- polysaccharide capsule external to cell wall prevents phagocytic adherence to bacterial organism - Anti-capsular antibodies allow more effective phagocytosis (opsonisation)

- produced by gram +ve and gram -ve - secreted - among most toxic substances known - exotoxin polypeptides are good antigens- induce antibody production - Convert to toxoids when heated or chemically treated - used in vaccine manufacture

- Integral part of cell walls of gram -ve - LPS - Produce generalised fever and septic shock - Toxic portion is lipid A

Darryl odontogenic infections Flashcards by Leela Green

What is an abcess

A localised collection of pus in a cavity formed by disintegration of tissues

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What is cellulitis

Diffuse swelling of inflammatory exudate within soft tissue

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What is pus

Collection of soft-tissue debris, live and dead microorganisms, neutrophils, tissue exudate

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What is fascial space

Potential space which exists between fascial planes of soft tissue

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What is a opportunistic infection

Arise when commencals overgrow another population and are pathogenic

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What species tends to dominate the oral cavity?

Streptococci spp.

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What causes odontogenic infections

Caries
Periodontal disease
Pericoronitis
Trauma
Pathology e.g. cysts
Tumors
Post-op infections

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What are some outcomes of periapical infection/pathology?

Treatment and resolution
Unresolved chronic draining sinus or fistula
Progression to cellulitis
Progression and spread to fascial spaces

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What are some factors influencing course of infection

microorganism
host defence
misdiagnosis
inappropriate/inadequate treatment
delayed treatment

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Whate are some determinants of bacterial pathogenicity

Transmission
Adherence to cell surfaces
Invasiveness
Presence of capsule
endo/exotoxin production

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Describe invasiveness

Invasion followed by inflammation
Tissue degraded by
- Collagenase
- Coagulase
- Immunoglobulin (Ig) A protease
- Leukocidins

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Describe capsule

polysaccharide capsule external to cell wall prevents phagocytic adherence to bacterial organism
Anti-capsular antibodies allow more effective phagocytosis (opsonisation)

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Describe exotoxins

produced by gram +ve and gram -ve
secreted
among most toxic substances known
exotoxin polypeptides are good antigens- induce antibody production
Convert to toxoids when heated or chemically treated
used in vaccine manufacture

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Describe endotoxins

Integral part of cell walls of gram -ve
LPS
Produce generalised fever and septic shock
Toxic portion is lipid A

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What are some biological effects of endotoxins

-Fever due to interleukin-1 release from macrophages
- Hypotension and shock
- Disseminated intravascular coagulation
- Complement cascade activation
- Macrophage and B- lymphocyte activation

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What are some local host defences against odontogenic infection

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Cell overturn
Keratinised tissue
Indigenous bacteria

What are some humoral host defences against odontogenic infection

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Immunoglobulins
Complement cascade
Chemotaxis
Opsonisation

What are some cellular host defences against odontogenic infection

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Macrophages
Lymphocytes

What are host defences influenced by

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Age
General health status
Uncontrolled systemic disease
Immune defects
Medications

What are some routes of spread of infection

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Direct route
Blood
Lymphatics
(follows path of least resistance)

What are the maxillary fascial spaces (7)

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palatal
facial/buccal
canine fossa
upper lip
infratemporal fossa
temporal fossa
paranasal sinuses

What are the mandibular fascial spaces (8)

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Submental
Sublingual
Submandibular
Submasseteric
Parotid
Pterygomandibular
Parapharyngeal
Peritonsillar

What are important points for patient assessment

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presentation
cause
progression
prev. treatment
recurrence
systemic disease
local involvement
systemic involvement

Hallmarks of acute inflammation

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Redness
Swelling
Heat
Pain
Loss of function

What tests can help with assessment of the patient

Radiographs - OPG - IO films - CT scans Lab tests - Blood tests - Cultures - Specimens

When to seek urgent help

- Rapidly progressing swelling - Airway difficulties - Swallowing difficulties - Inability to control secretions - Fascial space involvement - Severe trismus - Toxic appearance - Compromised host defence

Explain management

-Surgical drainage (Obtain and maintain) - Remove source of infection - Adjunctive therapy - Review

Clinical considerations for odontogenic infections

- No local anaesthetic - Use blocks when possible - Change needle if contaminated - May need more local (dilution) - Local may not work - Consider regional block or GA - Removal of source always superior to antibiotics only

When to use antibiotics for odontogenic infection?

- severe or prolonged infection - immunocompromise - systemic issues - inadequate surgical drainage

Why may surgical treatment of odontogenic infection fail?

- Inadequate surgery - Depressed immune status - Foreign body retention - Wrong diagnosis - Failure to recognise problems - Delayed treatment

Why may antibiotic treatment of odontogenic infection fail?

- Inadequate dose - Inadequate frequency - Inappropriate administration - Non-compliance - Wrong diagnosis of microbe - Bacterial resistance

Describe causes of cavernous sinus thrombosis (3)

- Direct from infratemporal fossa - Indirect from upper lip via sup. labial vascular plexus - Indirect from canine fossa via inferior ophthalmic and facial vasculature

What are symptoms of cavernous sinus thrombosis

- limited extra-ocular movements - pressure headaches - generalised malaise - meningitis - septicaemia

Describe lateral pharyngeal space infection

Infection of contents - Internal jugular - carotid erosion - cranial nerve compression Spread to mediastinum via spread to retropharyngeal space (mediastinitis)

What is ludwig's angina

a potentially life-threatening, progressive cellulitis involving bilateral submental, sublingual, and submandibular spaces

What does ludwig's angina result in

- Elevation and displacement of the tongue - Potential airway obstruction from cellulitic oedema or tongue obstruction - inability to control secretions - 70% arise from odontogenic infections

Describe prevention of odontogenic infections

- Regular, quality oral health care - Identification of source - Identification of susceptible patients - Appropriate therapy - Appropriate referral - Good surgical technique - Appropriate antibiotics

What are 6 revision points

- Odontogenic infection is common - Ranges from minor to life threatening - Recognition and diagnosis is vital - Appropriate management - Ludwig's angina is dangerous - If you can't breathe nothing else matters

Darryl odontogenic infections Flashcards

(38 cards)