diseases of the teeth and gums - lecture 10 Flashcards
on inspection of lips what do you note?
color, moisture, lumps, ulcers, cracking or scaliness
on inspection of oral what do you note?
color, ulcers, and nodules
on inspection of gum and teeth what do you note?
color, presence, and position of teeth
on inspection of roof of mouth what do you note?
color
what do you percuss in intra-oral exam?
symptomatic tooth/teeth
what do you inspect in intra-oral exam?
color, symmetry (esp. tonsils), presence of exudate, swelling, ulceration or tonsillar enlargement
what do you palpate in infra-oral exam?
in and around the tongue and gingiva (to feel for masses that you couldn’t otherwise see)
what is the health status of oral cavity linked to?
cardiovascular disease, diabetes, and other systemic illnesses
assume any head and neck infection or swelling is what?
odontogenic (arising from the teeth) in origin until proven otherwise
what type of infection are dental caries?
bacterial
what do dental caries cause?
- demineralization and destruction of the hard tissues of the teeth
- Impacts enamel, dentin, and cementum
what are dental caries the result of?
production of acid by bacterial fermentation of food debris accumulated on the tooth surface.
if demineralization exceeds saliva and other remineralization factors?
If demineralization exceeds saliva and other remineralization factors, such as from calcium and fluoridated toothpastes, these once hard tissues progressively break down, producing dental caries
dental infection risk factors
- Low socioeconomic status/poor access to care
- Poor oral hygiene
- Poor nutrition (milk bottle caries)
- Inadequate fluoride
- Decreased salivary flow
- Use of anticholinergic medications
bacteria that causes dental caries?
streptococcus mutans
majority of dental problems can be avoided through?
flossing, brushing, with fluoride toothpaste and biannual cleaning
what is linked to severe periodontal disease?
SMOKING
-AVOID IT!!!
pathophysiology of dental caries
Caries or trauma can lead to pulpal death which, in turn, leads to infection of pulp and/or abscess of adjacent tissues via direct or Hematogenous bacterial colonization
what is a systemic risk factor for periodontal disease?
diabetes mellitus
-longer duration of DM and poor metabolic control increases the risk and severity of periodontal disease
pregnancy gingivitis
approximately 50% experience condition due to hormonal changes promoting increase in alterations in types and amounts of pathogens
pyogenic granuloma
occur in 1% of women
- Exaggerated response to irritation
- (red bump and bleeds like crazy; usually benign)
s/sx of dental infection
- Pain at infected site or referred to ears, jaw, cheek or sinuses
- Sensitivity to hot or cold stimuli (hint for carie)
- Pain on biting
- throb along nerve pathway (CN V)
what should children < 4y.o with stiff neck, street and dysphagia worked up for?
retropharyngeal abscess secondary to molar infection (signs of bacterial infection)
physical exam for dental infection
assess for:
- Gingival edema and erythema
- Cheek or intraoral swelling
- Presence of fluctuant mass
- suppuration (Swelling, pus-like) of gingival margin or tooth
- Lymphadenopathy
what may severe dental infection present with?
dysphagia (difficulty swallowing), fever, or signs of airway compromise
do you perform lab tests for dental infections?
NO, unless pt looks acutely ill
if pt is acutely ill, what do you perform?
- CBC w/diff (tells you if bacterial vs viral)
- C&S (aerobic and anaerobic cultures)
what are the most likely organisms involved in dental infections?
anaerobic gram-negative rods and anaerobic gram-positive cocci
imaging for dental infections?
CT to determine extent and density of the swelling, locating the abscess within the soft tissue and bone. This aids in determining treatment course.
diff dx for dental infections?
- Bacterial or viral throat infection (use CBC w/diff)
- Otitis media (if dental infection present, think referred pain)
- Sinusitis (important to know if complicated or uncomplicated)
- Viral or aphthous stomatitis
- Temporomandibular joint (TMJ) dysfunction (myofascial pain)
- Parotitis – most concerned about mumps
- Cyst
- Jaw pain can be an angina equivalent
dental infection txt
PenVK & NSAID
also amox
first line abx for dental infection?
pen VK
second line abx for dental infection?
clindamycin +/- metronidazole
use clindamycin for what?
If long-standing infection or previously treated infection that doesn’t respond to first line treatment
what do you use if patient is allergic to penicillin?
clindamycin or erythromycin
patient education for dental infections
- Biannual dental visits
- Nutritional education
- Limit the frequency of sugar/carbonated drinks and sugary or sticky foods
- In young children, avoid sleeping with a bottle to decrease the chance of milk bottle dental caries
- Brush and floss daily
- Caretakers should tend to their personal oral hygiene, +/- chlorhexidine rinses in 1st 3 years of the child’s life to decrease the risk of transmission of the caries causing microorganisms
complications of dental infections?
- Ludwig’s angina
- vincent’s angina (‘trench mouth’)
- retropharyngeal infection (abscess)
clinical pearls of dental infections?
- Do not ignore toothache pain
- Treat patients with facial swelling aggressively, as infection can spread quickly
- Don’t prescribe opioid for tooth pain
