Lesson 7 Inflammation

Front 1

Conditions patients usually complain about

Back 1

● Pain ● Swelling ● Esthetics ● Difficulty in mastication ● Difficulty in swallowing

Front 2

imbued with the responsibility of taking care of the oral health of people

Back 2

dentists

Front 3

two morbid states that often present several diagnostic dilemmas to the dentist

Back 3

Inflammation and Infection

Front 4

presence of a reproducing pathogen (bacteria, viruses etc.) in the body.

Back 4

infection

Front 5

can happen without any inflammation

Back 5

tetanus infection

Front 6

a common response by the body to infection or general disturbance.

Back 6

inflammation

Front 7

A localized protective response elicited by injury or destruction of tissues, which serves to destroy, dilute or wall off the injurious agent and the injured tissue.

Back 7

inflammation

Front 8

Cardinal signs of Inflammation:

Back 8

Calor (heat; hyperemia) ● Dolor (pain; nerve chemical mediators ● Functio laesa (loss of function; pain) ● Rubor (redness; hyperemia) ● Tumor (swelling; exudation)

Front 9

Mechanism of Inflammation

Back 9

Vasodilation ● Exudation ● Emigration ● Chemotaxis

Front 10

Excessive swelling causes congestion of the tissues ● Congestion may cause compression of vital tissues

Back 10

swelling

Front 11

Probably the single most important reason why patients see dentists ● Discomfort may interfere with a patient's activities.

Back 11

pain

Front 12

Managing pain and swelling begins with

Back 12

identifying the cause

Front 13

Signs of infection:

Back 13

Fever ● Lymphadenopathy ● Abscess ● Cellulitis ● Inflammation ● Trismus

Front 14

The invasion of a host organism's bodily tissues by disease causing organisms, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce

Back 14

infection

Front 15

Always caused by microbial invasion

Back 15

infection

Front 16

Not always caused by an infections

Back 16

inflammation

Front 17

Managed with antibiotics

Back 17

infection

Front 18

Managed by NSAIDs or other inflammatory measures

Back 18

inflammation

Front 19

Thorough examination:

Back 19

● Dental caries ● Periodontitis ● Ulcerations ● Traumatic occlusion ● Areas of erythema ● Percussion ● Absence of visible causes ● Radiographic evaluation ● Palpation

Front 20

S.O.C.R.A.T.E.S.

Back 20

Site - ● Onset - sudden or gradual? ● Character - ● Radiation - ● Associations - ● Time course - ● Exacerbating/Relieving Factors - ● Severity

Front 21

greater than that of paracetamol and is comparable to that of weak opioids

Back 21

analgesics of nsaids

Front 22

weak opiods

Back 22

(codeine, tramadol,

Front 23

required to achieve anti inflammatory than analgesic effects

Back 23

higher doses

Front 24

Optimum duration of treatment for analgesic purposes

Back 24

3 days

Front 25

Patients benefit from receiving optimal NSAID doses given at regular, ‘‘___ ’’ time interva

Back 25

clock based

Front 26

It is recommended to give NSAIDs before surgery.

Back 26

Pre-operative analgesia

Front 27

less effective as an analgesic when compared with ibuprofen and naproxen.

Back 27

celecoxib

Front 28

Combination therapy of NSAIDs andParacetamol

NON OPIODS DRUG

Back 28

Front 29

analgesic effect of acetaminophen is considered ____ when combined with NSAIDs

Back 29

synergistic

Front 30

A commercially available combination product containing ______ may be an option and is easy to prescribe.

