4. Infection Symposium - Spread of Dental Infection

Question 1

Define Ludwig’s angina.

Answer 1

Bilateral cellulitis of sublingual and submandibular spaces as a result of dental infection.

Question 2

What is the main risk a dentist should be concerned about when they suspect a patient has Ludwig’s angina ?

Answer 2

Compromised airway.

Question 3

What are the intra-oral features of Ludwig’s angina ?

Answer 3

Raised tongue.
Difficulty breathing, swallowing.
Drooling.

Question 4

What are the extra-oral features of Ludwig’s angina ?

Answer 4

Diffuse redness.
Swelling bilaterally in submandibular region.

Question 5

What are the systemic signs of Ludwig’s angina ?

Answer 5

Increased HR, respiratory rate, temperature and WBC count.

Question 6

What steps should a GDP in primary care take when they suspect a patient has Ludwig’s angina ?

Answer 6

Referral to MaxFax for IV antibiotics and removal of the cause .
Ensure patient fasts until MaxFax opinion is given.

Question 7

What are the two areas where infection associated with lower anteriors can spread ?

Answer 7

Mental and submental space.

Question 8

What are the five areas where infection associated with lower premolars/molars can spread ?

Answer 8

Buccal, submasseteric, sublingual, submandibular, lateral pharyngeal space.

Question 9

What are the three areas where infection associated with upper anteriors can spread ?

Answer 9

Lip, nasolabial, infra-orbital.

Question 10

Are maxillary infections more likely to spread buccally or lingually ? Why ?

Answer 10

Buccally due to denser bone on the palate.

Question 11

If a maxillary infection spreads buccally, where can the infection spread to ?

Answer 11

Below insertion of the buccinator into buccal sulcus (forming draining sinus).
Above insertion of the buccinator into buccal space.

Question 12

Of all the maxillary teeth, which infection of what tooth is most likely to spread palatally ? Why ?

Answer 12

Lateral incisor - roots are more palatally placed.

Question 13

If a mandibular infection spreads buccally, where can the infection spread to ?

Answer 13

Above insertion of the buccinator into buccal sulcus (forming draining sinus).
Below insertion of the buccinator into buccal space.

Question 14

If a mandibular infection spreads lingually, where can the infection spread to ?

Answer 14

Perforates bone above mylohyoid attachment - sublingual space.
Perforates bone below mylohyoid attachment - submandibular space.

Question 15

What is more serious - spreading mandibular infection into sublingual OR submandibular space ?

Answer 15

Submandibular space.

Question 16

Are mandibular infections more likely to spread buccally or lingually ? Why ?

Answer 16

Lingual - bone is much thinner lingually.

Question 17

Infection associated with a mandibular premolar is most likely to spread lingually into what space ? Why ?

Answer 17

Sublingual - root tends to be above the level of the mylohyoid line.

Question 18

Infection associated with mandibular third molar is most likely to spread lingually into what space ? Why ?

Answer 18

Submandibular - root tends to be below the level of the mylohyoid line.

Question 19

What three spaces posteriorly can infection spread into which might cause the patient to present with trismus ? Why ?

Answer 19

Infratemporal space.
Masseteric space.
Pterygomandibular space.
Muscles will begin to spasm.

Question 20

What are the three most concerning posterior areas of spreading infection ?

Answer 20

Lateral pharyngeal space.
Retro-pharyngeal space.
Pre-vertebral space.
All pose risk of compromised airway.

Question 21

What are the three ways which drainage can be performed intra-orally ?

Answer 21

Incise through soft tissues.
Extripate the tooth.
XLA tooth.

Question 22

When might antibiotic therapy be required for a patient with spreading dental infection ?

Answer 22

Cannot be drained fully.
Showing signs of systemic illness.

Question 23

What are the four parts of SIRS ?

Answer 23

Increased HR, temperature, respiratory rate and raised WBC count.