Odontogenic Infections

Question 1

dentoalveolar infections

Answer 1

localized to alveolar area

Question 2

odontogenic infections

Answer 2

dental infections that spread to surrounding tissues

Question 3

pulpitis

Answer 3

1. caries approaching pulp

2. pulp compromised by inflammation

Question 4

T/F: abx is used to treat pulpitis

Answer 4

false, not effective

Question 5

pulpitis initially lowered threshold and prolonged pain response to what?

Answer 5

cold or other stimulus

Question 6

onset of spontaneous pain in pts with pulpitis is sign of what?

Answer 6

inevitable pulpal necrosis

Question 7

T/F: pulpitis can be reversed with timely treatment of caries

Answer 7

true

Question 8

periapical lesions (apical periodontitis)

Answer 8

pulp nectrotic, blood supply interrupted, immune cells can’t reach canal –> inflammatory response shifts to periapical tissues

Question 9

bone resorption in periapical lesions allow space for what?

Answer 9

immune cell barrier

Question 10

where is bacteria in periapical lesions are most numerous?

Answer 10

root canal… low levels in periapical tissues

Question 11

T/F: since pulp of periapical lesions is necrotic, often asymptomatic and only detected on radiographs

Answer 11

true

Question 12

T/F: acute dentoalveolar (periapical) abscess is an acute exacerbation of periapical lesion

Answer 12

true

Question 13

bacteria and PMNs in acute dentoalveolar (periapical) abscess are confined to where?

Answer 13

bone at apex

Question 14

clinical features of acute dentoalveolar (periapical) abscess

Answer 14

1. severe aching, throbbing pain

2. sensitive to pressure

Question 15

what brings relief in acute dentoalveolar (periapical) abscess?

Answer 15

drainage of pus

Question 16

where does pus under pressure tunnels in acute dentoalveolar (periapical) abscess escape?

Answer 16

to surface by path of least resistance

Question 17

T/F: soft tissue abscess must be surgically drained

Answer 17

true

Question 18

drainage of acute dentoalveolar (periapical) abscess may occur spontaneously through what?

Answer 18

fistula to surface

Question 19

T/F: acute dentoalveolar (periapical) abscess is stable and painless

Answer 19

true

Question 20

T/F: fistula with parulis and pus (gum boil) spontaneously drains when pressure builds

Answer 20

true

Question 21

T/F: acute dentoalveolar (periapical) abscess is an emergency

Answer 21

false, is NOT

Question 22

drainage of acute dentoalveolar (periapical) abscess depends on what?

Answer 22

anatomic location

Question 23

T/F: path of least resistance may be into tissue spaces

Answer 23

true

Question 24

T/F: drainage into tissue spaces and orofacial involvement is not an emergency

Answer 24

false, it’s serious and an emergency

Question 25

clinical features of cellulitis

Answer 25

1. bacteria invade soft tissue 2. inflammation 3. edema - tissues hard (indurated) 4. not fluctuant (no pus) 5. erythema (redness) and warmth 6. painful 7. fever may be present

Question 26

how is soft tissue involvement determined?

Answer 26

by perforation of cortical bone in relation to muscle attachments

Question 27

what bacteria causes odontogenic facial cellulitis

Answer 27

alpha-streptococci

Question 28

what causes nonodontogenic facial cellulitis

Answer 28

1. skin or mucous membrane trauma 2. sinus bacteria 3. Hemophilis influenzae 4. Hib vaccine lowered incidence

Question 29

what virus can cause acute facial swelling and pain?

Answer 29

mumps

Question 30

odontogenic facial cellulitis occurs more often on lower face

Answer 30

true but upper face is common too

Question 31

nonodontogenic facial cellulitis usually occurs on lower face

Answer 31

false, upper face

Question 32

T/F: cellulitis may progress to new, secondary abscess formation

Answer 32

true

Question 33

clinical features of secondary soft tissue abscess

Answer 33

1. fluctuant 2. erythematous 3. pointed

Question 34

is the secondary abscess in direct communication with the primary abscess?

Answer 34

no

Question 35

tx for secondary soft tissue abscess

Answer 35

must be drained

Question 36

external drainage of soft tissue abscess

Answer 36

intraoral or extraoral fistula

Question 37

internal drainage of soft tissue abscess

Answer 37

into tissue spaces leading to potentially serious infections

Question 38

'pointing' facial swelling

Answer 38

spontaneous extra-oral drainage may occur and scarring is a concern

Question 39

what is preferred when tx'ing 'pointing' facial swelling?

