M25 - Abscesses Flashcards
Give dental abscesses synonyms.
- Dentoalveolar abscess
- Periapical abscess
- Apical abscess
- Chronic periapical dental infection
- Dental pyogenic infection
- Periapical periodontitis
Describe the development of dentoalveolar abscesses.
• Carious lesion • Bacteria spread to pulp – via dentinal tubules • Acute inflammation – pulpitis – necrosis of the pulp • Chronic localised – abscess – pulp remains viable
what causes a dentoalveolar abscess?
• Traumatic fracture or tooth wear • Traumatic exposure during treatment • Via Periodontal membrane & root canals • Anachoresis – seeding via pulpal blood supply – rare
what do dentoalveolar abscesses remain?
- Acute or chronic
* tender to pressure
how does dentoalveolar access soft tissue?
– Direct spread
– Indirect spread
what are the symptoms of abscesses?
- Pain
- Swelling
- Erythema
- Suppuration
What are key factors of abscesses?
- Number of virulent bacteria • Local and systemic immunity
* Anatomical damage
Name facultative anaerobes from dentoalveolar abscesses.
– S. anginosus-group • (especially S. anginosus) – S. oralis-group – Enterococcus faecalis – Actinomyces spp.
Name strict anaerobes from dentoalveolar abscesses.
– Peptostreptococcus spp. – Porphyromonas gingivalis – Tanerella forsythia – Prevotella spp (10-87%). – Fusobacterium nucleatum
Describe the treatment of abscesses.
• Specimen collection – needle aspiration (anearobes) • Local Management – Drain the pus (incision through root canal) - remove residual pus through incision – e.g. buccal sulcus • Treatment – Amoxicillin or clarithromycin – Metronidazole
what is a periodontal abscess?
Infection of periodontium acute or chronic
what is the cause of periodontal abscesses?
– Occlusion of opening
prevents drainage
– Impaction of foreign objects
what are the symptoms of a periodontal abscess?
– Sudden onset
– Swelling
– Redness/tenderness
– May spread & destroy bone/soft tissue
What organisms are involved in abscesses?
• GNABs – Porphymonas, Prevotella • Streptococci – variety • Others – Treponema, Actinomyces, – F. nucleatum – Propionobacterium
Describe the extraction of of abscesses.
– severe disease
– poor prognosis
– recurrent infection
Describe the drainage of abscesses.
– gentle scaling
– irrigate with 0.9% saline
– antibiotics:
Penicillin, Erythromycin or metronidazole
What gram negative bacteria are associated with infection after root canal treatment?
– F. nucleatum
– Prevotella
– Campylobacter rectus
What gram positive bacteria are associated with infection after root canal treatment?
– S. oralis, S. mitis, S. anginosus, S. gordonii – Enterococcus faecalis – Candida albicans – Lactobacilli
Describe features of enterococcus faecalis.
- Facultative anaerobe
- Common in intestine
- Can be eradicated in small numbers
- Difficulty comes with high levels
What are key features of enterococcus faecalis?
– Adhere to collagen
– Persistence in nutrient poor environments
– Biofilm formation
– Resistant to calcium hydroxide & sodium hypochlorite
– Low-high pH range
– Salinity & temp resistance
Describe ‘dry’ socket.
- Localised infection
- Following extraction the socket fails to heal
- Sparse anaerobic infection
what is the prophylaxis of ‘dry socket’?
chlorohexidine irrigation prior to & post extraction
what is the treatment for ‘dry socket’?
antispeptic dressing & metronidazole
Describe how abscesses are caused by dental implants.
• Endentulous treatment of dental implants
– surgical trauma (overheating of bone or compression of bone chips)
– persistence of root particles or foreign bodies
– infection of implant surface
(saliva & bacterial plaque)
– implant into infected site
• Immediate or delayed abscesses
– S. aureus (0.7-15%) & S. epidermidis (4-65%)
– Fusobacteria, anaerobic Streptococci
• Remove implant & antibiotic therapy
What is Ludwig’s angina?
• Acute Cellulitis
• Bilateral infection
– sublingual & submandibular spaces
What are the symptoms of Ludwig’s angina?
– Base of mouth & tongue
swell
– Brawny oedema & swelling of neck tissues
– Airway obstruction (asphyxiation)
How often is there post extraction infection in Ludwig’s angina?
90% of cases
what are the oral commensals of Ludwig’s angina?
– ß-hemolytic oral Streptococci (41%)
– Porphyromonas, & Prevotella, Fusobacteria,
– Staphylococci (27%-50%) & Enterococci
what is the management of Ludwig’s angina?
• Ensure airway remains open – surgical intervention – Drainage _ parenteral hydration • High dose antibiotic treatment – intravenous penicillin – ceftriaxone + metrinodazole
What is the osteomyletis of the jaw?
Inflammation of medullary cavity of the mandible or the maxilla
what are the symptoms of the acute osteomyelitis of the jaw?
pain, mild fever, loosening of teeth & exudate of pus through gingiva or sinuses of affected skin
what are the symptoms of the chronic osteomyelitis of the jaw?
few symptoms, tender & indurated skin
what bacteria can cause osteomyletis of the jaw?
• Normally endogenous oral flora;
– Tanerella, Prevotella & Porphymonas spp
– M. tuberculosis, & T. pallidium rarely
what can occur in post radiation therapy of osteomyletis?
– necrosis of blood supply, reduced saliva flow
– Exogenous bacteria
• e.g. E. coli, Proteus, & Klebsiella
Name 4 bacterial infections of the salivary glands.
- Acute bacterial parotitis
- Chronic bacterial parotitis
- Recurrent parotitis of childhood
- Submandibular sialadentitis
what are the predisposing factors of acute bacterial parotitis?
– drugs (prescription)
– abnormalities
– generalised sialectasis
what is the presentation of acute bacterial parotitis?
– swelling of parotid gland(s) – pain
– purulent secretions
– rarely fever & chills
What is the microbiology of acute bacterial parotitis?
– S. aureus, oral Streps, Haemophilus & anaerobes
what is the treatment of acute bacterial parotitis?
_ co-amoxyclav
– flucloxacillin, erythromycin
– salavation
• (increased fluid intake)
Describe chronic bacterial parotitis.
• Recurrent infections • Damaged glands or Sjorgen’s syndrome • Chronic nature can lead to replacement fibrosis • Destruction of gland
Describe parotitis of childhood.
– Observed prior to puberty – Repeated acute episodes – Cause : • duct abnormalities • preceding mumps • foreign body • trauma
Describe submandibular sialadenitis.
– Rare – similar to acute parotitis – calculi or strictures – treatment & micro • as acute parotitis
Give summary slide.
• CMS information – Pulpitis microbiology – Abscesses in the oral environment – Salivary Gland infections • Microbiology – Assign likely endogenous species – Infection evidence of underlying clinical problem that requires addressing once treated.
