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Microbiology for Dentists > 23. Dental Abscesses > Flashcards

23. Dental Abscesses Flashcards

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1
Q

Define ‘abscess’

A
  • collection of pus
  • walled off by a barrier of inflammatory reaction
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2
Q

Abscesses are … meaning …-producing

A
  • pyogenic
  • pus
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3
Q

Pathogenesis of abscesses

A
  • can develop in any confined space
  • to which bacteria can gain access and multiply
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4
Q

Did dental abscesses used to be serious?

A
  • leading cause of death
  • London Bills of Mortality said ‘teeth’ were the 5th or 6th leading cause of death
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5
Q

How is a periodontal abscess defined?

A
  • differentiated from dentoalveolar ones as tooth associated with it has vital pulp
  • infection in periodontal pocket - foreign body/obstruction
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6
Q

Symptoms of periodontal abscess

A
  • swelling and erythema
  • pus likely to discharge from gingival margin
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7
Q

Microbiology of periodontal abscess

A
  • associated with Prophyromonas species
  • Provotella
  • Fusobacterium species
  • haemolytic streptococci
  • actinomyces species
  • spirochetes
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8
Q

Management of periodontal abscess

A
  • treated by local measures
  • drainage, subgingival instrumentation, irrigation
  • extraction?
  • antibiotic prescription only if spreading infection and systemic involvement
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9
Q

Routes of infection in dentoalveolar/periapical abscess

A
  • dental caries
  • exposed dentinal tubules
  • direct pulp exposure
  • lateral/apical foramen
  • blood-borne bacteraemia
  • root fracture
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10
Q

What is endodontic infections?

A
  • infected pulp
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11
Q

Periodontal disease causes … while dental caries causes …, both lead to …

A
  • lateral periodontal abscess
  • endodontic infection
  • dentoalveolar abscess (through a periapical granuloma/cyst for endodontic disease first)
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12
Q

Dentoalveolar abscess causes what?

A
  • dry socket
  • osteomyelitis
  • facial space infection
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13
Q

What, other than dentoalveolar abscess, can cause facial space infections?

A

pericoronitis

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14
Q

What do facial space infections lead to?

A
  • Ludwig’s angina
  • cavernous sinus thrombosis
  • then death after both
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15
Q

How to treat endodontic infections?

A
  • root canal treatment cleans out canals and seals to prevent bacterial access
  • sodium hypochlorite, chlorhexidine, calcium hydroxide and iodine are commonly used to kill residual bacteria
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16
Q

What causes a flare-up in endodontic infection?

A
  • survival of species such as Enterococcus faecalis
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17
Q

What type of bacteria cause dental abscesses?

A
  • gram positive coccus
  • gram negative rods
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18
Q

Most abscesses are mixed infections of … and … but difficult to sample. why?

A
  • facultative and strict anaerobes
  • because the sample is gained and hard to not contaminate
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19
Q

Give some facultative anaerobes in abscess formation?

A
  • oral streptococci
  • strep anginosus
  • staphylococcus spp.
20
Q

Give some obligate anaerobes in abscess formation

A
  • fusobacterium species
  • prevotella species
  • prophyromonas
  • tannerella forsythia
  • treponema denticola
  • clostridium
  • actinomyces
21
Q

Factors that affect bacterial population in abscess

A
  • oxygen tension (select for anaerobes)
  • availability of nutrients (selects for proteolytic bacteria)
  • bacterial interactions (selects for mutual co-operation)
  • immune response
22
Q

Explanations for selecting a population of 3-4 species

A
  • multiple infectiom but only certain species survive
  • one species infects and prepares the way for appropriate others
23
Q

Coaggregation between diff bacteria in periodontal and endodontic infection leads to …

A
  • coinvasion of epithelial cells (e.g F. nucleatum can carry strep cristatus into cells)
  • coinvasion of dentine tubules
24
Q

Localised spread of infection is through …
into …

A
  • soft tissue abscess
  • sinus linking main abscess cavity with mouth/skin
  • through soft tissue (cellulitis)
    INTO
  • adjacent facial space
  • deeper layers like osteomyelitis
  • maxillary sinus
  • indirectly to lymphatic and haematogenous routes
25
Q

Define ‘osteomyelitis’

A
  • inflammation of medullary bone within maxilla or mandible with posterior extension #
  • into the adjacent cortical bone and overlying periosteum
26
Q

How is osteomyelitis treated?

