Oral Abscesses Flashcards
How do oral abscesses present?
Routes of prokaryotic infections of the mouth:
- pain, swelling, erythema, suppuration
- caries/trauma: periapical or dentoalveolar abscess
- gingival: gumm tissue inflammation
- periodontitis: periodontal abscess
- pericoronitis: partially erupted teeth
List key factors of dentoalveolar abscesses:
Treatment?
- remains localised
- number/type of virulent bacteria
- local/systemic immune response
- anatomical damage
Treatment:
- drainage/RCT/extraction
- antibiotics
- antimicrobials
Why do abscesses appear as swollen, inflamed areas?
What is the pus?
Whats the causative agent?
Swollen, inflamed areas:
- immune response
- recruitment of WBC
- plasma etc
Pus:
- dead tissue/debris/DNA
- immune cells
- infectious material
- fluid
Causative agent:
- infectious agent
- foreign body
What are facultative anaerobes?
What are strict anaerobes?
Give an example of each
Facultative anaerobe: bacteria which can grow in the presence and absence of oxygen
e.g. S. anginosus-group, S. oralis, actinomyces, enterococcus faecalis
Strict anaerobe: microorganisms that are killed by normal atmospheric concentrations of oxygen
e.g. prevotella, fusobacterium nucleatum, tanerella forsythia
What is the cause and syptoms of a periodontal abscess?
What bacteria tend to be associated with periodontal abscesses?
Cause:
- occlusion of opening prevents drainage
- impaction of foreign objects
Symptoms:
- sudden onset
- swelling/redness/tenderness
- may spread and destroy tissue/bone
Tend to be associated with a mixture of bacteria from gingival pockets e.g. prevotella, porphyromonas, variety of streptococci, fusobacteria nucleatum, actinomyces
Name bacteria associated with endodontic infections:
Gram positive:
- Strep. oralis, S. mitis, S. anginosus, S. gordonii
- enterococcus faecalis: resistant to hogh and low pH so difficult to erradicate
- lactobacilli
- staphylococci
Gram negative:
- fusobacterium nucleatum
- prevotella
What is ‘dry’ socket?
- localised infection following extraction, the socket fails to heal
- sparse anaerobic bacteria associated such as fusobacterium nucleatum
- prophylaxis: chlorohexidine irrigation prior to and post extraction
- treatment: antiseptic dressing and metronidazole
Explain a bit about osseointegrated implants and abscesses and the associated bacteria:
Periimplantitis can cause immediate or delayed abscesses:
- staphylococcus aureus and staphylococcus epidermidis
- aggregatibacter, prevotella, fusobacteria, anaerobic streptococci
Remove implant and antibiotic therapy to treat
Historically, what was associated with actinomyces?
Why is this not necessarily true?
What is the major species of actinomyces causing a mass in the head and neck?
What is it characterised by?
What is required to treat this?
Historically, actinomyces reported to be associated with root surface caries
Polymicrobial nature means this is now questionable and S. mutans and R. denticola are considered important
Major species: actinomyces israelii
- characteristic ‘pus’, known as sulphur granules but not actually sulphur
Extended antibiotic treatment e.g. penicillin up to 6 weeks treatment
What is Treponema denticola associated with?
T. denticola and P. gingivalis are commonly found associated with each other in chronic perio lesions
- grown in mixed biofilms
What is necrotising gingivitis?
What is it associated with?
Symptoms?
Microbiology:
Treatment?
An acute painful true infection of the gingivae
Associated with: immunosuppression
- poor OH
- plaque retentive factors
- smoking
Symptoms: inflammation, spontaneous bleeding, intense pain, tissue destruction, bad taste
Microbiology: large amounts of fusobacterium, and spirocheates
Treatment: metronidazole therapy, OH advice
What is ludwig’s angina?
Symptoms?
Causes?
Microbiology:
- Acute cellulitis, bilateral infection (submandibular and sublingual spaces)
Symptoms:
- tongue and FOM swell
- brawny oedema and swelling of neck tissues
- airway obstruction
Cause due to extraction on lower arch
Microbiology: beta-haemolytic oral streptococci, staphylococci, enterococci, prevotella, fusobacteria
