Spread of infection

Question 1

Two main modes of spread of odontogenic infection?

Answer 1

• Direct spread (through tissues/fascial spaces)
• Indirect spread (through blood/lymphatics)

Question 2

What is the direct path of spread from the tooth? (6)

Answer 2

pulpal chamber-periodontal structures-alveolar bone- soft tissues- primary fascial spaces- secondary fascial spaces

Question 3

What is sinusitis?

Answer 3

Inflammation of the sinuses

Question 4

What are the symptoms of odontogenic sinusitis? (5)

Answer 4

• pressure/pain
• nasal congestion
• post nasal drip
• foul smelling or tasting discharge
• fever, weakness

Question 5

What is the risk associated with sinusitis?

Answer 5

Infection can travel to other sinuses and potentially to the cranial cavity and brain

Question 6

What are some factors affecting spread of odontogenic infection? (4)

Answer 6

• Host defences
• Virulence of microorganism
• Thickness of bone
• Proximity of root apex

Question 7

What are the maxillary primary fascial spaces? (4)

Answer 7

• Vestibular space
• Palatal space
• Canine space
• Buccal space

Question 8

What are the mandibular primary fascial spaces? (6)

Answer 8

• Vestibular space
• Buccal space
• Submental space
• Sublingual space
• Submandibular space
• Pterygomandibular space

Question 9

What teeth spread to vestibular space?

Answer 9

All teeth

Question 10

What teeth spread to palatal space?

Answer 10

All teeth particularly lateral incisors and palatal roots of molars

Question 11

What teeth spread to canine space?

Answer 11

Maxillary canines and 1st premolars

Question 12

What teeth spread to buccal space?

Answer 12

Premolars and molars

Question 13

What teeth spread to submental space?

Answer 13

Mandibular incisors

Question 14

What teeth spread to sublingual space?

Answer 14

Mandibular premolars and molars

Question 15

What teeth spread to submandibular space?

Answer 15

Mandibular molars

Question 16

What teeth spread to pterygomandibular space?

Answer 16

mandibular 3rd molars

Question 17

What is an abcess?

Answer 17

A localised entrapment of pathogens in a well circumscribed area. These are filled with pus and the pus will travel through the path of least resistance to form the lesion.

Question 18

What is osteomyelitis?

Answer 18

Inflammation or swelling of the bone (alveolar) marrow. This is uncommon in the jaw.

Question 19

What is cellulitis?

Answer 19

Diffuse inflammation of soft tissue spaces.

Question 20

What are some symptoms of cellulitis? (4)

Answer 20

• Firm swelling
• Pain
• Redness
• Dysphasia

Question 21

What is the outcome of cellulitis?

Answer 21

• May confine to a tissue space to form an abcess
• Can spread to multiple spaces-Ludwig’s angina

Question 22

How is cellulitis treated?

Answer 22

• Removal of cause
• Antibiotics

Question 23

What are the signs and symptoms of osteomyelitis? (3)

Answer 23

• Xray evidence of bone sequestration
• Tingling or numbness in lower lip
• Multiple discharging sinuses

Question 24

What is the outcome of osteomyelitis?

Answer 24

Bone resorption and formation of sequestra

Question 25

What is the treatment process of osteomyelitis?

Answer 25

- Removal of cause - Removal of sequestra - Antibiotics - Hyperbaric oxygen

Question 26

What can an dentoalveolar abcess lead to?

Answer 26

Fistula/stoma formation

Question 27

What are some treatments of dentoalveolar abcesses?

Answer 27

- Restoration or extraction - Surgical drainage - Moist heat packs - Mouth rinses - Antibiotics

Question 28

What are some types of dentoalveolar abcesses?

Answer 28

- Periapical - Gingival - Periodontal - Periocoronal

Question 29

What is a fistula?

Answer 29

A tract caused by a chronic abcess

Question 30

What is bacteraemia/septicaemia?

Answer 30

When bacteria enters the blood circulation. This may cause issues in high risk patients as bacteria may lodge in compromised tissues

Question 31

Why is antibiotic prophylaxis used in high risk patients?

Answer 31

To prevent bacteraemia or septicaemia and therefore infective carditis

Question 32

What is lymphadenopathy?

Answer 32

Swelling/inflammation of lymph nodes

Question 33

What is cavernous sinus thrombosis?

Answer 33

When an infected thrombus lodges in the cavernous sinus on the side of the sphenoid bone.

Question 34

Where can infection spread to the cavernous sinus from? (4)

Answer 34

- The infratemporal space- needle - The upper lip - The canine fossa - Dangerous triangle of the face

Question 35

What are the signs and symptoms of cavernous sinus thrombosis? (4)

Answer 35

- Fever, drowsiness - Oedema in the eye lids, tearing - Loss of vision - Pressure headaches

Question 36

What can cavernous sinus thrombosis lead to?

Answer 36

Meningitis- death hence why immediate hospitalisation and IV antibiotics is necessary

Question 37

What is Ludwig's angina?

Answer 37

A potentially life threatening, fast moving cellulitis involving bilateral submental, sublingual, submandibular spaces

Question 38

Spread from where causes ludwig's angina?

Answer 38

Mandibular teeth, piercings

Question 39

What is the risk associated with Ludwigs angina?

Answer 39

Spread to parapharyngeal and retropharyngeal space, causing oedema of the larynx and raising of the tongue blocking the airway completely- death

Question 40

What are the symptoms of ludwig's angina?

Answer 40

- High fever - Difficulty with speech, swallowing, breathing

Question 41

How can spread of odontogenic infection be prevented?

Answer 41

- Thorough medical history taking before any treatment - Strict adherence to infection control measures - Early diagnosis and proper treatment

Question 42

How can infection spread by blood vascular system?

Answer 42

Pathogens travelling in veins

Question 43

When can bacteraemia be caused?

Answer 43

During dental treatment or while draining an infected oral site. Bacteria may lodge in compromised tissues and set up serious infections.

Question 44

How