Spread of Oral Infections oral Pathology Question And Answers

Spread of Oral Infections oral Pathology Question And Answers

Question 1. What is called an odontogenic infection?
Answer. An infective process involving the tooth and its supporting structures is known as odontogenic infection.

Question 2. Name the common odontogenic infections in the oral cavity.
Answer. The common odontogenic infections are as follow:

• Pericoronitis
• Gingival abscess
• Periodontal abscess
• Periapical abscess
• Subperiosteal abscess
• Osteomyelitis.

Read And Learn More: Oral Pathology Short Notes Question And Answers

Question 3. Why odontogenic infections spread from mouth to local or the distant sites?
Answer. If proper intervention is not done at the right time, odontogenic infections may spread to the local or the distant sites.

Question 4. Which factors are responsible for the spread of odontogenic infections from mouth to the distant sites?
Answer. Mainy three factors determine the distant spread of oral infections:

• Virulence of the microorganisms
• Immunity of the host
• Anatomical site of the initial infection.

Question 5. How spread of odontogenic infections vary with the causative microorganisms?
Answer.

• Some organisms producing odontogenic infections are more virulent than others
• Moreover few organisms, e.g. Streptococcus sp. can produce enzymes like hyaluronidase and firinolysins, etc.
• which help in the spread of infection by breaking tissues barriers.

Question 6. How host immunity determines the spread of oral infections?
Answer. If the host or the patient has a high degree of body resistance, then the distant spread of infection is less likely and vice versa.

Question 7. How site of infection in the mouth determines its distant spread?
Answer. Thin cortical plates of jawbone and presence of loose tissue spaces around the primary wound increases the chance of distant spread of infection.

Question 8. In which situations, local sites resist the spread of infection?
Answer. Presence of thick cortical plates of bone or tough tissue sites (e.g. areas of muscle attachments) offer good resistance against the distant spread of infection.

Question 8a. Name the sequels of odontogenic infections.
Answer.

• Localized abscess formation
• Acute cellulitis
• Ludwig’s angina
• Cavernous sinus thrombosis
• Bacteremia, septicemia, toxemia and pyemia.

Question 9. What are space infections?
Answer. Odontogenic infections often spread through natural pathways into potential tissue spaces situated between different planes of fascia. These types of infections developing in various tissue spaces are known as the space infections.

Question 10. Name the space infections related to maxilla and mandible.
Answer. Space infections in the vicinity of the jaw bones are divided into two broad groups— those related to the maxilla and those related to the mandible. Space infections related to maxilla and mandible are as follow:

Question 11. What are the clinical features of canine fossa infection?
Answer. Pain and tenderness over infraorbital region, fever and submandibular lymphadenopathy,etc.

Question 12. What is the infective source in case of canine fossa infection?
Answer. Infected maxillary canine tooth.

Question 13. In case of palatal space infection, from which sources the infections may actually come?
Answer. From infected maxillary lateral incisors and infection via palatal roots of maxillary molars.

Question 14. What are the clinical features of palatal space infection?
Answer. Pain and an extremely tendered swelling over the palate.

Question 15. Describe the boundary of infratemporal space.
Answer.

• Anteriorly: Maxillary tuberosity
• Posteriorly: Lateral pterygoid muscle, condyle of the mandible and temporalis muscle
• Laterally: Tendon of the temporalis muscle and coronoid process of mandible
• Medially: Lateral pterygoid plate and inferior belly of the lateral pterygoid muscle.

Question 16. Name the contents of the infratemporal space.
Answer.

• Pterygoid plexus and internal maxillary artery
• Mandibular, myelohyoid, lingual, buccinator and chorda tympani nerves
• External pterygoid muscle.

Question 17. What are the sources (of infection) in case of infratemporal space infection?
Answer. Infected maxillary molar teeth or infected needles or solution used for injection of the maxillary tuberosity.

Question 18. Name the clinical features of infratemporal space infection.
Answer.

• Trismus, pain and swelling of the eyelids when postzygomatic fossa is involved
• Dysphagia due to involvement of pharynx
• Swelling in the preauricular region, this might extend up to the cheek.

Question 19. What is the pterygomandibular space and in between which structures it lies?
Answer. Pterygomandibular space is the inferior portion of the infratemporal space and it lies between the internal pterygoid muscle and the ramus of mandible.

