ORS - Spread of Infection

Question 1

Who was the founder of Ludwig’s Angina?

When did he first describe this condition?

Answer 1

Willhelm Friedrich von Ludwig

1836

Question 2

Explain Ludwig’s Angina in detail

Answer 2

Rare skin infection on the floor of the mouth, under the tongue

Potentially life threatening cellulitis

More common in adults than children

It affects the bilateral, submandibular,
sublingual and submental tissue spaces

If left untreated, swelling can obstruct the
airways causing airway compromise

Question 3

What is Ludwig’s Angina most commonly caused by?

Answer 3

Infected lower molars

or

Pericoronitis which is an infection of
the gums surrounding the partially erupted
lower 3rd molars

Question 4

What are the signs and symptoms of Lugwig’s Angina?

Answer 4

(THE SWAN USED VIBER RAPIDLY)

Trimus 
Swelling 
Weakness
Airway Compromise
Neck 

Voice Change
Bilateral Submandibular/Sublingual/Submental tissues affected
Raised floor of mouth

Redness of skin
Pyrexia (high fever)
Drooling with Dysphagia (difficulty in swallowing)

Question 5

What is the surgical management of Ludwig’s Angina?

Answer 5

Intubation to protect airways
IV antibiotics, analgesis
Removal of source of infection
Surgical drainage of the tissue spaces

Question 6

If Ludwig’s Angina is serious, how should it be treated?

Answer 6

Immediate hospitalization
medical emergency
In hospital under OMFS team

Question 7

If Ludwig’s Angina is not treated, is this dangerous?

Answer 7

Yes, untreated cases may be fatal within 24hours

Question 8

What is Ludwig’s Angina?

Answer 8

A type of severe cellulitis involving the floor of the mouth

Question 9

Why is Ludwig’s Angina a life threatening emergency?

Answer 9

Airway obstruction can occur rapidly as a result of it

Question 10

What are the 2 regions in the body for infection?

Answer 10

Lymphatic Tissue

Tissue spaces (spaces between 
fascia organs and other 
tissues/structures)

Question 11

What is an abscess?

Answer 11

Localised, well defined collection of pus, fluctuant swelling

Question 12

What is cellulitis?

Answer 12

Diffuse swelling due to fluid exudates in connective tissue.

soft in early stages but can become firm, board-like in later stages.

Question 13

Where do upper teeth infections normally spread?

Answer 13

Cheek and under eye

Swelling lower eyelid - eye closure

Primary maxillary space - leading to orbital cellulitis or cavernous sinus thrombosis

Question 14

What is Cavernous sinus thrombosis?

Answer 14

Backward flowing venous blood spread infections to an area under the brain, known as the
cavernous sinus – formation of a blood clot

Question 15

What are the symptoms of Cavernous sinus thrombosis?

Answer 15

• Decrease of loss of vision
• Exophthlamos (bulging eyes)
• Headaches
• Paralysis of the cranial nerves which course through the cavernous sinus
• Can be life threatening

Question 16

What are the signs and symptoms of local and systemic infection?

Answer 16

Local:

• Inflammation
• Swelling
• Red/Hot (vasodilatation)
• Trimus
• Halitosis (draining pus)

Systemic:

• Febrile (raised teperature)
• Lymphadenopathy
• Rash
• Difficulty swallowing
• Airway compromise – difficulty breathing – this is a real emergency
• C-reactive protein (CRP) and WBC raised

Question 17

How do you perform culture and sensitivity testing?

Answer 17

• Take a sample of the pus which will have the microbe in it
• On a swab, you put this on a dish of agar and grow the micro-organism
• Once you’ve done the test, you will be able to find out which antibiotic the patient will respond to

Question 18

What are some of the complications if the infection spreads?

Answer 18

• Airway impingement (Ludwig’s angina)
• Intracranial spread orbital veins (cavernous sinus thrombosis)
• Osteomyelitis of jaws
• Scarring from extra oral sinus
• Sepsis, septic shock
• Endocarditis

Question 19

What are the 3 steps of managing dental infections?

Answer 19

1. Removal Source of Infection (Extraction, endodontic treatment, periodontal treatment)
2. Drain Pus (Incision and drainage fluctuant swelling, pus sample sent for MC&S, extra-oral incision and drainage & placement of drains under GA)
3. Supportive Therapy (Antibiotics, analgesia, fluids)

Question 20

What is OMRF?

Answer 20

Oral and maxillofacial surgery is the specialty of dentistry that includes the diagnosis and surgical and related treatment of diseases, injuries, and defects involving both the functional and esthetic aspects of the hard and soft tissues of the head,
mouth, teeth, gums, jaws and neck.

Question 21

What is the difference between an ‘infection’ and an ‘inflammation’?

Answer 21

• Infection:
  Colonisation/invasion and multiplication of a micro-organism (bacteria/virus/fungus) in the
  body
• Inflammation:
  Body’s response to injury (bacterial/virul/trauma/autoimmune)

Question 22

Where does an acute and chronic periapical abscess progress from?

Answer 22

• Acute: progressing from pulpitis
• Chronic: progressing from acute exacerbation of a chronic periapical
  granuloma