Lecture 9- Odontogenic infections

Question 1

most common cause of pulpal inflammation and necrosis is …

Answer 1

bacterial infection

Question 2

… are necessary for pulpal and periapical disease to occur

Answer 2

bacteria (pulp exposures in germ free rats shows that the pulp forms reparative dentin)

Question 3

… is critical for success of pulpal therapy

Answer 3

good seal (pulpotomies and root canal treatments)

Question 4

most bacteria cultured from necrotic pulps are …. and gram …. bacilli

Answer 4

anaerobic

negative

Question 5

based on cultivation studies, … and … are significant bacteria because they have been associated with periapical abscesses

Answer 5

prevotella

porphyromonas

Question 6

… and … species are responsible for the foul odor of some necrotic pulps

Answer 6

prevotella

porphyromonas

Question 7

endodontic infections are … bacterial infections

Answer 7

mixed

Question 8

nutrients differ in the canal so in pulpal infections, coronally where there are salivary constituents (carbs) there are …. bacteria like … and …

and more apically, serum and cellular proteins are the predominant species so … bacteria grow here like …. , …. and ….

Answer 8

saccharolytic
streptococci and lactobacilli

proteolytic
fusobacterium, porphyromonas, and prevotella

Question 9

if the only pain the patient has with pulpitis is when they drink something cold (NOT spontaneous pain) then it is….

Answer 9

reversible!

Question 10

periapical lesions will lead to … which is when osteoclasts make a hole in the bone to make space for the neutrophils that are being recruites

Answer 10

apical periodontitis

Question 11

since pulp is necrotic in periapical lesions/apical periodontitis, patients are often …

Answer 11

asymptomatic (only detected o nradiograph)

Question 12

bone resorption takes place in periapical lesions/apical periodontitis to allow

Answer 12

inflammatory cells to accumulate

Question 13

most periapical lesions are … that are …. dominated (but other inflammatory cells present)

Answer 13

granulomas

macrophage

Question 14

…. abscess is an acute exacerbation of periapical lesion. not sure what causes the shift though, could be bacterial species or lowered immune response

Answer 14

acute dentoalveolar (periapical)

Question 15

in an acute dentoalveolar (periapical) abscess, …. bacterial infection is confined to bone at apex. and … and … are seen in the apical tissues

Answer 15

purulent

bacteria and PMNs

Question 16

Is pain present in an acute dentoalveolar (periapical) abscess?

Answer 16

yes, very painful, tooth is sensitive to pressure (aching/throbbing pain)

Question 17

What brings relief to the patient with an acute dentoalveolar periapical abscess?

Answer 17

drainage of pus through extraction or endodontic acess

Question 18

in an acute dentoalveolar periapical abscess, spontaneous drainage may occur 2 ways:

Answer 18

1. fistula to surface (not bad)

2. into tissue leading to orofacial involvement (BAD)

Question 19

T/F spontaneous drainage through fistula to surface of an acute dentoalveolar abscess is common with primary teeth

Answer 19

true. roots are short and bone is NOT dense)

Question 20

what is the palliative treatment for tx of pulpal/ periapical disease?

Answer 20

long-acting anesthetic

Question 21

Why are antibiotics not effective in pulpal and periapical disease?

Answer 21

b/c blood supply is compromised

Question 22

when can antibiotics help in pulpal or periapical disease?

Answer 22

when infection is in the tissues where there is blood supply

Question 23

T/F antibiotics work well with getting rid of pus from abscesses

Answer 23

false. they wont get into the pus and kill the bacteria, need surgical accompaniment

Question 24

whats the definitive treatment for pulpal or periapical disease?

Answer 24

root canal treatment: cleaning of canals and a good coronal seal

Question 25

Root canals work 95% of the time but sometimes fail. why?

Answer 25

- biofilm still present at apex | - debris in inaccessible regions of canals

Question 26

treatment for persistent apical lesions

Answer 26

endodontic microsurgery also called apicoectomy

Question 27

an endodontic microsurgery or apicoectomy is used to

Answer 27

clean apex of bacteria and necrotic tissue

Question 28

Endodontic microsurgery/ apicoectomy procedure steps

Answer 28

- apex accessed surgically - tip of apex removed - apical foramen is cleaned - sealed with biocompatible agent such as MTA (mineral trioxide aggregate)

Question 29

when dental infections spread to surrounding tissues they are called...

Answer 29

odontogenic infections

Question 30

odontogenic infections range from .... to the alveolar area, extending to adjacent .... or to .... infection

Answer 30

localized (dentoalveolar infections) facial tissues disseminated systemic

Question 31

when periapical infections spread to surrounding tissues the usual course is an initial .... or tissue invasion

Answer 31

cellulitis

Question 32

... is when bacteria invade the tissues and the tissues themselves become infected

Answer 32

cellulitis

Question 33

treatment for cellulitis?

Answer 33

antibiotics (good blood supply)

Question 34

areas of ... and ... in tissues may form secondary to cellulitis

Answer 34

necrosis abscess

Question 35

lower facial cellulitis is almost always

Answer 35

dental related

Question 36

T/F upper facial cellulitis has a dental origin half of the time

Answer 36

true

Question 37

in cellulitis, the tissue is ... and ... there is no... and it is not

Answer 37

swollen hard (indurated) pus fluctuant

Question 38

cellulitis may proceed to a 2nd phase ...

Answer 38

abscess formation

Question 39

an abscess will be ... and erythematous and it will have ...

Answer 39

fluctuant pus

Question 40

are abscesses vascular or avascular

Answer 40

avascular

Question 41

... and ... are the most widely used antibiotics because

Answer 41

inexpensive low side effects wide spectrum

Question 42

... is the alternative choice antibiotic is penicillin isnt working

Answer 42

clindamycin (broad spectrum and expensive though)

Question 43

will extraction of the tooth cure cellulitis?

Answer 43

no because infection is already in the tissues

Question 44

3 types of bone infections

Answer 44

Alveolar osteitis (dry socket) Osteomyelitis os the jaw medication induced osteonecrosis of the jaw (MRONJ)

Question 45

Alveolar osteitis (dry socket) is delayed healing of extraction site because of ...

Answer 45

premature breakdown of fibrin clot exposing bone and biofilm starts to form on bone first

Question 46

symptoms of alveolar osteitis (dry socket)

Answer 46

``` swelling redness throbbing pain mal-odor oozing ```

Question 47

treatment of alveolar osteitis (dry socket)

Answer 47

gauze soaked in vasoline with iodine

Question 48

can you use antibiotics for dry sockets?

Answer 48

not effective beacause biofilm is the problem

Question 49

treatment for osteomyelitis of the jaw?

Answer 49

surgical debridement and long term antibiotic therapy