management minor odontogenic infections

Question 1

Odontogenic Infections - Etiology

Answer 1

1. Pulpal Infections
2. Periapical abscess
3. Periodontal abscess
4. Pericoronal abscess
5. Infections from Root stumps

Question 2

Microbiology of Oral Infections

Answer 2

 Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
 Anaerobes predominant (75%)

Question 3

Mix of Bacteria Present in Odontogenic Infections
From Early To Late Stage

Answer 3

Question 4

Immune Status of the Patients - Host Defense

Answer 4

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.

Question 5

edema, cellulitis, abcess comparisons

Answer 5

Question 6

Spread of Odontogenic Infections
 Propagation of?
 Spreads how?
 Favors path of?
 Location determined by:
most present as?

Answer 6

 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

Question 7

Spread of Odontogenic Infections
 May begin as?

Answer 7

 May begin as well-delineated, self-limiting condition with potential to spread and result in a major fascial space infection.

Question 8

types of odontogenic infections

Answer 8

 Periapical osteitis
 Intrabony abscess
 Cellulitis
 Abscess

Question 9

Odontogenic Infections
Signs of Inflammation

Answer 9

 Dolor - Pain
 Tumor - Swelling
 Calor - Warmth
 Rubor – Redness
 Loss of function: Trismus, Difficulty in breathing, swallowing, chewing

Question 10

Cellulitis
 app? palpation?
 Inflammatory response not yet forming?
 Microorganisms?

Answer 10

 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.

Question 11

Abscess formation
 As inflammatory response matures and?
 An abscess is a?
 drainage?

Answer 11

 As inflammatory response matures and an abscess develops.
 An abscess is a localized collection of pus.
 May develop spontaneous drainage intraorally or extraorally

Question 12

Odontogenic infection - Principles of Treatment

Answer 12

 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

Question 13

Determine the severity of infection and obtain a detailed history

Answer 13

Chief Complaint and History of present complaint
 Onset
 Duration
 Symptoms
 Medical History including medication

Question 14

Determining the state of the patients host defense

Answer 14

 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

Question 15

Physical Examination of infection
 Vital Signs

Answer 15

 Temperature - systemic involvement >101 F
 Blood Pressure - Mild elevation
 Pulse - >100
 Respiratory Rate - Normal 14-16

Question 16

clinical exam
 General appearance
 It is important to determine the?
 Palpate the area of?
swellings?

Answer 16

 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

Question 17

 Normal vs abnormal tissue architecture:
 Distortion of?
 Soft palate?
 Nasal tip, nasolabial fold, circumorbital area?

Answer 17

 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

Question 18

 Identify causative factors?

Answer 18

 Tooth, root tip, foreign body, etc

Question 19

Determine whether to be treated by dentist or a Oral and Maxillofacial
surgeon?

Answer 19

 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?

Question 20

Definitive Treatment of Minor Odontogenic Infections
1. Remove ?
2. Establish ?
3. Choose and prescribe?
4. Supportive?
5. Re-evaluate?

Answer 20

1. Remove the cause of infection.
2. Establish drainage.
3. Choose and prescribe the appropriate Antibiotics
4. Supportive care, including proper rest and nutrition
5. Re-evaluate the patient frequently

Question 21

removing infection cause methods
which two were highlighted?

Answer 21

Pulpectomy
Extraction
Remove foreign body
Debride non-viable bone

Question 22

Surgical Treatment of infections:
 Incision and drainage
 Dependent?
 Incision in?
 Adequate?
 Exploration of all?
 Irrigation?

Answer 22

 Incision and drainage
Dependent site
Incision in healthy tissue
Adequate drainage
Exploration of all involved spaces
Irrigation

Question 23

Incision and Drainage
 Drainage of?
 Reduction of?
 Increased?
 Increases delivery of ?
 Obtain specimen for?

Answer 23

 Drainage of pus
 Reduction of tissue tension
 Increased blood flow
 Increases delivery of host defenses
 Obtain specimen for culture and
sensitivity(C&S)

Question 24

Indications for antibiotics
 Rapidly progressive?
 Diffuse?
 Fascial space?
 Compromised?
 Severe?
 Osteo?
 Trauma?

Answer 24

 Rapidly progressive swelling
 Diffuse swelling (cellulitis)
 Fascial space involvement
 Compromised host defenses
 Severe pericoronitis
 Osteomyelitis
 Trauma

Question 25

Principles of Antibiotic selection
 spectrum?
 Based on?
 Compatible with?

Answer 25

 Narrow spectrum
 Based on identification of causative organism and sensitivity
 Compatible with patient’s drug histor

Question 26

principles Abx tx
 Use what form of therapy?
 Use what spectrum drug?
 Use antibiotic with the lowest?
 bactericidal vs bacteriostatic?
 Be aware of?

Answer 26

 Use Empiric Therapy
 Use narrowest spectrum drug
 Use antibiotic with the lowest toxicity
 Use bactericidal antibiotic
 Be aware of Cost

Question 27

supportive care with infections

Answer 27

 Nutrition/hydration
 Oral hygiene
 Analgesics
 Follow-up care

Question 28

Patient Monitoring with infections

Answer 28

 Re-evaluate the patient frequently
 Response to treatment
 Temperature
 Swelling
 How do you feel?
 Need for additional imaging?

Question 29

Reasons For Treatment Failure with infections
 Inadequate?
 host responses?
 Antibiotic problems?

Answer 29

 Inadequate Surgery
 Depressed host responses
 Antibiotic problems:
Patient noncompliance
Drug not reaching the site
Drug dose too low
Antibiotic resistance