Oral Infections Flashcards
Treatment principles of acute infection
General and local
General:
Admission if unwell
Analgesia
Control of infection
Local: Removal of cause Drainage Prevention of spread Restoration of function
Microbial aetiology of dentoalveolar abscesses
FASBENS
Fusobacterium Aneorobic cocci - peptostreptococcus, paryimonas Streptococcus Black pigmented anaerobes Eubacterium Non-pigmented anaerobes Spirochaetes
Periodontal abscess
Pain
Swelling - small, localised, diffuse
Lymphadenopathy and fever may be present
Facial or neck cellulitis v rare
Tooth usually vital
Could be due to pre-existing perio pocket becoming inflamed by foreign body
Or trauma to preiodontium
Or secondary infection of lateral periodontal cyst
Radiolucency lateral aspect of tooth
Multiple perio abscesses in poorly controlled diabetics
Microbial aetiology - same as chronic perio + candida
Treatment - drain and debride
Streptococcal gingivostomatitis
Rare in non-compromised hosts
Most frequently follows tonsilitis
Severe inflammation of gingiva with marked pain
Caused by s.pyogenes - complications fascitis, tissue destruction, rheumatic heart disease, nephritis
Would need to differentiate from drug and viral causes so would need to take samples and send to microbiology to check cause
Treatment - prompt txt wit pencillin
Acute ulcerative gingivitis
Poor OH, smoking, stress
Ulceration and destruction of interdental papilla
Invasion of tissue by microorganisms
Halitosis, bad breath, malaise, lymphadenopathy
Txt - debridement, hygiene
Cancrum oris or noma
Usually preceded by ANUG and a recent deblitating illness e.g. infection:
viral - measles
bacterial - TB, SF
parasitic infection - malaria
use of immunosupressants/malnutrition
F. necropharum, P. intermedia
T vincenti, T. denticola
T. forsythia, a-streptococciTuberculosis
^ incidence in UK, esp among immigrants
Rare in oral cavity - usually secondary to pulmonary TB, cough or cervical lymphadenopathy
Can result in delayed healing after tooth extraction - can cause osteomyelitis
Oral ulceration
Investigation - smear/sample
Biopsy - stained with NZ stain
Culture - Lowenstein Jensen medium - brown colonies = mycobacterium tuberculosis
Serology - PCR, reactive T cells
Txt - Abs for 6 months
Histology will show epithelioid granulomas, caseation
Syphilis
1^ lesion - chancre on lip, tongue, ulcer, local oedema, painless
Smear shows spirochaetes - treponema pallidum
Treponemas are visible only by dark field illumination
Gram - but too thin to be gram stained
Lymphadenopathy
2^ syphilis - 6 weeks after healing of chancre. Snail track ulcers, lyphadenopathy, skin rash
3^ syphilis - recognised by gumma on palette, tongue or tonsil - firm necrotic centre surrounded by inflamed tissue
Leukoplakia on dorsum tongue and increased incidence oral cancer
Congenital syphilis
Hutchinsons incisors
Mulberry molars
Gonorrhoea
Pharynx and any part of mucosa can be affected
Variable appearance - ulceration, oedema, pseudomembranes
Direct examination of smear and or culture necessary to diagnose - Neisseria gonorrhoae
Pink blobs - polymophonuclear lymphocytes, pink dots - gram - diplococci - N. gonorrhoae
On the rise, superbug, developing Ab resistance
Actinomycosis
Large lump/bulge, usually under mandible
Slow growing lump, usually secondary to trauma e.g. broken jaw
Actinomyces israelli, A.oris, A.naeslundii
Smear - gram stain will show + branches filamentous microbes
Histology will show locules of pus surrounded by fibrous septa
Txt - surgical drainage and debridement, Abs 6-8 weeks
Acute bacterial sialadenitis
Ascending infection - mainly parotid
Usually failure of secretion e.g. Sjogrens, gland pathology, sialolithiasis, drugs
Unilateral, firm, red swelling, extreme pain, trismus, possibly febrile, milking duct releases pus
Sampling difficult
Microbial causes - oral streptococci, oral anaerobes, staphylococcus aureus
Txt - amoxicillin, flucloxacillin
Exploration - sialography after resolution, possible surgical exploration
Angular chelitis
Haemtological deficiency - Fe, vit B2, 3, 6, 12
Candida sp., staph aureus - alone or mixed
Treat with miconazole, nystatin or fusidic acid depending on cause
Spread of infection in mandible
Spread of denoalveolar infection governed by site of origin and surrounding tissue planes limited by facial layers and muscle insertions. Position of apices of tooth relative to this will influence clinical presentation
If apex of mandibular molar is above mylohyoid attachment, infection will track laterally above mylohyoid space - sublingually
If apex of mandibular molar is below mylohyoid attachment, infection will track down mylohyoid and present E/O on the skin, under lower border of mandible
If infection tracks laterally, above attachment of buccinator, infections tracks through buccal cortex and abscess in buccal sulcus adjacent to tooth
If infection tracks below attachment of buccinator, would present in the skin of the face above the angle of the mandible
Infections from lower 2/3rd molars can track posteriorly into masticator space or pharyngeal/retropharyngeal space.
Sub-masseteric abscess - profound trismus
Spread to pharyngeal/retropharyngeal space - dangerous due to airway compromise and tracking of pus into chest via retropharyngeal space
Spread of infection in maxilla
Most maxillary abscesses point bucally in the mouth as bone is thinnest here
Roots of some lateral incisors and palatal roots of 6’s can point palatally
Infection can track superiorly in the roots of upper premolars and molars into maxillary sinus
Relationship between apices and levator anguli oris and buccinator determines whether abscess points in oral cavity or skin of cheek
Apex of upper canines can be situated above origin of levator anguli oris and infection can present at medial canthus of eye, deep to levator labii superioris
Acute pseudomembranous candidosis
Creamy, thick, white plaques - thick biofilm of yeast and hyphal forms
Easily rubbed off - bleeding base
Erythematous/atrophic candidosis - HIV
Long standing, erythematous lesions
Acute atrophic candidosis
Site
Cause
Txt
Red, painful lesions
Most commonly dorsum of tongue
Causes: prolonged corticosteroid or Ab therapy
Bacterial flora altered, candida allowed to thrive
Treatment - reduce Ab use if possible
Median rhomboid glossitis
Erythematous area on dorsum tongue - epithelial proliferation and candida within epithelium
Not premalignant
Diagnosis usually on clinical grounds
Typically matching lesion on palate
