TUT - Pyogenic infection

Question 1

What questions should you ask when a patient presents with toothache?

Answer 1

CO / HPC (SOCRATES)
- are the symptoms changing
- how do you feel in yourself
- any bad taste
- is the tooth mobile

PDH
- regular attender ?
- last visit and RFA
- any prev XLA +/- complications

PMH and SH

Question 2

What special investigations should be considered with a working diagnosis of acute periapical abscess?

Answer 2

• sensibility testing
• TTP
• mobility
• IO radiographs

Question 3

How do you manage acute periapical abscess?

Answer 3

• NO antibiotics
• endo/XLA +/- incision and drainage
• review 48-72 hrs post treatment and provide advice on what to expect/when to get back in touch ie signs of spreading infection

Question 4

What antibiotics are effective against streptococci?

Answer 4

• penicillin
• clindamycin

Question 5

What is the cellular target of penicillin?

Answer 5

Cell wall

Question 6

What is the cellular target of clindamycin?

Answer 6

Protein synthesis

Question 7

What antibiotics are effective against strict anaerobes?

Answer 7

• penicillin
• metronidazole

Question 8

What is the cellular target of metronidazole?

Answer 8

DNA synthesis

Question 9

What questions should you ask when a patient presents with signs of spreading infection?

Answer 9

• when did the swelling begin?
• is it increasing/decreasing in size?
• dysphagia? when did it begin?
• reduced mouth opening?
• bad taste?
• do they have a temperature? do they feel unwell?

Question 10

What further investigations are required if a patient presents with spreading infection?

Answer 10

• temperature
• pulse rate
• respiratory rate
• BP/SpO2 if available

Question 11

What is SBAR?

Answer 11

S - situation
B - background
A - assessment
R - recommendation