Spread Of Infection Flashcards
What are the main treatment options for a dental abscess?
Extirpation
Incise and drain
Drain via perio pocket (if perio abscess)
Extraction
When does an abscess require extra oral drainage?
If the infection has spread to buccal/ submandibular space.
What anatomical structures should be considered when draining a lower lingual/ buccal and upper palatal swelling?
Lower lingual - lingual nerve - dont incise here
Lower buccal - mental nerve (in premolar region)
Palatal - greater palatine nerve
How are anatomical structures avoided when incising?
Incise superficially and when incising on palate, incise in an antero-posterior direction
Why is anaesthesia difficult to achieve in infection?
There is a low pH, therefore the LA becomes charged (ionised) and cannot cross the membrane to block the sodium channels.
Dissociation of LA is more difficult.
Should the incised lesion be sutured closed? Why?
No, dont suture incision after drainage.
This allows further drainage and promotes healing.
Describe the path of spread of infection from a lower 6, spreading buccally.
Infection travels from apex of the tooth.
Travels buccally:
If the infection perforates below the insertion of the buccinator muscle, infection will travel into buccal space.
If infection perforates above the insertion of the buccinator, the infection will travel into buccal sulcus (Intra oral).
Opposite for upper teeth.
Describe the path of spread of infection from a lower 6, spreading lingually?
If the infection perforates below the insertion of mylohyoid muscle (usually only lower 8s), infection will travel into submandibular space.
If infection perforates above the insertion of mylohyoid, infection will travel into sublingual space.
Describe the path of spread of infection from an upper 6, spreading palataly?
If infection from an upper tooth is travelling palatally, infection can spread to the sinus (chronic sinusitis) / palate (intra oral)
How does infection progress from the submandibular/ sublingual space?
The mylohyoid muscle has no posterior attachment therefore, infection can travel backwards into masticatory space. This is a red flag sign.
What spaces make up the masticatory space?
Submasseteric, pterygomandibular and infratemporal space.
If infection is in masticatory space, what may the patient present with and what causes this?
Severe trismus
The infection is acidic, therefore causing the masticatory muscles to spasm.
From the masticatory space, where can infection further travel? What will the patient present with?
Can spread even further back into lateral pharyngeal space (limited opening and pharynx pushed in)
And further into retropharyngeal space (difficulty swallowing and breathing)
How can a dental infection cause compression on the heart?
Infection can spread from submandibular space, to masticatory spaces, to retropharyngeal spaces which communicate with superior medialstinum (compresses heart).
How can a microbial sample be taken for a dental abscess?
Swab
Pus aspirate
What is the best method for microbial sampling and why?
Pus aspirate - less contamination from oral cavity, microorganisms stored and travel in aerobic conditions.
On clinical exam, what should you feel for when patient presents with large swelling? What does this show?
Palpate for border of the mandible as this shows if infection has spread into submandibular space.
From phone assessment, what are some red flag symptoms?
Difficulty breathing
Eye closure
Drooling
Elevated tongue
Hoarseness
What is Ludwig’s angina?
Bilateral cellulitis of sublingual and submandibular spaces.
When infection crosses the midline, urgent referral to maxfacs.
What special investigations should be considered when a patient presents with an abscess?
Pulp sensibility testing
Tender to percussion
Mobility
IO radiographs
What are common bacteria isolated from acute dento alveolar abscesses? And which antibiotic is effective against each?
Streptococci - penicillin and erythromycin/ clindomycin
Strict anaerobes - penicillin and metronidazole
If signs of spreading infection, what investigations should be carried out?
Temperature
Pulse
Respiratory rate
BP
Oxygen saturation
What is SIRS and how is it diagnosed?
Systemic inflammatory response syndrome
Diagnosed when patient presents with 2/4:
- temperature <36 or >38
- heart rate >90 bpm
- respiratory rate >20 breaths per min
- WCC <4000 or >12,000
What is sepsis?
Life threatening condition caused by over reaction of the bodys immune response to infection (SIRS + infection).
What factors influence the path of infection spread?
Location of infection
Thickness of bone, muscle and facial attachments
If pt with pleading infection was to be admitted to hospital, how might they be managed?
ABC
Signs and symptoms of sepsis (sepsis 6) and ressuscitation if appropriate
Intravenous antibiotics (benzoyl penicillin and metronidazole)
Incision and drainage under GA (and extraction of potentially infected teeth)
Pus aspirate
