Management of Minor Odontogenic Infections Flashcards
odontogenic infections range from:
low grade infections to severe life threatening infections
most odontogenic infections are easily managed with:
minor surgery and antibiotics if treated early
what is the etiology for odontogenic infections
- pulpal infections
- periapical abscess
- periodontal abscess
- pericoronal abscess
- infections from root stumps
what is the microbiology of oral infections
mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
- anaerobes predominant - 75%
- aerobic - 25%
what are the bacteria present in the acute stages, mixed stages, and chronic stages of odntogenic infection
-acute infection: gram positive aerobes predominate
- mixed: gram positive aerobes decreasing
- chronic infection: anaerobes predominate
immunity against any type of infection is dependent on:
- humoral immune response
- cell mediated immune response
- local factors in immune response
what are the pt related factors decreasing the immune response
- decreased peripheral circulation
- systemic disease
- malnutrition
- medications that suppress immune system
- diseases of the immune system
- xerostomia
what microbial factors decrease the immune response
- selection for certain organsims by previous AB therapy
- virulence of specific organismsw
what local factors decrease the immune response
- hematoma
- traumatic surgery
- pre existing infections
- chronic pericoronitis
- anatomic location of infection
- compromised vascular supply
- necrotic tissue
describe the propagation of infection
- spreads equally in all directions
- favors path of least resistance
- location determined by thickness of bone at apex and muscle attachments
most odontogenic infections present as a :
vestibular space abscess
how does an odontogenic infection spread
- may begin as well delineated, self limiting condition with potential to spread and result in a major fascial space infection
what can the spread of odontogenic infections turn into
-periapical osteitis
- intrabony abscess
- cellulitis
- abscess
what are the signs of inflammation
- dolor- pain
- tumor- swelling
- calor- warmth
- rubor- redness
- loss of function- trismus or difficulty in breathing, swallowing, chewing
describe cellulitis
- 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
describe abscess formation
- 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:
- a detailed history about progress of infection
- medical history
- assess the state of the patients host defense
- perform thorough clinical and radiographic exam
what are the principles of treatment of odontogenic infection
- determine the severity of the infection
- determine whether to be treated by dentist or oral and maxillofacial surgeon
- treat the infection surgically
- support the patient medically and nutritionally
- evaluate patient frequently
what info should you obtain about the chief complaint and history of present complaint
- onset
- duration
- symptoms
- medical history including meds
what are the possible causes of compromised host defenses
- disease related
- drug related
what are the disease related problems causing compromised host defenses
- poorly controlled diabetes
- renal disease
- malnutrition- alcoholism or disease
- neoplastic disease and radiation therapy
- splenectomy
what are the drug related problems causing compromised host defenses
- immunosuppressive: glucocorticoids and cyclosporine and azathioprine
- cytotoxic agents: methotrexate
what are the vital signs and values during physical exam
- temperature: systemic involvement if over 101F
- BP: mild elevation
- pulse: greater than 100
- respiratory rate: normal 14-16
what are the types of swelling
brawny swelling
- fluctuant swelling
what is done in the clinical exam
- general appearance
- determine extent and presence of infection- intra and extra oral eval
- palpate area of swelling
- normal vs abnormal tissue architecure
- identify causative factors
what is examined in the normal vs abnormal tissue architecture exam
- distortion of mucobuccal fold
- soft palate symmetric with uvula in midline - deviation -> involvement of lateral pharyngeal space
- nasal tip, nasolabial fold, circumorbital areas
what radiographs should be taken for minor odontogenic infection
pano and PA
what might be the causative factors for the swelling
tooth, root tip, foreign body
what is considered in determining who should treat this infection
- rapidly progressing infection
- difficulty breathing
- difficulty swallowing
- fascial space involvement
- elevated temperature greater than 101F
- trismus - less than 10mm
- toxic appearance
- compromised host defenses
what is the definitive treatment of minor odontogenic infections
- remove the cause of infection
- establish drainage
- choose and prescribe the appropriate antibiotics
- supportive care, including proper rest and nutrition
- re evaluate the pt frequently
how do you remove the cause of infection
- pulpectomy
- extraction
- remove foreign body
- debride non viable bone
what is considered in I and D
- dependent site
- incision in healthy tissue
- adequate drainage
- exploration of all involved spaces
- irrigation
what is the goal of I and D
- drainage of pus
- reduction of tissue tension
- increased blood flow
- increases delivery of host defenses
- obtain specimen for culture and sensitivity
what are the indications for antibiotics
- rapidly progressive swelling
- diffuse swelling (cellulitis)
- fascial space involvement
- compromised host defenses
- severe pericoronitis
- osteomyelitis
- trauma
what are the principles of antibiotic selection
- based on identification of causative organism and sensitivity
- compatible with patients drug history
- use empiric therapy
- use narrowest spectrum drug
- use antibiotic with the lowest toxicity
- use bactericidal antibiotic
- be aware of cost
what are the commonly prescribed antibiotics
- penicillin V
- amoxicillin
- augmentin- amoxicillin and clavulanic acid
- clindamycin
- cephalexin
- erythromycin
- metronidazole
when is augmentin prescribed
bacteria resistant to beta lactam antibiotics
what supportive care is used
- nutrition/hydration
- oral hygiene
- analgesics
- follow up care
what needs to be evaluated in patient monitoring
- re evaluate the pt frequently
- response to treatment: temperature, swelling
- need for additional imaging
what are the reasons for treatment failure
- inadequate surgery
- depressed host responses
- antibiotic problems
what are the possible antibiotic problems
- patient noncompliance
- drug not reaching the site
- drug dose too low
- antibiotic resistance
