Dr. Pompura -- Dental Infections Flashcards
(45 cards)
Describe the pathogenesis of a dento-alveolar abscess
- Inoculation from the nerve of the tooth to the apex of the tooth
- Stick in jaw bone
- Spread most commonly through lateral extension (least resistance)
5 ways odontogenic infection can spread
- Direct extension
- Lymphatic spread
- Hematologous spread
- Ingestion (rare – HCl acidity in stomach)
- Aspiration
NOTE: 2, 3, 4, 5, esp. in severely immunocompromised patient
3 factors affecting the outcome of an odontogenic infection
- Organism virulence
- Host resistance
- Anatomical pathways of the spread of infection via direct extension (basically, luck)
3 destinations of dentoalveolar abscess spread
Infection perforates into the cortical plates and periostium and:
- Drains into the superficial tissues into the oral cavity
- Drains onto the skin
- Tracts into deeper fascial planes and spaces
Reason for facial inflammation and eye swelling to the point that it is closed in event of odontogenic infection
- Upper cuspid tooth (upper eye tooth) origin
- Infection stuck between 3 muscles of the area
- Filling of infraorbital space
- Eye closes
If infection reaches the infraorbital space, to where can it spread and how?
Cavernous sinus via veins of the face
Clinical picture of infraorbital space infection (2)
- Swelling toward eye
- No trismus
Medial boundary of the buccal space
Buccinator muscle
Lateral boundary of buccal space
Subcutaneous tissue and skin
Clinical picture of buccal space infection (2)
- Cheek swelling
- No trismus
Location of sublingual space
Floor of the mouth between the mucosa and the mylohyoid muscle
Clinical picture of sublingual space infection
Elevation of the tongue and floor of mouth (causes “hot potato” voice)
Most common source of sublingual space infection
Wisdom tooth removal
Space with which the sublingual space communicates posteriorly
Submandibular space
Location of the submandibular space
Below the mylohyoid muscle
Clinical picture of submandibular space infection (3)
- Firm, ill-defined swelling below the anterior border of the mandible
- Tender
- Mild trismus
Define Ludwig’s Angina and the spaces involved
Aggressive rapidly spreading cellulitis (NOT abscess) involving:
- Bilateral submandibular spaces
- Bilateral sublingual spaces
- Submental space
Emergent situation – LOSS OF AIRWAY IMMINENT
3 divisions of the parapharyngeal spaces
- Pterygomandibular space
- Lateral pharyngeal space
- Retropharyngeal space
Clinical picture of parapharyngeal space infection (4)
- Terribly sore throat
- Inability to swallow
- Trismus
- 1 side of tonsils edematous and uvula deviated
2 spaces that, if infected, may cause madiastinitis or brain abscess
- Retropharyngeal space
- Prevertebral (“danger”) space
7 steps of the acute inflammatory reaction involved in the evolution of odontogenic infection without treatment
- Acute pulpitis
- Inflammation
- Cellulitis in the pulp
- Abscess in the pulp
- Cellulitis or abscess at the peri-apical area
- Cellulitis of the surrounding soft tissue spaces
- Abscess of the surrounding soft tissue spaces
Usefulness of understanding the steps of the acute inflammatory reaction of odontogenic infections in terms of treatment
Helps to determine the timing and therefore the microorganisms involved so that the right antibiotics can be chosen
2 possible outcomes of chronic odontogenic infection
- Infectio ncan remain dormant and relatively asymptomatic, but can turn into acute phase when patient’s resistance is lowered
- Constant bacteremia via the seating or pumping action of chewing on infected tooth. May affect distal organs (i.e. infective endocarditis)
5 clinical findings of acute odontogenic infection
Cardinal signs of inflammation
- Pain
- Swelling
- Warmth over the affected area
- Loss of function (i.e. trismus, dysphagia, dysphonia, dyspnea)
- Redness
