[The dentogenic inflammation, diagnosis, course and treatment]. / De dentogene ontsteking: diagnose, beloop en behandeling.

Inflammation begins as a response of the immune system to an external, harmful stimulus. This stimulus can be chemical, mechanical or bacterial in nature. The inflammatory response is necessary to create optimal conditions for healing. In case of pulpitis, a peri-apical granuloma, peri-coronitis or periodontitis, complaints arise as a result of an inflammatory reaction. With further progression, such as an infiltrate or a submucosal abscess, the bacteria will eventually invade the tissues and develop an infection. Given the high prevalence of dental diseases, oral health care providers are regularly confronted with the consequences of dentogenic inflammation and subsequent infections. Each specific stage of dentogenic inflammation presents symptoms that are important for making the correct diagnosis. This is important in applying the optimal dental, surgical or medical treatment.

[A human bite wound caused a severe life threatening infection]. / Een mensenbeet met desastreuze gevolgen.

Within 24 hours after a human bite trauma, a 34-year-old male patient became septic and ended up at an intensive care unit. The combination of a local damage of the skin or mucosa, aggressive micro-organisms, local host factors, and some bad luck resulted in necrotizing fasciitis for this patient. This is a very rapid progressive infection which can spread via fat tissue and the muscle fascia. The occurrence of extensive necrosis releases a lot of cytokines and acute-phase proteins, resulting in a systemic reaction. The consequential vasodilatation makes it necessary for the heart to pump harder in order to maintain the circular volume. The patient will soon become septic and hemodynamically unstable. This can also lead to multiple organ failure with potentially fatal consequences. Because necrotizing fasciitis can be caused by commensal bacteria, even young healthy patients are at risk for this invasive life threatening disease. Early recognition of the clinical manifestations can prevent a fatal outcome.

[Inflammation and infection: cellular and biochemical processes]. / Ontsteking en infectie: de cellulaire en biochemische processen.

The terms inflammation and infection are often used interchangeably. Technically this is incorrect. Inflammation is defined as the body's response to a potentially damaging stimulus. Infection involves tissue invasion by microorganisms. An inflammatory reaction will be provoked when infection occurs in an otherwise healthy patient. Inflammation can be recognized clinically by 5 cardinal signs: rubor (redness), calor (warmth), tumor (swelling), dolor (pain), and functio laesa (loss of function). These clinical signs can be explained by the biochemical and cellular processes activated during the inflammatory response. Rubor and calor are the result of local vasodilation. Tumor, dolor and functio laesa result from extravasation of blood plasma, white blood cells, and inflammatory mediators. Pulpitis is an example of inflammation; a periapical abscess is an example of infection.