4. Infection Symposium - Spread of Dental Infection Flashcards
Define Ludwig’s angina.
Bilateral cellulitis of sublingual and submandibular spaces as a result of dental infection.
What is the main risk a dentist should be concerned about when they suspect a patient has Ludwig’s angina ?
Compromised airway.
What are the intra-oral features of Ludwig’s angina ?
Raised tongue.
Difficulty breathing, swallowing.
Drooling.
What are the extra-oral features of Ludwig’s angina ?
Diffuse redness.
Swelling bilaterally in submandibular region.
What are the systemic signs of Ludwig’s angina ?
Increased HR, respiratory rate, temperature and WBC count.
What steps should a GDP in primary care take when they suspect a patient has Ludwig’s angina ?
Referral to MaxFax for IV antibiotics and removal of the cause .
Ensure patient fasts until MaxFax opinion is given.
What are the two areas where infection associated with lower anteriors can spread ?
Mental and submental space.
What are the five areas where infection associated with lower premolars/molars can spread ?
Buccal, submasseteric, sublingual, submandibular, lateral pharyngeal space.
What are the three areas where infection associated with upper anteriors can spread ?
Lip, nasolabial, infra-orbital.
Are maxillary infections more likely to spread buccally or lingually ? Why ?
Buccally due to denser bone on the palate.
If a maxillary infection spreads buccally, where can the infection spread to ?
Below insertion of the buccinator into buccal sulcus (forming draining sinus).
Above insertion of the buccinator into buccal space.
Of all the maxillary teeth, which infection of what tooth is most likely to spread palatally ? Why ?
Lateral incisor - roots are more palatally placed.
If a mandibular infection spreads buccally, where can the infection spread to ?
Above insertion of the buccinator into buccal sulcus (forming draining sinus).
Below insertion of the buccinator into buccal space.
If a mandibular infection spreads lingually, where can the infection spread to ?
Perforates bone above mylohyoid attachment - sublingual space.
Perforates bone below mylohyoid attachment - submandibular space.
What is more serious - spreading mandibular infection into sublingual OR submandibular space ?
Submandibular space.
Are mandibular infections more likely to spread buccally or lingually ? Why ?
Lingual - bone is much thinner lingually.
Infection associated with a mandibular premolar is most likely to spread lingually into what space ? Why ?
Sublingual - root tends to be above the level of the mylohyoid line.
Infection associated with mandibular third molar is most likely to spread lingually into what space ? Why ?
Submandibular - root tends to be below the level of the mylohyoid line.
What three spaces posteriorly can infection spread into which might cause the patient to present with trismus ? Why ?
Infratemporal space.
Masseteric space.
Pterygomandibular space.
Muscles will begin to spasm.
What are the three most concerning posterior areas of spreading infection ?
Lateral pharyngeal space.
Retro-pharyngeal space.
Pre-vertebral space.
All pose risk of compromised airway.
What are the three ways which drainage can be performed intra-orally ?
Incise through soft tissues.
Extripate the tooth.
XLA tooth.
When might antibiotic therapy be required for a patient with spreading dental infection ?
Cannot be drained fully.
Showing signs of systemic illness.
What are the four parts of SIRS ?
Increased HR, temperature, respiratory rate and raised WBC count.
