odontogenic infection

Question 1

treating odontogenic infections

Answer 1

1) source control
2) decompress swelling
3) adjunctive anomalities

Question 2

signs of infections

Answer 2

1) fever
2)

Question 3

mixed infection microbiology

Answer 3

1) 60% of odontogenic infections are mixed
- aerobes
- anaerobes
2) 30% of odontogenic infection are anaerobic only
3) 10% of odontogenic infections are aerobic only

Question 4

anaerobes (obligate anaerobes)

Answer 4

1) prevotella! and friends
2) 75%
3) endotoxins
4) gram - rods
- extended spectrum penicillin

Question 5

aerobic (facultative)

Answer 5

1) streptococcus (gram + cocci)
2) staphylococcus
3) others

Question 6

viridans streptococci

Answer 6

1) most common aerobes
- facultative

Question 7

bacteroides, prevoltella

Answer 7

1) oral Bacteroides

Question 8

hyaluronidase

Answer 8

1) allows bacteria to spread through subcutaneous tissue
2) tissue and WBC breakdown - abscess
3) increase in hydrostatic pressure compromises blood flow leading to ischemia

Question 9

determine severity of infection

Answer 9

1) vestibular routine and localized
2) multiple spaces
- severe and often causes trismus
3) multiple spaces involving airway - life threatening
3) multiple spaces involving parapharyngeal spaces and mediastinum - life threatening

Question 10

complete history

Answer 10

1) SOAP
2) chronic or acute
3) review of systems
- diabetes
- HIV
- end stage renal disease
- other immunocompromised states

Question 11

physical exam

Answer 11

1) big to small
- vitals, temp, O2, appearance
2) constitutional symptoms
- weight loss, headache, fatigue, etc
3) outside to inside
- H&N exam, swelling ,induration, abscess, trismus, dentitions, tongue, FOM, mucosa etc.

Question 12

dont write WNL for IOE

Answer 12

1) write tongue, FOM non-remarkable

Question 13

imagine studies

Answer 13

1) PA xrays
2) pano
3) CBCT
4) medical grade CT

Question 14

lab studies

Answer 14

1) CBC
- with differential to assess immature bands
-left shift means battling acute infection
2) culture and sensitivity for infections not responsive to empiric therapy
3) gram stain
- for + (purple) and - (pink) identification

Question 15

evaluate patient host mechanisms

Answer 15

1) medical comorbidities
- diabetes, alcoholism malnutrition
- hematologic
- chemo, corticosteroids
2) try this
- diabetes, TB, asthma, CVD, liver DX, kidney DX
3) bisphosphonate, or monoclonal ABs, anticoagulation profile

Question 16

can patient be treated by GDDS or OMS

Answer 16

1) location and severity
- multispace odontogenic infections involving trismus or airway compromise
- refer to OMS
2) surgical access ?
- trismus, protected airway
3) status of host defenses ?
- may need hospital admission, IV antibiotics

Question 17

odontogenic infections are surgically managed

Answer 17

1) surgery changes environment from predominantly anaerobic to aerobic
2) surgery eliminates the source, establishes drainage
3) not only for abscesses, can facilitate healing of cellulitis

Question 18

surgical technique

Answer 18

1) determine most appropriate route
- must have surgical access
2) incise explore and drain
- be mindful of mental foramen, IA nerve, palatine vessels, pterygoid venous plexus
3) assess need for empiric treatment only or culture and sensitivity
4) LA anesthetic considerations
- acidic environment requires more alkaline anesthetic
- can see infection into nearby spaces
5) sweep space looking for loculations of pus
6) placement of penrose rains if indicated
- sutured
7) gravity dependent drainage
8) copious irrigation with or without antibacterial (chlorohexidine)
9) advance drains if purulence persists, remove when it ceases

Question 19

support patient medically

Answer 19

1) hydration, nutrition, pain control, antibiotics, blood glucose
2) watch out for hypertension, dysthymias, CHF, autoimmune diseases, etc

Question 20

antibiotics

Answer 20

1 )weigh risks and benefits
2) more severe infections require antibiotic therapy to control spread to nearby spaces not included in the surgery
3) prevotella is an opportunistic obligate anaerobe resistant to clindamycin
- susceptible to metronidazole
4) target peak plasma level is 4-5 times the minimum