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BDS4 Oral Surgery > Infection symposium > Flashcards

Infection symposium Flashcards

1
Q

2 most common sources of odontogenic infection

A
  • dental abscess
  • pericoronitis
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2
Q

Lower molar spread

A
  • submandibular
  • buccal
  • sublingual
  • vestibular
  • lateral phyarngeal space (more concerning- airway)
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3
Q

upper molar spread

A
  • buccal
  • palatal
  • max sinus
  • vestibular spaces
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4
Q

upper canine spread

A

infraorbital region

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5
Q

what is infraorbital spread a risk for

A

cavernous sinus thrombosis as such a long root

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6
Q

what teeth are most likely to give palatal spread

A
  • upper lateral incisors
  • palatal root of upper 6
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7
Q

how do you initially manage a patient with infection

A
  • assess general health (pale, clammy, nauseous, holding side of face etc)
  • problems with swallowing or breathing, hot potato sign
  • ask how long its been there for
  • how fast was the onset
  • are they in pain (won’t affect management much)
  • have they taken analgesia

MH
- allergies
- changes to medications

Smoking and alcohol but limited hx

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8
Q

Examining a pt with infection

A
  • EO: lymph nodes, feel for mandibular border, check their eye
  • IO: FoM, buccal sulcus, pharyngeal area, deviation of the uvula, are they able to protrude their tongue, trismis
  • then focus on big swelling
  • carious molars? (TTP, mobility, radiograph if possible)
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9
Q

what does deviation of the uvula indicate

A

odema collecting (not a good sign)

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10
Q

what is the most imporant thing to do with a localised infection

A

remove the source of infection; don’t let a pt just have antibiotics when you know you can do something

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11
Q

If you can’t remove the source of infection, what would you do

A
  • incise and drain
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12
Q

if you can’t remove the source of infection and you can’t incise and drain what do you do

A

give antibiotics

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13
Q

if it is difficult to get the pt numb, what anesthetic can you give and why does it work better

A

Mepivacaine
- ph is closer to abscess so can help to get them numb

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14
Q

what is ludwigs angina

A

Submandibular, sublingual and submental spaces bilateral swelling

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15
Q

what to do if someone has ludwigs angina

A

phone an ambulance or could lose airway

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16
Q

What does SIRS stand for

A

systemic inflammatory response syndrome

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17
Q

What are the signs of SIRS

A
  • temperature (<36oC; >38oC)
  • heart rate (>90bpm)
  • respiratory rate (>20 breaths per min)
  • white blood cell count (<4 or >12 g/L)
  • blood glucose level (>7.7ml mmol, not diabetic)
  • altered mental state

2 or more + infection consider sepsis

18
Q

what are more serious signs of infection

A
  • fever
  • dehydration
  • rapid progression of swelling
  • increasing trismis
  • quality and location of swelling
  • elevation of tongue, firmness of Fom
  • difficulty with speech (dysarthia) and swallowing (dysphagia)
  • involvement of eye
19
Q

what patient factors might make you more concerned

A
  • diabetic
  • on steroids
20
Q

if the infection is deemed not severe, what do you do

A
  • worsening advice given e.g. don’t lie flat, if it gets worse go to a and e
21
Q

when would you use antibiotics with a local infection

A
  • local measures have failed e.g. tooth removed but swelling remained
  • patient is systemically unwell
  • cellulitis is present
  • the infection is spreading
22
Q

what is a dental abscess

A

infection secondary to odontogenic source, collection of suppuration (pus)

23
Q

tx options for dental abscess

A
  • RCT
  • extraction
24
Q

if you can’t anesthetise the tooth how do you proceed

A
  • IDB and buccal infiltration
  • give max dose (try intraligamentary and lingual too)
  • give it time
  • explain to patient it’s due to the acidic nature of infection and that this sometimes happens
  • apex is probably the problem, soft tissues should be numb so incise and drain
  • reassure, continue on pain management, give worsening advice
  • tell them to come back and write down that you said to do that
25
Q

how to incise and drain an abscess

A
  • incise 1cm down to bone perpendicular as possible to abscess with scalpal
  • use e.g. howarths to open up incision
26
Q

Where can an infection in the mandible spread to

A
  • sublingual
  • submandibular
  • submasseteric (trismis)
  • buccal
  • submental
27
Q

how to do an extra oral exam of someone with a swelling

A
  • feel full border of mandible
  • palpate LNs
  • ask them to open their mouth as much as possible before it is painful
  • try and then open their mouth further, if they can’t it’s due to submasseteric infection
28
Q

how to do an IO exam of someone with an infection

A
  • identify source
  • which teeth are TTP
  • mobility
  • sinuses
  • feel sulcus (bouncing? hot? painful?)
  • compare to unaffected side
  • tongue grazed?
  • feel floor of mouth (should be bouncy, not hard)
  • uvula
  • oropharynx
29
Q

in what position should you examine the patient

A

DO NOT put them supine or could lose airway

30
Q

if they’ve taken paracetamol how could that affect your examination of them

A

could be masking a temperature that they have

31
Q

Management of spreading infection - what antibiotics would you give

A

Pen V and metronidazole

new evidence that more effective together than if just one

32
Q

management of spreading infection - what obs should you take

A
  • obs machine = heart rate, oxygen saturation and blood pressure
  • are their lips blue?
  • do they look pale?
33
Q

normal resting heart rate

A

60-90bpm

34
Q

normal temperature

A

37oC

35
Q

normal o2 saturation

A

96-100%

36
Q

normal blood pressure

A

80-120(systolic)-60-80 (diastolic)

37
Q

what is the risk of not treating someone with a spreading infection

A
  • could get sepsis
  • life threatening condition due to organ failure
  • orbital swelling can spread higher, cavernous sinus thrombosis (straight to a and e)
  • media stenitis when spreads lower (affects thoracic organs)
38
Q

what is septic shock

A

hypovolemia leading to organ failure

39
Q

what are the sepsis 6

A

3 go in:
- antibiotics
- oxygen
- IV fluid

3 go out:
- urine
- blood
- lactate

40
Q

what protein in the blood is very high if someone is unwell

A

C-reactive protein

41
Q

What swellings can dentists drain

A

only IO ones

42
Q

if you need to get someone to hospital what is it important that you tell them

A
  • to go straight there
  • do not eat anything

BDS4 Oral Surgery (10 decks)

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