Abscess

Question 1

What is an abscess

Answer 1

Collection of bacterial cells. Sometimes can be fungal

Question 2

What are the presentations of an abscess

Answer 2

Swelling, erythema, suppuration, pain

Question 3

What is cellulitis

Answer 3

Gone below the normal epidermis and is spreading through the supportive tissue

Question 4

How can organisms cause abscesses?

Answer 4

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.

Question 5

Dentoalveolar abscess

Answer 5

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..

Question 6

Treatment of dentolalveolar abscess

Answer 6

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.

Question 7

Periapical abscess

Chronic periodical abscess

Answer 7

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)

Question 8

Apical abscess

Answer 8

Infection of the root canal of the tooth

Question 9

Dental pyogenic infection

Answer 9

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

Question 10

Periapical periodontits/apical periodontits

Answer 10

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.

Question 11

Process of abscess

Answer 11

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

Question 12

Which groups are the facultative anaerobes

Answer 12

1) Streptococcus anginosus
2) Streptococcus oralis- bacterial endocarditis
3) Enterorcoccus faecelis
4) Actinomycines

Question 13

What are the strict anaerobes

Answer 13

Prevotella spirochetes

Fusobacterium nucelatum

Question 14

Periodontal abscess

Answer 14

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/

Question 15

Which species is responsible for periodontal abscess

Answer 15

Prevotella
Porphyromonas

Variety of streptococci

Others:

Trepenoma, Actinomyces, Fusobacterium nucleatum

Question 16

Treatment of periodontal abscess

Answer 16

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.

Question 17

What species are mainly responsible for Endodontic infections

Answer 17

Gram negative- fusobacterium nucleatum

Gram positive- Streptococci, enterococcous faecelis

Question 18

Enterococcus Faecalis

Its key features

Answer 18

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

Question 19

Dry socket- post extraction localised osteomyelitis

Answer 19

Infection of the bone caused when the socket doesn’t heal properly following an extraction- sparse anaerobic infection

Question 20

Prophylaxis and treatment of dry socket

Answer 20

Prophylaxis- cholorohexidine irrigation prior to and post extraction.
Treatment involves antiseptic dressing with metronidazole

Question 21

Osseointergrated implants- periiimplantitis associated infections

Answer 21

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

Question 22

What would be responsible for a periimplantitis

Answer 22

Staph aureus or Staph epidermis

Question 23

Actinomyces

Actinomyces Israelli

Answer 23

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

Question 24

What is one of the key characteristics of actinomyces

Answer 24

Sulphur granules- which are the mass of actinomyces - aggregation of the filaments that come together

Question 25

What treatment is usually prescribed for actinomyces

Answer 25

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.

Question 26

What are the oral Spirocheates?

Answer 26

These are gram negative bacteria in which the flagella is stuck between the inner and outer membrane causing a helical movement to occur

Question 27

What are the examples of spirocheates

Answer 27

Treponema Vincentii

Treponema denticola

Question 28

Treponema Denticola

Answer 28

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

Question 29

Acute necrotizing ulcerative gingivitis-/ NG/ ANUG/NUG or Vincents disease

Answer 29

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

Question 30

What is responsible for acute necrotising ulcerative gingivitis?

Answer 30

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

Question 31

Treatment of ANUG

Answer 31

1) intensive local oral hygiene- ultrasonic scaler
2) irrigate with chlorhexidine
3) short course of antibiotics- usually metranidozole as it is an anaerobic bacteria-

Question 32

Ludwigs Angina

Answer 32

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.

Question 33

What is responsible for Ludwigs Angina

Answer 33

Presence of staphylococci- 27%-50%

beta hemolytic streptococci- 41%

Question 34

What is the treatment for Ludwigs Angina

Answer 34

Surgical intervention

High dose of antibiotic treatment- intravenous penicillin- cefitrizone and metronidazole