​Kembara Xtra - Medicine - Dental Infection

​Kembara Xtra - Medicine - Dental Infection 
Infection of the Teeth 
pain and swelling in the head and neck region with an odontogenic (teeth and supporting structures) origin of infection; if neglected, can progress to serious and even life-threatening infections. odontogenic refers to the origin of infection in the teeth and supporting structures.
Until it can be confirmed otherwise, you should consider any illness or swelling in the head and neck to have an odontogenic etiology.
The following system(s) are affected: the oropharynx, the throat, the dental, and the gastrointestinal systems
odontogenic infections, dental abscess are some synonyms for dental abscess.

The study of epidemiology, including incidence and prevalence. 
More than ninety percent of all head and neck infections have their start in the mouth or teeth.
17% of children and young adults (ages 5 to 19) have untreated dental caries.
> 26% of people older than 20 years have untreated dental caries in their mouths.

 The prevalence of untreated dental caries is significantly greater among non-Latino black (21%) and Latino (18%) children and adolescents.

92 percent of adults aged 20 to 64 have had dental caries in their permanent teeth at some point in their lives.
Approximately 17% of persons older than 64 years old do not have any teeth.


Causes and effects: etiology and pathophysiology 

Caries in the teeth are the most prevalent form of chronic disease in the entire world.
Caries or trauma can cause the death of the tooth pulp, which can then cause infection and/or abscess of the neighboring tissues through either direct or hematogenous bacterial colonization of the bloodstream.
Caries, often known as "cavity," is a bacterial infection that is contagious and causes demineralization and destruction of tooth tissue (enamel, dentin, and cementum). Caries is also referred to as "tooth decay."
Streptococcus mutans is easily passed on to infants who have recently received their first teeth from their carers.
There is frequently a polymicrobial mix of anaerobes in dental abscesses, including viridans streptococci and Streptococcus anginosus. S. mutans acidic secretions are thought to play a role in the development of early caries.
Lactobacilli are not detected in healthy persons but are abundant in patients with severe caries. Anaerobes, such as peptostreptococci, Bacteroides, Prevotella, and Fusobacterium, have also been implicated.
Dental caries (and consequent additional infections) can be avoided by maintaining proper oral hygiene, consuming a diet low in cariogenic foods, having access to fluoride, and receiving expert dental treatment. Fluoride supplementation has led to a significant reduction in the incidence of dental caries.

Having a low socioeconomic position, having a parent or sibling with a history of caries or existing untreated dental caries (particularly in the past 12 months), having previous dental caries, having poor access to dental or health care, not having dental insurance, and having a phobia of dentists are all risk factors.

Poor oral hygiene; poor nutrition, including a diet that contains high levels of sugary foods and drinks; Trauma to the teeth or jaw; Inadequate access to and use of fluoride; gingival recession (increased risk of root caries); physical and mental disabilities; inadequately controlled systemic diseases (such as diabetes); decreased salivary flow (as a result of, for example, the use of anticholinergic medications; immunologic diseases; radiation therapy to the head and neck);

Prevention 

Flossing and the use of interdental brushes, brushing with fluoride toothpaste, systemic fluoride (fluoridated bottled water; fluoride supplements for high-risk patients and in non-fluoridated areas), fluoride varnish for all children age 6 years and moderate- to high-risk patients, and regular dental cleanings are the best ways to prevent most dental problems. It is important to improve maternal dentition, use chlorhexidine gluconate rinses, and utilize products containing xylitol for mothers, particularly during the first two years of a child's life, in order to prevent the transfer of S. mutans from a mother or other caregiver to a baby. Quit smoking, as this habit has been shown to increase the severity of periodontal disease. Maintaining good control of systemic disorders, such as diabetes

 Two applications of fluoride varnish each year, performed by primary care practitioners in the dental or medical fields

Associated conditions include extensive caries, crowding, and many missing teeth; periapical and periodontal abscess; soft tissue cellulitis; and periodontitis, which is characterized by profound inflammation and infection of the gingiva, alveolar bone support, and ligaments.

The patient's history includes the following: pain in the afflicted tooth; pain that can be referred to the ears, jaw, cheek, neck, or sinuses; headaches for no apparent reason; sensitivity to hot and cold temperatures; pain that can be unprovoked, intermittent, and/or continuous.
Pain when biting or chewing Trismus (inability to open mouth) Bleeding or purulent drainage from gingival tissues When severe infection (systemic) – Fever – Difficulty breathing or swallowing – Raspy voice – Mental state changes When severe infection (systemic) – Trismus (inability to open mouth) Bleeding or purulent drainage from gingival tissues When
Check for retropharyngeal abscess in children younger than 4 years old who have a stiff neck, a sore throat, and difficulty swallowing.


The Patient's Clinical Examination 
Gingival edema and erythema; swelling of the cheek (extraoral) or vestibular (intraoral); a fluctuant mass at the implicated location; suppuration of the gingival edge; submandibular or cervical lymphadenopathy; a severe (systemic) infection may present with dysphagia, fever, and symptoms of airway compromise.

Differential Diagnosis Bacterial or viral pharyngitis Pericoronitis (inflammation and infection of gum flap over mandibular last molar, typically third molars) Otitis media or externa; sinusitis Headache or migraine Viral (HSV1, herpangina, hand-foot-mouth disease) or aphthous stomatitis Temporomandib

Results From the Laboratory 

Initial Tests (lab, imaging)
No first laboratory tests are required unless the patient appears to be in critical condition.
If the patient is acutely unwell, a CBC and differential should be considered.
- If an abscess is present, the pus should be drained or aspirated and cultured for both aerobic and anaerobic organisms.
— Polymicrobial illnesses often consisting of anaerobic gram-negative rods and anaerobic gram-positive cocci.

