management minor odontogenic infections Flashcards
Odontogenic Infections - Etiology
- Pulpal Infections
- Periapical abscess
- Periodontal abscess
- Pericoronal abscess
- Infections from Root stumps
Microbiology of Oral Infections
Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
Anaerobes predominant (75%)
Mix of Bacteria Present in Odontogenic Infections
From Early To Late Stage
Immune Status of the Patients - Host Defense
Immunity against any type of infection is dependant on:
Humoral immune response
Cell Mediated immune response
Local factors in immune response
Problems with one of the above mechanisms would increase the potential for infection.
edema, cellulitis, abcess comparisons
Spread of Odontogenic Infections
Propagation of?
Spreads how?
Favors path of?
Location determined by:
most present as?
Propagation of infection
Spreads equally in all directions
Favors path of least resistance
Location determined by:
Thickness of bone at apex
Muscle attachments
Most present as a vestibular space abscess
Spread of Odontogenic Infections
May begin as?
May begin as well-delineated, self-limiting condition with potential to spread and result in a major fascial space infection.
types of odontogenic infections
Periapical osteitis
Intrabony abscess
Cellulitis
Abscess
Odontogenic Infections
Signs of Inflammation
Dolor - Pain
Tumor - Swelling
Calor - Warmth
Rubor – Redness
Loss of function: Trismus, Difficulty in breathing, swallowing, chewing
Cellulitis
app? palpation?
Inflammatory response not yet forming?
Microorganisms?
Diffuse, reddened, brawny swelling that is tender to
palpation.
Inflammatory response not yet forming a true abscess.
Microorganisms have just begun to overcome host defenses and spread beyond tissue planes.
Abscess formation
As inflammatory response matures and?
An abscess is a?
drainage?
As inflammatory response matures and an abscess develops.
An abscess is a localized collection of pus.
May develop spontaneous drainage intraorally or extraorally
Odontogenic infection - Principles of Treatment
Determine the severity of the infection by obtaining the following information
- A detailed history about progress of infection
- Medical history
- Assess the state of the patients host defense
- Perform thorough clinical and radiographic examination
Determine whether to be treated by dentist or a Oral and maxillofacial surgeon.
Treat the infection surgically
Support patient medically and nutritionally
Evaluate patient frequently
Determine the severity of infection and obtain a detailed history
Chief Complaint and History of present complaint
Onset
Duration
Symptoms
Medical History including medication
Determining the state of the patients host defense
Compromised host defenses
Disease related:
Poorly controlled diabetes
Renal disease
Malnutrition(alcoholism or disease)
Neoplastic disease and radiation therapy
Splenectomy
Drug related
Immunosuppressives
Glucocorticoids
Cyclosporine and Azathioprine
Cytotoxic agents
Methotrexate
Physical Examination of infection
Vital Signs
Temperature - systemic involvement >101 F
Blood Pressure - Mild elevation
Pulse - >100
Respiratory Rate - Normal 14-16
clinical exam
General appearance
It is important to determine the?
Palpate the area of?
swellings?
General appearance
It is important to determine the presence and extent of infection.(Thorough extra oral and intra oral examination)
Palpate the area of swelling
Brawny swelling
Fluctuant Swelling
Normal vs abnormal tissue architecture:
Distortion of?
Soft palate?
Nasal tip, nasolabial fold, circumorbital area?
Normal vs abnormal tissue architecture:
Distortion of mucobuccal fold
Soft palate symmetric with uvula in midline (deviation → involvement of lateral pharyngeal space)
Nasal tip, nasolabial fold, circumorbital area
Identify causative factors?
Tooth, root tip, foreign body, etc
Determine whether to be treated by dentist or a Oral and Maxillofacial
surgeon?
Who should treat?
Rapidly progressing infection
Difficulty breathing
Difficulty swallowing
Fascial space involvement
Elevated temperature(>101F)
Trismus(<10mm)
Toxic appearance
Compromised host defenses
Need I & D?
Need hospitalization?
Definitive Treatment of Minor Odontogenic Infections
1. Remove ?
2. Establish ?
3. Choose and prescribe?
4. Supportive?
5. Re-evaluate?
- Remove the cause of infection.
- Establish drainage.
- Choose and prescribe the appropriate Antibiotics
- Supportive care, including proper rest and nutrition
- Re-evaluate the patient frequently
removing infection cause methods
which two were highlighted?
Pulpectomy
Extraction
Remove foreign body
Debride non-viable bone
Surgical Treatment of infections:
Incision and drainage
Dependent?
Incision in?
Adequate?
Exploration of all?
Irrigation?
Incision and drainage
Dependent site
Incision in healthy tissue
Adequate drainage
Exploration of all involved spaces
Irrigation
Incision and Drainage
Drainage of?
Reduction of?
Increased?
Increases delivery of ?
Obtain specimen for?
Drainage of pus
Reduction of tissue tension
Increased blood flow
Increases delivery of host defenses
Obtain specimen for culture and
sensitivity(C&S)
Indications for antibiotics
Rapidly progressive?
Diffuse?
Fascial space?
Compromised?
Severe?
Osteo?
Trauma?
Rapidly progressive swelling
Diffuse swelling (cellulitis)
Fascial space involvement
Compromised host defenses
Severe pericoronitis
Osteomyelitis
Trauma
Principles of Antibiotic selection
spectrum?
Based on?
Compatible with?
Narrow spectrum
Based on identification of causative organism and sensitivity
Compatible with patient’s drug histor
principles Abx tx
Use what form of therapy?
Use what spectrum drug?
Use antibiotic with the lowest?
bactericidal vs bacteriostatic?
Be aware of?
Use Empiric Therapy
Use narrowest spectrum drug
Use antibiotic with the lowest toxicity
Use bactericidal antibiotic
Be aware of Cost
supportive care with infections
Nutrition/hydration
Oral hygiene
Analgesics
Follow-up care
Patient Monitoring with infections
Re-evaluate the patient frequently
Response to treatment
Temperature
Swelling
How do you feel?
Need for additional imaging?
Reasons For Treatment Failure with infections
Inadequate?
host responses?
Antibiotic problems?
Inadequate Surgery
Depressed host responses
Antibiotic problems:
Patient noncompliance
Drug not reaching the site
Drug dose too low
Antibiotic resistance
