dental infections Flashcards
what problems are linked to oral health
CVD
diabetes
others
what are caries
tooth decay/cavity
what causes caries
production of acid by bacterial fermentation of food debris on tooth surfaces which causes demineralization + destruction of hard tissues in teeth
what are the had tissues of teeth
enamel
dentin
cementum
risk factors for caries
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
prevention of caries
floss, brush, fluoride, biannual cleaning
avoid smoking
what bacteria causes caries
strep mutans
also linked to anaerobes (P.streptococci, bacteroides, prevotella, fusobacterium, lactobacilli)
how do caries lead to dental infections
leads to pulpal death –> infection of pulp +/or abscess of adjacent tissues via direct or hematogenous colonization
how is strep mutans transmitted
transmitted to newly dentate infants vertically from caregivers
commonly associated conditions of caries
rampant caries throughout dentition periodontal abscess soft tissue cellulitis pericoronitis periodontitis
relevance of diabetes to dental infections
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
dental infections in elderly population
fewer dentures - more teeth loss of motor skills + dexterity medication induced xerostomia risk of oral cancer is increased cognition changes
pregnancy gingivitis
50%
due to hormonal changes -> increase in alterations in types + amounts of pathogens
pyogenic granuloma
in 1% of pregnant pts
exaggerated response to irritation
little red bump that bleeds heavily if bumped
signs + symptoms of dental infection
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
children < 4yrs w stiff neck, sore throat + dysphagia should be worked up for….
retropharyngeal abscess secondary to molar infection
what should you look for in physical exam
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
diagnostic tests for dental infection
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)
if multiple organisms are involved in dental infection, what are they most likely?
anaerobic G- rods + anaerobic G+ cocci
imaging for dental infection
dental films of suspected teeth
panoramic to eval extent of infection
CT scan considered
ddx of dental infections
bacterial/viral throat infection otitis media sinusitis viral or aphthous stomatitis TMJ dysfunction parotitis cyst ANGINAL EQUIVALENT
in what pt population should jaw pain be considered an anginal equivalent
postmenopausal women or long term diabetics
especially if lower-left portion of jaw
treatment of dental infection
abx prn pain control (NSAIDs + aspirin, opiates if necessary but BE CAREFUL, nerve block w bupivacaine)
first line abx treatment for dental infection + for PCN allergy
pen Vk
if PCN allergy - clinda or erythromycin
