failureAlkoholism/Chronic lever diseaseMalnutritionAgingLeukemiaOthers