Question 20. How infections can reach pterygomandibular space?
Answer. From pericoronitis of mandibular third molar tooth and infected needles used for injection into the space.

Question 21. Describe the clinical features of pterygomandibular space.
Answer. Severe trismus with radiating pain and occasional swelling of the lateral–posterior region of soft palate.

Question 22. How temporal pouch infection occurs?
Answer. It occurs as secondary infections from submasseteric, pterygopalatine and infra-temporal spaces. Moreover infections from maxillary molars can also reach into this pouch.

Question 23. What is a parotid space?
Answer. Parotid space is a compartment formed by splitting of the investing layer of deep cervical fascia.

Question 23a. Name the contents of the parotid space.
Answer.

• Parotid glands
• Extra- and intraglandular lymph nodes
• Facial nerve and auriculotemporal nerve
• Posterior facial vein
• External carotid artery, internal maxillary and superfiial temporal artery, etc.

Question 24. From which sources infections reach the parotid space?
Answer. Secondary infections from lateral pharyngeal and submasseteric spaces.

Question 25. What are the clinical features of parotid space infection?
Answer. A smooth and painful swelling in front and below the external ear; or occasional swelling of the entire face along with fever, chills, etc.

Question 26. Where from the infection often reaches the mental space?
Answer. Mandibular anterior teeth.

Question 27. What are the clinical features of mental space infection?
Answer. It produces a tense painful swelling in the chin region.

Question 28. What are the clinical features of submental space infection?
Answer. Painful swelling in the submental area with occasional dyspnea or dysphagia.

Question 29. What is the other name of submandibular space?
Answer. Submaxillary space.

Question 30. Describe the boundaries of submandibular space.
Answer.

• Medially: Hyoglossus and digastric muscles
• Laterally: Superfiial fascia and skin
• Superiorly: Posterior portion of hyoglossus muscle.

Question 31. What are the contents of submandibular space?
Answer. Submandibular salivary gland and lymph nodes.

Question 32. What are the main sources of infection for submandibular space?
Answer. Infected mandibular molars.

Question 33. Which space infection is most common in the orofacial region?
Answer. Submandibular space infection is the most common of all space infections in the orofacial region.

Question 34. Describe the clinical features of submandibular space infection?
Answer. Fever and pain with swelling near the angle of the mandible. There are often submandibular lymphadenitis and sialadenitis in the submandibular salivary gland.

Question 35. In which areas submandibular space infection can spread?
Answer. Infections from the submandibular space may extend to the sublingual and submental spaces, and rarely to the lateral pharyngeal spaces.

Question 36. Name the serious consequences of submandibular space infection.
Answer.

Distant spread of infection from the submandibular space may result in infections of the cranial fossa or the mediastinum.
Involvement of the pharynx and the larynx may cause dyspnea and dysphagia.

Question 37. Name the treatments of submandibular space infection.
Answer.

• Surgical drainage
• Antibiotic therapy
• Treatment of the offending tooth
• Tracheotomy may be required in cases of airway obstruction.

Question 38. Where is the sublingual space situated?
Answer. Sublingual space is situated above the submandibular space.

Question 39. Describe the boundary of sublingual space.
Answer.

• Superiorly–mucosa of the flor of the mouth
• Inferiorly–mylohyoid muscle
• Anterolaterally–body of the mandible
• Posteriorly–hyoid bone
• Medially–median raphae of the tongue.

Question 40. Where from infections reach the sublingual space?
Answer. From mandibular teeth except second and third molars; and infections from the submandibular space.

Question 41. Describe the clinical features of sublingual space infection.
Answer. Swelling of the flor of the mouth, airway obstructions in severe cases with dysphagia, etc.

Question 42. Describe the clinical features of lateral pharyngeal space infection.
Answer.

• Pain and trismus with fever and chill
• Dysphagia and dyspnea due to involvement of the pharynx and larynx.

Question 43. In uncontrolled cases, infection from lateral pharyngeal space may spread to which organ?
Answer. Infection can spread to the mediastinum via the pre-vertebral fascia.

Question 44. Name the possible complications of lateral pharyngeal space infection.
Answer.

• Septicemia and respiratory paralysis
• Thrombosis of the internal jugular vein
• Erosions of the internal carotid artery.

Question 44a. In which location there is collection of pus in quinsy?
Answer. Peritonsillar space.

