Bacterial Infections of Orofacial Tissues 2 Flashcards
How do non-odontogenic infections cause damage?
*Pus formation
*toxins
*tissue damage
*invasiveness
What is the order of non odontogenic presentations?
- Folliculitis : immediately around the follicle. Most common, least dangerous
- Boils: If it persists, follicle gets blocked and infection persists, turns into boil.
- Carbuncles : multiple side by side follicles start to get involved and get infected
- Furuncles: Infection spreads and starts to undermine the skin/mucosa
What origins can an infection come from that presents on the skin?
- skin
- dental
- underlying salivary gland
What type of infection is erysipelas?
A superficial spread of a streptococcal infection. Extremely infectious
What symptoms do you get with erysipelas?
- Oedema / cellulitis of dermis
- May be systemically unwell
- Erythema - can use pen on area to monitor the spread. If grows rapidly within hours, give aggressive antibiotics.
- If patient or staff comes with it, send them home as extremely infectious.
What type of infection is impetigo?
- Less troublesome than erysipelas.
- A streptococcal/ staphylococcal infection with vesicles.
- These can rupture with exudate with yellow crust.
Must send staff/pts home as extremely contagious.
What is the issue with ‘skin infections’?
They can mimic dental infections.
eg, A patient presents and has a ‘sebaceous gland/cyst’ removed but turns out it is actually a non vital upper premolar chronic infection that has tracked through to the cheek.
This explained why it kept coming back- the infection source was not removed!
Remember to always check orally to rule this out. Put GP for location
How to ensure a skin infection is not dental in origin?
- Check for any culprit teeth including:
- History = tooth ache/filled/broken down teeth
- Exam and radiograph to confirm the history
- Check for a palpable sinus track - point of infection on skin is fixed to bone underneath
What is sepsis?
An infection of the blood stream due to an over reaction of the immune system from another infection. This results in severe symptoms and can kill.
May be caused by seemingly trivial infections.
Who is at risk of sepsis?
*Very young- developing immune systems
*Very old- failing immune systems
*Immune suppressed (steroids, methotrexate- biological response modifiers)
*NEUTROPENIC (CHEMOTHERAPY)- reduced WBCs= neutropenic
*Recent infection or operation
*IVDA - intravenous drug users
What body systems does sepsis affect?
*Cardiovascular - heart failure, cannot maintain BP
*Respiratory- fluid/ oedema in lungs bc cant get enough oxygen in body
*Liver
*Kidney
*Blood- platelets and WBC increase or decrease bc they are being consumed by infection
*Neurological
What are the symptoms of Sepsis?
*Altered mental state/behaviour - particularly kids or older people (drowsy or very restless)
*Raised respiratory rate (>20/min)
*Systolic BP<100mmHg (mm of murcury)
*Pulse rate >90bpm - note that children have naturally higher pulses
*Not passed urine last 12hr - due to kidney damage
*Temperature <36 degrees - even more worrying than high temp
*Skin: mottled/ashen/non-blanching rash/ signs of
potential skin infection
Explain the BUFALOS acronym for sepsis?
Used to remember the management and treatment of Sepsis
-B lood samples : full blood count/ glucous/ venous gases/glucose/clotting factors
-U rine output: initiate strict hourly fluid balance
-F luid resuscitation : to make up for dehydration
-A ntibiotics : intravenous, within an hour. Do not delay empirical AB therapy as it may save a pt’s life, check allergies!
-L actate monitoring : indicates circulation problems (body forced to respire anaerobically due to hypoxia)
-O xygen : keep levels 94% or more. COPD people keep between 88-92%
-Senior review
What type of infection is necrotising fasciitis?
Streptococcal infection usually through trivial wounds/infection site and spreads rapidly. May be systemically unwell
Necrotising therefore ‘dissolves’ tissues
The necrosis of tissues come from the toxins, complement cascade/ coagulation
The infection may undermine tissues therefore the surface might not represent what is underneath
What is the implications of necrotising fasciitis?
If not treated, may die of systemic sepsis and lose limb
May also get air in the tissues due to fermenting bacteria
