Localised infection tutorial

Question 1

What are the sources of odontogenic infection?

Answer 1

Abscesses

Pericoronitis

Question 2

How may a patient who has an odontogenic infection present generally?

Answer 2

Distressed

Uncomfortable

Pain

Nausea

Sweating

Question 3

When should a patient be sent to hospital before assessment?

Answer 3

If they are struggling to swallow, speak or breath

Question 4

What should be done if a patient has a sinus draining EO in gdp?

Answer 4

Refer to OMFS

Question 5

What should you look for when carrying out an IO assessment when patient presents with odontogenic infection?

Answer 5

Look for swellings in FOM

Check for fluctuation in pharyngeal area
-> deviation of uvula is a sign of oedema

Check tongue movement- will be unable to move if swelling in FOM

Check for trismis

-> if any of these are present- send to hospital

Question 6

What should you do if a patient has an odontogenic infection but there are multiple carious teeth present?

Answer 6

Check if TTP/mobile

Take radiograph- may or may not be possible (OPT?)
-> if you can’t - go for tooth you think is most likely

Question 7

What should you do if you cannot remove the source of infection?

Answer 7

Incision and drainage
-> if I/D not possible consider AB

Question 8

Why is it difficult to achieve anaesthesia in patients who have an infection? What can be done?

Answer 8

As infection is acidic and LA is a weak base meaning its function can be affected
-> Give it time- reattempt, try different injections
-> Use mepivicaine- has a more acidic pH

Question 9

What is Ludwig’s Angina?

Answer 9

Bilateral swelling of submandibular, submental and sublingual spaces
-> medical emergency
-> requires intubation and EO drains

Question 10

What signs suggest that you should refer for OMFS opinion in suspected local infection?

Answer 10

Pyrexia

Low o2 saturation

Inc HR/BR

Dehydration- check elasticity of skin on hand

Rapid progression of swelling

Trismus

Eye involvement- diplopia

-> If 2 of these- send to hospital

Question 11

When is AB given for odontogenic infection?

Answer 11

If local measures fail

If patient systemically unwell- pyrexic, nauseous

Cellulitis- hard feeling, loss of fluctuation

Infection is spreading

Question 12

How is incision and drainage achieved?

Answer 12

Use number 15 blade, cut line 1cm in width down to bone (from perpendicular angle)

Pull tissues apart in all direction with ash or Howarth’s

Massage area to encourage drainage

• Be careful in areas near nerves