Oral Surgery Final Flashcards
Odontogenic infection % aerobic % anaerobic -Gram positive _ -Gram negative _
25% aerobic
75% anaerobic
Gram positive cocci
Gram negative rods
Typical infections
_ are aerobes only
_ are mixed
_ are anaerobic only
7%
60% mixed
33% anaerobic
2 stages of ondontogenic infection
- Aerobic bacteria initiation
- spreading factors
- necrosis and hypoxemia - Anaerobic bacteria
- toxins
- wall off infection (abscess)
Course of odontogenic infection (3 stages)
Cellulitis
Abscess
Fistula
What causes cellulitis
Early vs. late cellulitis
Strep
Early: mild, soft, red, easy to treat
Late: diffuse, hard, life threatening, hard to treat
Abscesses are filled with _
Anaerobes
3 things that determine how odontogenic infections spread
Muscle attachments
Bone thickness
Root angulation
_ infection occurs in max anterior teeth because the roots are below _
Vestibular
Muscles
_ space infection occurs in the max posterior because roots of the teeth are _
Buccal
Above buccinator muscle
How to distinguish a buccal space infection
Feel inferior border of mandible, all infection is above it
Can drain in mouth
How to determine a submandibular space infection
Infection is below inferior border of mandible
Hard to drain into mouth
Ludwig’s angina
Bilateral submandibular, sublingual and submental space cellulitis
Primary space infections (6)
Vestibular Canine Buccal Sublingual Submental Submandibular
Vestibular space infections are where
Max anterior gingiva
6 secondary spaces can be infected
Pterygomandibular Masseteric Superficial and deep temporal Lateral pharyngeal Retropharyngeal Pre-vertebral
If infection gets into masticator space, what is hallmark of infection?
Can’t open mouth more than 15 mm (trismus)
How can a dentist cause pterygomandibular infection
Inject into a real dirty mouth
3 major complications of lateral pharyngeal space infections
Airway impingement
Spread to superior mediastinum
Spread into danger space/inferior mediastinum
How do severe fascial space infections happen
Prevent?
High speed hand piece, non-sterile air and water vented into space
Back venting air piece
What 5 things need to be considered in determining severity of disease
Rate of progression Quality and quantity and location of swelling Trismus Systemic involvement Airway
Admission is advised for swelling in _ and _
Secondary and neck spaces
Trismus indicates _
Secondary space involvement
Temp > _ indicates systemic involvement
101
Who is referred/admitted? _ onset _ compliance Severe swelling _ involvement _ Airway concerns Immunocompromised
Rapid onset Poor compliance Secondary space involvement <15mm opening Temp >101
Main surgical goal, 2 others
Remove source of infection
Drain pus
Release tension, improve circulation
Mild infection antibiotics:
Moderate infection antibiotics:
PCN allergy
Mild: amoxicillin 500 mg
Mod: amox 500 mg and metronidazole 500 mg
PCN allergy: cephalexin (with metro)
For a severe odontogenic infection, do what?
Mild allergy?
Severe allergy?
Penicillin G with metronidazole
Cephalexin for mild allergy
Clindamycin for severe allergy
1 reason for treatment failure
Inadequate surgery
Least likely reason for treatment failure
Antibiotic problems
3 types of bony preprosthetic surgery
Alveoloplasty
Torus reduction
Tuberosity reduction
3 types of soft preprosthetic surgery
Inf. Papillary hyperplasia
Inf. Fibrous hyperplasia
Frenal attachments
3 systemic and 3 local factors responsible for variation in amount of bone resorption
Systemic:
Nutritional abnormalities
Osteoporosis
Endocrine dysfunction
Local:
Alveoloplasty at time of extraction
Dentures
Facial form
6 anatomical factors to consider when planning a tissue supported prosthesis
Ridge form Osseus prominences Tuberosity form Vestibular depth Adjacent vital structures Inter-arch distance
Immediate vs delayed alveoloplasty
Immediate: at time of extractions
Delayed: after bony healing of socket, 2 surgeries
3 types of alveoloplasty
Digital compression
Intraseptal
Surgical
Tori vs. exostoses
Tori on lingual
Exostoses buccal
Tori harder to remove
Max tori consideration
Can be pneumatized and communicate with nasal passage
What causes inflammatory papillary hyperplasia
Treatment
Mechanical irritation
Ill-fitting dentures
Poor oral hygiene
Fungal infections
Non-surgical (denture adjustment, antifungal)
Surgical excision
Abrasion of superficial layer of palatal mucosa
What causes inflammatory fibrous hyperplasia
Denture irritation from ill fit or allergy
Tissue excised from infla. Fibrous hyperplasia should be _
Submitted for histological evaluation
4 steps to metastatic infection
Surgery
Transient bacteremia
Distant susceptible site
Infection
How does SBE form
Extraction, bacteremia
Agglutination antibodies bind bact.