 Take individual films of any teeth that might be affected, particularly the root apices. Perform tests that involve palpation, percussion, and cold sensitivity.
A CT scan or panoramic film of the patient's teeth and jaw in order to determine the severity of the illness.

Additional Examinations, as well as Other Important Factors

 A panoramic radiograph should be taken, especially if trismus is present. A CT scan might be beneficial if the face swelling spreads below the inferior border of the jaw or into the infraorbital area. This helps to detect the lesion so that an oral and maxillofacial surgeon or an ENT surgeon can potentially make an incision and drain the fluid.

Management 

If there is no swelling or other systemic evidence of infection, treating the discomfort with antibiotics is not necessary.
Consider making an incision and getting it drained if the problem is isolated.
Appropriate pain control: anti-inflammatory medicines are the first line of treatment; in rare circumstances, short-course opioids may be appropriate.
If infection is severe (systemic symptoms), consider hospitalization with IV antibiotics until stable; may need intraoral or extraoral incision and drainage; definitive treatment (extraction or root canal therapy) necessary to prevent progression or recurrence. Refer to oral health provider for definitive treatment: root canal, extraction, gum therapy. If infection is severe (systemic symptoms), consider hospitalization with IV antibiotics until stable.

Preventative Steps and Precautions 
Ibuprofen doses of 600 to 800 milligrams (10 milligrams per kilogram for children) q6h, or 650 to 1,000 mg of acetaminophen (for pediatric patients, 10 to 15 mg/kg of body weight). q4–6h as needed for pain relief
When treating moderate to severe pain, acetaminophen combined with ibuprofen (for its synergistic action) and a limited amount of opioids may be effective.
a local nerve block using a long-acting anesthetic, such as bupivacaine; avoiding penetrating infection in order to prevent infection from tracking.

The First Line Of Defense Is Medication
Amoxicillin: 500 mg TID for 7 to 10 days; in children, 40 to 60 mg/kg/day divided TID Clindamycin: 300 mg PO TID for 7 days if penicillin allergy If you have an allergy to penicillin, use clindamycin.
Second in Rank
Clindamycin: 300 mg PO TID for 7 to 10 days Amoxicillin/clavulanic acid (500 mg/125 mg), 1 tablet PO TID for 7 days Clindamycin: 300 mg PO TID for 7 days Amoxicillin/clavulanic acid (500 mg/125 mg), 1 tablet PO TID for 7 days If the infection is severe, IV antibiotics (ampicillinsulbactam, cefoxitin, cefotetan) should be considered.
Consider using metronidazole at a dosage of 500 milligrams orally three times daily for a period of seven days to achieve greater bone penetration and excellent anaerobic coverage. Metronidazole should not be administered on its own because doing so can hasten the development of resistant strains; rather, it may be combined with amoxicillin or clindamycin.

Concerns Deserving of Referral 

Talk things over with your dentist and make sure you get enough follow-up care.

Surgical Methods and Operations 
Large, recurrent abscesses should be incised, and the pus should be drained. Root canal therapy or extraction is the definitive treatment.

Admissions 
In order to be admitted to the hospital, a patient must meet the following criteria: swelling that affects the deep spaces of the neck, the floor of the mouth, or the infraorbital region; a deviation of the airway; unstable vital signs; a temperature of more than 101 degrees Fahrenheit; chills; a raspy voice; disorientation or delirium; or evidence of invasive infection or cellulitis.
Ensure that the airway is secure.

if necessary, administer resuscitative fluids through an IV. make sure the patient has proper dental hygiene.
Use chlorhexidine gluconate to gargle or swab the mouth twice daily. Gargle with warm saltwater several times a day, especially after an incision and drainage. Apply ice packs to the affected area to reduce swelling and facilitate drainage.
Discharge the patient when the following conditions are met: the airway is not compromised; the abscess and sepsis have been cleared up; the patient is able to take oral intake and walk.

Ongoing Medical Attention 
It is important to educate people about the importance of good oral hygiene, the necessity for follow-up dental care, and the possible health consequences that might result from a lack of dental care.

Follow-Up Ensure that you have an adequate oral intake, including protein, and follow up with your oral health practitioner within the next 24 hours.

Nutrition 

It is important to keep up a balanced diet because germs thrive on starch and processed sugar.
Avoid eating meals that are high in sugar and tend to stick in your teeth.
Avoid drinking sugary or carbonated beverages throughout the day, and instead go for water as your beverage of choice in between meals.

Considerations Relating to Children

In youngsters, limit the amount of sugary drinks they consume and warn them against sleeping with a bottle; fluoride varnish should be applied twice a year (or more frequently for children who are at higher risk) for children younger than six years old.

Patient Education Prevent cavities and periodontal disease. Educate patients.
Go to the dentist at least once every six months. Reduce the number of times you consume sugary or fizzy beverages, as well as the number of times you eat sugary or sticky meals.
If you want to reduce the risk of dental caries in young children, it is best not to let them sleep with a bottle.

Brush your teeth twice a day and use dental floss or an interdental brush every day.


With the appropriate treatment, the prognosis is very good.

Complications include: Ludwig angina; retropharyngeal and mediastinal infection; osteomyelitis; endocarditis/cardiac tamponade; submental infection; submandibular infection; can induce unstable diabetes in diabetics; can make preexisting heart disease worse; can cause brain abscess or death; submandibular infection; submental infection; endocarditis/cardiac tamponade; sub