10/13/2015

1

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?

10/13/2015

2

10/13/2015

3

snow board mt rainier.JPG

10/13/2015

4

10/13/2015

5

Factoid

� If the pt is experiencing temperature sensitivity with lingering pain to hot and cold abx therapy is not indicated

� If the pt is experiencing constant pain, no real temperature sensitivity antibiotics are indicated

Oral Bacteria

10/13/2015

6

Two main danger zones

� Floor of Mouth/Deep Neck Space infections

�Cavernous Sinus Thrombosis

10/13/2015

7

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.

10/13/2015

8

“A unique aspect o

f

the ve i ns in the head and neck is their valveless n

at ur e”

Maxillofacial Infections

Selected Readings

OMFS Vol 2 No 1

10/13/2015

9

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 with caution in the elderly and poor GFR

Dx Labs & Exams

�CBC and basic chem panel

�Ct jaws and neck with contrast

�MRI with contrast (CST)

� Panorex or 2d rendering

10/13/2015

10

“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

10/13/2015

11

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

� Antifybrinolytics

� Amicar (aminocaproic acid)?

� Tranexamic Acid?

� Plavix shmavix

� Coumadin who cares? ☺

� Same for Eliquis, Rivaroxaban, Pradaxa CrCl<30

10/13/2015

12

Xerostomia

(drug induced or pathologic)

� Biotene

� Sugarless chess

� Pilocarpine

� Saliva substitutes

� Smoking cessation

�Other non alcoholic mouth rinses

10/13/2015

13