Cellulitis Flashcards
what % of all hospital ER visits are dental related?
1%
*cost = 760$
how many deaths occur due to acute oral conditions each year?
more than 30 deaths / year
dental infections that spread to surrounding tissues
odontogenic infections
when periapical infections spread to surrounding tissues, the usual course is a initial ____
cellulitis (tissue invasion)
*areas of necrosis and abscess in tissues may form secondary to cellulitis
an early stage endo infection where the pulp is compormised by inflammation and the extent of bacterial growth is unclear
pulpitis
*can be reversed if treated early
what are the early stage symptoms for pulpitis?
- lowered threshold and prolonged pain response to cold
* onset of spontaneous pain signals shift to irreversible status and eventual necrosis
what is the significance of the inflammatory response of periapical lesions
bone resporption takes place, allows space for inflammatory cells to accumulate and prevent spread of disease
are periapical lesions symptomatic?
no, bc the pulp is necrotic
acute exacerbation of periapical lesion, shift in bacterial species toward immune response.
painful and tooth is sensitive to pressure, drainage brings relief
acute dentoalveolar (periapical) abscess
how serious is the drainage of an acute dentoalveolar (periapical) abscess to the tissue spaces
very serious since it leads to orofacial involvement
what are dental infections that spread to surrounding tissues called?
odontogenic infections
in cellulitis, how does infection spread?
through soft tissue via vascular channels or direct autolysis of tissue
what are the symptoms of cellulitis?
- edema (hard tissues)
- erythema (warm and red)
- painful
- fever
differential dx of odontogenic facial cellulitis
- bacteria from tooth
- alpha strep
differential dx of nonodontogenic facial cellulitis
- skin or mucous membrane trauma
- sinus bacteria
- H. influenza
- Hb vaccine lowered incidence
where are odontogenic lesions usually found?
lower face
where are nonodontogenic lesions found?
upper face
what might progressing cellulitis lead to?
progress to soft tissue abscesses
-may proceed to a 2nd phase of new abscess formation
how is the only way to resolve a soft tissue abscess?
must have drainage
-intra or extra oral
intra oral is preferreable
what is the most frequently isolated bacteria in odontogenic facial celluli
alpha-hemolytic
what are the two types of DEFINITIVE tx for pulpal and periapical diseases?
- extraction of teeth
- RCT
what is the tx of cellulitis?
- temporarily managed with antibiotic therapy
- resolve quickly if source of infection is removed
- may require antibiotics even after ext of tooth
what is the tx of soft tissue abscess
if tooth ext or root canal therapy does not provide a path of drainage for abscess, must have surgical drainage for resolution
what antibiotic has less frequent dosage schedule and better taste?
amox
what antibiotic has a broad spectrum?
metronidazole bc kills anaerobes
what antibiotic is bacteriostatic?
clindamycin
what are the red flags of cellulitis?
- elevation of the tongue/floor of mouth
- respiratory distress
- drooling
- rapid pulse
- toxic appearance
- peri-orbital involvement
typically presenting with drooling, elevation of floor of mouth, difficulty swallowing, difficulty breathing, limited neck range of motion
CAN BE LIFE THREATENING
ludwig’s angina
- 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
periobrital cellulitis
what are the indicators of urgency?
- rapid onset (overnights vs days)
- fever
- pain levels (cant eat/drink)
- prior tx (antibiotics failed)
what is the mean hosptial stay for Nationwide ?
2 days (4 days nationally)
what are the reasons to defer definitive tx and give antibiotic?
- hospital admission
- general anesthesia required
