Odontogenic Infections

Question 1

Define cellulitis

Answer 1

Diffuse swelling of inflammatory exudate within soft tissue, usually pyogenic in nature

Question 2

What is the most common odontogenic infection?

Answer 2

Vestibular abscess.

Question 3

Infections in the buccal space are likey to have originated from what teeth?

Answer 3

Upper and lower premolars, upper molars

Question 4

Hwo can you tell the difference between a buccal space infection and a sub-mandibular space infection?

Answer 4

If you can palpate the inferior border of the mandible - buccal space. If not - submandibular.

Question 5

Maxillary canines are most likely to cause infections in what space?

Answer 5

Canine space.

Maxillray laterals and premolars can also cause infection here.

Question 6

A patient presents in acute pain from a suspected odontogenic infection, with facial swelling.

What systemic examination do you perform?

Answer 6

• airway and breathing assesment
• Swallowing assesment
• Vital signs

Question 7

A patient presents with an acute odontogenic infection with swelling. Describe your local extra-oral assessment.

Answer 7

• Swelling
• Erythema
• Fistulae or abscess
• Lympadenopathy

Question 8

list 8 reasons to consider an ED or specialist referral of an odontogenic infection

Answer 8

1. Airway difficulties
2. Rapidly deteriorating general condition
3. Swallowing difficulties
4. Severe trismus
5. Systemic signs (fever, dehydration)
6. Infection involving moderate or high severity fascial planes
7. Compromised host defences
8. Need for patient control of systemic disease or GA for definitive tx

Question 9

Management of odontogenic should be primarily:

Answer 9

Removal of source. Eg surgically vs medically.

Question 10

List 3 methods of odontogenic infection spread to the cavernous sinus:

Answer 10

1. Direct spread from infra-temporal fossa
2. Indirect from upper lip via superior labial plexus
3. Indirect spread from canine fossa via inferior ophthalmic and facial vasculature

Question 11

Why is the danger triangle a problem

Answer 11

Facial vasculature have no valves

Question 12

5 signs of cavernous sinus thrombosis

Answer 12

• Limited extra-ocular muscle movements
• Pressure headaches
• Generalised malaise
• Meningitis
• Septicemia

Question 13

What % of Ludwigs Angina arises from odontogenic infections

Answer 13

70%

Question 14

What is Ludwigs Angina?

Answer 14

A rapidly progressive cellulitis involving the bilateral submental, sublingual and submandibular spaces.

Results in elevation and displacement of tongue, leading to dysphagia and inability to control secretions.

Potential airway obstruction.