dentoalveolar abscess and infection

Question 1

what type of bacteria are involved in periapical and dentoalveolar abscesses?

name them

Answer 1

subgingival species

• streptococcus sanguis
• lactobacillus species
• actinomyces species
• capnocytophaga species
• fusobacterium species
• treponema species
• prevotella species
• porphyromonas gingivalis
• a. actinomycetemcomitans
• veillonella species

Question 2

what is ludwigs angina and how does it occur?

Answer 2

• 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

Question 3

how can cavernous sinus thrombosis occur

Answer 3

• 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

Question 4

describe the steps of formation of a dentoalveolar abscess

Answer 4

1. Untreated caries
2. Caries advances and enters pulp chamber
3. Pulp death
4. Infection spread into tooth through periapical foramen into surrounding periapical tissues
   
   • this process can take months or years
5. Chronic infection explodes and causes symptoms
6. Acute dentoalveolar abscess

Question 5

When do extra-oral swellings occur when there is a dentoalveolar abscess?

When do intra-oral swellings occur when there is a dentoalveolar abscess

Answer 5

• 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

Question 6

describe the clinical presentation of a dentoalevolar abscess

Answer 6

• Constant throbbing pain
• Often located to one tooth
• Tooth TTP
• Negative vitality testing
• Intra-oral and/or extra-oral swelling
• Radiograph showing periapical radiolucency

Question 7

What is the preferred method for microbial sampling?

Answer 7

sampling by aspirating the pus out of the abscess

Question 8

what are the issues with microbial sampling using a swab?

Answer 8

• High risk of contaminating swab with saliva
• Abscesses contain only anaerobic bacteria
  
  • sensitive to atmospheric oxygen
  • will die on swab

Question 9

What is the treatment of acute dentoalveolar abscess

Answer 9

• Drainage
• Incision of soft tissues
  
  • ethyl choloride spray used on surface to anaesthetise
• Extraction of tooth
• Extirpation of pulp

Question 10

In what situations should you consider the use of antibiotics as treatment for a dentoalveolar abscess?

Answer 10

• only if
  
  • Infection is spreading
  • Drainage is not achieved
  • Patient has raised temperature
  • Patient is immuno-compromised

Question 11

What antibiotics are used for dental infections?

Answer 11

• amoxicillin
• phenoxymethyl penicillin
• erythromycin
• clinamycin
• co-amoxiclav
• metronidazole

Question 12

what is the first choice of antibiotic therapy?

Answer 12

amoxicillin

Question 13

dose and notes for amoxicillin for dentoalveolar abscess

Answer 13

amoxicillin 250g capsule

dose : 500mg every 8 hours

reduced in children

Question 14

what is the mechanism of amoxicillin ?

Answer 14

• amoxicillin binds to wall of bacteria
• affects cell wall to break it down

Question 15

describe how bacteria is resistant to amoxicillin

Answer 15

• bacteria releases beta lactamase enzyme
• beta lactamase breaks down amoxicillin

Question 16

dose and notes for metronidazole

Answer 16

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

Question 17

what second line drug os prescribed if there is no response to amoxicillin?

dose and notes

Answer 17

co-amoxiclav

• 250mg/125mg tablet
• dose : 250mg/125mg every 8 hours
• is amoxicillin augmented with clavulanic acid

Question 18

describe the mechanism of co-amoxiclav on bacteria

Answer 18

clavulanic acid destroys beta lactamase enzyme

amoxicillin able to then bind to bacterial cell wall and break down

bacterial death

Question 19

dose and notes for clinamycin

Answer 19

• 150mg capsule
• dose : 150mg every 6 hours

Question 20

what should we consider when prescribing antibiotics?

Answer 20

• 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

Question 21

what is pericoronitis?

Answer 21

• 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

Question 22

what are the treatment options for pericoronitis?

Answer 22

• 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

Question 23

what is suppurative sialadenitis?

what treatment?

Answer 23

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

Question 24

what is peri-implantitis?

what treatment?

Answer 24

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