diseases of the teeth and gums - lecture 10

Question 1

on inspection of lips what do you note?

Answer 1

color, moisture, lumps, ulcers, cracking or scaliness

Question 2

on inspection of oral what do you note?

Answer 2

color, ulcers, and nodules

Question 3

on inspection of gum and teeth what do you note?

Answer 3

color, presence, and position of teeth

Question 4

on inspection of roof of mouth what do you note?

Answer 4

color

Question 5

what do you percuss in intra-oral exam?

Answer 5

symptomatic tooth/teeth

Question 6

what do you inspect in intra-oral exam?

Answer 6

color, symmetry (esp. tonsils), presence of exudate, swelling, ulceration or tonsillar enlargement

Question 7

what do you palpate in infra-oral exam?

Answer 7

in and around the tongue and gingiva (to feel for masses that you couldn’t otherwise see)

Question 8

what is the health status of oral cavity linked to?

Answer 8

cardiovascular disease, diabetes, and other systemic illnesses

Question 9

assume any head and neck infection or swelling is what?

Answer 9

odontogenic (arising from the teeth) in origin until proven otherwise

Question 10

what type of infection are dental caries?

Answer 10

bacterial

Question 11

what do dental caries cause?

Answer 11

• demineralization and destruction of the hard tissues of the teeth
• Impacts enamel, dentin, and cementum

Question 12

what are dental caries the result of?

Answer 12

production of acid by bacterial fermentation of food debris accumulated on the tooth surface.

Question 13

if demineralization exceeds saliva and other remineralization factors?

Answer 13

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

Question 14

dental infection risk factors

Answer 14

• Low socioeconomic status/poor access to care
• Poor oral hygiene
• Poor nutrition (milk bottle caries)
• Inadequate fluoride
• Decreased salivary flow
• Use of anticholinergic medications

Question 15

bacteria that causes dental caries?

Answer 15

streptococcus mutans

Question 16

majority of dental problems can be avoided through?

Answer 16

flossing, brushing, with fluoride toothpaste and biannual cleaning

Question 17

what is linked to severe periodontal disease?

Answer 17

SMOKING

-AVOID IT!!!

Question 18

pathophysiology of dental caries

Answer 18

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

Question 19

what is a systemic risk factor for periodontal disease?

Answer 19

diabetes mellitus

-longer duration of DM and poor metabolic control increases the risk and severity of periodontal disease

Question 20

pregnancy gingivitis

Answer 20

approximately 50% experience condition due to hormonal changes promoting increase in alterations in types and amounts of pathogens

Question 21

pyogenic granuloma

Answer 21

occur in 1% of women

• Exaggerated response to irritation
• (red bump and bleeds like crazy; usually benign)

Question 22

s/sx of dental infection

Answer 22

• 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)

Question 23

what should children < 4y.o with stiff neck, street and dysphagia worked up for?

Answer 23

retropharyngeal abscess secondary to molar infection (signs of bacterial infection)

Question 24

physical exam for dental infection

Answer 24

assess for:

• Gingival edema and erythema
• Cheek or intraoral swelling
• Presence of fluctuant mass
• suppuration (Swelling, pus-like) of gingival margin or tooth
• Lymphadenopathy

Question 25

what may severe dental infection present with?

Answer 25

dysphagia (difficulty swallowing), fever, or signs of airway compromise

Question 26

do you perform lab tests for dental infections?

Answer 26

NO, unless pt looks acutely ill

Question 27

if pt is acutely ill, what do you perform?

Answer 27

• CBC w/diff (tells you if bacterial vs viral)

- C&S (aerobic and anaerobic cultures)

Question 28

what are the most likely organisms involved in dental infections?

Answer 28

anaerobic gram-negative rods and anaerobic gram-positive cocci

Question 29

imaging for dental infections?

Answer 29

CT to determine extent and density of the swelling, locating the abscess within the soft tissue and bone. This aids in determining treatment course.

Question 30

diff dx for dental infections?

Answer 30

• 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

Question 31

dental infection txt

Answer 31

PenVK & NSAID

also amox

Question 32

first line abx for dental infection?

Answer 32

pen VK

Question 33

second line abx for dental infection?

Answer 33

clindamycin +/- metronidazole

Question 34

use clindamycin for what?

Answer 34

If long-standing infection or previously treated infection that doesn’t respond to first line treatment

Question 35

what do you use if patient is allergic to penicillin?

Answer 35

clindamycin or erythromycin

Question 36

patient education for dental infections

Answer 36

• 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

Question 37

complications of dental infections?

Answer 37

• Ludwig’s angina
• vincent’s angina (‘trench mouth’)
• retropharyngeal infection (abscess)

Question 38

clinical pearls of dental infections?

Answer 38

• Do not ignore toothache pain
• Treat patients with facial swelling aggressively, as infection can spread quickly
• Don’t prescribe opioid for tooth pain