Dental Conditions
3.1 Infection
Compendium 1990;11:492,494,498
Cause: Poor dental hygiene leading to dental and gum disease, or as manifestations of systemic disease as seen in diabetes mellitus, rheumatologic disorders, hematologic diseases, or infectious diseases, such as TB; increase caries with passive smoking (Jama 2003;289:1258)
Epidem: Common as first dental visit for many who come to the ER, especially children < 3.5 yr of age (52%) (Ped Dent 1997;19:470). Common pathogens include Streptococcus pyogenes, Streptococcus mitis, Streptococcus salivarius, Staphlococci, Streptococcus faecalis, Escherichia coli, and Klebsiella (Aust Dent J 1978;23:107).
Pathophys: Breakdown of tooth or gum leading to secondary infectious complication (J Am Dent Assoc 1969;78:1016).
Periodontal abscess is an abscess between the tooth and gingiva.
Necrotizing gingivitis are caused by a spirochete very similar to Treponema pallidum; it is a Fusobacteria spp.
Sx: Halitosis, pain, swelling.
Si: Localized edema, erythema, or tenderness; ulcerations; dental caries; lymphadenopathy.
Cmplc: Tooth loss; secondary abscess in gingivitis.
Lab: None, unless systemic disease sought.
Emergency Management:
(Brit Dent J 1989;166:41)
Periodontal abscess:
Warm rinses.
Antibiotics: PCN VK 500 mg po bid to qid, Clindamycin for treatment failures or if PCN allergic—300 mg po qid; perhaps metronidazole for PCN failures (Brit J Oral Surg 1977;14:264).Related posts:
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