Infection Flashcards
Spread of infection, dental abscesses
Symptoms of pulp hyperaemia/ reversible pulpitis
Pain lasting for seconds
Pain stimulated by cold or sweet foods
Pain resolves after stimulus
Reversible inflammation of the pulp
Symptoms of irreversible pulpitis/ acute pulpitis
Constant Severe Pain
Likely to keep patient awake at night
Reacts to Thermal Stimuli
Poorly Localised Pain - referral of pain
No (or Minimal) Response to analgesics
How may acute periodontitis show up on a radiograph?
No Big radiolucency because no bone loss.
Loss of clarity of lamina dura
Radiolucent shadow - may indicate and “old” lesion e.g. flare-up of apical granuloma.
Delay in changes at the apex of the tooth - widening of apical periodontal space.
What is the cause of traumatic periodontitis?
Parafunction - tooth clenching or grinding.
How to treat traumatic periodontitis?
Occlusal adjustment - tooth somewhere is too high
Therapy for parafunction
What are symptoms of acute apical abscess?
Severe unremitting pain
Acute tenderness to percussionand mastication
Swelling
What happens once acute apical abscess perforates through bone?
Pain often remits
Swelling, redness and heat in soft tissues become increasingly apparent.
As swelling increases pain returns
There is INITIAL reduction in tenderness to percussion o the tooth as pus escapes into soft tissues.
Treatment for acute apical abscess?
Recommend optimal analgesia - NSAIDs
DO NOT PRESCRIBE ANTIBIOTICS unless signs of spreading systemic infection
Provide drainage
- Soft tissue incision intra/ extra-orally
Remove source/ cause of infection
- Extract tooth
- Pulp extirpation
- Periradicular surgery
What are local factors that would indicate need for antibiotics after pulpal infection?
Airway compromised
Dysphagia
Trismus
Lymphadenopathy - enlargement of lymph nodes, usually due to infection
Location (e.g. FOM)
What are some systemic medical conditions that may indicate need for antibiotics following a pulpal infection?
Immunocompromised patient - HIV, blood disorders, chemotherapy patients etc.
Previous infective endocarditis
Diabetes - poorly controlled
Elderly
Describe periapical granuloma (chronic apical periodontitis)
Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries).
What is the aetiology of a periapical (radicular) cyst?
Caries, trauma, periodontal disease
Death of dental pulp
Apical bone inflammation
Dental Granuloma
Stimulation of epitheilial rests of Malassez
Epithelial Proliferation
Periapical Cyst Formation
What is a periapical (radicular) cyst?
It arises from epithelial residues in the periodontal ligament as a result of inflammation - generally from necrotic pulp
Where does infection go if perforates ABOVE the insertion of mylohyoid muscle?
Sublingual space/ abscess
What space will infection go if perforates the bone BELOW the insertion of the mylohyoid muscle?
Submandibular abscess.
More problematic than sublingual as can then progress to other areas.
Where does the abscess go If a lower tooth perforates BELOW the lower insertion of a buccinator?
Into the mouth
Where does the abscess go if a lower tooth perforates ABOVE the lower insertion of buccinator?
Into the buccal space.
What abscess infections are more likely to go palatially?
Palatal root of molar or lateral incisors as their roots are placed more palatially.
What happens if infection spreads into superficial temporal, deep temporal, masseteric or pterygomandibular space (masseteric spaces)?
- Any of the surrounding masticatory muscles may go into spasm and cause severe trismus, not allowing the patient to open their mouth.
- Then can develop to going into retro/ lateral pharyngeal spaces
- Then pre-vertebral - very dangerous
Where would an infection from upper anterior teeth spread?
Lip
Nasolabial region
Lower eyelid
Where would infection from upper premolars and molars spread to?
Sinus
Cheek
Buccal
Infra-temporal region
Maxillary antrum (very rare)
Palate (less common)
Where would infection from lower anteriors spread?
Mental and submental space
Labial - more likely because labial bone is thinner - easier to diffuse through
Where would infection from lower premolars and molars gp?
Buccal space
Sub-masseteric space
Sublingual space
Submandibular space
Pterygomandibular
Lateral pharyngeal space
Retro-pharyngeal
What is the aim of treatment for abscesses/ spread of infection?
Establishment of drainage
Removal of source of infection
Antibiotic therapy (not always needed)
