Management of Minor Odontogenic Infections

Question 1

Odontogenic Infections - Introduction
Infection of dental origin is one of the commonest diseases affecting the oro-facial
region.
Range from …
Most are easily managed with (2)

Answer 1

low-grade infections to severe life-threatening infections.

minor surgery and antibiotics (If treated early)

Question 2

Odontogenic Infections - Etiology
(5)

Answer 2

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

Question 3

Most oral infections are mixed in origin consisting of …
— predominant (75%)

Answer 3

aerobic and anaerobic gram
positive and gram negative organisms
Anaerobes

Question 4

mmune Status of the Patients - Host Defense
Immunity against any type of infection is dependant
on
(3)
Problems with one of the above mechanisms would
increase the potential for —.

Answer 4

 Humoral immune response
 Cell Mediated immune response
 Local factors in immune response

infection

Question 5

Spread of Odontogenic Infections
 Propagation of infection
(3)

Answer 5

 Spreads equally in all directions
 Favors path of least resistance
 Most present as a vestibular space abscess

Question 6

 Location determined by:
(2)

Answer 6

 Thickness of bone at apex
 Muscle attachments

Question 7

Spread of Odontogenic Infections
 May begin as well-delineated, self-limiting condition with potential to spread and
result in a major fascial space infection.
(4)

Answer 7

 Periapical osteitis
 Intrabony abscess
 Cellulitis
 Abscess

Question 8

Odontogenic Infections
Signs of Inflammation
(5)

Answer 8

 Dolor - Pain
 Tumor - Swelling
 Calor - Warmth
 Rubor – Redness
 Loss of function

Question 9

 Loss of function
(2)

Answer 9

 Trismus
 Difficulty in breathing, swallowing, chewing

Question 10

Cellulitis
(3)

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
(3)

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

 Determine the severity of the infection by obtaining the following information
(5)

Answer 12

• A detailed history about progress of infection
• Medical history
• Assess the state of the patients host defense
• Perform thorough clinical and radiographic examination

Question 13

Odontogenic infection - Principles of Treatment
(5)

Answer 13

 Determine the severity of the infection by obtaining the following information
 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 14

Chief Complaint and History of present complaint
(4)

Answer 14

 Onset
 Duration
 Symptoms
 Medical History including medication

Question 15

Compromised host defenses
 Disease related
 Poorly controlled diabetes
(5)

Answer 15

 Renal disease
 Malnutrition(alcoholism or disease)
 Neoplastic disease and radiation therapy
 Splenectomy

Question 16

Compromised host defenses
 Drug related
(2)

Answer 16

Immunosuppressives
 Cytotoxic agents

Question 17

 Immunosuppressives
(2)
 Cytotoxic agents
 (1)

Answer 17

 Glucocorticoids
 Cyclosporine and Azathioprine

Methotrexate

Question 18

Vital Signs
(4)

Answer 18

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

Question 19

Clinical Examination

Answer 19

 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 20

Clinical Examination
 Normal vs abnormal tissue architecture:
(3)
 Identify causative factors:
(1)

Answer 20

Clinical Examination
 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 areas
 Identify causative factors:
 Tooth, root tip, foreign body, etc.

 Tooth, root tip, foreign body, etc.

Question 21

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

Answer 21

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 22

Definitive Treatment of Minor Odontogenic Infections
(5)

Answer 22

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 23

Principles in Treatment of Oral and Para-oral Infections
(5)

Answer 23

Remove the cause of infection
Pulpectomy
Extraction
Remove foreign body
Debride non-viable bone

Question 24

Incision and drainage
(5)

Answer 24

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

Question 25

Incision and Drainage (5)

Answer 25

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

Question 26

Indications for antibiotics (7)

Answer 26

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

Question 27

Principles of Antibiotic selection (3)

Answer 27

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

Question 28

Principles of Antibiotic therapy Use Empiric Therapy (5)

Answer 28

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

Question 29

Commonly Prescribed Antibiotics (7)

Answer 29

 Penicillin V  Amoxicillin  Augmentin (Amoxicillin and clavulanic acid)  Bacteria resistant to beta-lactam antibiotics  Clindamycin  Cephalexin  Erythromycin  Metronidazole

Question 30

Supportive Care (4)

Answer 30

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

Question 31

Patient Monitoring (3)

Answer 31

 Re-evaluate the patient frequently  Response to treatment  Need for additional imaging?

Question 32

 Response to treatment (3)

Answer 32

 Temperature  Swelling  How do you feel?

Question 33

Reasons For Treatment Failure (3)

Answer 33

 Inadequate Surgery  Depressed host responses  Antibiotic problems

Question 34

 Antibiotic problems (4)

Answer 34

 Patient noncompliance  Drug not reaching the site  Drug dose too low  Antibiotic resistance