A
  • difficult to treat effectively
  • more common in reduced vascularity
  • local debridement, topical antiseptic on exposed areas, antibiotics as required
27
Q

When osteomyelitis presents, typical isolates include …

A
  • obligate anaerobes
  • Actinomyces species
28
Q

List tissue spaces

A
  • pterygomandibular
  • lateral pharyngeal
  • retropharyngeal
  • submasseteric
  • buccal
  • vestibular
  • sublingual
  • submandibular
  • submental
29
Q

Management scheme of dental abscess

A
  • signs and symptoms
  • assess patient - in detail and medical history
  • define location, nature and swelling
  • systemic symptoms?
  • identify cause of infection
  • diagnosis
  • treatment
30
Q

Treatment of dental abscess process

A
  • local measures
  • drain pus if present
  • tooth extraction
  • access and drain through root canal
  • soft tissue pus drain by incision
  • debride infected periodontal pockets
  • irrigate/debride infected operculum
31
Q

When do we provide antibiotics?

A
  • evidence of spreading infection
  • lymph node involvement
  • swelling
  • persistant swelling despite local treatment
  • trismus
  • failure to respond to local measures
  • uncooperative patient
  • floor of mouth swelling
  • breathing risk
32
Q

Warning signs with abscesses

A
  • swelling, pain and raising of tongue
  • elevated floor of mouth
  • malaise
  • fever
  • swelling of neck or tissues in submandibular/sublingual space
33
Q

Explain Ludwig’s angina with abscesses

A
  • progression of dentoalveolar infection to cause widespread swelling of tissue spaces (submental/lingual/mandibular)
  • swelling of neck and difficulty breathing
  • spread of infection through fascial spaces to mediastinum
34
Q

Microbiology of Ludwig’s angina

A
  • Prevotella species
  • Porphyromonas species
  • Fusobacterium species
  • anaerobic strep
35
Q

3 antibiotics we prescribe for this

A
  • amoxicillin
  • phenoxymethylpenicillin
  • metronidazole
36
Q

What’s a major problem for prescribing antibiotics for abscesses?

A
  • antibiotic resistance
  • increase in antibiotic resistance to dentoalveolar infection
37
Q

What is pericoronitis?

A
  • superficial infection of operculum, occasional local spread of infection
  • infection in space between tooth and overlying soft tissue
38
Q

What bacteria are involved with pericoronitis?

A
  • P.intermedia
  • anaerobic strep
  • fusobacterium species
  • T. forsythia
  • A. actinomycetemcomitans
39
Q

Management of pericoronitis

A
  • local measures
  • irrigation
  • extraction?
  • if spreading infection and systemic involvement, prescription of antibiotics and metronidazole drug of choice
40
Q

What is cervicofacial actinomycosis?

A
  • opportunistic infection caused by members of Actinomyces genus (A. israelii in 90% of cases, A.bovis or A. naeslundii)
  • most commonly a submandibular swelling, at the angle of mandible. Can be local or diffused
  • tooth extraction or trauma likely to precipitate infection with bacterial species reaching deeper tissues
41
Q

How does cervicofacial actinomycosis progress?

A
  • swelling progresses and multiple sinuses develop
  • thick and yellow pus expressed from sinus
  • pus contains visible granules called sulphur granules (consist of calcified aggregates of Actinomyces filaments)
42
Q

Causes of necrotising gingivitis

A
  • poor oral hygeine/poor plaque control
  • immunocompromised
  • poor diet/poor general health
  • smokers
43
Q

What is necrotising gingivitis? What bacteria?

A
  • superficial infection of gingival margins
  • associated with fuso-spirochaetal bacteria (treponema species and prevotella intermedia)
44
Q

Treatment of necrotising gingivitis

A
  • OHI and improvement in oral hygeine
  • removal of supra and subgingival deposits, periodontal instrumentation/ultrasonic debridement
  • risk factor identification/management
  • prescribe only in more severe cases - metronidazole if doing so
45
Q

Oral soft tissue infections are …

A

bacterial, viral or fungal

Microbiology for Dentists (37 decks)

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