M25 - Abscesses

Question 1

Give dental abscesses synonyms.

Answer 1

• Dentoalveolar abscess
• Periapical abscess
• Apical abscess
• Chronic periapical dental infection
• Dental pyogenic infection
• Periapical periodontitis

Question 2

Describe the development of dentoalveolar abscesses.

Answer 2

•  Carious lesion
•  Bacteria spread to pulp
–  via dentinal tubules
•  Acute inflammation
–  pulpitis
–  necrosis of the pulp
•  Chronic localised 
–  abscess
–  pulp remains viable

Question 3

what causes a dentoalveolar abscess?

Answer 3

•  Traumatic fracture or tooth wear
•  Traumatic exposure during treatment
•  Via Periodontal membrane & root canals
•  Anachoresis
–  seeding via pulpal blood supply 
–  rare

Question 4

what do dentoalveolar abscesses remain?

Answer 4

• Acute or chronic

* tender to pressure

Question 5

how does dentoalveolar access soft tissue?

Answer 5

– Direct spread

– Indirect spread

Question 6

what are the symptoms of abscesses?

Answer 6

• Pain
• Swelling
• Erythema
• Suppuration

Question 7

What are key factors of abscesses?

Answer 7

• Number of virulent bacteria • Local and systemic immunity

* Anatomical damage

Question 8

Name facultative anaerobes from dentoalveolar abscesses.

Answer 8

–  S. anginosus-group
•  (especially S. anginosus) 
–  S. oralis-group
–  Enterococcus faecalis
–  Actinomyces spp.

Question 9

Name strict anaerobes from dentoalveolar abscesses.

Answer 9

–  Peptostreptococcus spp.
–  Porphyromonas gingivalis
–  Tanerella forsythia
–  Prevotella spp (10-87%).
–  Fusobacterium nucleatum

Question 10

Describe the treatment of abscesses.

Answer 10

•  Specimen collection 
–  needle aspiration
(anearobes)
•  Local Management
–  Drain the pus (incision through root canal) - remove residual pus through incision
–  e.g. buccal sulcus
 •  Treatment
–  Amoxicillin or clarithromycin
–  Metronidazole

Question 11

what is a periodontal abscess?

Answer 11

Infection of periodontium acute or chronic

Question 12

what is the cause of periodontal abscesses?

Answer 12

– Occlusion of opening
prevents drainage
– Impaction of foreign objects

Question 13

what are the symptoms of a periodontal abscess?

Answer 13

– Sudden onset
– Swelling
– Redness/tenderness
– May spread & destroy bone/soft tissue

Question 14

What organisms are involved in abscesses?

Answer 14

•  GNABs
–  Porphymonas,
Prevotella
•  Streptococci –  variety
•  Others
–  Treponema,
Actinomyces,
–  F. nucleatum
–  Propionobacterium

Question 15

Describe the extraction of of abscesses.

Answer 15

– severe disease
– poor prognosis
– recurrent infection

Question 16

Describe the drainage of abscesses.

Answer 16

– gentle scaling
– irrigate with 0.9% saline
– antibiotics:
Penicillin, Erythromycin or metronidazole

Question 17

What gram negative bacteria are associated with infection after root canal treatment?

Answer 17

– F. nucleatum
– Prevotella
– Campylobacter rectus

Question 18

What gram positive bacteria are associated with infection after root canal treatment?

Answer 18

–  S. oralis, S. mitis, S.
anginosus, S. gordonii
–  Enterococcus faecalis
–  Candida albicans
–  Lactobacilli

Question 19

Describe features of enterococcus faecalis.

Answer 19

• Facultative anaerobe
• Common in intestine
• Can be eradicated in small numbers
• Difficulty comes with high levels

Question 20

What are key features of enterococcus faecalis?

Answer 20

– Adhere to collagen
– Persistence in nutrient poor environments
– Biofilm formation
– Resistant to calcium hydroxide & sodium hypochlorite
– Low-high pH range
– Salinity & temp resistance

Question 21

Describe ‘dry’ socket.

Answer 21

• Localised infection
• Following extraction the socket fails to heal
• Sparse anaerobic infection

Question 22

what is the prophylaxis of ‘dry socket’?