Question 45. What is cellulitis?
Answer. Cellulitis is an acute edematous, purulent inflmmatory process, which spreads diffusely through different tissue spaces or fascial planes.

Question 46. Name the microorganisms, which often cause cellulitis.
Answer. Microorganisms such as Streptococcus pyogenes and anaerobes, particularly Bacteroides most commonly produce facial cellulitis.

Question 47. Name one important characteristic of the microorganisms producing cellulitis.
Answer. These organisms often produce hyaluronidase and firinolysins; these proteolytic enzymes help in diffuse spread of infection by breaking down the tissue barriers.

Question 48. Describe the clinical features of cellulitis.
Answer. Cellulitis often presents large, diffuse, painful swelling over the face or neck, which is usually fim and brawny. The condition may be associated with fever, chill and leukocytosis, etc. with regional lymphadenopathy.

Question 49. How the overlying facial skin color changes in different types of cellulitis?
Answer. When facial cellulitis involves the superfiial tissue spaces, the overlying skin often appears purplish, however the skin appears normal when the infection spreads along the deeper tissue spaces.

Question 50. Name the complications of cellulitis.
Answer.

• Trismus, dyspnea and dysphagia are the common complications
• Development of pus discharging intraoral or extraoral sinuses
• Some lesions may spread over a wide area and can even involve the entire face
• Development of Ludwig’s angina.

Question 51. What are the important histological features of cellulitis?
Answer. Collection of large amount of firin and serum flid in the tissue, separation of periosteum and muscles from the bony surface due to accumulation of flid.

Question 52. What are the treatments of cellulitis?
Answer. Drainage, antibiotic therapy and elimination of the primary source of infection, etc

Question 53. What is Ludwig’s angina?
Answer. Ludwig’s angina is an overwhelming diffuse, suppurative cellulitis, which simultaneously involves the submandibular, sublingual and submental spaces bilaterally.

Question 54. Name the common predisposing factors which facilitate the development of Ludwig’s angina.
Answer. Diabetes mellitus, HIV infection, oral transplants and aplastic anemia, etc.

Question 55. Name the common microorganisms which cause Ludwig’s angina.
Answer. Hemolytic streptococci are the most frequently encountered organism is to cause Ludwig’s angina. However, Staphylococci, Bacteroides and Fusiform bacilli may also be involved.

Question 55a. What is the main causative organism in Ludwig’s angina?
Answer. Haemolytic streptococci or Streptococcus haemolyticus.

Question 56. What are the primary sources of infection in Ludwig’s angina?
Answer.

• Odontogenic infections, e.g periapical, pericoronal or periodontal lesions of mandibular molar teeth
• Gunshot injury or stab wounds in the flor of the mouth with secondary infection
• Infection following fracture of mandible
• Osteomyelitis of the jaw
• Infection of orofacial soft tissues
• Spread of infection from peritonsillar or parapharyngeal abscesses
• Submandibular sialadenitis.

Question 57. Name the spaces involved in Ludwig’s angina.
Answer. Bilateral submandibular, sublingual and submental spaces are involved in Ludwig’s angina.

Question 58. Describe the clinical appearance of Ludwig’s angina.
Answer.

• Rapidly spreading, large, diffuse and board-like aggressive bilateral swelling of the upper part of neck and flor of the mouth with brawny induration
• Because of swelling tongue is elevated and pushed up against the palate; patients often have a typical open-mouthed appearance
• The enlarged tongue often protrudes outside the mouth and the condition is called woody tongue
• Patient is often unable to open the mouth, speak or swallow properly
• Usually the patient is very toxic with high fever, chill, rapid pulse, dysphagia, sore throat, drooling and fast respiration, etc.
• The swollen area of the neck is fim, painful, non-flctuant and does not pit upon pressure
• In untreated cases, cellulitis may spread further and cause a massive swelling in the neck above the hyoid bone; this condition is often known as bull neck.

Question 59. Name the common complications of Ludwig’s angina.
Answer.

• Edema of glottis with respiratory obstructions which might cause even death.
• Development of cavernous sinus thrombosis, meningitis, brain abscess and suppurative encephalitis, etc.

Question 60. What is the treatment of Ludwig’s angina?
Answer.

• High dose of antibiotics and drainage by incision at the anterior part of the neck.
• Emergency tracheostomy may be required in cases of airway obstructions.

