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AU '18 - Peds III exam III > Odontogenic Infections > Flashcards

Odontogenic Infections Flashcards

1
Q

dentoalveolar infections

A

localized to alveolar area

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2
Q

odontogenic infections

A

dental infections that spread to surrounding tissues

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3
Q

pulpitis

A
  1. caries approaching pulp

2. pulp compromised by inflammation

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4
Q

T/F: abx is used to treat pulpitis

A

false, not effective

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5
Q

pulpitis initially lowered threshold and prolonged pain response to what?

A

cold or other stimulus

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6
Q

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

A

inevitable pulpal necrosis

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7
Q

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

A

true

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8
Q

periapical lesions (apical periodontitis)

A

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

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9
Q

bone resorption in periapical lesions allow space for what?

A

immune cell barrier

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10
Q

where is bacteria in periapical lesions are most numerous?

A

root canal… low levels in periapical tissues

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11
Q

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

A

true

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12
Q

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

A

true

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13
Q

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

A

bone at apex

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14
Q

clinical features of acute dentoalveolar (periapical) abscess

A
  1. severe aching, throbbing pain

2. sensitive to pressure

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15
Q

what brings relief in acute dentoalveolar (periapical) abscess?

A

drainage of pus

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16
Q

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

A

to surface by path of least resistance

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17
Q

T/F: soft tissue abscess must be surgically drained

A

true

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18
Q

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

A

fistula to surface

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19
Q

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

A

true

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20
Q

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

A

true

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21
Q

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

A

false, is NOT

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22
Q

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

A

anatomic location

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23
Q

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

A

true

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24
Q

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

A

false, it’s serious and an emergency

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25
Q

clinical features of cellulitis

A
  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
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26
Q

how is soft tissue involvement determined?

A

by perforation of cortical bone in relation to muscle attachments

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27
Q

what bacteria causes odontogenic facial cellulitis

A

alpha-streptococci

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28
Q

what causes nonodontogenic facial cellulitis

A
  1. skin or mucous membrane trauma
  2. sinus bacteria
  3. Hemophilis influenzae
  4. Hib vaccine lowered incidence
29
Q

what virus can cause acute facial swelling and pain?

A

mumps

30
Q

odontogenic facial cellulitis occurs more often on lower face

A

true but upper face is common too

31
Q

nonodontogenic facial cellulitis usually occurs on lower face

A

false, upper face

32
Q

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

A

true

33
Q

clinical features of secondary soft tissue abscess

A
  1. fluctuant
  2. erythematous
  3. pointed
34
Q

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

A

no

35
Q

tx for secondary soft tissue abscess

A

must be drained

36
Q

external drainage of soft tissue abscess

A

intraoral or extraoral fistula

37
Q

internal drainage of soft tissue abscess

A

into tissue spaces leading to potentially serious infections

38
Q

‘pointing’ facial swelling

A

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

39
Q

what is preferred when tx’ing ‘pointing’ facial swelling?

A

surgical intra-oral drainage

40
Q

what bacterial is most frequently isolated in odontogenic facial cellulitis?

A

alpha-hemolytic streptococci

41
Q

types of tx of pulpal and periapical disease

A
  1. palliative

2. definitive

42
Q

palliative tx is aimed at what?

A

relieving pt’s syms

43
Q

examples of palliative tx

A

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

44
Q

abx are not effect against what?

A
  1. infections confined to pulp
  2. apical periodontitis
  3. abscesses
45
Q

definitive tx is aimed at what?

A

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

46
Q

tx of cellulitis

A
  1. temporarily managed with antibiotic therapy

2. will resolve more quickly if source of infection is removed

47
Q

tx of soft tissue abscess

A

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

48
Q

abx that has narrow spectrum but appropriate spectrum for milder infections

A

penicillin or amoxicillin

49
Q

penicillin or amoxicillin are bactericidal or bacteriostatic?

A

bactericidal

50
Q

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

A

true

51
Q

ORAL penicillins w/ b-lactamase inhibitor

A

augmentin

52
Q

IV penicillins w/ b-lactamase inhibitor

A

Unasyn

53
Q

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

A

bactericidal

54
Q

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

A

false, unlikely

55
Q

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

A

metronidazole

56
Q

T/F: clindamycin oral or IV is less resistance

A

true

57
Q

is oral or IV clindamycin bactericidal or bacteriostatic?

A

bacteriostatic

58
Q

omnious signs of an infection

A
  1. elevation of tongue/floor of mouth
  2. respiratory distress
  3. drooling
  4. rapid pulse
  5. toxic appearance
  6. peri-orbital involvement
59
Q

signs of Ludwig’s angina

A
  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
60
Q

clinical features of pre-septal cellulitis

A
  1. erythema
  2. induration
  3. tenderness of periorbital tissues
61
Q

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

A

false, rarely does

62
Q

orbital cellulitis is more common in who?

A

children

63
Q

clinical features of orbital cellulitis

A
  1. bulding eye (proptosis)
  2. loss of vision
  3. pain in eye
  4. brain abscess
64
Q

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

A
  1. BP maintained by increased cardiac work
  2. rapid pulse
  3. not indefinitely sustainable
65
Q

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

A
  1. BP can no longer be maintained

2. emergency

66
Q

other indicators of urgency

A
  1. rapid onset
  2. fever
  3. pain level (inability to eat and drink)
  4. prior treatment (abx and pain meds failed)
67
Q

criteria for referral/hospital admission

A 
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
68
Q

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

A
  1. hospital admission

2. general anesthesia required

AU '18 - Peds III exam III (12 decks)

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