Spread of dental infection: general Flashcards
Define abscess, state its causes and describe the histology of an abscess (4)
Definition:
• It is a localized collection of pus
Causes:
• It is caused by bacteria, foreign material and fibrin
Histology (4):
• Inflammation/formation of granulation tissue
• Masses of neutrophils, living and dead
• Necrotic tissue debris
• Leukocytes gather in the infected area and produce proteases that degrade dead tissue and convert it into pus
List the 5 possible causes of dental infections
- Periapical infections due to: pulpitis, peritonitis and pericoronitis
- Glandular tissue infections: salivary glands (major or minor) and lymph nodes
- Trauma leading to infection: fractures, soft tissue injuries
- Blood borne
- Iatrogenesis: cavity exposure and a failed root canal
State the 4 clinical features of dental infections/ abscess
- Severe pain
- Tenderness on percussion or touching the tooth during mastication
- Fever (pyrexia)
- Lymphadenopathy
List the 4 possible scenarios after an abscess
- It resolves and heals with scar formation
- Fistula
- The infections spreads
- Extreme cases, Noma (rapidly progressive often gangrenous infection of the mouth and face)
List the 3 places dental infections can spread into
- Fascial spaces (through connective tissue spaces)
- Lymphatic, resulting in lymphadenopathy
- Blood: Septicaemia
Describe what a fascial space is and mention its components (5)
- Afascia is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates musclesand other internal organs
- Therefore fascial spaces are potential spacesthat exist between the fasciaeand underlying organs and other tissues.
Composed of: • Neurovascular bundles • Glands • Lymph nodes • Loose connective tissue (such as adipose tissue) • Dense collagen
State the three types of fascial spaces in the head and neck region
- Suprahyoid fascial spaces
- Fascial spaces of face
- Fascial spaces of the neck
State the symptoms of a fascial infection (9)
- Pain
- Swelling
- Trismus
- Surface erythema
- Pus formation (fluctuation)
- Fever
- Lymphadenopathy
- Malaise
- Leukocytosis
State the complications associated with fascial infections (6)
- Dysphagia (lateral and retropharyngeal spaces)
- Dyspnoea (due to fever or constriction of the airway)
- Stiff neck, headache (lateral and retropharyngeal spaces)
- Double vision (e.g. canine space infection)
- DIC (In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood’s clotting factors, which can lead to massive bleeding in other places)
- Death
For the fascial spaces of the face, state the subcategories (7)
• Canine space • Buccal space • Parotid space • Infratemporal space • Masticatory space - Masseteric - Pterygomandibular
For the suprahyoid fascial spaces, state the subcategories (3)
- Submandibular space
- Submental
- Sublingual
For the fascial spaces of the neck, state the subcategories (3)
- Lateral pharyngeal space
- Retropharyngeal space
- Carotid sheath
Explain the process of incision and drainage of an abscess
- Could be carried out either intraorally or extraorally depending on the location of the infection
- Removal of infection source: extraction of the tooth (teeth) or RCT
- Aspiration of pus prior to incision allows a more accurate sampling method as it reduces contamination and helps preserve anaerobic bacteria
- Incise in healthy skin and mucosa when possible (in an aesthetically acceptable area like the shadow of the jaw or natural skin crease). An incision placed at a site where the tissues are necrotic will not heal properly
- When possible, place the incision in a dependent position to encourage drainage by gravity
- Dissect bluntly, an separate tissue with a closed surgical clamp or fingers. Explore all portions of the abscess cavity thoroughly so that compartmentalized areas of pus are disrupted. Extend the dissection to the roots of teeth responsible for the infection. This helps minimise damage to salivary glands and other structures
- Avoid damage to the nerves and blood vessels. For example, use a 2 finger distance from the mandibular line to avoid marginal mandibular branch of CN VII and facial artery
- Place a drain and stabilize it with sutures, especially in bilateral, submandibular space infections. Remove drain when drainage becomes minimal
- Clean wound margins daily under sterile conditions to remove clots and debris
Explain the use of antibiotics and supportive therapy as treatment for an abscess
Antibiotics
• Can be provided empirically or a specific antibiotic given based on culture and sensitivity tests.
• Penicillin has the potential to be the first-line agent in the treatment of odontogenic infections
Supportive therapy (2)
• Hydration (i.v. fluid, nutrients)
• Airway patency (tracheotomy)
State the characteristics of malignant lymphadenopathy in terms of:
- Onset and duration
- Associated infection site
- Symptoms
- Progression
- Fixation
- Responsiveness to antibiotics
- Distribution
Onset and duration:
Slow
Associated infection site:
Not always
Symptoms:
Painless. Firm and matted
Progression:
Continuous enlargement overtime
Fixation:
Hard and fixed
Responsiveness to antibiotics:
Continued enlargement
Distribution:
Unilateral