Answer 22

chlorohexidine irrigation prior to & post extraction

Question 23

what is the treatment for ‘dry socket’?

Answer 23

antispeptic dressing & metronidazole

Question 24

Describe how abscesses are caused by dental implants.

Answer 24

• Endentulous treatment of dental implants
– surgical trauma (overheating of bone or compression of bone chips)
– persistence of root particles or foreign bodies
– infection of implant surface
(saliva & bacterial plaque)
– implant into infected site
• Immediate or delayed abscesses
– S. aureus (0.7-15%) & S. epidermidis (4-65%)
– Fusobacteria, anaerobic Streptococci
• Remove implant & antibiotic therapy

Question 25

What is Ludwig’s angina?

Answer 25

• Acute Cellulitis
• Bilateral infection
– sublingual & submandibular spaces

Question 26

What are the symptoms of Ludwig’s angina?

Answer 26

– Base of mouth & tongue
swell
– Brawny oedema & swelling of neck tissues
– Airway obstruction (asphyxiation)

Question 27

How often is there post extraction infection in Ludwig’s angina?

Answer 27

90% of cases

Question 28

what are the oral commensals of Ludwig’s angina?

Answer 28

– ß-hemolytic oral Streptococci (41%)
– Porphyromonas, & Prevotella, Fusobacteria,
– Staphylococci (27%-50%) & Enterococci

Question 29

what is the management of Ludwig’s angina?

Answer 29

•  Ensure airway remains open
–  surgical intervention
–  Drainage
_ parenteral hydration
•  High dose antibiotic treatment –  intravenous penicillin
–  ceftriaxone + metrinodazole

Question 30

What is the osteomyletis of the jaw?

Answer 30

Inflammation of medullary cavity of the mandible or the maxilla

Question 31

what are the symptoms of the acute osteomyelitis of the jaw?

Answer 31

pain, mild fever, loosening of teeth & exudate of pus through gingiva or sinuses of affected skin

Question 32

what are the symptoms of the chronic osteomyelitis of the jaw?

Answer 32

few symptoms, tender & indurated skin

Question 33

what bacteria can cause osteomyletis of the jaw?

Answer 33

• Normally endogenous oral flora;
– Tanerella, Prevotella & Porphymonas spp
– M. tuberculosis, & T. pallidium rarely

Question 34

what can occur in post radiation therapy of osteomyletis?

Answer 34

– necrosis of blood supply, reduced saliva flow
– Exogenous bacteria
• e.g. E. coli, Proteus, & Klebsiella

Question 35

Name 4 bacterial infections of the salivary glands.

Answer 35

• Acute bacterial parotitis
• Chronic bacterial parotitis
• Recurrent parotitis of childhood
• Submandibular sialadentitis

Question 36

what are the predisposing factors of acute bacterial parotitis?

Answer 36

– drugs (prescription)
– abnormalities
– generalised sialectasis

Question 37

what is the presentation of acute bacterial parotitis?

Answer 37

– swelling of parotid gland(s) – pain
– purulent secretions
– rarely fever & chills

Question 38

What is the microbiology of acute bacterial parotitis?

Answer 38

– S. aureus, oral Streps, Haemophilus & anaerobes

Question 39

what is the treatment of acute bacterial parotitis?

Answer 39

_ co-amoxyclav
– flucloxacillin, erythromycin
– salavation
• (increased fluid intake)

Question 40

Describe chronic bacterial parotitis.

Answer 40

•  Recurrent infections 
•  Damaged glands or
Sjorgen’s syndrome
•  Chronic nature can lead
to replacement fibrosis 
•  Destruction of gland

Question 41

Describe parotitis of childhood.

Answer 41

–  Observed prior to puberty 
–  Repeated acute episodes
–  Cause :
•  duct abnormalities
•  preceding mumps 
•  foreign body
•  trauma

Question 42

Describe submandibular sialadenitis.

Answer 42

–  Rare
–  similar to acute parotitis
–  calculi or strictures
–  treatment & micro 
•  as acute parotitis

Question 43

Give summary slide.

Answer 43

•  CMS information
–  Pulpitis microbiology
–  Abscesses in the oral environment
–  Salivary Gland infections
•  Microbiology
–  Assign likely
endogenous species
–  Infection evidence of underlying clinical problem that requires addressing once treated.