Infections I Flashcards
Describe the clinical appearance of dentoalveolar abscess and how it forms
Infection at the apices of the roots de novo or within a pre-existing granuloma.
Localised to alveolar bone or burst into soft tissue or spread through fascial planes.
Describe the microbiology of a dentoalveolar abscess
Similar to necrotic pulp microflora
Describe the treatment of a dentoalveolar abscess
Drainage of pus and removal of source of infection by RCT or extraction
Antimicrobial agent is prescribed adjectively if there is systemic involvement or drainage cannot be established immediately.
Describe the clinical appearance of a periodontal abscess
Due to occlusion of the opening of the periodontal pocket or impaction of foreign bodies
Describe the microbiology of a periodontal abscess
Subgingival plaque is the source of organisms.
Anaerobic gram negative rods, alpha haemolytic and anaerobic streptococci and spirochaetes
Describe the treatment route of a periodontal abscess
Depends on the periodontal assessment either periodontal treatment or extraction.
Antimicrobial agent is prescribed adjectively if there is systemic involvement or drainage cannot be established immediately.
What are the risk factors of bacterial sialadenitis
- Dehydration
- Reduced salivary flow
- Local abnormalities in the salivary gland architecture
What are some of the causative microorganisms of bacterial sialadenitis
- Staphylococcus aureus
- Alpha haemolytic streptococcus
- Anaerobes
Describe the clinical picture/features/symptoms idk of bacterial sialadenitis
- Acute or chronic
- Painful
- Swelling
- Tender to touch
- Purulent discharge from duct orifice
- Overlying skin may be erythematous
- Patient may have fever, malaise and leukocytosis
What is needed for the diagnosis of bacterial sialadenitis
- History and clinical findings
- Microbiology analysis of pus sample
- After resolution of acute phase, investigate for correctable salivary gland abnormalities
What are the management options for bacterial sialadenitis
- Empirical antibiotic is either flucoxacillin or amoxicillin-clavulanate
- Clindamycin
- Increased fluid intake
- Surgical drainage in severe cases
Describe the aetiology of necrotising ulcerative gingivitis
- Strict anaerobic bacteria (spirochetes and fusobacterium)
What are the risk factors for necrotising ulcerative gingivitis
- Poor oral hygiene
- Smoking
- Stress
- Malnutrition
- Vitamin Deficiency
- Immunodeficiency
Describe the clinical picture idk of necrotising ulcerative gingivitis
- Rapid development
- Painful ulceration
- Gingival margin and inter dental papillae
- Halitosis
- Usually widespread but can be localised particularly to the lower anterior region
What is usually used for the diagnosis of necrotising ulcerative gingivitis
Microscopic examination of a gram-stained smear shows numerous fusobacteria, medium sized spirochetes and acute inflammation
What are the management options of necrotising ulcerative gingivitis
- Mechanical cleaning by scaling and debridement
- oral hygiene
- Metronidazole or Amoxicillin
- Chlorhexidine mouthwash BD
What is nova/cancrum oris/necrotising ulcerative stomatitis/fusospirochetal gangrene
Gangrene of the mouth and face
What are the risk factors for Noma/Necrotising ulcerative stomatitis
- Necrotising ulcerative gingivitis (NUG)
- Malnutrition
- Poor oral hygiene
- Debilitation after serious illness
- Immunosuppression
How does Noma/Necrotising ulcerative stomatitis spread
Through muscle and bone not anatomical spaces of head and neck
What is the cause of noma/necrotising ulcerative stomatitis
Anaerobic infection especially fusobacterium necrophorum
other bacteria: prevotella intermedia, alpha haemolytic streptococcus, actinomyces
What is actinomycosis and how does it typically present
Chronic, long standing infection of actinomyces
Typically presents as swelling at angle of the mandible in a young male leading to multiple draining sinuses if left untreated
What are some complications associated with actinomycosis
Abscess formation, draining sinus tracts, fistulae and tissue fibrosis
What are some of the risk factors of actinomycosis
- Dental caries and extraction
- Gingivitis and gingival trauma
- Poor oral hygiene
- Immunosuppression
What diagnostic sample is needed to diagnose actinomycosis
Aspirated pus with aggregates of actinomyces forming yellow particles “sulphur granules”
What treatment options are there for actinomycosis
Surgical drainage, removal or dead tissue in addition to long course of penicillin or erythromycin
What are the causative microorganisms of staphylococcal mucositis
Staphylococcus aureus
What are the risk factors of staphylococcal mucositis
Elderly
Semi-comatose
Dehydration
Crohn’s disease
Describe the clinical picture of staphylococcal mucositis
start with oral discomfort and mucosal erythema, progress to wide spread crusting and bleeding of the oral mucosa
Describe the treatment of staphylococcal mucositis
Regular oral lavage and anti-staphylococcal antibiotic
What bacteria causes tuberculosis and how is it spread
Mycobacterium tuberculosis
It spreads from droplets of sputum containing the bacteria
What oral manifestations can result from tuberculosis
Classical intramural lesion: ulcer on the dorsum of the tongue (can be other oral sites) with irregular and raised borders
What drugs can be used for the chemotherapy of tuberculosis
Rifampicin
Isoniazide
Ethambutol
Pyrazinamide
What can be used for the diagnosis of oral tuberculosis
- Histopathology
- Ziehl-Neelsen stain
- Microbiology culture on
- Lowen-stein-jensen’s media and prolonged incubation
- Molecular microbiology
- Tuberculin skin test positive in both active and vaccination
What bacteria causes syphilis and how is it transmitted
Treponema Pallidum (motile helical rods) Sexual contact or vertically or via blood transfusions
Describe the primary infection of syphilis
Highly infectious firm nodule at the site of inoculation that break down after a few days to leave painless ulcer with indurated margins, usually on genitals, lymphadenopathy, resolves in 3-12 weeks without scarring
Describe the secondary infection of syphilis
Highly infectious macular papular rash, mucosal ulcers and condylomata late, lymphadenopathy, febrile illness, malaise, 6 weeks after primary lesion resolves, resolves in 2-6 weeks
Describe the tertiary infection of syphilis
3-15 years after infection. Gummatous syphilis, neurosyphilis or cardiovascular syphilis. Oral lesions are either gamma in the palate or leukoplakia of the dorsum surface of the tongue
Describe congenital syphilis
Infected mother in primary or secondary stage pass infection to the developing foetus causing nasal deformity and hutchinson’s triad
What are he treatment options for syphilis
Penicillin
What are the Standard Precautions that should be taken for all patients
- Hand hygiene
- Personal protective equipment
- Environmental cleanliness
- Equipment cleanliness and sterilisation
- Prevention of occupational exposure
- Management of blood and body fluid spillage
- Safe handling of uniforms
- Safe disposal of waste
When are transmission based precautions used
When Standard infection control procedures (SICPs) are insufficient to prevent transmission of an infectious agent
What kinds of transmission based precautions are there
- Contact precautions
- Droplet precautions
- Airborne precautions
