Dentoalveolar and Salivary Gland Infections

Question 1

What is dentoalveolar infection?

Answer 1

Used to describe pyogenic conditions which affect teeth and supporting structures

Question 2

How is periodontal abscess different from dentoalveolar abscess?

Answer 2

Periodontal abscess is associated with vital pulp

Question 3

Describe an acute dentoalveolar abscess

Answer 3

Represents onset of a suppurative process at the apex of the root of a tooth with a necrotic pulp

Question 4

Name 3 ways bacterial can gain access to apical tissue

Answer 4

1. Direct spread from pulp chamber
2. Through periodontal membrane on root surface
3. Local blood vessels

Question 5

What is the relationship between dentoalveolar infection and bacteria?

Answer 5

• No single causative pathogen has been identified

- Considered a polymicrobial infection

Question 6

Name 5 dentoalveolar infections of the alveolar cavity

Answer 6

1. Periodontal abscess
2. Dentoalveolar abscess
3. Ludwig’s angina
4. Osteomyelitis
5. Actinomycosis

Question 7

What causes a periodontal abscess?

Answer 7

A blockage, occasionally due to impaction of foreign bodies into an established periodontal pocket

Question 8

`Name 4 gram-negative obligate anaerobe species associated with periodontal abscess

Answer 8

1. Porphyromonas spp. (P. gingivalis)
2. Prevotella spp. (P. intermedia)
3. Fusobacteria spp. (F. nucleatum)
4. Spirochaetes (T. denticola)

Question 9

Name a facultative anaerobe species associated with periodontal abscess

Answer 9

Streptococci spp. (S. mutans)

Question 10

What 4 processes usually cause dentoalveolar abscess?

Answer 10

1. Extension of caries into dentine
2. Pulpal exposure via trauma
3. Via periodontium
4. Via circulation

Question 11

Name 5 obligate anaerobes associated with dentoalveolar abscess

Answer 11

1. Peptostreptococcus spp.
2. Porphyromonas gingivalis
3. Prevotella intermedia
4. Prevotella melaninogenica
5. Fusobacterium nucleatum

Question 12

Name 3 facultative anaerobes associated with dentoalveolar abscess

Answer 12

1. Streptococcus milleri
2. Streptococcus sanguinis
3. Actinomyces spp.

Question 13

Name 2 ways samples can be collected from dentoalveolar abscesses

Answer 13

1. Direct aspiration of pus into sterile syringe

2. Use of paper points

Question 14

What are 3 methods of laboratory investigations of dentoalveolar abscesses?

Answer 14

1. Microscopy
2. Culture
3. Sensitivity

Question 15

What can occur if dental abscesses are not adequately treated?

Answer 15

They progress and infection can spread beyond oral cavity

Question 16

How does Ludwig’s angina arise?

Answer 16

Spread of infection from dental abscess to fascial spaces

Question 17

Name 4 methods of direct spread of infection of dentoalveolar abscesses

Answer 17

1. Spread into superficial soft tissues
2. Spread into adjacent fascial spaces
3. Spread into alveolar bone
4. Spread into maxillary sinus

Question 18

Name 2 methods of indirect spread of infection of dentoalveolar abscesses

Answer 18

1. Lymphatic (via lymphatic system)

2. Haematogenous (via bloodstream)

Question 19

Where does infection in the anterior mandible spread to?

Answer 19

Sublingual space

Question 20

Where does infection in the posterior mandible spread to?

Answer 20

Submandibular space

Question 21

Why must infection of the 3rd molar be treated with particular caution?

Answer 21

It is found at the junction of a number of different fascial spaces and can easily spread along fascial planes and compromise the airway

Question 22

What is Ludwig’s angina?

Answer 22

Rapidly spreading cellulitis involving the floor of the mouth

Question 23

What is the major complication with Ludwig’s angina?

Answer 23

Swelling of the anterior soft tissues of the neck has potential for airway obstruction

Question 24

Name 4 commonly isolate organisms involved in Ludwig’s angina

Answer 24

1. Anaerobic Gram negative bacilli
2. Alpha haemolytic streptococci
3. Staphylococci
4. Enterobacteria

Question 25

Describe the bacteriology of Ludwig’s angina with regards to synergistic effects

Answer 25

• Mixed aerobic / anaerobic infection
• Combination has synergistic effect
• Production of proteases which contribute to rapidly spreading cellulitis

Question 26

What is sialadentitis?

Answer 26

Inflammation of salivary glands due to infection

Question 27

Why does sialadenitis not occur in healthy individuals?

Answer 27

Bacteria cannot ascend into parotid duct and invading salivary gland by natural flushing activity of saliva

Question 28

Describe Mumps virus

Answer 28

RNA paramyxovirus spread by direct contact with saliva and droplet spread

Question 29

When does bacterial sialadenitis occur?

Answer 29

In patients with reduced salivary flow or abnormalities in gland architecture

Question 30

Name 4 possible causes of reduced salivary flow

Answer 30

1. Drugs
2. Irradiation
3. Sjogren’s syndrome
4. Dehydration

Question 31

What drugs may reduce salivary flow?

Answer 31

Opioids

Question 32

Name 3 gland architecture abnormalities which can cause sialadenitis

Answer 32

1. Sialoliths (stones)
2. Strictures (narrowing of duct)
3. Sialectasis (dilatation of ducts)

Question 33

How may diet affect salivary flow?

Answer 33

Salivary flow is reduced if food intake is reduced

Question 34

Name 2 bacteria commonly associated with bacterial sialadenitis

Answer 34

1. Alpha-haemolytic streptococci

2. Staphylococcus aureus

Question 35

Name 4 bacteria occasionally associated with bacterial sialadenitis

Answer 35

1. Haemophilus spp.
2. Eikenella corrodens
3. Bacteroides spp.
4. Facultative anaerobic streptococci