Spread of Infection

Question 1

6 types of odontogenic infection?

Answer 1

Caries
Periodontitis
Periapical periodontitis
Pericoronitis
Osteomyelitis
Maxillary sinusitis

Question 2

What is pericoronitis?

Answer 2

inflammation due to infection around a partially erupted tooth – most common mandibular 3rd molars.

Question 3

What is osteomyelitis?

Answer 3

infection of the medullary component of the bone – more common in MANDIBLE, can present with same symptoms as odontogenic pain.

Question 4

What 4 factors determine the sequelae of infection?

Answer 4

Virulence of the organism

Host resistance

Local anatomy

Treatment of infection

Question 5

What does the position of the tooth root relative to the buccal/ lingual plate determine?

Answer 5

Whether the swelling will present buccally or lingually/ palatally.

Question 6

What does the position of the tooth root relative to the muscle attachments determine?

Answer 6

• Below muscle attachments: present intraoral fluctuant swelling
• Above muscle attachments: will present into the primary tissue spaces and then along the fascial planes.

Question 7

Why are bacteria not enough to eliminate infection in a necrotic tooth?

Answer 7

No vasculature in tooth hence antibiotics cannot reach source of infection.

Question 8

Why do bacteria help eliviate symptoms of a necrotic tooth?

Answer 8

ANTIBIOTICS WILL ONLY ELIMINATE THE BACTERIA LIVING IN THE PDL – REDUCE SYMPTOMS BUT NOT KILL SOURCE OF INFECTION BECAUSE IT CANNOT REACH THE NON VASCULAR INSIDE OF THE TOOTH.

Question 9

What two factors determine the odontogenic potential route of spread of infection?

Answer 9

The position of the apex relative to the BUCCAL/ LABIAL PLATE and the MUSCLE ATTACHMENTS.

Question 10

What are the 5 potential routes of spread for a maxillary molar?

Answer 10

• Short buccal roots, close to the lingual plate, below muscle attachment  BUCCAL SULCUS SWELLING.
• Long root, above muscle attachment  BUCCAL SPACE.
• Root close to the antrum  ANTRAL INFECTION.
• Root close to the nose  NASAL INFECTION.
• Root close to the palatal shelf  PALATAL SWELLING.

Question 11

What are the 4 potential routes of spread for a mandibular molar?

Answer 11

Intraoral swelling, buccal swelling, submandibular space swelling, sublingual space swelling.

Question 12

What is cellulitis?

Answer 12

• Diffuse inflammation of the soft tissues which is NOT CIRCUMSCRIBED or CONFINED to one area but tends to SPREAD THROUGH TISSUE SPACES ALONG FASCIAL PLANES.

Question 13

What can be seen/ felt in cellulitis (3)? Why?

Answer 13

Heat, redness, swelling due to VASODILATION.

Question 14

What is a negative of cellulitis?

Answer 14

• Vasodilation leads to opening of the potential tissue spaces and fascial planes, the cellulitis helps SPREAD the infection.

Question 15

What are the 4 potential routes of spread of infection from mandible down FASCIAL PLANES?

Answer 15

• around laryngeal inlet –> ASPHYXIATION.
• Down retropharyngeal, pretracheal, prevertebral fascia –> MEDIASTINITIS

Question 16

Infection of which spaces can lead to Mediastinitis?

Answer 16

PRETRACHEAL FASCIA/ PREVERTEBRAL FASCIA/ RETROPHARYNGEAL SPACE

Question 17

What is Ludwig’s angina?

Answer 17

Severe cellulitis.
- Bilateral involvement of SUBMANDIBULAR, SUBMENTAL, SUBLINGUAL, PARAPHARYNGEAL.

Question 18

What are 5 clinical presentations of Ludwig’s angina?

Answer 18

• Board like swelling of FOM, elevation of tongue, dysarthria, dysphagia, trismus.

Question 19

What are 2 complications of Ludwig’s Angina?

Answer 19

• Glottal edema and SUFFOCATION.
• mediastinitis.

Question 20

What is ludwig’s angina considered?

Answer 20

ANESTHETIC EMERGENCY.

Question 21

What is the managment of Ludwig’s angina?

Answer 21

• EMERGENCY
• Bilateral Hilton’s Method
• Tracheostomy
• IV steroids and antibiotics
• Irradicate cause once patient stable.

Question 22

What presentation may cause cavernous sinus thrombosis?

Answer 22

peri-orbital edema.

Question 23

What are 3 consequences of cavernous sinus thrombosis?

Answer 23

• Death, difficulty moving eye, proptosis of eye.

Question 24

What are the Cavernous sinus contents?

Answer 24

Pituitary gland, third ventricle
- abduscent nerve, trochlear nerve, internal carotid artery, maxillary division of trigeminal, ophthalmic branch of trigeminal, oculomotor nerve.

(ATIMOO)

Question 25

What do virulent microoganisms commonly have and what does it do?

Answer 25

Produce COLLAGENASES that can help break down surrounding structure to facilitate spread

Question 26

Two reasons a patient could be immunocompromised

Answer 26

uncontrolled diabetes, immunosupressants

Question 27

What is sepsis?

Answer 27

• Life-threatening organ dysfunction caused by DYSREGULATED HOST RESPONSE to infection.

Question 28

8 Symptoms of Sepsis?

Answer 28

• Symptoms: slurred speech, extreme shivering, no urine in a day, severe breathlessness, illness so bad feel there’re dying, skin mottle/ discolored/ashen, rash doesn’t blanch with pressure, cyanosis of lip/skin/tongue.

Question 29

What are specific diagnostic indications of sepsis?

Answer 29

• Patient with INFECTION and TWO OR MORE:
• Temperature greater than 38 or less than 36.
• Heart rate more than 90 (high risk more than 130/min)
• Respiratory rate more than 20 (high risk more than 25).
• WCC More than 12 or less than 4.
• BP systolic less than 100 (high risk less than 90).