Periapical Tissue and Jaw Infections Flashcards
What is the difference between a peridontal abscess and dentoalveolar abscess?
Etiological differences?
- periodontal
- abscess forms along tooth root
- polymicrobial
- from periodontitis
- will notice gum receding, and reddness
- abscess forms along tooth root
- dentoalveolar
- abscess forms at end of tooth root
- polymicrobial
- anaerobes very important
- abscess can extend and show itself in the gums along the tooth
- caries have gotten thorugh enamel & dentin, down to the root
- abscess forms at end of tooth root
What is the major symptom for both dentoalveolar/periodontal abscess? How could you determine which tooth is affected?
- symptoms
- pain in and around affected tooth
- swelling of face over the abscess site
- can tapp tooth to see which causes pain – prob the one wiht the abscess
Diagnosis and treatment of dentoalveolar/peridontal abscess?
- Diagnosis
- refer to dentist
- radiograph of tooth
- Therapy
- remove tooth, root canal, incise adn drain abscess
What is Ludwig’s angina?
Why is it so concerning & where does it most commonly occur?
Predisposing factors?
- cellulitis of sublingual/submylohyoid spaces
- rapidly fatal without treatment
- can occur in children wtih out any precipitating cause
- rare, but most commonly encountered neck space infection
- predisposing factors
- dental caries
- recent dental treatment
- sickle cell disease
- compromised immune system
- trauma
- tongue piercing
common etiological agents of Ludwig’s angina
- Bacterial isolates vary adn are often mixed
- streptococcus
- Bacteriodes
- Fusobacterium
- Staphylococcus aureus
If have foul breath odor, more likely to be anaerobes
Symptoms of Ludwig’s angina?
- severely ill/fever
- severe dysphagia (trouble swallowing)
- trismus (lock jaw)
- appear toxic
- sittign upright
- drooling
- dysphonia
- swelling and erythema of neck under chin
- floor mouth tender to touch
- pain on movement of tongue
- tongue moved up and bacwards
- acute airway closure can occur at any time
How do you diagnose Ludwig’s angina?
Treatment?
Prevention?
- Diagnose
- clinically
- CT scan
- blood cultures
- Treatment
- adequate airway managment
- antibiotics
- anaerpbes & Staf aureus
- Incision and drainage (only if antibiotics fail)
- nutrition and hydration
- Prevention
- good oral hygeine
12 year old male; tooth pain. Most likely diagnosis?
- Caries?
- Gingivitis?
- Periodontal disease?
- Dentoalveolar abscess?
- Periodontal abscess?
Caries
no history of gums bleeding/they aren’t receding/look healthy
also, not usually a complaint of pain if it is gingivitis
12 year old male; tooth pain
Most important virulence factor causign patient’s current condition?
- Acidogenicity
- Anaerobic growth
- Capsule
- Collagenases
- Hemolysins
- Acidogenicity
acid produced by the organism is producing the caries
25 year old male; bleedign gums. Most likely diagnosis?
- Caries
- Gingivitis
- Periodontal disease
- Alveolar abscess
- Periodontal abscess
- Gingivitis
no lossening of teeth (prob not periodontal disese)
35 year old female; 2 year history of bleeding gums; loose teeth/ Most likely diagnosis?
- Dental Caries
- Gingivitis only
- Acute nectorizin ulcerative gingivitis
- Chronic periodontitis
- Aggressive periodontitis
Chronic periodontitis
Do not have history of bad breath, no history of poor hygeine, only complaining of bleeding – it also has been happenign for 2 years, with aggressive it would have progressed in months
We don’t see any dental caries in the teeth
35 year old female; 2 year history of leedign gums; loose teeth. Most important virulence factor causing the loose teeth in this patient?
- Acidogenicity
- Anaerobic growth
- Capsule
- Collagenases
- Hemolysins
- Collagenases
(but also, the hemolysins do cause damage to the red blood cells– increasing inflammation, but not creating loosening of teeth)
50 year old male; swelling of the face and painful tooth (right lower 1st molar). Vitals: temp-99, pulse-85/min, resp-15/min, BP-12/85. No signs of periodontal disease or pain on tongue movement. Most likely diagnosis?
- Dental Caries
- Gingivitis
- Acute necrotizing ulcerative gingivitis
- Dentoalveolar abscess
- Periodontal abscess
- Ludwigs’s angina
- Dentoalveolar abscess
no signs periodontal disease, so probably not a periodontal abscess
could be ludwig’s but seems to be more on the side of the face than the chin (would also expect a much higer temp & pain on tongue movement)
35 year old male; vitals: temp-104, pulse-120/min, resp-17/min, BP-140/90. Sore throat and drooling, unable to open mouth more than 3 mm. Tongue movement is painful. Most likely diagnosis?
- Dental caries
- gingivitis
- acute necrotizing ulecerative gingivitis
- dentoalveolar abscess
- periodontal abscess
- ludwig’s angina
Ludwig’s angina
What is the name for inflammation of the mucosal surfaces of the mouth and tongue?
What are the two most common infections causes?
Stomatitis
causes: HSV 1 & 2; Candida albicans
gingivostomatitis common with HSV
What is the incubation period for oral herpes?
Duration?
What are the symptoms?
- Incubation
- 2-12 days
- Duration
- 2-3 weeks
- Primary symptoms-
- fever
- malaise
- muscle aches
- irritable
- Additional
- pain/itching/burning at infection site (often first infection will be within the mouth and subsequent will be on the lips)
- cluster of blisters erupt
- blister breakdown forms a small, shallow gray ulcer on a red base
- cervical lymphadenopathy
Oral herpes diagnosis?
Treatmetn?
- Diagnosis
- Clinical diagnosis
- culture ofr virus
- serology
- Tzanck test positive
- big syncytia
- Treatment
- usually self-limiting
- if sever- antiviral agents
- antivirals will NOT cure
Whta are the 3 types of candidiasis?
- Pseudomembranous - thrush (common in young infants)
- acute
- Erythematous - red (common in people with dentures)
- acute
- chronic
- Hyperplastic (leukoplakia) – white or speckled
- chronic
- can result in a cancerous growth
The following clinical manifestations indicate waht diagnosis?
- creamy-white plaques (mucosal cells, neutrophils, yeast cells)
- hard to remove
- when removed can leave behind inflamed base that may be painful and bleed
Candidiasis
Acute pseudmembranous (thrush)
The following clinical manifestations indicate what diagnosis?
- red areas of varying sizes
- any part of the oral mucosa
- if on tongue, fiery red and shiny with depapillation
- can be acute or chronic
- problem for denture wearers
Erythematous candidiasis
The following clinical manifestations indicate what diagnosis?
- individual lesion of cheek near commisure, at angles of mouth or on the tongue
- chronic discrete, raised lesions
- homogenous or speckled areas
- does not rub off
Candidiasis
Hyperplastic (leukoplakia)
can become malignant
What is oral hairy leukoplaia?
What is the etiological cause?
- latera borderes of tongue
- usually in
- immunocompromised,
- those with malignant tumors
- organ transplant recipients
- Etiology
- Epstein Barr Virus
Oral Hairy Luekopplakia Dianosis and Treatment
- Diagnosis
- made clinically
- scraping look for Cowdry type A inclusions (cidophilic material of droplet-like masses surrounded by clear halos within nucle)
- Treatment
- Rarely treated unless patient has HIV
- anti-retroviral therapy
- If treating leukoplakia
- podophyllum resin and antiviral agent
