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Oral Health

Considerations for the Medical

Professional

Or how can I discuss the oral

cavity and still look like I

know what I’m talking about?

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Factoid

� I f the pt is experiencing temperature

sensitiv ity with lingering pain to hot and

cold abx therapy is not indicated

� I f the pt is experiencing constant pain, no real temperature sensitivity antibiotics are

indicated

Oral Bacteria

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Two main danger zones

� Floor of Mouth/Deep Neck Space

infections

� Cavernous Sinus Thrombosis

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Urgent care required

� Dysphagia

� Pooling saliva

� Dyspnea

� Trismus

� Floor of mouth raised

Delayed care o.k.

� No dyspahgia

� No trismus

� Floor of mouth supple

Cavernous Sinus Thrombosis

� Headache associated with cn III, !V, V

deficit

� Eye swelling/ fullness/ pain

� Bilat. Eye swelling, confusion, coma,

death

� MRI with contrast

� 50% cultures positive for s.a.

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Urgent care

� Consider aggressive i.v. abx. therapy

� Steroid therapy in appropriate patients

� Monitor vitals and pulse oximetry

� Arrange for:

� transfer

� refer to appropriate specialist

� consult anesthesia

Rapid Onset of Facial Cellulitis of Odontogenic Origin

� Assess pt ability to fight infection

� Clindamycin x 300mg tid x 7- 10 days

� Amoxicillin x 500mg tid x 7-10 days plus Flagyl x 500mg tid x 7-10 days

� Unasyn (1.5gm -3.0gm) q6 + Flagyl 500 mg tid x 7-10 days

� MRSA? � Use Bactrim w ith caution in the elderly and poor GFR

Dx Labs & Exams

� CBC and basic chempanel

� Ct jaws and neck with contrast

� MRI with contrast (CST)

� Panorex or 2d rendering

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“the most important therapeutic

action in the management of orofacial infections is the drainage of

pus, and antibiotics are merely an adjunct…”

Pogrel, A; OMFS Clinics of North America: Feb, 1993

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Bells Palsy vs. Ischemic Stroke

Bells Palsy vs Ischemic Stroke

Bells Palsy

� Peripheral VII� Slow onset with

progressive worsening (hrs-days)

� Able to wrinkle forehead one side

� No tongue deviation� Absence of central

symptoms

Ischemic Stroke

� Central

� Acute onset(minutes)� Able to wrinkle

forehead bilaterally

� Tongue deviation to opposite side of lesion

� Dysarthria, diplopia, dysphagia c.n. V dys/anesthesia

� Weakness in limbs

Anticoagualted Dental Patients – routine oral surgery

� Best controlled via surgical approach

� Amicar

� TranexamicAcid

� Plav ix shmavix

� Coumadin who cares? ☺

� Same for Eliquis, Rivaroxaban, Pradaxa

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Xerostomia (drug induced or pathologic)

� Biotene

� Sugarless chess

� Pilocarpine

� Saliva substitutes

� Smoking cessation

� Other non alcoholic mouth rinses

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