23. Dental Abscesses Flashcards

(45 cards)

1
Q

Define ‘abscess’

A
  • collection of pus
  • walled off by a barrier of inflammatory reaction
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2
Q

Abscesses are … meaning …-producing

A
  • pyogenic
  • pus
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3
Q

Pathogenesis of abscesses

A
  • can develop in any confined space
  • to which bacteria can gain access and multiply
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4
Q

Did dental abscesses used to be serious?

A
  • leading cause of death
  • London Bills of Mortality said ‘teeth’ were the 5th or 6th leading cause of death
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5
Q

How is a periodontal abscess defined?

A
  • differentiated from dentoalveolar ones as tooth associated with it has vital pulp
  • infection in periodontal pocket - foreign body/obstruction
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6
Q

Symptoms of periodontal abscess

A
  • swelling and erythema
  • pus likely to discharge from gingival margin
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7
Q

Microbiology of periodontal abscess

A
  • associated with Prophyromonas species
  • Provotella
  • Fusobacterium species
  • haemolytic streptococci
  • actinomyces species
  • spirochetes
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8
Q

Management of periodontal abscess

A
  • treated by local measures
  • drainage, subgingival instrumentation, irrigation
  • extraction?
  • antibiotic prescription only if spreading infection and systemic involvement
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9
Q

Routes of infection in dentoalveolar/periapical abscess

A
  • dental caries
  • exposed dentinal tubules
  • direct pulp exposure
  • lateral/apical foramen
  • blood-borne bacteraemia
  • root fracture
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10
Q

What is endodontic infections?

A
  • infected pulp
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11
Q

Periodontal disease causes … while dental caries causes …, both lead to …

A
  • lateral periodontal abscess
  • endodontic infection
  • dentoalveolar abscess (through a periapical granuloma/cyst for endodontic disease first)
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12
Q

Dentoalveolar abscess causes what?

A
  • dry socket
  • osteomyelitis
  • facial space infection
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13
Q

What, other than dentoalveolar abscess, can cause facial space infections?

A

pericoronitis

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14
Q

What do facial space infections lead to?

A
  • Ludwig’s angina
  • cavernous sinus thrombosis
  • then death after both
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15
Q

How to treat endodontic infections?

A
  • root canal treatment cleans out canals and seals to prevent bacterial access
  • sodium hypochlorite, chlorhexidine, calcium hydroxide and iodine are commonly used to kill residual bacteria
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16
Q

What causes a flare-up in endodontic infection?

A
  • survival of species such as Enterococcus faecalis
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17
Q

What type of bacteria cause dental abscesses?

A
  • gram positive coccus
  • gram negative rods
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18
Q

Most abscesses are mixed infections of … and … but difficult to sample. why?

A
  • facultative and strict anaerobes
  • because the sample is gained and hard to not contaminate
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19
Q

Give some facultative anaerobes in abscess formation?

A
  • oral streptococci
  • strep anginosus
  • staphylococcus spp.
20
Q

Give some obligate anaerobes in abscess formation

A
  • fusobacterium species
  • prevotella species
  • prophyromonas
  • tannerella forsythia
  • treponema denticola
  • clostridium
  • actinomyces
21
Q

Factors that affect bacterial population in abscess

A
  • oxygen tension (select for anaerobes)
  • availability of nutrients (selects for proteolytic bacteria)
  • bacterial interactions (selects for mutual co-operation)
  • immune response
22
Q

Explanations for selecting a population of 3-4 species

A
  • multiple infectiom but only certain species survive
  • one species infects and prepares the way for appropriate others
23
Q

Coaggregation between diff bacteria in periodontal and endodontic infection leads to …

A
  • coinvasion of epithelial cells (e.g F. nucleatum can carry strep cristatus into cells)
  • coinvasion of dentine tubules
24
Q

