Exam 2 sweep 1 Flashcards
Most important priority in odontogenic infections
remove source of infection
Aerobic in —% of odontogenic infections
25
2 stage progression for
odontogenic infections
- initiation by aerobic bacteria
- second stage by anaerobic bacteria
In —– stage, abscess becomes walled off
second
Odontogenic infection - natural course
Cellulitis, abscess, fistula
Abscess is
primarily anaerobes, pus filled cavity
Bone thickness, muscle attachment, root angulation are all determinants of
spread
Max infection spread -
thin labial bone, thick palatal bone, roots of anterior teeth generally below muscles, roots of posterior teeth above muscles
Mand infection spread determined by
thin labial bone, thin lingual bone, mylohyoid attachment
Ludwig’s angina linked to
bilateral submandibular, sublingual, submental cellulitis
Trismus in pterygomandibular space - Direct spread from
submandibular or sublingual infection
Needle track infection
Lateral pharyngeal space
Vascular necrosis and hemorrhage
Erosion into oral cavity with aspiration of pus
Direct airway impingement
Spread to superior mediastinum
Spread into Danger Space with access to inferior mediastinum
With invasion into —– or ——, admission is needed
secondary space or neck space
Trismus under —– consider referral/admission
Trismus under —– admit
15 mm,
10mm
Temperature
—– indicates systemic involvement
Oral temperature not accurate
> 101
Malaise —-
how is the patient coping with infection
—– not a good measure of severity of odontogenic infection
WBC
-Elevated early and remains high throughout treatment
Criteria for Referral/Admission
Rapid onset not responsive to appropriate treatment
Poor compliance
Severe indurated swelling Secondary space involvement Trismus <15mm
Temperature >101
Airway concerns Compromised host defense
Principles of Incision and Drainage
Aspirate through sterile prep skin Incise dependant area
Incise healthy tissue
Explore entire space
Explore adjacent spaces Drain all spaces
PCN severe allergy - use
Clindamycin, 300mg q8h x 7 days
Clarithromycin, 500mg q12h x 7days
PCN mild allergy - use
Cephalexin, 500mg q6h x 7 days
Cephadroxil, 500mg q12h x 7 days May also add Metronidazole to these
Moderate infection - use
PCN VK, 500mg q6h plus Metronidazole, 500 mg q 8h
Mild infection - use
PCN VK, 500mg q6h x 7 days
SBE -
Extraction produces bacteremia
Agglutinating antibodies bind bacteria
Clumped AB/bacteria complex circulates
Infect sterile thrombus on diseased tissue or prosthetic material Infection
Who now requires prophylaxis w/antibiotics
Prosthetic cardiac valve
Previous infective endocarditis
Cardiac transplant patients with valve defects Specific At Risk Congenital Heart Disease
13% of all SBE due to
dental work
Endocarditis
Bacteremia 15 minutes or less Few species cause
May occur even with prophylaxis No human trials
High dose of cidal drug is needed
Standard prophy
Amoxicillin 2gm (50mg/kg) po 1 hour pre
Parenteral
Ampicillin 1gm (50mg/kg) IV or IM 30 minutes pre-op
With non-coronary vascular grafts Prophylaxis for
6 months
Forgot prophylaxis
Give within
2 hours
TJR Prophylaxis Regimen
Amoxicillin or Cephalexin 2 gm
Ampicillin 2 gm or Cefazolin 1 gm IV or IM Clindamycin 600mg PO or IV
Time antibiotic correctly
First dose —–
Repeat dose at—–
before surgery
1⁄2 therapeutic interval
Correct prophy does at
4x MIC, 2x therapeutic dose
Indications for Prophylaxis for Dentoalveolar Surgery
Poorly controlled metabolic disease Immunosuppressed
Surgery longer than 3 hours Contaminated wound
Insertion of major foreign body
Surgery adjacent to sinus such as implant placement or graft
Bony impactions
Same regimen as SBE prophylaxis
Surgery
Inflammatory papillary hyperplasia Inflammatory fibrous hyperplasia Frenal attachments
Preserve the ——. Especially important for ——-
buccal plate
maxillary molars and canine eminences
Types of alveoloplasty
Digital compression
Intraseptal
Surgical - reflection of facial mucoperiosteal flap and removal of undercuts and irregularities
Intraseptal Alveoloplasty
Indications :
Ridge with regular contour
Adequate height
Undercut to the depth of the labial vestibule
Surgical alveoloplasty with
full thickness flap
Buccal Exostosis Less common than ---------- torus Usually in ------------ Indications for reduction ---------
maxillary or mandibular
maxillary molar areas
Interfere with stability or retention of denture Chronic traumatic ulceration
After max tuberosity surgery, at least
2-3mm sulcus height distal to tuberosity needed
Inflammatory Papillary Hyperplasia
Treatment
Non surgical
-Proper denture adjustment, Antifungals e.g.: Nystatin
Surgical excision
Abrasion of the superficial layer of palatal mucosa
Inflammatory Fibrous Hyperplasia
Denture rim flap of tissue*
Reline denture after tx.
If lesion persists for —— or more with no known etiology, biopsy
2 weeks
Biopsy Any inflammatory lesion that does not
respond to local therapy
within
two weeks
Biopsy Persistent changes in
epithelial tissue
BIopsy Lesions that interfere with
function
Biopsy Bone lesions that are not
identifiable by
clinical and radiological findings
Bulla
Loculated fluid in or under the epithelium of skin or mucosa
Erosion
Superficial ulcer (excoriation)
Macule
Circumscribed area of color change without elevation
Papule
Small palpable mass, elevated above the epithelial surface
Nodule
Large palpable mass, elevated above the epithelial surface
Plaque
Flat elevated lesion, the confluence of papules
Pustules
Cloudy or white vesicle (PMN leukocytes)
Scale
Macroscopic accumulation of keratin
Ulcer
Loss of epithelium
Color
Red more ominous than white
Biopsy if Persistent —– changes
Any ——- under normal tissue
Inflammatory changes of unknown cause
persistent for long periods
hyperkeratotic
tumescence
Biopsy types
Oral Cytology
Aspirational
Incisional
Excisional
Cytology indications
Large areas of mucosal change
Need for monitoring dysplastic changes
Cytology technique
Moistened tongue depressor or cement spatula
Lesion scraped
Smear and fixate over glass slide
Aspiration indications
Lesions suspected to contain fluid
Intraosseous lesions
Aspiration technique
18 G needle, 5 or 10 ml syringe Needle inserted during aspiration Repeated repositioning
Cortical perforation if needed
Incisional indications
Extensive lesion (>1 cm) Hazardous location High suspicion of malignancy Closure
Incisional technique
Representative area Wedge fashion (deep and narrow) Include normal tissue
Excisional indications
Small lesion (<1 cm) Benign appearance Closure
Excisional tech
Entire lesion
Margin of normal tissue (2
-
3mm)
When doing soft tissue biopsy and administering local, Wait —- for hemostasis
10 minutes
Soft tissue biopsy - borders:
2-3 mm border for benign, 5 mm for malignant
Use traction sutures whenever possible for
soft tissue biopsy
Specimen care
10% formalin solution (4% formaldehyde)
20 times the volume of the specimen
Totally immersed in solution
Following soft tissue biopsy for closure,
Undermine mucosa Primary closure Surgical dressing
Aspirate - ——– lesions
Radiolucent
For intraosseous bone biopsy - —–mm bone around lesion
4-5
Osseous window
Burs Round
Trephine Rongeurs
Avoid anatomic structures Submit osseous window with specimen
