Spread of infection Flashcards
Two main modes of spread of odontogenic infection?
- Direct spread (through tissues/fascial spaces)
- Indirect spread (through blood/lymphatics)
What is the direct path of spread from the tooth? (6)
pulpal chamber-periodontal structures-alveolar bone- soft tissues- primary fascial spaces- secondary fascial spaces
What is sinusitis?
Inflammation of the sinuses
What are the symptoms of odontogenic sinusitis? (5)
- pressure/pain
- nasal congestion
- post nasal drip
- foul smelling or tasting discharge
- fever, weakness
What is the risk associated with sinusitis?
Infection can travel to other sinuses and potentially to the cranial cavity and brain
What are some factors affecting spread of odontogenic infection? (4)
- Host defences
- Virulence of microorganism
- Thickness of bone
- Proximity of root apex
What are the maxillary primary fascial spaces? (4)
- Vestibular space
- Palatal space
- Canine space
- Buccal space
What are the mandibular primary fascial spaces? (6)
- Vestibular space
- Buccal space
- Submental space
- Sublingual space
- Submandibular space
- Pterygomandibular space
What teeth spread to vestibular space?
All teeth
What teeth spread to palatal space?
All teeth particularly lateral incisors and palatal roots of molars
What teeth spread to canine space?
Maxillary canines and 1st premolars
What teeth spread to buccal space?
Premolars and molars
What teeth spread to submental space?
Mandibular incisors
What teeth spread to sublingual space?
Mandibular premolars and molars
What teeth spread to submandibular space?
Mandibular molars
What teeth spread to pterygomandibular space?
mandibular 3rd molars
What is an abcess?
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.
What is osteomyelitis?
Inflammation or swelling of the bone (alveolar) marrow. This is uncommon in the jaw.
What is cellulitis?
Diffuse inflammation of soft tissue spaces.
What are some symptoms of cellulitis? (4)
- Firm swelling
- Pain
- Redness
- Dysphasia
What is the outcome of cellulitis?
- May confine to a tissue space to form an abcess
- Can spread to multiple spaces-Ludwig’s angina
How is cellulitis treated?
- Removal of cause
- Antibiotics
What are the signs and symptoms of osteomyelitis? (3)
- Xray evidence of bone sequestration
- Tingling or numbness in lower lip
- Multiple discharging sinuses
What is the outcome of osteomyelitis?
Bone resorption and formation of sequestra
What is the treatment process of osteomyelitis?
- Removal of cause
- Removal of sequestra
- Antibiotics
- Hyperbaric oxygen
What can an dentoalveolar abcess lead to?
Fistula/stoma formation
What are some treatments of dentoalveolar abcesses?
- Restoration or extraction
- Surgical drainage
- Moist heat packs
- Mouth rinses
- Antibiotics
What are some types of dentoalveolar abcesses?
- Periapical
- Gingival
- Periodontal
- Periocoronal
What is a fistula?
A tract caused by a chronic abcess
What is bacteraemia/septicaemia?
When bacteria enters the blood circulation. This may cause issues in high risk patients as bacteria may lodge in compromised tissues
Why is antibiotic prophylaxis used in high risk patients?
To prevent bacteraemia or septicaemia and therefore infective carditis
What is lymphadenopathy?
Swelling/inflammation of lymph nodes
What is cavernous sinus thrombosis?
When an infected thrombus lodges in the cavernous sinus on the side of the sphenoid bone.
Where can infection spread to the cavernous sinus from? (4)
- The infratemporal space- needle
- The upper lip
- The canine fossa
- Dangerous triangle of the face
What are the signs and symptoms of cavernous sinus thrombosis? (4)
- Fever, drowsiness
- Oedema in the eye lids, tearing
- Loss of vision
- Pressure headaches
What can cavernous sinus thrombosis lead to?
Meningitis- death
hence why immediate hospitalisation and IV antibiotics is necessary
What is Ludwig’s angina?
A potentially life threatening, fast moving cellulitis involving bilateral submental, sublingual, submandibular spaces
Spread from where causes ludwig’s angina?
Mandibular teeth, piercings
What is the risk associated with Ludwigs angina?
Spread to parapharyngeal and retropharyngeal space, causing oedema of the larynx and raising of the tongue blocking the airway completely- death
What are the symptoms of ludwig’s angina?
- High fever
- Difficulty with speech, swallowing, breathing
How can spread of odontogenic infection be prevented?
- Thorough medical history taking before any treatment
- Strict adherence to infection control measures
- Early diagnosis and proper treatment
How can infection spread by blood vascular system?
Pathogens travelling in veins
When can bacteraemia be caused?
During dental treatment or while draining an infected oral site. Bacteria may lodge in compromised tissues and set up serious infections.
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