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Oral Surgery III > Management of Minor Odontogenic Infections > Flashcards

Management of Minor Odontogenic Infections Flashcards

1
Q

odontogenic infections range from:

A

low grade infections to severe life threatening infections

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2
Q

most odontogenic infections are easily managed with:

A

minor surgery and antibiotics if treated early

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3
Q

what is the etiology for odontogenic infections

A
  • pulpal infections
  • periapical abscess
  • periodontal abscess
  • pericoronal abscess
  • infections from root stumps
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4
Q

what is the microbiology of oral infections

A

mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
- anaerobes predominant - 75%
- aerobic - 25%

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5
Q

what are the bacteria present in the acute stages, mixed stages, and chronic stages of odntogenic infection

A

-acute infection: gram positive aerobes predominate
- mixed: gram positive aerobes decreasing
- chronic infection: anaerobes predominate

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6
Q

immunity against any type of infection is dependent on:

A
  • humoral immune response
  • cell mediated immune response
  • local factors in immune response
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7
Q

what are the pt related factors decreasing the immune response

A
  • decreased peripheral circulation
  • systemic disease
  • malnutrition
  • medications that suppress immune system
  • diseases of the immune system
  • xerostomia
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8
Q

what microbial factors decrease the immune response

A
  • selection for certain organsims by previous AB therapy
  • virulence of specific organismsw
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9
Q

what local factors decrease the immune response

A
  • hematoma
  • traumatic surgery
  • pre existing infections
  • chronic pericoronitis
  • anatomic location of infection
  • compromised vascular supply
  • necrotic tissue
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10
Q

describe the propagation of infection

A
  • spreads equally in all directions
  • favors path of least resistance
  • location determined by thickness of bone at apex and muscle attachments
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11
Q

most odontogenic infections present as a :

A

vestibular space abscess

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12
Q

how does an odontogenic infection spread

A
  • may begin as well delineated, self limiting condition with potential to spread and result in a major fascial space infection
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13
Q

what can the spread of odontogenic infections turn into

A

-periapical osteitis
- intrabony abscess
- cellulitis
- abscess

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14
Q

what are the signs of inflammation

A
  • dolor- pain
  • tumor- swelling
  • calor- warmth
  • rubor- redness
  • loss of function- trismus or difficulty in breathing, swallowing, chewing
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15
Q

describe cellulitis

A
  • 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
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16
Q

describe abscess formation

A
  • as inflammatory response matures and an abscess develops
  • an abscess is a localized collection of pus
  • may develop spontaneous drainage intraorally or extraorally
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17
Q

determine the severity of the infection by obtaining the following information:

A
  • a detailed history about progress of infection
  • medical history
  • assess the state of the patients host defense
  • perform thorough clinical and radiographic exam
18
Q

what are the principles of treatment of odontogenic infection

A
  • 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
19
Q

what info should you obtain about the chief complaint and history of present complaint

A
  • onset
  • duration
  • symptoms
  • medical history including meds
20
Q

what are the possible causes of compromised host defenses

A
  • disease related
  • drug related
21
Q

what are the disease related problems causing compromised host defenses

A
  • poorly controlled diabetes
  • renal disease
  • malnutrition- alcoholism or disease
  • neoplastic disease and radiation therapy
  • splenectomy
22
Q

what are the drug related problems causing compromised host defenses

A
  • immunosuppressive: glucocorticoids and cyclosporine and azathioprine
  • cytotoxic agents: methotrexate
23
Q

what are the vital signs and values during physical exam

A
  • temperature: systemic involvement if over 101F
  • BP: mild elevation
  • pulse: greater than 100
  • respiratory rate: normal 14-16
24
Q

what are the types of swelling

A

brawny swelling
- fluctuant swelling

25
Q

what is done in the clinical exam

A
  • 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
26
Q

what is examined in the normal vs abnormal tissue architecture exam

A
  • distortion of mucobuccal fold
  • soft palate symmetric with uvula in midline - deviation -> involvement of lateral pharyngeal space
  • nasal tip, nasolabial fold, circumorbital areas
27
Q

what radiographs should be taken for minor odontogenic infection

A

pano and PA

27
Q

what might be the causative factors for the swelling

A

tooth, root tip, foreign body

27
Q

what is considered in determining who should treat this infection

A
  • rapidly progressing infection
  • difficulty breathing
  • difficulty swallowing
  • fascial space involvement
  • elevated temperature greater than 101F
  • trismus - less than 10mm
  • toxic appearance
  • compromised host defenses
28
Q

what is the definitive treatment of minor odontogenic infections

A
  • 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
29
Q

how do you remove the cause of infection

A
  • pulpectomy
  • extraction
  • remove foreign body
  • debride non viable bone
30
Q

what is considered in I and D

A
  • dependent site
  • incision in healthy tissue
  • adequate drainage
  • exploration of all involved spaces
  • irrigation
31
Q

what is the goal of I and D

A
  • drainage of pus
  • reduction of tissue tension
  • increased blood flow
  • increases delivery of host defenses
  • obtain specimen for culture and sensitivity
32
Q

what are the indications for antibiotics

A
  • rapidly progressive swelling
  • diffuse swelling (cellulitis)
  • fascial space involvement
  • compromised host defenses
  • severe pericoronitis
  • osteomyelitis
  • trauma
33
Q

what are the principles of antibiotic selection

A
  • 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
34
Q

what are the commonly prescribed antibiotics

A
  • penicillin V
  • amoxicillin
  • augmentin- amoxicillin and clavulanic acid
  • clindamycin
  • cephalexin
  • erythromycin
  • metronidazole
35
Q

when is augmentin prescribed

A

bacteria resistant to beta lactam antibiotics

36
Q

what supportive care is used

A
  • nutrition/hydration
  • oral hygiene
  • analgesics
  • follow up care
37
Q

what needs to be evaluated in patient monitoring

A
  • re evaluate the pt frequently
  • response to treatment: temperature, swelling
  • need for additional imaging
38
Q

what are the reasons for treatment failure

A
  • inadequate surgery
  • depressed host responses
  • antibiotic problems
39
Q

what are the possible antibiotic problems

A
  • patient noncompliance
  • drug not reaching the site
  • drug dose too low
  • antibiotic resistance
40
Q
A

Oral Surgery III (11 decks)

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