Answer 39

surgical intra-oral drainage

Question 40

what bacterial is most frequently isolated in odontogenic facial cellulitis?

Answer 40

alpha-hemolytic streptococci

Question 41

types of tx of pulpal and periapical disease

Answer 41

1. palliative | 2. definitive

Question 42

palliative tx is aimed at what?

Answer 42

relieving pt's syms

Question 43

examples of palliative tx

Answer 43

pharmacologic tx w/ analgesics and/or long-acting local anesthetic agents

Question 44

abx are not effect against what?

Answer 44

1. infections confined to pulp 2. apical periodontitis 3. abscesses

Question 45

definitive tx is aimed at what?

Answer 45

ridding the pt of cause of infection (i.e. extraction of tooth or root canal)

Question 46

tx of cellulitis

Answer 46

1. temporarily managed with antibiotic therapy | 2. will resolve more quickly if source of infection is removed

Question 47

tx of soft tissue abscess

Answer 47

if tooth extraction or root canal tx doesn't provide path of drainage for abscess, surgical incision and drainage required for resolution

Question 48

abx that has narrow spectrum but appropriate spectrum for milder infections

Answer 48

penicillin or amoxicillin

Question 49

penicillin or amoxicillin are bactericidal or bacteriostatic?

Answer 49

bactericidal

Question 50

T/F: compared to penicillin, amoxicillin has less frequent dosage schedule and better taste

Answer 50

true

Question 51

ORAL penicillins w/ b-lactamase inhibitor

Answer 51

augmentin

Question 52

IV penicillins w/ b-lactamase inhibitor

Answer 52

Unasyn

Question 53

are penicillins w/ b-lactamase inhibitor bactericidal or bacteriostatic?

Answer 53

bactericidal

Question 54

T/F: resistance to penicillins w/ b-lactamase inhibitor is likely

Answer 54

false, unlikely

Question 55

addition of what to penicillin or amoxicillin covers anaerobes thus creating broader spectrum?

Answer 55

metronidazole

Question 56

T/F: clindamycin oral or IV is less resistance

Answer 56

true

Question 57

is oral or IV clindamycin bactericidal or bacteriostatic?

Answer 57

bacteriostatic

Question 58

omnious signs of an infection

Answer 58

1. elevation of tongue/floor of mouth 2. respiratory distress 3. drooling 4. rapid pulse 5. toxic appearance 6. peri-orbital involvement

Question 59

signs of Ludwig's angina

Answer 59

1. drooling 2. elevation of tongue/floor of mouth 3. difficulty swallowing (dysphagia) 4. difficulty breathing (dyspnea) 5. limited neck range of motion 6. trismus

Question 60

clinical features of pre-septal cellulitis

Answer 60

1. erythema 2. induration 3. tenderness of periorbital tissues

Question 61

T/F: pre-septal cellulitis often progresses to orbital cellulitis

Answer 61

false, rarely does

Question 62

orbital cellulitis is more common in who?

Answer 62

children

Question 63

clinical features of orbital cellulitis

Answer 63

1. bulding eye (proptosis) 2. loss of vision 3. pain in eye 4. brain abscess

Question 64

compensated shock in child that is in pain and doesn't want to drink

Answer 64

1. BP maintained by increased cardiac work 2. rapid pulse 3. not indefinitely sustainable

Question 65

uncompensated shock in child that is in pain and doesn't want to drink

Answer 65

1. BP can no longer be maintained | 2. emergency

Question 66

other indicators of urgency

Answer 66

1. rapid onset 2. fever 3. pain level (inability to eat and drink) 4. prior treatment (abx and pain meds failed)

Question 67

criteria for referral/hospital admission

Answer 67

``` 1. Fever and malaise (overall sick appearance) 2. Rapid progression of infection 3. Failed outpatient therapy 4. Trismus (masticator space involvement) 5. Impending airway compromise (dysphagia/dyspnea) 6. Deep space infection 7. Peri-orbital swelling 8. Compromised host 9. Fragile social situation/likely poor compliance 10. Special healthcare needs ```

Question 68

what are the reasons to defer definitive tx and give abx?

Answer 68

1. hospital admission | 2. general anesthesia required