dentoalveolar abscess and infection Flashcards
what type of bacteria are involved in periapical and dentoalveolar abscesses?
name them
subgingival species
- streptococcus sanguis
- lactobacillus species
- actinomyces species
- capnocytophaga species
- fusobacterium species
- treponema species
- prevotella species
- porphyromonas gingivalis
- a. actinomycetemcomitans
- veillonella species
what is ludwigs angina and how does it occur?
- untreated dental caries can lead to endodontic infection
- may lead to the formation of a dentoalveolar abscess
- this may spread into facial spaces if not treated properly
- may lead to ludwigs angina
- ludwigs angina =
- when infection spreads into the pharyngeal passages and tissue planes
- inflammation
- obstruction of the airways
- can lead to death
how can cavernous sinus thrombosis occur
- untreated dental caries can lead to endodontic infection
- may lead to the formation of a dentoalveolar abscess
- this may spread into facial spaces if not treated properly
- may lead to cavernous sinus thrombosis
- inflammation in the maxilla spreads to cavernous sinus
describe the steps of formation of a dentoalveolar abscess
- Untreated caries
- Caries advances and enters pulp chamber
- Pulp death
- Infection spread into tooth through periapical foramen into surrounding periapical tissues
- this process can take months or years
- Chronic infection explodes and causes symptoms
- Acute dentoalveolar abscess
When do extra-oral swellings occur when there is a dentoalveolar abscess?
When do intra-oral swellings occur when there is a dentoalveolar abscess
- where the infection spreads is determined by the muscle attachments
If below attachment of buccinator muscle of the molar area = extraoral swelling
If above = intraoral swelling
describe the clinical presentation of a dentoalevolar abscess
- Constant throbbing pain
- Often located to one tooth
- Tooth TTP
- Negative vitality testing
- Intra-oral and/or extra-oral swelling
- Radiograph showing periapical radiolucency
What is the preferred method for microbial sampling?
sampling by aspirating the pus out of the abscess
what are the issues with microbial sampling using a swab?
- High risk of contaminating swab with saliva
- Abscesses contain only anaerobic bacteria
- sensitive to atmospheric oxygen
- will die on swab
What is the treatment of acute dentoalveolar abscess
- Drainage
- Incision of soft tissues
- ethyl choloride spray used on surface to anaesthetise
- Extraction of tooth
- Extirpation of pulp
In what situations should you consider the use of antibiotics as treatment for a dentoalveolar abscess?
- only if
- Infection is spreading
- Drainage is not achieved
- Patient has raised temperature
- Patient is immuno-compromised
What antibiotics are used for dental infections?
- amoxicillin
- phenoxymethyl penicillin
- erythromycin
- clinamycin
- co-amoxiclav
- metronidazole
what is the first choice of antibiotic therapy?
amoxicillin
dose and notes for amoxicillin for dentoalveolar abscess
amoxicillin 250g capsule
dose : 500mg every 8 hours
reduced in children
what is the mechanism of amoxicillin ?
- amoxicillin binds to wall of bacteria
- affects cell wall to break it down
describe how bacteria is resistant to amoxicillin
- bacteria releases beta lactamase enzyme
- beta lactamase breaks down amoxicillin
dose and notes for metronidazole
for patients who are sensitive to penicillin
200 mg tablet
dose : 400mg every 8 hours
reduced in children
warn of interaction with alcohol : usually very sick
what second line drug os prescribed if there is no response to amoxicillin?
dose and notes
co-amoxiclav
- 250mg/125mg tablet
- dose : 250mg/125mg every 8 hours
- is amoxicillin augmented with clavulanic acid
describe the mechanism of co-amoxiclav on bacteria
clavulanic acid destroys beta lactamase enzyme
amoxicillin able to then bind to bacterial cell wall and break down
bacterial death
dose and notes for clinamycin
- 150mg capsule
- dose : 150mg every 6 hours
what should we consider when prescribing antibiotics?
- hypersensitivity reactions
- drug interactions
- is it safe in pregnancy and breast feeding
- medical conditions - liver and kidney disease?
- prescribe for 5 days but advise take for as short a time as possible
- once symptoms have resolved
what is pericoronitis?
- infection localised to operculum of tissue overlying a partially erupted tooth
- usually a lower third molar
- niche for bacteria under soft tissue
- swells up due to bacterial infection
what are the treatment options for pericoronitis?
- irrigation under operculum
- antibiotics
- if signs of swelling or raised temperature
- first choice: metronidazole
- possibly :
- extraction of the upper third molar
- traumatises the swollen tissue
what is suppurative sialadenitis?
what treatment?
suppurative infection of parotid or submandibular salivary gland
painful swelling of gland and obvious discharge at duct opening
treatment :
- if systemic signs then consider antibiotic : amoxicillin
what is peri-implantitis?
what treatment?
destructive inflammatory process affecting the soft and hard tissues around an implant
microbiology similar to periodontal disease
localised treatment but may require use of amoxicillin, co-amoxiclav or metronidazole, tetracyclines
