dental infections

Question 1

what problems are linked to oral health

Answer 1

CVD
diabetes
others

Question 2

what are caries

Answer 2

tooth decay/cavity

Question 3

what causes caries

Answer 3

production of acid by bacterial fermentation of food debris on tooth surfaces which causes demineralization + destruction of hard tissues in teeth

Question 4

what are the had tissues of teeth

Answer 4

enamel
dentin
cementum

Question 5

risk factors for caries

Answer 5

low socioeconomic
poor access to health care
fear of dentist
poor hygiene 
poor nutrition
truam to teeth or jaws
physical + mental disabilities
decreased salivary flow
use of anticholinergic meds

Question 6

prevention of caries

Answer 6

floss, brush, fluoride, biannual cleaning

avoid smoking

Question 7

what bacteria causes caries

Answer 7

strep mutans

also linked to anaerobes (P.streptococci, bacteroides, prevotella, fusobacterium, lactobacilli)

Question 8

how do caries lead to dental infections

Answer 8

leads to pulpal death –> infection of pulp +/or abscess of adjacent tissues via direct or hematogenous colonization

Question 9

how is strep mutans transmitted

Answer 9

transmitted to newly dentate infants vertically from caregivers

Question 10

commonly associated conditions of caries

Answer 10

rampant caries throughout dentition
periodontal abscess
soft tissue cellulitis
pericoronitis
periodontitis

Question 11

relevance of diabetes to dental infections

Answer 11

systemic risk factor for periodontal dz
longer duration of DM + poor metabolic control increases risk + severity of periodontal dz
severe periodontal dz in diabetes pts causes increased risk of worsening glycemic control

Question 12

dental infections in elderly population

Answer 12

fewer dentures - more teeth
loss of motor skills + dexterity
medication induced xerostomia
risk of oral cancer is increased
cognition changes

Question 13

pregnancy gingivitis

Answer 13

50%

due to hormonal changes -> increase in alterations in types + amounts of pathogens

Question 14

pyogenic granuloma

Answer 14

in 1% of pregnant pts
exaggerated response to irritation
little red bump that bleeds heavily if bumped

Question 15

signs + symptoms of dental infection

Answer 15

pain at infected site or referrred
sensitivity to hot/cold
unprovoked, intermittent or constant throb along nerve pathway
pain on biting
bleeding/purulent drainage from gingival tissues
severe- fever, dyspnea, dysphagia, death

Question 16

children < 4yrs w stiff neck, sore throat + dysphagia should be worked up for….

Answer 16

retropharyngeal abscess secondary to molar infection

Question 17

what should you look for in physical exam

Answer 17

gingival edema + erythema
cheek or intraoral swelling
fluctuant masses (abscess until proven otherwise)
suppuration of gingival margin/tooth (mushy tissues/pus)
lymphadenopathy
severe infection may present w dysphagia, fever or airway compromise

Question 18

diagnostic tests for dental infection

Answer 18

no initial labs unless pt looks acutely ill in which case get a CBC w diff, culture + sensitivity (if abscess preset- test for anaerobes + aerobes)

Question 19

if multiple organisms are involved in dental infection, what are they most likely?

Answer 19

anaerobic G- rods + anaerobic G+ cocci

Question 20

imaging for dental infection

Answer 20

dental films of suspected teeth
panoramic to eval extent of infection
CT scan considered

Question 21

ddx of dental infections

Answer 21

bacterial/viral throat infection
otitis media
sinusitis
viral or aphthous stomatitis
TMJ dysfunction
parotitis
cyst
ANGINAL EQUIVALENT

Question 22

in what pt population should jaw pain be considered an anginal equivalent

Answer 22

postmenopausal women or long term diabetics

especially if lower-left portion of jaw

Question 23

treatment of dental infection

Answer 23

abx prn
pain control (NSAIDs + aspirin, opiates if necessary but BE CAREFUL, nerve block w bupivacaine)

Question 24

first line abx treatment for dental infection + for PCN allergy

Answer 24

pen Vk

if PCN allergy - clinda or erythromycin

Question 25

second line abx tx for dental infection

Answer 25

clinda, consider double coverage w metronidazole if severe

Question 26

when should you consider the second line abx for dental infection

Answer 26

when long-standing infection or previously treated infection that doesn’t respond to penVk or erythromycin

Question 27

what is best for tooth pain

Answer 27

MOTRIN!!!

Question 28

how soon should pt follow up w dentist for dental infection

Answer 28

24hrs

Question 29

treatment of dental abscesses

Answer 29

I+D if large + fluctuant

Question 30

root canal or extraction

Answer 30

DENTIST NEEDS TO DO THIS

Question 31

initial stabilization of dental infection pts

Answer 31

secure airway

IVF in acutely ill

Question 32

admission criteria for dental infection

Answer 32

swelling in deep spaces of neck
unstable vital signs
fever
chills
confusion/delirium
evidence of invasive infection

Question 33

what is preferable to rinse with- chlorhexidene or salt water?

Answer 33

salt water!!

Question 34

discharge criteria for dental infection

Answer 34

airway not compromised
abscess + sepsis eliminated
able to take PO + ambulate

Question 35

what should pt avoid in diet for dental infections

Answer 35

refined sugar + starch
sticky sugar foods
CHILDREN- NO SLEEPING W BOTTLE

Question 36

complications of dental infections

Answer 36

ludwigs angina
vincents angina
retropharyngeal infection/abscess
mediastinal infection
osteomyelitis
endocarditis
submental infection
submandibular infection
unstable diabetes in diabetics
worsened preexisting heart disease
preterm labor
brain abscess/death

Question 37

ludwigs angina

Answer 37

sublingual cellulitis +/- tracking abscess inferiorly

POTENTIAL FOR AIRWAY ISSUE

Question 38

vincents angina

Answer 38

aka ANUG- acute necrotizing ulcerative gingivitis AKA trench mouth
smells like feces from far away