Bacterial Infection- Management

Question 1

Classic signs of acute inflammation?

Answer 1

CARDINAL SIGNS

Swelling, redness, pain, tenderness, heat, loss of function

Question 2

What may see in addition to the cardinal signs in acute inflammation?

Answer 2

Systemic signs - lymphadenopathy, pyrexia, malaise

Question 3

What is an abscess?

Answer 3

Pus-filled pathological cavity which forms as part of the inflammatory response to infection

Question 4

How can formation of abscess be confirmed?

Answer 4

Presence of fluctuance to gentle palpitation - pressure exerted by one finger should be felt by another finger as bounce

Question 5

What suspect is abscess but no fluctuance?

Answer 5

Cellulitis

Question 6

What should never do it cellulitis?

Answer 6

Drain

Question 7

How diagnose abscess?

Answer 7

Clinical exam

Question 8

Can radiographs be used to diagnose abscess?

Answer 8

Radiograph usually don’t show change in PA tissue - takes 10 days for sufficient bone loss to be detected

Question 9

What is an early change which could be detected on radiograph to detect abscess?

Answer 9

Periodontal ligament widening

Question 10

How to abscess present?

Answer 10

Pus from acute abscess takes track of least resistance through cancellous bone and points onto nearest epithelium surface

Question 11

What classic microbial aetiology of abscess?

Answer 11

Black-pigmented anaerobes
Fusobacterium
Anaerobic cocci
Streptococcus 
Non-pigmented anaerobes
Eubacterium
Spirochaetes

Question 12

Example black-pigmenting anaerobe?

Answer 12

Prevotella

Porphymonoas gingivalis

Question 13

What are fusobacterium?

Answer 13

Gram -ve

Question 14

What are streptococcus?

Answer 14

Gram +ve

Question 15

When should pt be admitted to hospital w/ dental infection?

Answer 15

If systemically unwell - malaise, pyrexia, tachyacarida, hypotension

Question 16

How do systemically unwell pt get tx in hospital?

Answer 16

IV abs, surgical drainage

Analgesia

Question 17

Analgeisa of choice when pt systemically unwell?

Answer 17

NSAID - anit-pyrexial effect

Question 18

Local measures to deal with abscess?

Answer 18

Removal cause

Drainage

Question 19

Why are ab not indicated for abscess when no systemic involvement?

Answer 19

Abscess if fluid filled cavity with blood vessel around, not within
Ab can’t diffuse in sufficient quantity

Question 20

What CAN ab do in abscess?

Answer 20

Stop spread

Question 21

Typical ab given for dento-alveolar infection?

Answer 21

Combination amoxicillin and metronidazole

Question 22

What does the local measure of removing cause mean?

Answer 22

XLA non-vital teeth
Removal sequestrae
Removal foreign bodies
Removal salivary calculi

Question 23

Why is removing cause of infection so important?

Answer 23

Most important management in infection

Question 24

What clinical signs indicate pus formation?

Answer 24

Reddening
Fluctuant
Point maximum tenderness

Question 25

How drain abscess?

Answer 25

Surgical incision under LA

Question 26

Adv of surgical incision > spontaneous draining?

Answer 26

Leaves less scarring

Question 27

How prevent spread of infection?

Answer 27

Drainage
Antimicrobials
Rest

Question 28

How is rest achieved oro-facial region?

Answer 28

Difficult - trismus is ‘natural’ way of rest

Question 29

What to be cautious of when providing LA for drainage?

Answer 29

That LA not into abscess cavity

Do this by injection parallel to mucosal surface = superficial anaesthesia

Question 30

How to make surgical incision for drainage abscess?

Answer 30

Horizontal incision parallel to occlusal surface
1-2CM length
Open abscess cavity w/ artery forceps

Question 31

What need to consider when making surgical incisions?

Answer 31

Local anatomy
e.g mental nerve apex lower 4/5
greater palatine nerve - upper first molar

Question 32

When may a drain need to be placed for abscess?

Answer 32

Not needed intra-oral

Needed when pus passed through several planesof tissue e.g deep neck abscess