Spread of Infection Flashcards
How does infection spread into the buccal space from upper teeth?
Infection can spread from the apex following an acute apical abscess and can go through bone buccally (above insertion of buccinator)-
Why is palatal spread of infection less likely in uppers?
Bone is more dense (infection tends to spread via path of least resistance)
-> extreme pain- due to stretching of the tissue
When is palatal spread more likely?
If palatal root or lateral incisor (as root can be quite palatally placed)
What occurs if infection perforates below the insertion of buccinator from upper tooth?
It drains into the mouth
-> Gives bad taste and a bursting bubble (abscess)
What occurs if infection from upper tooth spreads upwards?
Maxillary sinusitis
How does infection spread into the sublingual space from lower teeth?
lingually above the insertion of mylohyoid
What happens if infection perforates mylohyoid muscle?
It can spread into submandibular space
What can happen when infection passes buccally in lower teeth?
It can:
Go above buccinator attachment- into mouth
Below- into buccal space
In lower jaw where does infection anteriorly and posteriorly tend to spread?
Anterior- labially
Posterior- lingually
-> bone is thinner
How does the mylohyoid line dictate the space in which infection is likely to spread?
Infection spread depends on the location of tooth i.e 7 roots are below the mylohyoid line so typically spreads to submandibular space
What is the significance in terms of infection spread of the mylohyoid being open at the back?
Sublingual infections can spread into submandibular space (VV)
Why is the space surrounding the ptergyoid plates and muscles a hotspot for infection spread?
There is little resistance and neighbouring spaces all communicate
What is the name for the space surrounding the pterygoid muscles and plates?
Masticatory space- misleading as there isn’t one space
What is the effect of infection in pterygoid muscle region?
Trismus due to muscle spasm
What occurs when infection spreads into lateral pharyngeal space? Why is it worrying?
Bulge in pharynx
-> This space contains many important nerves and vessels
Where can infection spread from lateral pharyngeal space and what can it cause?
Retropharyngeal space (behind pharynx) or into pre-vertebral space
-> It then can spread into base of skull (infection of brain) or superior/inferior mediastinum (can cause pressure on heart)
What is the route of infection from tooth to CS thrombosis?
Infection from lower tooth spreads back into lateral pharyngeal space or infratemporal space and reach pterygoid Venus plexus which communicates with veins reaching the cavernous sinus (no valves to stop infection)
Infection from upper tooth can spread into infraorbital space and get into veins (valveless) and reach cavernous sinus
What is the treatment for CS thrombosis?
Drainage
How does different bacteria affect spread?
Spread can be worse with more virulent bacteria
How can infection in buccal space be identified?
Swelling of face
Inability to close eye
How can an infection with infraorbital spread be identified?
Loss of nasolabial fold
-> If this is not affected, it may suggest it is only buccal space that is affected (but every patient is unique and has different anatomy)
What tooth is most likely to give infraorbital spread?
Canine
What happens if infections are left untreated?
They can spread further:
Upper infections tend not to spread down (apart from buccal space which can go to lateral pharyngeal space)
Lower infection tends to spread back more easily (apart from anteriors which tend to go to mental/submental space)
Where does infection tend to spread from different regions in upper jaw?
Upper Anterior Teeth
Lip
Nasolabial region
Lower eyelid
Upper Lateral Incisor
Palate (Less common)
Upper Premolars and Molars
Cheek
Infra-temporal Region
Maxillary Antrum (Very rare)
Palate (Less common)
What is the issue with submental spread of infection?
It can drain out of the skin (EO)- this can cause scarring that would need to be fixed by plastic surgeon
What indicates an infection in lowers could be serious?
If mandible cannot be palpated
Where does infection tend to spread to from different areas of lower jaw?
Lower Anteriors
Mental and Submental Space
Lower Premolars & Molars
Buccal Space
Submasseteric Space
Sublingual Space
Submandibular Space
Lateral Pharyngeal Space
What are the options for management of spreading infection?
Establishment of drainage- IO/EO
Removal of source of infection- Extraction, RCT, caries removal
AB therapy
How is a large spreading abscess managed?
Can be done under LA and GA
Drainage- extirpate pulp, remove tooth, incise skin to remove pus and pressure build up
Removal of source- can be difficult as anaesthesia is poorer
Antibiotics- not required if drainage, removal of source and patient is not systemically unwell
What does SIRS stand for?
systemic inflammatory response syndrome
What are the features of SIRS?
Temperature- >38/<36
Raised HR- >90bpm
Raised respiratory rate- >20 breaths per min
WCC- >12000 per ml/ <4000 per ml
What should you do if you suspect someone is suffering from SIRS?
Urgently refer for treatment in hospital environment (if 2/3 signs are positive)- likely given IV antibiotics
Why may drainage be dangerous in submandibular region, how can the risk be mediated?
Marginal mandibular branch of CN7 could be severed
-> Incise 2 fingers down from lower border of mandible
What are the methods of bursting and draining and abscess?
Stick finger/instrument in hole
Hilton technique- instrument with two ends (tweezers)- close, place into sinus and open
-> Complete drainage is unlikely- suture (prolene) in a drain for a few days- if dressing looks dirty on removal, then keep drain in until it looks clean
What secretion comes from an abscess?
Serous-anguinus (blood and pus)
How does Ludwig’s angina from dental infection present?
Swelling under neck and raised tongue (can compromise airways)
SHOCK- low body temp, HR, respiratory rate
What is NEWS?
National Early Warning Score-emergency medicine assessment for deteriorating patients