Bacteria complex circulates
Infect sterile thrombus
2 people who need prophylaxis
Prosthetic cardiac valve
Previous infective endocarditis
_% of SBE comes from dentistry
13%
Antibiotic prophylaxis regimen
Why?
Amoxicillin 2 mg 1 hr preposterous
Predictable blood level from 1 dose
If allergy to penicillin
Clindamycin 600 mg 1 hr preop
What if a patient is already on antibiotics
Use different one
T/F prophylactic antibiotics are recommended prior to dental procedures to prevent prosthetic joint infections
FALSE not recommended anymore
Prophylaxis principles
Give to those with significant risk (rare in dentistry)
Time it correctly (before treatment)
Correct antibiotic and dose
Stop after surgery
T/F treatment for prevention is different than treatment for actual infection
TRUE
T/F give antibiotics to prevent dry socket
FALSE - rinse with chlorhexidine or administer local
Indications for prophy for dentoalveolar surgery
Poorly controlled metabolic disease Immunosuppressed Surgery longer than 3 hrs Contaminated wound Insertion of major foreign body Surgery adjacent to sinus Bony impaction
4 indications for biopsy
Lesions persist 2+ weeks
Persistent changes in epithelial tissue
Lesions that interfere with function
Bone lesions not identifiable by clinical or radiological findings
5 things to note about lesions
Size/shape Single/multiple Surface texture Color Sharpness of bordersa
4 types of biopsies
Oral cytology
Aspirational biopsy
Incisional
Excisional
Cytology biopsy
How
Why
Brush smeared over and onto slide
Large areas of mucosal change
Aspiration biopsy
What
Why
Syringe, take fluid
Lesions suspected to contain fluid or intraosseus lesion
Incisional biopsy
What
Why
Deep and narrow wedge taken out
Extensive lesion, hazardous location
Suspicion of malignancy
Excisional biopsy
What
Why
Take whole lesion (all the way around it)
Small, benign appearance
Why refer a biopsy
Malignancy suspected Close to anatomical structure Sedation Medically compromised Further surgery
Put biopsied tissue in what
10% formalin solution
20 times the volume of the specimen
When taking a bone biopsy, how much to take
4-5 mm of sound bone around lesion
When a biopsy is done, what needs to be documented
Preop counseling Post op counseling Date/time History Clinical description Follow up
4 things required in a patient provider relationship
Chief complaint and diagnostic studies
History of present illness and diagnosis
Med history
Physical exam
6 things dentists can prescribe
Analgesics Antibiotics Antimicrobials Anti-inflammatory Anxiolytics Muscle relaxants
3 things required before a dentist can write a prescription
State license
Registration
DEA registration number
5 things on a prescription
Patient info Date issued Drug info Refill authorization Prescriber info
Drug info includes
Drug name Strength Dosage form Route Directions for use Duration Quantity Special instructions
Abbreviations: a.c. ad lib b.i.d caps d.a.w Gtt, gtts p.r.n q.d. q.i.d t.i.d
Ac=before meal Ad lib= use freely Bid = twice daily Caps=capsules Daw= dispense as written (brand) Gtt=drops Prn= as needed Qd=once a day Qid=4 times a day Tid=3 times a day
Max dose per day:
Acetaminophen
Aspirin
Ibuprofen
4000mg
4000mg
2400mg/3200mg
