3BDS: management of the spread of infection. oral surgery 2

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types of odontogenic infections
caries, peri-apical periodontitis,
periodontitis, periodontitis, pericoronitis, osteomyelitis, maxillary sinusitis
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what influences the sequelae of infection
- virulence of the organism involved
-host resistance to infection
- local anatomy
-treatment of infection
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what has an impact where the spread of infection would be
position of the apex in relation to the buccal or lingual or palatal shelf. also in relation to muscle attachment =
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where could the spread of infection be from a maxillary tooth if it has short root
short buccal root- apex closer to buccal plate, below the level of muscle of attachment so will present in the buccal sulcus
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where could the spread of infection be from a maxillary tooth if it has long root
long root+ above the level of muscle attachment it will present in the buccal space. if its close to the antrum it will present as an antrum infection. it can also spread to the nose if its closer to the nose or if its closer to the palatal shelf - it wou
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where could the spread of infection be from a mandibular tooth
for same reasons- can be a buccal swelling, it can go into the face and end up with a submandibular face swelling, it can go sublingually and end up with a sublingual swelling
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what is cellulitis
massive facial swellings associated with odontogenic bacrterial infections= body’s reaction to the insult. bacterial infective insult but the insult can also be trauma

Diffuse inflammation of the soft tissues which is not circumscribed or confined to one
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what is sepsis
life-threatening organ dysfunction caused by a dysregulated host response to infection.

a complication of odontogenic infection
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how would odontogenic infection cause sepsis
odontogenic infection can spread systemically. in the vascular or lymphatics supply to eventually cause sepsis
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what are the symtoms for sepsis
Slurred speech
• Extreme shivering
• Passed no urine in a day
• Severe breathlessness
• Illness so bad feel they’re dying
• Skin mottled/discoloured/ashen
Rash doesn’t blanch with pressure • cyanosis of lip/skin/tongue
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any patient with a source of infection and two or more of the following .... has sepsis
temp >38 or <36
HR >90 (High risk >130/min)
respiratory rate >20 (high risk >25 breaths/min)
WCC >12 or <4
BP Systolic <100 (high risk <90)
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what is the management for sepsis?
• Take blood cultures ideally before antibiotics • Take serum lactate >2mmol/l
• Give oxygen
• Give empirical intravenous antibiotics
• Give IV fluids
• Monitor urine output
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what are the principles of management of odontogenic infection
- eliminate the cause of the infection ASAP (extripate the pulp, extract tooth)
- provide a path of least resistance (incision and drainage)
- symtomatic management (analgesics and mouthwash, general measures )
- review 48-72hours, consider referral if
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what is orocutaneous fistula
pathological communication between the cutaneous surface of the face and the oral cavity.

us drain extraorally through the skin.
epithelial lined tract connecting two cavities
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what is buccal space infection
-erosion of bone caused by a build up of pus above the attachment to buccinator
- most common maxillary molars

clinically= swelling of cheek below, zygomatic arch
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canine space infection
canine root long enough to pass muscles facial expression

clinically: infra orbital swelling (obliteration of nasolabial fold )
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how does infra temporal space infection present? what usually causes this infection
clinically: severe trismus, building of temporalis, cavernous sinus thrombosis

upper 8
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what artery and nerves are found in the cavernous sinus
internal carotid A
Abducent N
Occularmotor N
Trochlear N
Trigeminal Div I, II
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submandibular space infection, what causes
trismus, firm swelling in SM region
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sub lingual space infection where is the swelling
little extra-orally, I/O swelling FOM
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What teeth with what kind of roots cause SM, SL infection
usually lower molars
long roots= SM space
short roots= SL space: apex of tooth closer to lingual plate, apex of tooth above mylohyoid
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how does submental space infection present ? what teeth causes this infection
usually lower incisors
clinically it presents- firm swelling under chin, discomfort on swallowing
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the cervical fascial spaces:
where could the infection go to from the prevertebral space and what is the inferior boundary
inferior boundary: diaphragm
infection of whole mediastinum
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infection from retropharyngeal space could go on to secondary infection of...
posterior mediastinum
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what are the 3 cervical fascial spaces
lateral pharyngeal space, prevertebral space and retrophyngeal space
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what is an abscess
circumscribed collection of pus. and as it gets larger it compresses adjacent tissues
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what are the local measures for an abscess
drainage and remove cause
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when to use the hiltons method for drainage
use when pus present in soft tissues
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what is the Hilton's method
find the most dependent point of abscess (incise through mucosa and periosteum with Number 11 blade, avoid vital structures, blunt dissection to break down locals of pus)
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why is the blunt dissection needed ?
o get rid of locule of pus. we use a spencer’s arch. well forcep or … scisors you want to open and close the instrument to break the locule strands supporting them which wouldrelease the the ous which will drain out
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what are the supportive general measures
adequate fluid intake, rest, diet
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what analgesics are given as general measures in certain situations
paracetamol, ibuprofen, dihydrocodeine, co-codamol (8/500mg, 15/500mg or 30/500mg)
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what are indication for the prescription of antibiotics
- systemic involvement, significant cellulitis, compromised host defences, involvement of fascial spaces
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what is the 1st line antibiotic for dental infection
penicillin V
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Most abscesses are anaerobic so you could also prescribe .. especially for pericoronitis
metronidazole
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in severe infection cases what antibiotics would you prescribe together
metronidazole and penicillin V
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when is it appropriate to refer.
rapidly progressing infection, difficulty in breathing, difficulty in swallowing, involvement of fascial tissue spaces (SM neck involvement),
temp >39,
severe trismus, compromised host defences, infection not responding to Rx
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what sites of drainage would need LA
buccal/ labial sulcus.
palate (parallel to vessels)
SL space (buccal and parallel to sublingual fold)
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what sites of drainage require general anaesthetic
submental, Submandibular, parapharyngeal, infra temporal, pterygomandibular, submasseteric
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what does Ludwig's angina involve, what is it?
involves submandibular, submental, sublingual spaces bilaterally
it is severe cellulitis. rapid, broad like swelling of floor of mouth, elevation of tongue, dysphagia, dysarthria, trimus
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what can Ludwig's angina cause
mediastinitis, glottal oedema (suffocation)
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what is the management for Ludwig's angina ?
bilateral Hilton's drainage [LA]
tracheostomy
IV steroids and antibiotics
irradiate cause once patient stable
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Card 2

Front

what influences the sequelae of infection

Back

- virulence of the organism involved
-host resistance to infection
- local anatomy
-treatment of infection

Card 3

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what has an impact where the spread of infection would be

Back

Preview of the front of card 3

Card 4

Front

where could the spread of infection be from a maxillary tooth if it has short root

Back

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Card 5

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where could the spread of infection be from a maxillary tooth if it has long root

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