Abscess Flashcards
What is an abscess
Collection of bacterial cells. Sometimes can be fungal
What are the presentations of an abscess
Swelling, erythema, suppuration, pain
What is cellulitis
Gone below the normal epidermis and is spreading through the supportive tissue
How can organisms cause abscesses?
Endogenous organisms- already present in the mouth and if they gain access to a tissue- gross inflammatory response that expresses virulence factors that can take up the host immune system and cause damage.
Organisms can also gain access externally through trauma- may have underlying inflammatory conditions such as caries, periodontitis, gingivitis so the protective barrier is already damaged.
Dentoalveolar abscess
This is when the associated tooth is infected- location is important because if it is the mandible, could potentially cause blockage of the trachea where as the upper dentition could lead to sinusitis..
Treatment of dentolalveolar abscess
Local measures include opening up a root canal or making an incision, it can involve drainage. Removal of primary site is key for delivering antimicrobials, chlorhexidine.
Serious infections- lead to indirect spread away from the primary site and chiefly treatment would be antibiotics.
Periapical abscess
Chronic periodical abscess
Collection of pus at the root of the tooth that has been spread from the tooth to the surrounding tissue.
Chronic- when the pain has been happening for a long time (persistently)
Apical abscess
Infection of the root canal of the tooth
Dental pyogenic infection
Infection in which the pus produced is known as pyogenic (pus-producing infection). A wound, whether surgical or accidental has a tendency to become infected - staphylococcus aureus. Where the abscess produces pus
Periapical periodontits/apical periodontits
Periapical periodontitis/ apical periodontitis- Acute or chronic inflammatory lesion around the apex of tooth root, most commonly caused by bacterial invasion of the pulp of the tooth.
Process of abscess
It can be caused by an infectious agent or a foreign body which then produces an immune response leads to the recruitment of white blood cells and this accumulation causes pus formation that contains dead tissue/immune cells/ infectious agents
Which groups are the facultative anaerobes
1) Streptococcus anginosus
2) Streptococcus oralis- bacterial endocarditis
3) Enterorcoccus faecelis
4) Actinomycines
What are the strict anaerobes
Prevotella spirochetes
Fusobacterium nucelatum
Periodontal abscess
Infection of the periodontium (surrounding gum tissue) . Swelling and edema can destroy various tissue and tend to be associated with a mixed population of bacteria. Its symptoms can range from sudden onset, swelling, redness and this may spread and destroy bone or tissue/
Which species is responsible for periodontal abscess
Prevotella
Porphyromonas
Variety of streptococci
Others:
Trepenoma, Actinomyces, Fusobacterium nucleatum
Treatment of periodontal abscess
Acute- local measures- drainage, extraction
chronic- option of irrigation
Antibiotics is the first one- beta lactams e.g. penicillin. if penicillin allergy, erythromycin is used. If the bacteria is primarily anaerobic, it would be metronidazole.
What species are mainly responsible for Endodontic infections
Gram negative- fusobacterium nucleatum
Gram positive- Streptococci, enterococcous faecelis
Enterococcus Faecalis
Its key features
Gram positive facultative anaerobe- resistant to massive ph changes. Additionally their metabolism can alter the Ph dramatically. Resistant to calcium hydroxide and sodium hypochlorite.
It adheres to collagen and is persistent in nutrient- poor environments
Dry socket- post extraction localised osteomyelitis
Infection of the bone caused when the socket doesn’t heal properly following an extraction- sparse anaerobic infection
Prophylaxis and treatment of dry socket
Prophylaxis- cholorohexidine irrigation prior to and post extraction.
Treatment involves antiseptic dressing with metronidazole
Osseointergrated implants- periiimplantitis associated infections
Dental implants can cause surgical trauma and persistence of root particles of foreign objects could cause an immediate or delayed abscess. Quite tricky because when you place an implant- you want it to be sticky enough to stick to the bone but not too sticky to cause bacterial communities to exist
What would be responsible for a periimplantitis
Staph aureus or Staph epidermis
Actinomyces
Actinomyces Israelli
Found in sub and supra gingival plaque
This is an opportunistic pathogen that is endogenous arising from normal flora- producing this mass under the skin
What is one of the key characteristics of actinomyces
Sulphur granules- which are the mass of actinomyces - aggregation of the filaments that come together
What treatment is usually prescribed for actinomyces
These usually have an extended period of 6 weeks of antibiotics- where penicillin/ amoxicillin has unto a 6 week as it is quite difficult penetrating these actinomyces aggregations.
What are the oral Spirocheates?
These are gram negative bacteria in which the flagella is stuck between the inner and outer membrane causing a helical movement to occur
What are the examples of spirocheates
Treponema Vincentii
Treponema denticola
Treponema Denticola
Superoxide mutase- breakdown of hydrogen peroxidase
Bubbles that can deliver proteolytic enzymes- co-aggregate and cause damage to the host and the enzymes that it releases
Associated with porphymonas gingivalis- commonly associated in chronic perio lesions
Acute necrotizing ulcerative gingivitis-/ NG/ ANUG/NUG or Vincents disease
Acute painful true infection of the gingival. It can cause inflammation, spontaneous bleeding, and is associated with immunosuppression- e.g. malnutrition and poor diet-leads to a bad smell
What is responsible for acute necrotising ulcerative gingivitis?
Fusobacterium and trepenoma vincenttii- it is a fuso-spirocheates complex:
- stimulate collagenase- breakdown the structural protein
- secretes serine proteases- breakdown key enzymes and tissues
- Immune suppression via cell inducing apoptosis
Treatment of ANUG
1) intensive local oral hygiene- ultrasonic scaler
2) irrigate with chlorhexidine
3) short course of antibiotics- usually metranidozole as it is an anaerobic bacteria-
Ludwigs Angina
Acute cellulitis- bilateral infection of the submandibular and sublingual glands. Big space with loose tissue
Linked to post-extraction as it causes a sudden access point for micro-organisms- could cause pressure buildup in the trachea that can lead to asphyxiation.
What is responsible for Ludwigs Angina
Presence of staphylococci- 27%-50%
beta hemolytic streptococci- 41%
What is the treatment for Ludwigs Angina
Surgical intervention
High dose of antibiotic treatment- intravenous penicillin- cefitrizone and metronidazole