Localised spread of infection is through …
into …

A
  • soft tissue abscess
  • sinus linking main abscess cavity with mouth/skin
  • through soft tissue (cellulitis)
    INTO
  • adjacent facial space
  • deeper layers like osteomyelitis
  • maxillary sinus
  • indirectly to lymphatic and haematogenous routes
25
Define 'osteomyelitis'
- inflammation of medullary bone within maxilla or mandible with posterior extension # - into the adjacent cortical bone and overlying periosteum
26
How is osteomyelitis treated?
- difficult to treat effectively - more common in reduced vascularity - local debridement, topical antiseptic on exposed areas, antibiotics as required
27
When osteomyelitis presents, typical isolates include ...
- obligate anaerobes - Actinomyces species
28
List tissue spaces
- pterygomandibular - lateral pharyngeal - retropharyngeal - submasseteric - buccal - vestibular - sublingual - submandibular - submental
29
Management scheme of dental abscess
- signs and symptoms - assess patient - in detail and medical history - define location, nature and swelling - systemic symptoms? - identify cause of infection - diagnosis - treatment
30
Treatment of dental abscess process
- local measures - drain pus if present - tooth extraction - access and drain through root canal - soft tissue pus drain by incision - debride infected periodontal pockets - irrigate/debride infected operculum
31
When do we provide antibiotics?
- evidence of spreading infection - lymph node involvement - swelling - persistant swelling despite local treatment - trismus - failure to respond to local measures - uncooperative patient - floor of mouth swelling - breathing risk
32
Warning signs with abscesses
- swelling, pain and raising of tongue - elevated floor of mouth - malaise - fever - swelling of neck or tissues in submandibular/sublingual space
33
Explain Ludwig's angina with abscesses
- progression of dentoalveolar infection to cause widespread swelling of tissue spaces (submental/lingual/mandibular) - swelling of neck and difficulty breathing - spread of infection through fascial spaces to mediastinum
34
Microbiology of Ludwig's angina
- Prevotella species - Porphyromonas species - Fusobacterium species - anaerobic strep
35
3 antibiotics we prescribe for this
- amoxicillin - phenoxymethylpenicillin - metronidazole
36
What's a major problem for prescribing antibiotics for abscesses?
- antibiotic resistance - increase in antibiotic resistance to dentoalveolar infection
37
What is pericoronitis?
- superficial infection of operculum, occasional local spread of infection - infection in space between tooth and overlying soft tissue
38
What bacteria are involved with pericoronitis?
- P.intermedia - anaerobic strep - fusobacterium species - T. forsythia - A. actinomycetemcomitans
39
Management of pericoronitis
- local measures - irrigation - extraction? - if spreading infection and systemic involvement, prescription of antibiotics and metronidazole drug of choice
40
What is cervicofacial actinomycosis?
- opportunistic infection caused by members of Actinomyces genus (A. israelii in 90% of cases, A.bovis or A. naeslundii) - most commonly a submandibular swelling, at the angle of mandible. Can be local or diffused - tooth extraction or trauma likely to precipitate infection with bacterial species reaching deeper tissues
41
How does cervicofacial actinomycosis progress?
- swelling progresses and multiple sinuses develop - thick and yellow pus expressed from sinus - pus contains visible granules called sulphur granules (consist of calcified aggregates of Actinomyces filaments)
42
Causes of necrotising gingivitis
- poor oral hygeine/poor plaque control - immunocompromised - poor diet/poor general health - smokers
43
What is necrotising gingivitis? What bacteria?
- superficial infection of gingival margins - associated with fuso-spirochaetal bacteria (treponema species and prevotella intermedia)
44
Treatment of necrotising gingivitis
- OHI and improvement in oral hygeine - removal of supra and subgingival deposits, periodontal instrumentation/ultrasonic debridement - risk factor identification/management - prescribe only in more severe cases - metronidazole if doing so
45
Oral soft tissue infections are ...
bacterial, viral or fungal