Cellulitis

Question 1

what % of all hospital ER visits are dental related?

Answer 1

1%

*cost = 760$

Question 2

how many deaths occur due to acute oral conditions each year?

Answer 2

more than 30 deaths / year

Question 3

dental infections that spread to surrounding tissues

Answer 3

odontogenic infections

Question 4

when periapical infections spread to surrounding tissues, the usual course is a initial ____

Answer 4

cellulitis (tissue invasion)

*areas of necrosis and abscess in tissues may form secondary to cellulitis

Question 5

an early stage endo infection where the pulp is compormised by inflammation and the extent of bacterial growth is unclear

Answer 5

pulpitis

*can be reversed if treated early

Question 6

what are the early stage symptoms for pulpitis?

Answer 6

• lowered threshold and prolonged pain response to cold

* onset of spontaneous pain signals shift to irreversible status and eventual necrosis

Question 7

what is the significance of the inflammatory response of periapical lesions

Answer 7

bone resporption takes place, allows space for inflammatory cells to accumulate and prevent spread of disease

Question 8

are periapical lesions symptomatic?

Answer 8

no, bc the pulp is necrotic

Question 9

acute exacerbation of periapical lesion, shift in bacterial species toward immune response.
painful and tooth is sensitive to pressure, drainage brings relief

Answer 9

acute dentoalveolar (periapical) abscess

Question 10

how serious is the drainage of an acute dentoalveolar (periapical) abscess to the tissue spaces

Answer 10

very serious since it leads to orofacial involvement

Question 11

what are dental infections that spread to surrounding tissues called?

Answer 11

odontogenic infections

Question 12

in cellulitis, how does infection spread?

Answer 12

through soft tissue via vascular channels or direct autolysis of tissue

Question 13

what are the symptoms of cellulitis?

Answer 13

• edema (hard tissues)
• erythema (warm and red)
• painful
• fever

Question 14

differential dx of odontogenic facial cellulitis

Answer 14

• bacteria from tooth

- alpha strep

Question 15

differential dx of nonodontogenic facial cellulitis

Answer 15

• skin or mucous membrane trauma
• sinus bacteria
• H. influenza
• Hb vaccine lowered incidence

Question 16

where are odontogenic lesions usually found?

Answer 16

lower face

Question 17

where are nonodontogenic lesions found?

Answer 17

upper face

Question 18

what might progressing cellulitis lead to?

Answer 18

progress to soft tissue abscesses

-may proceed to a 2nd phase of new abscess formation

Question 19

how is the only way to resolve a soft tissue abscess?

Answer 19

must have drainage
-intra or extra oral

intra oral is preferreable

Question 20

what is the most frequently isolated bacteria in odontogenic facial celluli

Answer 20

alpha-hemolytic

Question 21

what are the two types of DEFINITIVE tx for pulpal and periapical diseases?

Answer 21

• extraction of teeth

- RCT

Question 22

what is the tx of cellulitis?

Answer 22

• temporarily managed with antibiotic therapy
• resolve quickly if source of infection is removed
• may require antibiotics even after ext of tooth

Question 23

what is the tx of soft tissue abscess

Answer 23

if tooth ext or root canal therapy does not provide a path of drainage for abscess, must have surgical drainage for resolution

Question 24

what antibiotic has less frequent dosage schedule and better taste?

Answer 24

amox

Question 25

what antibiotic has a broad spectrum?

Answer 25

metronidazole bc kills anaerobes

Question 26

what antibiotic is bacteriostatic?

Answer 26

clindamycin

Question 27

what are the red flags of cellulitis?

Answer 27

• elevation of the tongue/floor of mouth
• respiratory distress
• drooling
• rapid pulse
• toxic appearance
• peri-orbital involvement

Question 28

typically presenting with drooling, elevation of floor of mouth, difficulty swallowing, difficulty breathing, limited neck range of motion
CAN BE LIFE THREATENING

Answer 28

ludwig’s angina

Question 29

• also called “pre-septal cellulitis”
• erythema, induration, tenderness of periobital tissues
• rarely progress to orbital cellulitis

*more common in children, bulging eyes, loss of vision, pain in eye, brain abscess

Answer 29

periobrital cellulitis

Question 30

what are the indicators of urgency?

Answer 30

• rapid onset (overnights vs days)
• fever
• pain levels (cant eat/drink)
• prior tx (antibiotics failed)

Question 31

what is the mean hosptial stay for Nationwide ?

Answer 31

2 days (4 days nationally)

Question 32

what are the reasons to defer definitive tx and give antibiotic?

Answer 32

• hospital admission

- general anesthesia required