Odontogenic Infections Flashcards
dentoalveolar infections
localized to alveolar area
odontogenic infections
dental infections that spread to surrounding tissues
pulpitis
- caries approaching pulp
2. pulp compromised by inflammation
T/F: abx is used to treat pulpitis
false, not effective
pulpitis initially lowered threshold and prolonged pain response to what?
cold or other stimulus
onset of spontaneous pain in pts with pulpitis is sign of what?
inevitable pulpal necrosis
T/F: pulpitis can be reversed with timely treatment of caries
true
periapical lesions (apical periodontitis)
pulp nectrotic, blood supply interrupted, immune cells can’t reach canal –> inflammatory response shifts to periapical tissues
bone resorption in periapical lesions allow space for what?
immune cell barrier
where is bacteria in periapical lesions are most numerous?
root canal… low levels in periapical tissues
T/F: since pulp of periapical lesions is necrotic, often asymptomatic and only detected on radiographs
true
T/F: acute dentoalveolar (periapical) abscess is an acute exacerbation of periapical lesion
true
bacteria and PMNs in acute dentoalveolar (periapical) abscess are confined to where?
bone at apex
clinical features of acute dentoalveolar (periapical) abscess
- severe aching, throbbing pain
2. sensitive to pressure
what brings relief in acute dentoalveolar (periapical) abscess?
drainage of pus
where does pus under pressure tunnels in acute dentoalveolar (periapical) abscess escape?
to surface by path of least resistance
T/F: soft tissue abscess must be surgically drained
true
drainage of acute dentoalveolar (periapical) abscess may occur spontaneously through what?
fistula to surface
T/F: acute dentoalveolar (periapical) abscess is stable and painless
true
T/F: fistula with parulis and pus (gum boil) spontaneously drains when pressure builds
true
T/F: acute dentoalveolar (periapical) abscess is an emergency
false, is NOT
drainage of acute dentoalveolar (periapical) abscess depends on what?
anatomic location
T/F: path of least resistance may be into tissue spaces
true
T/F: drainage into tissue spaces and orofacial involvement is not an emergency
false, it’s serious and an emergency
clinical features of cellulitis
- bacteria invade soft tissue
- inflammation
- edema - tissues hard (indurated)
- not fluctuant (no pus)
- erythema (redness) and warmth
- painful
- fever may be present
how is soft tissue involvement determined?
by perforation of cortical bone in relation to muscle attachments
what bacteria causes odontogenic facial cellulitis
alpha-streptococci
what causes nonodontogenic facial cellulitis
- skin or mucous membrane trauma
- sinus bacteria
- Hemophilis influenzae
- Hib vaccine lowered incidence
what virus can cause acute facial swelling and pain?
mumps
odontogenic facial cellulitis occurs more often on lower face
true but upper face is common too
nonodontogenic facial cellulitis usually occurs on lower face
false, upper face
T/F: cellulitis may progress to new, secondary abscess formation
true
clinical features of secondary soft tissue abscess
- fluctuant
- erythematous
- pointed
is the secondary abscess in direct communication with the primary abscess?
no
tx for secondary soft tissue abscess
must be drained
external drainage of soft tissue abscess
intraoral or extraoral fistula
internal drainage of soft tissue abscess
into tissue spaces leading to potentially serious infections
‘pointing’ facial swelling
spontaneous extra-oral drainage may occur and scarring is a concern
what is preferred when tx’ing ‘pointing’ facial swelling?
surgical intra-oral drainage
what bacterial is most frequently isolated in odontogenic facial cellulitis?
alpha-hemolytic streptococci
types of tx of pulpal and periapical disease
- palliative
2. definitive
palliative tx is aimed at what?
relieving pt’s syms
examples of palliative tx
pharmacologic tx w/ analgesics and/or long-acting local anesthetic agents
abx are not effect against what?
- infections confined to pulp
- apical periodontitis
- abscesses
definitive tx is aimed at what?
ridding the pt of cause of infection (i.e. extraction of tooth or root canal)
tx of cellulitis
- temporarily managed with antibiotic therapy
2. will resolve more quickly if source of infection is removed
tx of soft tissue abscess
if tooth extraction or root canal tx doesn’t provide path of drainage for abscess, surgical incision and drainage required for resolution
abx that has narrow spectrum but appropriate spectrum for milder infections
penicillin or amoxicillin
penicillin or amoxicillin are bactericidal or bacteriostatic?
bactericidal
T/F: compared to penicillin, amoxicillin has less frequent dosage schedule and better taste
true
ORAL penicillins w/ b-lactamase inhibitor
augmentin
IV penicillins w/ b-lactamase inhibitor
Unasyn
are penicillins w/ b-lactamase inhibitor bactericidal or bacteriostatic?
bactericidal
T/F: resistance to penicillins w/ b-lactamase inhibitor is likely
false, unlikely
addition of what to penicillin or amoxicillin covers anaerobes thus creating broader spectrum?
metronidazole
T/F: clindamycin oral or IV is less resistance
true
is oral or IV clindamycin bactericidal or bacteriostatic?
bacteriostatic
omnious signs of an infection
- elevation of tongue/floor of mouth
- respiratory distress
- drooling
- rapid pulse
- toxic appearance
- peri-orbital involvement
signs of Ludwig’s angina
- drooling
- elevation of tongue/floor of mouth
- difficulty swallowing (dysphagia)
- difficulty breathing (dyspnea)
- limited neck range of motion
- trismus
clinical features of pre-septal cellulitis
- erythema
- induration
- tenderness of periorbital tissues
T/F: pre-septal cellulitis often progresses to orbital cellulitis
false, rarely does
orbital cellulitis is more common in who?
children
clinical features of orbital cellulitis
- bulding eye (proptosis)
- loss of vision
- pain in eye
- brain abscess
compensated shock in child that is in pain and doesn’t want to drink
- BP maintained by increased cardiac work
- rapid pulse
- not indefinitely sustainable
uncompensated shock in child that is in pain and doesn’t want to drink
- BP can no longer be maintained
2. emergency
other indicators of urgency
- rapid onset
- fever
- pain level (inability to eat and drink)
- prior treatment (abx and pain meds failed)
criteria for referral/hospital admission
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
what are the reasons to defer definitive tx and give abx?
- hospital admission
2. general anesthesia required
