CLINICAL CARE FOR DENTAL INFECTIONS

Question 1

What DX?
Inflammation of the dental pulp resulting from untreated caries, trauma, or multiple restorations. Its principle symptom is pain.

Answer 1

Pulpitis

Question 2

What type of pulpitis?

Pain occurs when a stimulus (usually cold or sweets) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 seconds.

Answer 2

reversible pulpitis

Question 3

What type of pulpitis?
Pain occurs spontaneously or lingers minutes after the stimulus is removed. A patient may have difficulty locating the tooth from which the pain originates, even confusing the maxillary and mandibular arches

Answer 3

irreversible pulpitis

Question 4

What can result from irreversible pulpitis as infection develops and extends through the apical foramen?

-The tooth can be exquisitely sensitive to pressure and percussion.
-elevates the tooth from its socket and feels high when the patient bites down.

Answer 4

periapical abscess

Question 5

What helps determine whether inflammation has extended beyond the tooth apex and help exclude other conditions?

Answer 5

X-rays

Question 6

True/ False
Pulpitis can spread from maxillary teeth and may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and cavernous sinus thrombosis.

Answer 6

True

Question 7

Pulpitis spread from mandibular teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and cavernous sinus thrombosis.

Question 8

TRUE/FALSE
Pulpitis spread from mandibular teeth may cause purulent sinusitis, meningitis, brain abscess, orbital cellulitis, and cavernous sinus thrombosis.

Answer 8

False
may cause Ludwig’s angina, parapharyngeal abscess,
mediastinitis, pericarditis, empyema, and jugular thrombophlebitis.

Question 9

In reversible pulpitis, pulp vitality can be maintained if the tooth is treated, usually by what?

Answer 9

Drill and fill

Question 10

Irreversible pulpitis and its sequelae requires what type of treatment?

Answer 10

endodontic (root canal) therapy or tooth extraction.

Question 11

Symptoms persist of worsen, can root canal therapy be repeated?

Answer 11

yes

Question 12

Symptoms persist of worsen, can root canal therapy be repeated?

Answer 12

yes

Question 13

Symptoms persist of worsen, can root canal therapy be repeated?

Answer 13

yes

Question 14

What Dx/TX
an acute or chronic inflammatory lesion around the apex of a tooth root which usually caused by bacterial invasion from the pulp of a necrotic tooth.

(1) Symptomatic: painful response to biting and/or percussion. May or may not be accompanied by radiographic changes.
(2) Asymptomatic: Appears as apical radiolucency but does not illicit pain to biting or percussion.

Answer 14

Periapical Periodontitis
TX
1) Symptomatic treatment
(2) Antibiotics
(3) Referral to dental for root canal therapy or tooth extraction.

Question 15

________________ is collection of pus at the apex of a tooth, usually caused by an infection that has spread from the apical foramen of a tooth with irreversible pulpitis to the surrounding tissues. It is a sequelae of Periapical Periodontitis.

Answer 15

Periapical abscess

Question 16

_______ is a collection of pus within the periodontium that occurs alongside a tooth as a result of an infection not caused by its root. It can be the result of food impaction in the sulcus, improperly scaled teeth, or penetration (ie toothpick, popcorn husk).

Answer 16

Periodontal abscess

Question 17

Periodontal abscess TX

Answer 17

(a) Systemic pain relief
(b) Drainage via gentle irrigation and dental scaling, else I & D.
(c) Antibiotics

Question 18

Periapical abscess TX

Answer 18

(a) Systemic pain relief
(b) Drainage via I & D
(c) Antibiotics
(d) Refer to dental for root canal therapy or tooth extraction

Question 19

What is inflammation of the gingiva, producing bleeding with swelling, redness, exudate, a change of normal contours, and occasionally, discomfort.

Answer 19

Gingivitis

Question 20

Chronic gingivitis, may evolve into what?

Answer 20

periodontitis

Question 21

The most common cause of gingivitis is _______ which allows plaque to accumulate between the gingiva and teeth (sulcus).

Answer 21

poor oral hygiene

Question 22

What dx/tx?
An acute, painful inflammation of the gingival flap over a partially erupted tooth, usually around mandibular 3rd molars (wisdom teeth).
-Infection is common, and an abscess may develop. Pericoronitis often recurs as food gets trapped beneath the flap.
-The gingival flap disappears when the tooth is fully erupted.

Answer 22

Pericoronitis
tx
removal of debris from under the gingival flap
via irrigation with saline, hydrogen peroxide, or chlorhexidine.
-Surgery to remove tissue may be warranted.
-Abscess that develop should be I & D’ed.

Question 23

What dx/tx
Erythematous tissue at gum lines with loss of stippling that bleeds upon probing.
Tissue may be bulbous and have halitosis.
-Gingival sulcus depths <=3 mm
-Pain is usually absent, except in more extreme acute cases.

Answer 23

gingivitis
tx
(1) Personal oral hygiene
(2) Refer to dental for cleaning if unable to resolve with personal hygiene.