Odontogenic infections Flashcards
What is an odontogenic infection?
An infection that arises either from dental caries or periodontal infections that can extend beyond the alveolar bone to involve the fascial spaces around the face and oral cavity.
Can be localised or diffuse in nature.
How does an odontogenic infection spread?
- spreads along the path of least resistance.
When would you refer an odontogenic infection?
- sepsis signs
- spreading cellulitis
- swelling compromising airway, difficulty swallowing and closure of eye
- dehydration
- significant trismus
- failure to resolve to previous treatments
- uncooperative patients
When are antibiotics given?
In signs of spreading infection, systemic symptoms or in the immunocompromised.
What are the 4 types of dental abscesses?
Periapical
Gingival
Periodontal
Pericoronal/pericoronitis
Why would a periapical abscess form?
Develops by extension of initial carious lesion into dentine and spread of bacteria into pulp causing acute or chronic inflammatory response and abscess formation.
Can also be caused by trauma
What is a Phoenix abscess?
It is a chronic periapical infection that is exasperated into an acute phase abscess
What are the symptoms of a periapical abscess?
Pain, TTP, swelling, discomfort on swallowing, limited mouth opening, non vital tooth with loss of lamina dura
What is the treatment for a periapical abscess?
Drainage of abscess through the tooth: - pulp extripation Drainage through incision of abscess Extraction Analgesia and prescribe antibiotics if drainage is not sufficient
Where would a gingival abscess form?
Forms in the space between the gum and tooth
Why would a periodontal abscess form?
It forms due to an active period of periodontal breakdown which occurs whilst there is marginal closure of the deep periodontal pocket occluding drainage.
They develop in deep perio pockets and common in patients with untreated perio
What are the symptoms of periodontal abscesses?
Pain and tenderness of gingivae TTP, vital tooth, bone loss Most likely unrestored tooth Increased tooth mobility Swelling +/- suppuration of gingivae
What is the treatment of periodontal abscesses?
Arrange appropriate periodontal hygiene treatment
Establish drainage - scaling and irrigate periodontal pocket
CHX MW may be useful for keeping clean
What is pericoronitis?
It is an infection under the operculum of a partially erupted tooth where there is communication between the oral cavity and erupting tooth.
What are the signs of pericoronitis?
Pain Swelling around gingivae can cause facial swelling Discomfort with swallowing Limited mouth opening Unpleasant taste or odour
What is the treatment of pericoronitis?
Analgesia, irrigate under the operculum with OHI
Obtain drainage if possible
Refer for emergency care if severe
XLA if repeated pericoronitis episodes
Antibiotics if systemic symptoms, immunocompromised
(metronidazole 400mg 3x daily for 3 days)
What 6 conditions ca spreading infection lead to?
- facial cellulitis
- osteomyelitis
- Ludwig’ s angina
- necrotising fasciitis
- cavernous sinus thrombosis
- Cancrum oris/Nora
What would be the pattern of spread of infection of maxillary molars/premolars?
Buccal space
Oral cavity
Maxillary sinus
What would be the pattern of spread of infection of maxillary canines?
Canine fossa: nasolabial fold, lower eyelid to buccal space
What would be the pattern of spread of infection of maxillary lateral incisors?
Palate and labially
What would be the pattern of spread of infection of mandibular 3rd molars?
Submasseteric space
Submandibular space via lingual plate
Pterygomandibular space
Lateral pharyngeal space and down neck
What would be the pattern of spread of infection if mandibular 2nd molars?
Lingual spread can lead to severe sublingual, submandibular, pterygomandibular and spreading neck infections
Sublingual space:
- describe the location of the space and symptoms if it was involved in spread of infection?
- bounded by mucosa of floor of mouth and mylohyoid muscle inferiorly
- swollen, red, little/no EO swelling, elevation of tongue causing dysarthria, dysphagia and dyspnoea.
Submandibular space:
describe the location of the space and symptoms if it was involved in spread of infection?
- lies between mylohyoid muscle, superficial fascia, platysma, skin containing submandibular glands and lymph nodes
- painful, red swelling immediately below lower border of mandible with involvement of MoM resulting in trismus