Question 60a. Which drug has mutual antagonism with ampicillin?
Answer. Chloramphenicol.

Question 61. What is cavernous sinus thrombosis?
Answer. Cavernous sinus thrombosis is a serious life-threatening condition characterized by formation of septic thrombi within the cavernous sinus and its numerous communicating branches.

Question 62. What are the external routes for spread of infection from face to cavernous sinus?
Answer. Facial and angular veins are the routes via which infections from upper lip, face, eye and nares, etc. often reach the cavernous sinus directly.

Question 63. What is the internal route for spread of infection from mouth to cavernous sinus?
Answer. The pterygoid plexus.

Question 64. Infections from which areas reach cavernous sinus via the internal route?
Answer. From upper and lower third molar teeth.

Question 65. Why infections spread much rapidly to the cavernous sinus via external route than the internal route?
Answer. Because facial and angular veins (external routes) are Questionuite longer vessels and they have no valve systems in them, as a result, infections often spread rapidly to the cavernous sinus via this route. On the other hand, spread of infection via the internal route (pterygoid plexus) occurs at a much slower pace, because the infection has to pass through many small and twisted venous passages of the pterygoid plexus.

Question 65a. Via which route does the infection from maxillary teeth reach the cavernous sinus?
Answer. Via the pterygoid plexus.

Question 66. Name the infections which spread via the internal route and cause cavernous sinus thrombosis.
Answer.

• Periapical/pericoronal/periosteal abscesses
• Otitis media
• Fracture of skull
• Meningitis
• Septicemia.

Question 67. Describe the clinical features of cavernous sinus thrombosis.
Answer. Patients with cavernous sinus thrombosis are often gravely ill and often have headache, tachycardia, stiffness of the neck, photophobia, increased lacrimation, proptosis, dilatation of pupil and exophthalmos, fiation of the eyeball and massive swelling of the nose and forehead, etc.

Question 68. Describe the treatment of cavernous sinus thrombosis.
Answer.

• Maintenance of airway in cases of respiratory distress
• Drainage
• Anticoagulant therapy.

Question 69. What is maxillary sinusitis?
Answer. Maxillary sinusitis can be defied as the acute or chronic inflmmations of the maxillary sinus.

Question 70. Enumerate the causes of maxillary sinusitis.
Answer.

• Extension of odontogenic infections
• Accidental entry of broken tooth inside the sinus
• Common cold
• Inflenza
• Exanthematous diseases
• Extension of infection from frontal or parietal sinuses
• Phycomycosis infection.

Question 71. Name the teeth from which infections often reach the maxillary sinus.
Answer. Upper premolar or molar teeth.

Question 72. Describe the clinical features of acute maxillary sinusitis.
Answer.

• Fever, malaise, discharge of pus into the nose with fetid breath
• Moderate to severe pain in the sinus region with swelling
• Referred pain in the teeth or in the ear.

Question 73. Describe the clinical features of chronic maxillary sinusitis.
Answer. Chronic maxillary sinusitis presents little pain, however, there may be occasional vague pain, stuffy sensation in the face and mild nasal discharge with foul breath, etc.

Question 74. Name the radiograph which is ideally advised for visualization of maxillary sinus.
Answer. Water’s view radiograph.

Question 75. What is the common radiographic fiding of chronic maxillary sinusitis?
Answer. Chronic maxillary sinusitis often produces clouding of the maxillary sinus on radiographs.

Question 76. What is focal infection?
Answer. Metastases of microorganisms or their toxins from a localized site of infection to any distant part of the body with subseQuestionuent injury are called focal infection.

Question 77. What is focus of infection?
Answer. Circumscribed area of tissue which is infected by exogenous pathogenic organisms and is usually located near the skin or mucosal surface is called a focus of infection.

Question 78. Name the common infective foci in the oral cavity.
Answer.

• Periapical abscess, periodontal abscess and pericoronitis
• Infected periapical granuloma or cyst
• Infected dental pulp or root canals or root fragments of teeth
• Osteomyelitis and syphilitic chancre
• Infections in the maxillary sinus, nasal sinus, throat and tonsils, etc.

Question 79. Name the diseases which might occur due to spread of infection from oral foci.
Answer.

• Subacute bacterial endocarditis
• Cavernous sinus thrombosis
• Meningitis and brain abscess
• Subdural empyema
• Suppurative encephalitis
• Ocular diseases
• Renal diseases
• Bacteremia, septicemia, toxemia and pyemia
• Rheumatoid arthritis and rheumatic fever.