Back 30

opioid and acetaminophen

Front 31

Commonly prescribed opioid for dental use

Back 31

Front 32

also known as narcotic analgesics. They have the potential for addiction and require a prescript

Back 32

opioid drugs

Front 33

are indicated for prevention of inflammatory manifestations (edema and trismus) (professional agreement)

Back 33

Glucocorticoids

Front 34

Use of steroid as an

Back 34

anti inflammatory

Front 35

duration of steroid use

Back 35

The optimum duration of treatment is 3 days, with a maximum of 5 days (professional agreement); since this

Front 36

The invasion of a host organism's bodily tissues by disease causing organisms, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce

Back 36

infection

Front 37

Most odontogenic infections due to

Back 37

mixed flora

Front 38

Most Odontogenic Infections Are Compose

Back 38

Aerobic – 5% ○ Anaerobic – 35% ○ Mixed – 60%

Front 39

stages of infection

Back 39

Front 40

cellulitis

Back 40

A painful swelling of the soft tissue of the mouth and face resulting from a diffuse spreading of purulent exudate along the fascial planes that separate the muscle

Front 41

abscess

Back 41

- Well defined localized borders● Pus accumulation in tissues● Fluctuant to palpation● Considered a chronic state

Front 42

Inflammatory causes of oral pain● Pulpal

Back 42

Reversible Pulpitis○

Irreversible Pulpitis○

Periapical Periodontitis○

Localized dentoalveolar abscess○

Facial cellulitis

Front 43

Inflammatory causes of oral pain peeiodontal

Back 43

Lateral periodontal abscess○

Pericoronitis○

Dry socket○

Plaque induced gingivitis○

Chronic periodontitis

Front 44

A considerable percentage of dental pain originates from acute and chronic infections of pulpal origin

Back 44

operative intervention

Front 45

should only be used in acute periodontal conditions where drainage or debridement is impossible,

Back 45

systemic antimictobials

Front 46

Factor Influencing Post-operative Infections

Back 46

-Size of bacterial inoculum ● Duration of surgery ● Presence of foreign body/implants ● State of host resistance

Front 47

Cardiac Conditions Considered for Antibiotic Prophylaxis

Back 47

Front 48

Common procedures done in the dental office

Back 48

-Extractions (single or multiple) ○ Frenectomies ○ Torus removal ○ Chronic apical infections

Front 49

Antibiotics must be in place prior to start of surgery

Back 49

Oral – 1 hour prior to surgery ■ Parenteral – less than 1 hour

Front 50

timing : Prolonged surgeries

Back 50

penicillin and clindamycin give every 3 hou

Front 51

timing : “Post operative prophylaxis”

Back 51

Evidence indicates increased infection if started after 2 hours

Front 52

Antibiotics are indicated in severe infections ● Signs Of Severety

Back 52

Fever ○ Dehydration ○ Rapid progression of swelling ○ Trismus ○ Quality and/or location of swelling ○ Marked pain ○ Elevation of tongue ○ Difficulty with speech and swallowing

Front 53

limited number of localized oral lesions that are indicated for antibiotic

Back 53

Periodontal abscess ○ Acute necrotizing ulcerative gingivitis ○ Pericoronitis.

Front 54

Organism causing infection is not seen ● Prescription is not based on luck ● Experience in previous treatments are the main basis ● Also based on our knowledge of the most common organisms involved in odontogenic infection ● Based on knowledge of antibiotic sensitivity of the suspected organism

Back 54

Empirical antibiotic prescription

Front 55

Commonly prescribed antibiotics in dental practice

Back 55

Front 56

Empiric therapy based on predictable organisms

Back 56

antibiotic therapy

Front 57

antibiotic of choice

Back 57

amoxicillin

Front 58

limited action on anaerobic

Back 58

Cephalosporin

Front 59

broad spectrum, less effective than penicillin. Largely replaced by Azithromycin

Back 59

erythromycin

Front 60

effective only against anaerobes

Back 60

metronidazole

Front 61

such as ciprofloxacin for established osteomyelitis

Back 61

quinolones

Front 62

is the shortest time that will prevent both clinical and microbiological relapse.

Back 62

ideal antibiotic duration

Front 63

usually mentioned in the known resources for antibiotic prescribing,

Back 63

frequency of prescribing

Front 64

most commonly based on expert opinion.

Back 64

whereas duration of treatment recommended in therapeutic guidelines

Front 65

most patients with acute dentoalveolar infections can safely be 2-3 days, provided that drainage has been establishe

Back 65

duration of antibiotic therapy