Management of Minor Odontogenic Infections Flashcards
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)
low-grade infections to severe life-threatening infections.
minor surgery and antibiotics (If treated early)
Odontogenic Infections - Etiology
(5)
- Pulpal Infections
- Periapical abscess
- Periodontal abscess
- Pericoronal abscess
- Infections from Root
stumps
Most oral infections are mixed in origin consisting of …
— predominant (75%)
aerobic and anaerobic gram
positive and gram negative organisms
Anaerobes
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 —.
Humoral immune response
Cell Mediated immune response
Local factors in immune response
infection
Spread of Odontogenic Infections
Propagation of infection
(3)
Spreads equally in all directions
Favors path of least resistance
Most present as a vestibular space abscess
Location determined by:
(2)
Thickness of bone at apex
Muscle attachments
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)
Periapical osteitis
Intrabony abscess
Cellulitis
Abscess
Odontogenic Infections
Signs of Inflammation
(5)
Dolor - Pain
Tumor - Swelling
Calor - Warmth
Rubor – Redness
Loss of function
Loss of function
(2)
Trismus
Difficulty in breathing, swallowing, chewing
Cellulitis
(3)
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
(3)
As inflammatory response matures and an abscess
develops.
An abscess is a localized collection of pus.
May develop spontaneous drainage intraorally or
extraorally.
Determine the severity of the infection by obtaining the following information
(5)
- A detailed history about progress of infection
- Medical history
- Assess the state of the patients host defense
- Perform thorough clinical and radiographic examination
Odontogenic infection - Principles of Treatment
(5)
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
Chief Complaint and History of present complaint
(4)
Onset
Duration
Symptoms
Medical History including medication
Compromised host defenses
Disease related
Poorly controlled diabetes
(5)
Renal disease
Malnutrition(alcoholism or disease)
Neoplastic disease and radiation therapy
Splenectomy
Compromised host defenses
Drug related
(2)
Immunosuppressives
Cytotoxic agents
Immunosuppressives
(2)
Cytotoxic agents
(1)
Glucocorticoids
Cyclosporine and Azathioprine
Methotrexate
Vital Signs
(4)
Temperature - systemic involvement >101 F
Blood Pressure - Mild elevation
Pulse - >100
Respiratory Rate - Normal 14-16
Clinical Examination
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
Clinical Examination
Normal vs abnormal tissue architecture:
(3)
Identify causative factors:
(1)
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.
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
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
(5)
- 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
Principles in Treatment of Oral and Para-oral Infections
(5)
Remove the cause of infection
Pulpectomy
Extraction
Remove foreign body
Debride non-viable bone
Incision and drainage
(5)
Dependent site
Incision in healthy tissue
Adequate drainage
Exploration of all involved spaces
Irrigation
Incision and Drainage
(5)
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
(7)
Rapidly progressive swelling
Diffuse swelling (cellulitis)
Fascial space involvement
Compromised host defenses
Severe pericoronitis
Osteomyelitis
Trauma
Principles of Antibiotic selection
(3)
Narrow spectrum
Based on identification of causative organism and sensitivity
Compatible with patient’s drug history
Principles of Antibiotic therapy Use Empiric Therapy
(5)
Use Empiric Therapy
Use narrowest spectrum drug
Use antibiotic with the lowest toxicity
Use bactericidal antibiotic
Be aware of Cost
Commonly Prescribed Antibiotics
(7)
Penicillin V
Amoxicillin
Augmentin (Amoxicillin and clavulanic acid)
Bacteria resistant to beta-lactam antibiotics
Clindamycin
Cephalexin
Erythromycin
Metronidazole
Supportive Care
(4)
Nutrition/hydration
Oral hygiene
Analgesics
Follow-up care
Patient Monitoring
(3)
Re-evaluate the patient frequently
Response to treatment
Need for additional imaging?
Response to treatment
(3)
Temperature
Swelling
How do you feel?
Reasons For Treatment Failure
(3)
Inadequate Surgery
Depressed host responses
Antibiotic problems
Antibiotic problems
(4)
Patient noncompliance
Drug not reaching the site
Drug dose too low
Antibiotic resistance