Question 80. What is infective endocarditis (IE)?
Answer. Infective endocarditis (IE) is an uncommon but life-threatening infection of the endocardial surface of the heart which may include one or more heart valves, the mural endocardium, or a septal defect.

Question 80a. What is the underlying risk in the disease infective endocarditis?
Answer. The disease often results in severe valvular insuffiiency which may lead to intractable congestive heart failure and myocardial abscesses.

Question 81. What are the types of infective endocarditis?
Answer. Acute bacterial endocarditis (ABE) and subacute bacterial endocarditis (SBE).

Question 82. What is the basic difference between the two types?
Answer. Even in untreated cases, patients often survive longer with the subacute bacterial endocarditis as opposed to the acute bacterial endocarditis.

Question 83. Is infective endocarditis always of bacterial origin?
Answer. It is predominantly a bacterial disease, but other organisms can also be responsible.

Question 84. Name the common causative organisms in infective endocarditis.
Answer.

• Staphylococcus aureus, coagulase-negative S. aureus
• Streptococcus viridans, intermedius group, Group D, BAC and G streptococci
• Nonenterococcal group D
• Pseudomonas aeruginosa
• HACEK (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella kingae)
• Candida albicans
• Bartonella.

Question 85. Name the common risk factors in infective endocarditis.
Answer.

• Diabetes mellitus
• Advanced age
• Use of anticoagulants
• Use of corticosteroids
• Surgical intervention to any part of pacemaker system
• Severe infection in oral cavity.

Question 86. What are the clinical features of infective endocarditis?
Answer.

• Fever, chills, anorexia, weight loss, malaise and headache
• Night sweats, shortness of breath, cough and chest pain
• Stiff neck, delirium, paralysis and conjunctiva hemorrhage
• Cerebrovascular accident or congestive cardiac failure in untreated cases.

Question 87. Why the disease infective endocarditis is so important in oral pathology and oral surgery?
Answer. The disease has tremendous importance to oral pathologists and surgeons, since large number of cases may happen following minor or major dental procedures where proper antibiotic prophylaxis has not been provided to the patient.

Question 88. Mention the cardiac conditions in which antibiotic prophylaxis for infective endocarditis is strongly recommended.
Answer. Prosthetic heart valve, history of previous infective endocarditis and congenital heart disease (CHD).

Question 89. Name the dental procedures which are likely to cause infective endocarditis.
Answer. All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa including:

• Tooth extraction
• Periodontal surgery
• Scaling and root planning
• Endodontic procedures
• Teeth cleaning
• Rubber dam/matrix/wedge placement.

Question 90. Name the daily activities unrelated to dental procedures which can cause infective endocarditis.
Answer.

• Tooth brushing
• Tooth flssing
• Use of wooden tooth-pricks
• Use of water irrigation devices
• Chewing food.

Question 91. Name the dental procedures which are unlikely to cause infective endocarditis.
Answer.

• Routine anesthetic injections through non-infected tissue
• Taking dental radiographs
• Placement of removable prosthesis
• Placement of removable orthodontic appliances
• Adjustment of orthodontic appliances
• Shedding of deciduous teeth
• Bleeding from trauma to the lips or oral mucosa.

Question 92. When should be the drug administered in antibiotic prophylactic regimens, for dental procedures in infective endocarditis?
Answer. It should be given as single dose 30 to 60 minutes before procedure.

Question 93. Mention the dose options for different antibiotic prophylactic regimens for dental procedures in infective endocarditis.
Answer. Oral amoxicillin 2 grams for adults or 50 mg/kg of body weight for children as a single dose 30 to 60 minutes before procedure.

Question 94. What should be the regimen if the patient is unable to take oral amoxicillin?
Answer.

• Amoxicillin 2g IV or IM for adults and 50 mg/kg IV or IM in children
• Cefazolin or Ceftriaxone 1g IM or IV and 50 mg/kg IM or IV in children.

Questionuestion 95. Which oral drugs should be chosen for dental prophylaxis in infective endocarditis, if the patient is allergic to penicillin?
Answer.

• Clindamycin 600 mg for adults and 20 mg/kg in children
• Azithromycin or clarithromycin 500 mg for adults and 15 mg/kg in children.