Bacterial Infections of the Orofacial Tissue 1 Flashcards
What is meant by bacterial load?
The quantity of bacteria in/around tissues
What are virulence factors?
Factors that make the bacteria more harmful/invasive such as enzymes
Why are we less likely to get bacterial infections in the head and neck region?
We get a lot of fresh blood into the head and neck, there is a constant supply of nutrients, red blood cells and white blood cells
What areas of the head and neck are more likely to cause infections?
Fascial spaces
Why are fascial spaces more susceptible to bacterial infections?
If bacteria get into them, they can open up and bacteria can pass very easily through the spaces (not a good blood supply to these spaces)
What are the 5 terms for describing inflammation?
Calor (hot), dolor (painful), rubor (redness), tumor (swelling), function laesi (loss of function)
What is an abscess?
A localised collection of pus (collection of bacteria, dead tissue and white cells)
What is cellulitis?
spreading infection (no collection of pus but may localise after a few days)
What are some local signs of infection?
redness, pain, induration (hardness), heat, swelling
What are some regional signs of infection?
trismus, dysphagia, difficulty breathing, lymphadenopathy (reactive lymph nodes)
What is a true REGIONAL sign of infection?
Lymphadenopathy (not related to calor, rubor, dolor, tumor or functio laesi) - its related to spread of infection through the lymphatic system to the regional lymph nodes where they will enlarge and react
What is meant by fluctuance when determining whether pus is present?
movement of the fluid within a swelling - fluctuation is a sign of pus being present
What are other ways of determining whether pus is present (5)
- Clinical suspicion (working with clinical experience)
- Aspiration (stick needle in it and see if you can draw it up)
- Spiking temperature
- Ultrasound scan
- CT scan
What are some of the implications of bacterial infections?
can impact the airway relatively quickly, ALWAYS a risk of systemic sepsis, if caused scarring on the skin (cosmetic), complications related to local spread (trismus)
What is the cavernous sinus
Cavity inside the brain which drains blood
What happens if bacteria enters the cavernous sinus?
Can lead to cavernous sinus thrombosis:
it can trigger the coagulation cascade and cause the whole sinus to thrombose… lack of venous drainage (eye will be red and painful)
What is Mediastinitis and how does it occur?
Mediastinitis is swelling and irritation (inflammation) of the chest area between the lungs (mediastinum). If bacteria/pus gets into this area it can be very dangerous
How is a buccal gingival abscess formed?
abscess expands over time, the pus will eventually break out of bone and it can travel to the buccal gingivae
How are sublingual abscesses formed? Does the pus go above or below the mylohyoid muscle?
abscess expands over time, the pus will eventually break out of bone and it can travel to the sublingual space. If the pus goes above the mylohyoid muscle it will go into the sublingual space
Why are sublingual abscesses easy to diagnose?
You get a lot of swelling v. quickly
- floor of mouth will raise up, will be painful/tense/uncomfortable
What happens if the pus breaks out of bone and travels below mylohyoid muscle?
It will travel to the submandibular space
- quite common
- quite often go with sublingual infections (combination)
What is the typical appearance of a submandibular abscess?
swelling in lower face/upper neck around one side
How does a fascial space infection occur?
abscess expand over time, the pus will eventually break out of bone and it can travel laterally to the outside of buccinator it gets into the fascial space
What is the typical presentation of a fascial space infection?
Swelling that starts at the lower border of the mandible and goes right up to the lower eye lid (hard to tell where the infection comes from)
What happens if the pus breaks out of bone and travels below the masseter?
Submassenteric/masticator infection occurs
What are some of the features of submassenteric infections?
constrained under masseter muscle, one feature of submasseteric abscess is that don’t tend to get huge amount of infection (not as much swelling)
- crucial sign is TRISMUS (inflammation under masseter muscle, loss of function means you get muscle spasm and pt won’t be able to open mouth
Why might a patient with a submassenteric infection need to be referred to secondary care?
if pt can’t open their mouth, won’t be able to take a lower tooth out or upper tooth out under LA –> pt needs to be referred to secondary care
What are the different infections you can get with upper teeth? (3)
- Gingival (buccal/palatal)
- Sinusitis
- Fascial
If you see a palatal swelling in the upper dentition which teeth are likely to be causing it and why?
Molars/incisors (1st molars/lateral incisors) as the roots tend to point palatally
Do fascial space infections present similarly in upper and lower teeth?
Yes
How do we diagnose infections?
- History
- Examination (look for local and systemic signs)
–> ALWAYS ABC - Investigations
If pus is present, is this an abscess or cellulitis?
abscess
What is the management for an abscess?
relieving and draining pus
What is the management for cellulitis?
Antibiotics
How do we decided if a patient requires urgent secondary care?
- ABC concerns
- assessment of airway: difficulty breathing, swallowing, speaking (has potential for airway problem to occur)
Why would giving a patient with an abscess lots of antibiotics not be effective?
antibx might not get into the pus and may not be effective
How is pus drained from an abscess?
- via incision
- by opening up tooth
- XLA/RCT
When might you want to consider prescribing antibiotics for an abscess?
As part of definitive tx plan
After draining pus/removing source of infection
What is a suitable prescription of antibiotics for post treatment of an abscess? (name and dose)
- Amoxicillin 500mg TID (3x daily)
- Metronidazole 400mg TID (3x daily)
- Erythromycin 500mg QID (4x daily)
Identify those patients who would need to be treated with special considerations?
- ABC
- Difficulty speaking, swallowing, breathing
- Trismus (can be associated with submasseteric space infection)
- Medically compromised
What conditions would make a patient medically compromised? (4)
- neutropenic (chemotherapy)
- head and neck radiotherapy
- bisphosphonate treatment (cancer/osteoporosis)
- pts may be less able to deal with infection
- diabetes (compromised immune system)
If a patient has a neck swelling what would you do?
Refer to secondary care as the swelling would need to be drained extra-orally
What is Ludwig’s angina?
Uncommon but can be dangerous!
acute bilateral submandibular space infection with or without sublingual involvement
What is the management of Ludwig’s angina? Why is it so dangerous?
Urgent referral to hospital for incision and drainage as airway may become compromised?
What is normal mouth opening?
40-60mm
If you have trismus, what will be the limitations of mouth opening?
20-35mm
