Spread of infection

Question 1

what is irreversible pulpitis?

Answer 1

bacteria invade the pulp chamber and root canal system from a carious lesion. Patient feels pain but cant identify tooth

Question 2

what is periapical periodontitis?

Answer 2

bacteria then invade periapical tissue and PDL inciting an acute inflammatory response. Patient feels pain and can identify tooth which is TTP

Question 3

how does bone resorption occur in periapical periodontitis?

Answer 3

Pus then accumulates due to polymorphonuclear leucocytes forming an abscess. This increases the hydrostatic pressure which triggers an osteoclastic reaction causing bone resorption

Question 4

in periapical periodontitis the bone resorption expands until it breaches the cortex via what?

Answer 4

the path of least resistance

Question 5

what tooth anatomy causes buccal/labial swelling?

Answer 5

short roots close to the buccal cortex
(most teeth except maxillary lateral incisors)

Question 6

what tooth anatomy causes palatal swelling?

Answer 6

roots close to the palatal cortex (maxillary lateral incisors)

Question 7

what tooth anatomy causes sublingual swelling?

Answer 7

roots are short and close to the lingual cortex

Question 8

what tooth anatomy causes swelling of the maxillary sinus and nose?

Answer 8

roots close to the sinus/nose

Question 9

what tooth anatomy causes swelling in the face?

Answer 9

roots are long relative to the muscles in the maxilla (upper molars and canines)

Question 10

what tooth anatomy causes swelling in the neck?

Answer 10

roots are long relative to the muscles in the mandible (lower molars and canines)

Question 11

what is cellulitis?

Answer 11

diffuse inflammation of soft tissue that tends to spread through tissue spaces along fascial planes

Question 12

cellulitis is characterised by what? 5

Answer 12

Oedema
Erythema
Pain
Heat
Loss of function (trismus -> inability to open mouth)(closure of eye)

Question 13

what special investigations would be used to diagnose periapical periodontitis?

Answer 13

vitality, TTP, mobility, radiograph

Question 14

how is periapical periodontitis treated?

Answer 14

Eradicate the source of infection -> remove pulp and endodontic treatment

Drain pus (suppuration)

Antibiotics to treat periapical tissue infection

Question 15

what are the limitations to antibiotics? 2

Answer 15

Only treat surrounding tissue not eradicate the source so chronic infection still persists

Need a blood supply to be delivered into the infected area to eliminate bacteria

Question 16

when should antibiotics be used?

Answer 16

Use if systemic involvement, significant cellulitis, compromised host defence, involvement of fascial spaces

Only prescribed when essential and local measures have been done to prevent antibiotic resistance

Question 17

when should you refer periapical periodontitis?

Answer 17

Rapid progress
Difficulty breathing or swallowing
Involvement of fascial tissue spaces
Temperature >39
Compromised host defences

Question 18

what causes infection of the canine space?

Answer 18

usually maxillary canine root long enough to pass muscles of facial expression

Question 19

infection of the canine space causes swelling where, what is this called?

Answer 19

infraorbital
peri-orbital cellulitis

Question 20

what causes infection of the buccal space?

Answer 20

usually maxillary molars -> erosion of pus above buccinator muscle

Question 21

infection of the buccal space causes swelling where?

Answer 21

cheek below the zygomatic arch

Question 22

infection of the infratemporal space is caused by what?

Answer 22

usually upper 8

Question 23

infection of the infratemporal space causes what? 3

Answer 23

trismus
bulging of temporalis
cavernous sinus thrombosis

Question 24

what causes infection of the sublingual space?

Answer 24

usually lower molars with short roots

Question 25

infection of the sublingual space causes swelling where?

Answer 25

floor of the mouth under the tongue

Question 26

what causes infection of the submandibular space?

Answer 26

usually lower molars with long roots

Question 27

infection of the submandibular space causes swelling where?

Answer 27

mandible

Question 28

infection of the submental space causes swelling where?

Answer 28

under the chin

Question 29

what causes infection of the submental space?

Answer 29

usually lower incisors

Question 30

what is ludwig's angina?

Answer 30

severe cellulitis in submandibular, submental and sublingual spaces bilaterally

Question 31

what is glottal oedema?

Answer 31

swelling of the glottic region causing suffocation

Question 32

what is mediastinitis?

Answer 32

inflammation/infection of the mediastinum

Question 33

infection of the retropharyngeal space leads to secondary infection where?

Answer 33

posterior mediastinum

Question 34

infection of the prevertebral space leads to infection where?

Answer 34

the whole mediastinum as inferior boundary is diaphragm

Question 35

infection of the peritonsillar region leads to what?

Answer 35

quinsy: abscess between tonsil and throat

Question 36

what is sepsis?

Answer 36

bodies response to infection causes damage to own tissues and organs

Question 37

what are the symptoms of sepsis?

Answer 37

Slurred speech or confusion Extreme shivering or muscle pain Passing no urine in a day Severe breathlessness Feels like you are going to die Skin discolouration