Infection symposium Flashcards
2 most common sources of odontogenic infection
- dental abscess
- pericoronitis
Lower molar spread
- submandibular
- buccal
- sublingual
- vestibular
- lateral phyarngeal space (more concerning- airway)
upper molar spread
- buccal
- palatal
- max sinus
- vestibular spaces
upper canine spread
infraorbital region
what is infraorbital spread a risk for
cavernous sinus thrombosis as such a long root
what teeth are most likely to give palatal spread
- upper lateral incisors
- palatal root of upper 6
how do you initially manage a patient with infection
- 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
Examining a pt with infection
- 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)
what does deviation of the uvula indicate
odema collecting (not a good sign)
what is the most imporant thing to do with a localised infection
remove the source of infection; don’t let a pt just have antibiotics when you know you can do something
If you can’t remove the source of infection, what would you do
- incise and drain
if you can’t remove the source of infection and you can’t incise and drain what do you do
give antibiotics
if it is difficult to get the pt numb, what anesthetic can you give and why does it work better
Mepivacaine
- ph is closer to abscess so can help to get them numb
what is ludwigs angina
Submandibular, sublingual and submental spaces bilateral swelling
what to do if someone has ludwigs angina
phone an ambulance or could lose airway
What does SIRS stand for
systemic inflammatory response syndrome
What are the signs of SIRS
- 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
what are more serious signs of infection
- 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
what patient factors might make you more concerned
- diabetic
- on steroids
if the infection is deemed not severe, what do you do
- worsening advice given e.g. don’t lie flat, if it gets worse go to a and e
when would you use antibiotics with a local infection
- local measures have failed e.g. tooth removed but swelling remained
- patient is systemically unwell
- cellulitis is present
- the infection is spreading
what is a dental abscess
infection secondary to odontogenic source, collection of suppuration (pus)
tx options for dental abscess
- RCT
- extraction
if you can’t anesthetise the tooth how do you proceed
- 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
how to incise and drain an abscess
- incise 1cm down to bone perpendicular as possible to abscess with scalpal
- use e.g. howarths to open up incision
Where can an infection in the mandible spread to
- sublingual
- submandibular
- submasseteric (trismis)
- buccal
- submental
how to do an extra oral exam of someone with a swelling
- 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
how to do an IO exam of someone with an infection
- 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
in what position should you examine the patient
DO NOT put them supine or could lose airway
if they’ve taken paracetamol how could that affect your examination of them
could be masking a temperature that they have
Management of spreading infection - what antibiotics would you give
Pen V and metronidazole
new evidence that more effective together than if just one
management of spreading infection - what obs should you take
- obs machine = heart rate, oxygen saturation and blood pressure
- are their lips blue?
- do they look pale?
normal resting heart rate
60-90bpm
normal temperature
37oC
normal o2 saturation
96-100%
normal blood pressure
80-120(systolic)-60-80 (diastolic)
what is the risk of not treating someone with a spreading infection
- 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)
what is septic shock
hypovolemia leading to organ failure
what are the sepsis 6
3 go in:
- antibiotics
- oxygen
- IV fluid
3 go out:
- urine
- blood
- lactate
what protein in the blood is very high if someone is unwell
C-reactive protein
What swellings can dentists drain
only IO ones
if you need to get someone to hospital what is it important that you tell them
- to go straight there
- do not eat anything
