Alveolar Abscess and Spreading Infection

Question 1

What are some intra oral signs of ludwig’s angina?

Answer 1

Trismus
Deviated uvula
Raised swollen tongue

Question 2

What vital structure should be considered when an incision is made on the palate?

Answer 2

The greater palatine artery

Question 3

When an abscess spontaneously drains what may this mean for the abscess itself?

Answer 3

It is going to be a Chronic/Reoccurring Abscess

Question 4

Where would you make an incision when draining an extra oral swelling of ludwigs angina?

Answer 4

2 fingers under marginal mandibular branch

Question 5

What are some origins of an abscess?

What conditions linked with them?

Answer 5

Periapical periodontitis
Periodontal disease
Pericorinitis

Question 6

After draining the pus and removing the cause of an abscess when may antibiotics be considered?

Answer 6

Antibiotics not always indicated (e.g. all pus drained) but may be indicated if severe, incomplete drainage or medical history concern (e.g. diabetic)

Question 7

What bacteria is usually responsible for cellulitis?

Answer 7

Streptococcus

Question 8

Describe how an infection spreads

Answer 8

1. Decrease in host defence system (e.g. immunocompromised, opportunistic infection or lack of tx)
2. Tissue invasion of pathogens
3. Rapid & non-specific inflammatory response

Question 9

In what direction does infection generally spread?

Answer 9

Area of least resistance

Question 10

Why are blood glucose levels considered for a special investigation for an abscess?

Answer 10

Poorly controlled diabetes increases your risk of infection

Question 11

Define abscess

Answer 11

Pathological cavity filled with pus and lined by a membrane

Question 12

What questions about history of pain should be asked for suspected ludwigs angina?

Answer 12

Can they complete sentences
Can they eat/drink

Question 13

What are clinical signs of Ludwig’s angina?

Answer 13

Raised swollen tongue
Fever
Dysphagia
Dyspnea (SOB)
Deviated uvula

Question 14

What is cellulitis?

Answer 14

Cellulitis is an infection caused by bacteria getting into the deeper layers of your skin (connective tissues) usually non pus producing but can accumulate at source if untreated

Question 15

What factors can affect the ability of an infection to spread?

Answer 15

Number and virulenece of organisms
Failure to drain pus
Patient health
Patient immune system

Question 16

What are some local signs of inflammation?

Answer 16

Pain
Swelling
Redness
Heat
Loss of function
Trismus
Lymphadenopathy

Question 17

What anatomical factors can affect the ability of an infection to spread? (3)

Answer 17

1. Site and source of infection
2. Natural barriers to spread
3. Point at which pus escapes through the bone and discharges into soft tissues

Question 18

What can determin whether an infection spread sublingual or submandibular?

Answer 18

The relationship of the mylohoid muscles

Question 19

What is gangrene?

Answer 19

Gangrene is a serious condition where a loss of blood supply causes body tissue to die

Question 20

What are some symptoms of an acute periapical abscess?

Answer 20

Soft tissue swelling
Poorly localised pain
Tooth painful to touch (if apical periodontitis)
Tooth mobility (if periodontal disease)

Question 21

What extraoral signs may you see in Ludwigs angina?

Answer 21

Drooling
Lymph node swelling
Swelling

Question 22

Label 1, 2 and 3

Answer 22

1. Apical formamen
2. Periodontal ligament
3. Bloodstream (Anachoresis)

Question 23

What are some systemic signs of inflammation?

Answer 23

Fever
Elevation in pulse
Alteration in haematological data
WBC increase
Serum protein increase