Oral Surgery Flashcards
What are some routes of spread of odontogenic infections?
Maxillary abscesses
Mandibular abscesses
What is the line on the left showing?
Buccal space
What are the lines showing?
Sublingual abscess
Mylohyoid muscle
What are the lines showing?
Submandibular gland
Mylohyoid muscle
Submandibular abscess
Platysma muscle
Where does the infection spread for upper anterior teeth?
Lip
Nasiolabial region
Lower eyelid
Where does infection spread for upper lateral incisor?
Palate
Where does infection spread for upper premolars and molars?
Cheek
Infratemporal region
Maxillary antrum
Palate
What does this photo show?
Palatal abscess
What does this photo show?
Intraoral (labial) abscess
What does this photo show?
Buccal/infraorbital spread
What does this show?
Infraorbital spread
What does this show?
Buccal space spread
What does this show?
Buccal space/infraorbital space spread
Where does infection spread for lower anteriors?
Mental and submental space
Where does infection spread for lower premolars and molars?
Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space
What does this show?
Submental spread
What does this show?
Submental sinus tract to skin
What is this?
Submandibular spread
What is this?
Buccal/submandibular spread
What does this lateral oblique radiograph show?
Buccal/submandibular spread
What does this show?
Submandibular sinus tract to skin
How to manage abscess?
Establishment of drainage: extraoral, intraoral
Removal of source of infection: immediate, delayed
Antibiotic therapy: toxicity, durability, MH
What does this show?
Submandibular space spread
What does this show?
Extraoral incision and drainage
What does this show?
Hilton technique
What does this show?
Placement of extraoral drain
What does this show?
Extraoral sinus
What does this show?
Buccal space spread
What does this show?
Submandibular space spread
What is Ludwig’s angina?
Bilateral cellulitis of sublingual and submandibular spaces
IO features of ludwigs angina?
Raised tongue
Difficulty breathing/swallowing
Drooling
EO features of ludwigs angina?
Diffuse redness and swelling bilaterally in submandibular region
Systemic features of ludwigs angina?
Increased HR, RR, temp, WCC
What does NEWS stand for?
National early warning score
What are some of the physiological parameters of NEWS?
RR, O2 saturation, any supplemental oxygen, temp, systolic BP, HR, level of consciousness
Complete this?
Clinical features of pulp hyperaemia?
Pain lasts seconds
Pain stimulated by hot/cold/sweet food
Pain resolved after stimulus
Caries approaching pulp but tooth can still be restored without treating pulp
Clinical features of acute pulpitis?
Constant severe pain
Reacts to thermal stimuli
Poorly localised pain
Referral of pain
No response to analgesics
Open symptoms less severe
How to diagnose acute pulpitis?
History
Visual examination
Negative TTP
Pulp testing equivocal
Radiographs
Diagnostic LA
Removal of restorations
How to diagnose acute periodontitis?
TTP
Non vital tooth
Slight increase in mobility
Radiographs
What is shown on radiographs for acute periodontitis?
Loss of clarity of lamina dura
Radiolucent shadow
Widening of apical periodontal space
Cause of traumatic periodontitis?
Parafunction (clenching/grinding)
How to diagnose traumatic periodontitis?
Clinical examination of occlusion
TTP
Normal vitality
Radiographs
Tx for traumatic periodontitis?
Occlusal adjustment
Parafunction therapy
What is the commonest pus producing infection?
Acute apical abscess
What are the initial symptoms of acute apical abscess?
Severe unremitting pain
Acute tenderness in function
Acute tenderness on percussion
What are symptoms of acute apical abscess once abscess perforates through bone?
Pain often remits
Swelling, redness, heat
As swelling increases pain returns
Initial reduction in TTP as pus escapes into soft tissues
Where does site of swelling of acute apical abscess depend upon?
Position of tooth in arch
Root length
Muscle attachments
Potential spaces in proximity to lesion e.g. submental/ sublingual spaces
Example of gram positive and gram negative cocci?
S.anginosus
Veillonella species
Example of gram positive and gram negative bacilli?
Actinomyces israelii
Prevotella intermedia
What is capnophilic?
Require carbon dioxide
What is facultative?
With and without oxygen
What is antimicrobial resistance?
Microorganisms change in ways that render medications used to cure the infections they cause ineffective
2 types of resistance of bacteria?
Intrinsic resistance
Acquired resistance
How can genes acquire resistance?
Mutation
Acquisition of new genes
How do viridans group streptococci e.g. S.mitte resist antibiotics?
Alter target site e.g. change from circular to square shape- if u change shape then penicillins can no longer stick to exert their actions
Label the pathways of periapical infection?
Infected or necrotic pulp
PDL
Alveolar bone
Apical foramen
Periapical infection
Key microbiological features of dental abscesses?
Endogenous infection
Often mixed infections
Strict anaerobes important
E.g. S.anginosus, P.intermedia
Bacteria in periodontal abscess?
Anaerobic streptococci
P.intermedia
Microbiology and treatment for salivary gland infection?
S.aureus
Mixed anaerobes
Drainage
Flucloxacillin and metronidazole
5 cardinal signs of inflammation?
Heat
Redness
Swelling
Pain
Loss of function
Microbiology for osteomyelitis of jaw
Anaerobic gram negative rods
Anaerobic streptococci
Streptococcus anginosus
Staphylococcus aureus
Acute apical abscess treatment?
- Provide drainage
Soft tissue incision intraorally
Soft tissue incision extraorally
Extract tooth
Pulp extirpation
Periradicular surgery - Need for antibiotics determined by severity, absence of adequate drainage, MH
Local factors affecting assessment of need for antibiotics
Toxicity
Airway compromisation
Dysphagia
Trismus
Lymphadenitis
Location (e.g. FOM)
Systemic factors affecting assessment of need for antibiotics- acute apical abscess
- Immunocompromised pt- HIV, drug induced (steroids), blood disorders (leukaemia)
- Diabetes
- elderly
What is reversible pulpitis
Level of inflammation in which returning to normal state is possible if noxious stimuli is removed.
Mild/moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds, no mobility, no pain on percussion
What is irreversible pulpitis
Higher level of inflammation in which dental pulp has been damaged beyond point of recovery
Sharp, throbbing, severe pain upon stimulation and pain may be spontaneous or occur without stimulation, pain persists after stimulating removed, can’t sleep
Etiology of periapical (radicular) cyst
Caries, trauma, periodontal disease
Death of dental pulp
Apical bone inflammation
Dental granuloma
Stimulation of epithelial rests of Malassez
Epithelial proliferation
Periapical cyst formation
What is sepsis
Life threatening organ dysfunction caused by dysregulated host response to infection.
Sepsis=SIRS+suspected infection
SIRS- systemic inflammation response syndrome
Temp <36 or 38C
Pulse >90/min
Resp rate >20/min
WCC <4 or >12
Primary care treatment for sepsis and ludwigs angina
Diagnosis
Seek advice/help
Secondary care treatment for sepsis and ludwigs angina
Sepsis 6:
1. Give high flow O2
2. Take blood cultures
3. Give IV antibiotics
4. Give fluid challenge
5. Measure lactate
6. Measure urine output
What does S, I and R mean for a choice of antibiotic?
S= susceptible at standard dose
I= susceptible at increased dose
R= resistant even with increased exposure/dose
What is antimicrobial stewardship?
Coherent set of actions which promote using antimicrobials responsibly
