Exam 2 sweep 1 Flashcards by Tyler Brown

Most important priority in odontogenic infections

remove source of infection

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Aerobic in —% of odontogenic infections

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2 stage progression for

odontogenic infections

initiation by aerobic bacteria
second stage by anaerobic bacteria

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In —– stage, abscess becomes walled off

second

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Odontogenic infection - natural course

Cellulitis, abscess, fistula

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Abscess is

primarily anaerobes, pus filled cavity

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Bone thickness, muscle attachment, root angulation are all determinants of

spread

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Max infection spread -

thin labial bone, thick palatal bone, roots of anterior teeth generally below muscles, roots of posterior teeth above muscles

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Mand infection spread determined by

thin labial bone, thin lingual bone, mylohyoid attachment

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Ludwig’s angina linked to

bilateral submandibular, sublingual, submental cellulitis

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Trismus in pterygomandibular space - Direct spread from

submandibular or sublingual infection

Needle track infection

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Lateral pharyngeal space

Vascular necrosis and hemorrhage
Erosion into oral cavity with aspiration of pus
Direct airway impingement
Spread to superior mediastinum
Spread into Danger Space with access to inferior mediastinum

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With invasion into —– or ——, admission is needed

secondary space or neck space

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Trismus under —– consider referral/admission

Trismus under —– admit

15 mm,

10mm

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Temperature

—– indicates systemic involvement
Oral temperature not accurate

> 101

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Malaise —-

how is the patient coping with infection

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—– not a good measure of severity of odontogenic infection

WBC

-Elevated early and remains high throughout treatment

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Criteria for Referral/Admission

Rapid onset not responsive to appropriate treatment
Poor compliance
Severe indurated swelling Secondary space involvement Trismus <15mm
Temperature >101
Airway concerns Compromised host defense

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Principles of Incision and Drainage

Aspirate through sterile prep skin Incise dependant area
Incise healthy tissue
Explore entire space
Explore adjacent spaces Drain all spaces

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PCN severe allergy - use

Clindamycin, 300mg q8h x 7 days

Clarithromycin, 500mg q12h x 7days

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PCN mild allergy - use

Cephalexin, 500mg q6h x 7 days

Cephadroxil, 500mg q12h x 7 days May also add Metronidazole to these

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Moderate infection - use

PCN VK, 500mg q6h plus Metronidazole, 500 mg q 8h

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Mild infection - use

PCN VK, 500mg q6h x 7 days

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SBE -

Extraction produces bacteremia
Agglutinating antibodies bind bacteria
Clumped AB/bacteria complex circulates
Infect sterile thrombus on diseased tissue or prosthetic material Infection

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Who now requires prophylaxis w/antibiotics

Prosthetic cardiac valve Previous infective endocarditis Cardiac transplant patients with valve defects Specific At Risk Congenital Heart Disease

13% of all SBE due to

dental work

Endocarditis

Bacteremia 15 minutes or less Few species cause May occur even with prophylaxis No human trials High dose of cidal drug is needed

Standard prophy

Amoxicillin 2gm (50mg/kg) po 1 hour pre

Parenteral

``` Ampicillin 1gm (50mg/kg) IV or IM 30 minutes pre-op ```

With non-coronary vascular grafts Prophylaxis for

6 months

Forgot prophylaxis | Give within

2 hours

TJR Prophylaxis Regimen

Amoxicillin or Cephalexin 2 gm | Ampicillin 2 gm or Cefazolin 1 gm IV or IM Clindamycin 600mg PO or IV

Time antibiotic correctly First dose ----- Repeat dose at-----

before surgery | 1⁄2 therapeutic interval

Correct prophy does at

4x MIC, 2x therapeutic dose

Indications for Prophylaxis for Dentoalveolar Surgery

Poorly controlled metabolic disease Immunosuppressed Surgery longer than 3 hours Contaminated wound Insertion of major foreign body Surgery adjacent to sinus such as implant placement or graft Bony impactions Same regimen as SBE prophylaxis

Surgery

Inflammatory papillary hyperplasia Inflammatory fibrous hyperplasia Frenal attachments

Preserve the ------. Especially important for -------

buccal plate maxillary molars and canine eminences

Types of alveoloplasty

Digital compression Intraseptal Surgical - reflection of facial mucoperiosteal flap and removal of undercuts and irregularities

Intraseptal Alveoloplasty | Indications :

Ridge with regular contour Adequate height Undercut to the depth of the labial vestibule

Surgical alveoloplasty with

full thickness flap

``` Buccal Exostosis Less common than ---------- torus Usually in ------------ Indications for reduction --------- ```

maxillary or mandibular maxillary molar areas Interfere with stability or retention of denture Chronic traumatic ulceration

After max tuberosity surgery, at least

2-3mm sulcus height distal to tuberosity needed

Inflammatory Papillary Hyperplasia  Treatment

Non surgical -Proper denture adjustment, Antifungals e.g.: Nystatin Surgical excision Abrasion of the superficial layer of palatal mucosa

Inflammatory Fibrous Hyperplasia

Denture rim flap of tissue* Reline denture after tx.

If lesion persists for ------ or more with no known etiology, biopsy

2 weeks

Biopsy Any inflammatory lesion that does not respond to local therapy within

two weeks

Biopsy Persistent changes in

epithelial tissue

BIopsy Lesions that interfere with

function

Biopsy Bone lesions that are not

identifiable by | clinical and radiological findings

Bulla

Loculated fluid in or under the epithelium of skin or mucosa

Erosion

Superficial ulcer (excoriation)

Macule

Circumscribed area of color change without elevation

Papule

Small palpable mass, elevated above the epithelial surface

Nodule

Large palpable mass, elevated above the epithelial surface

Plaque

Flat elevated lesion, the confluence of papules

Pustules

Cloudy or white vesicle (PMN leukocytes)

Scale

Macroscopic accumulation of keratin

Ulcer

Loss of epithelium

Color

Red more ominous than white

Biopsy if Persistent ----- changes Any ------- under normal tissue Inflammatory changes of unknown cause persistent for long periods

hyperkeratotic tumescence

Biopsy types

Oral Cytology Aspirational Incisional Excisional

Cytology indications

Large areas of mucosal change | Need for monitoring dysplastic changes

Cytology technique

Moistened tongue depressor or cement spatula Lesion scraped Smear and fixate over glass slide

Aspiration indications

Lesions suspected to contain fluid | Intraosseous lesions

Aspiration technique

18 G needle, 5 or 10 ml syringe Needle inserted during aspiration Repeated repositioning Cortical perforation if needed

Incisional indications

``` Extensive lesion (>1 cm) Hazardous location High suspicion of malignancy Closure ```

Incisional technique

``` Representative area Wedge fashion (deep and narrow) Include normal tissue ```

Excisional indications

Small lesion (<1 cm) Benign appearance Closure

Excisional tech

Entire lesion Margin of normal tissue (2 - 3mm)

When doing soft tissue biopsy and administering local, Wait ---- for hemostasis

10 minutes

Soft tissue biopsy - borders:

2-3 mm border for benign, 5 mm for malignant

Use traction sutures whenever possible for

soft tissue biopsy

Specimen care

10% formalin solution (4% formaldehyde) 20 times the volume of the specimen Totally immersed in solution

Following soft tissue biopsy for closure,

Undermine mucosa Primary closure Surgical dressing

Aspirate - -------- lesions

Radiolucent

For intraosseous bone biopsy - -----mm bone around lesion

4-5 Osseous window Burs Round Trephine Rongeurs Avoid anatomic structures Submit osseous window with specimen

Exam 2 sweep 1 Flashcards

(76 cards)