Bacterial Infection - Spread

Question 1

What governs spread dentoalveolar infection?

Answer 1

By site of origin and the surrounding tissue planes - limited by fascial layer and muscle insertion

Question 2

What muscles affect spread in mandible?

Answer 2

Buccinator

Mylohyoid

Question 3

What happens if infection tracks laterally in mandible?

Answer 3

Present on buccal or lingual surface

Question 4

If infection on apex mandibular tooth that lies above mylohyoid attachment how will infection present?

Answer 4

Present sublingual space

Question 5

Is sublingual presentation where did infection origintate from?

Answer 5

Apex mandibular tooth which lies above mylohyoid attachment

Question 6

How will infection present if tracked below mylohyoid?

Answer 6

Present submandibular space - lower border of mandible

Question 7

When will get presentation of infection in mandibular buccal sulcus?

Answer 7

Infection track buccal - perforate buccal cortex bove attachement of buccinator

Question 8

When will get infection at angle of mandible?

Answer 8

Infection tracked inferior to buccinator

Question 9

How can infection track in maxilla?

Answer 9

Lateral or palatal

Potential for superior infection into maxillary sinus

Question 10

What is important in understanding how infection spread?

Answer 10

Fascial planes and tissue space

Question 11

What are 3 separate parts of deep fascia?

Answer 11

Investing layer
Visceral layer
Prevertebral fascia

Question 12

What is investing fascial layer?

Answer 12

Superficial layer wraps around mandible and masticatory msucles

Question 13

What is visceral fasical layer?

Answer 13

Deep to investing layer - form fasical tube from base skull to aotric arch

Question 14

What is pre-vertebral fascial layer?

Answer 14

Wraps around spinal cord and verterbra

Question 15

What does spread of infection in mandible relate to?

Answer 15

Relation of tooth to insertion of buccinator and mylohyoid

Question 16

How does buccinator attach?

Answer 16

Lateral cortex of mandible adjacent to molar teeth

Question 17

How does mylohyoid attach?

Answer 17

Mylohyoid ridge - medial lingual cortex

Question 18

If have mandibular abscess which tracks laterally above buccinator where will it present?

Answer 18

Intra-oral

Question 19

If have mandibular abscess which track laterally below buccanator where will it present?

Answer 19

Facial skin

Question 20

If abscess track medial above mylohyoid where will it present?

Answer 20

Sublingual space

Question 21

If abscess track medial below mylohyoid where will it present?

Answer 21

Submandibular space

Question 22

Where can infection 2nd/3rd mandibular molars track?

Answer 22

Posterior into masticatory sapce/ phayngeal space = see profound trismus/ compromised airway

Question 23

Where do most maxillary infection track?

Answer 23

Buccal - bone thin = least resistance

Question 24

If have palatal infection where tracked from?

Answer 24

Lateral incisors

Palatal root first molar

Question 25

What can happen if apex maxillary canine above origin levator anguli?

Answer 25

Infection present medial canthus of eye

Question 26

When see deep neck space infection?

Answer 26

Rare but most dental in origin | From mandibular 2nd/3rd molars - apex often below mylohyoid

Question 27

Presenting feature deep neck space infection?

Answer 27

``` Fever Pain Sore throat Diff/ pain swallowing Trismus ```

Question 28

Management deep neck space infection?

Answer 28

General and local measures Airway management IV ab Surgical drainage

Question 29

What is a complication that can happen from spread infection from upper anterior tooth?

Answer 29

Drainage into cavernous sinus = cavernous sinus thrombosis

Question 30

Presenting symptoms of cavernous sinus thrombosis?

Answer 30

Loss eye mvement Ptosis = drooping upper lid Proptosis = bulging eye Chemosis = red eye

Question 31

When should ab be given?

Answer 31

Systemic infection: fever, malaise, nausea Sign spreading infection Chronic infection despite local measure Immuno-or medically compromised

Question 32

What conditions should ab be given with even if limited systemic involvement?

Answer 32

Osteomyelitis ANUG Sialdentitis

Question 33

How prescribe antimicrobials?

Answer 33

Aim at organism present Dose be 4-8x MIC in blood Present long enough to penetrate site

Question 34

Issue w/ broad spec ab?

Answer 34

Associate rise clostridium difficile

Question 35

Example broad spec ab?

Answer 35

Amoxicillin | Tetracycline

Question 36

When take care w/ broad spec ab?

Answer 36

Pt GI disease Elderly Consider prescribe PPI

Question 37

When NOT prescribe ab fro dental disease?

Answer 37

Pulpitis | Prevention dry socket

Question 38

Why may ab not work?

Answer 38

Agent doesn't reach site Impaired defence Inappropriate agent - resistance Poor pt compliance

Question 39

Why may ab not reach site infection?

Answer 39

Inadequate drainage Poor blood supply Presence foreign body Inadequate duration