Principle I: Determine Severity of Infection Medical Assignment Help

Principle I: Determine Severity of Infection

Most odontogenic infections are mild and require only minor therapy. When the patient comes for treatment, the initial goal is to assess the severity of the infection. This determination is based on a complete history of the current infectious illness and a physical examination. Complete history. The history of the patient’s infection follows the same general guidelines as any history. The initial purpose is to find out the patient’s chief complaint, Typical chief complaints of patients with infections are, “I have a toothache,” “My.jaw is swollen,”.or “I have a gum boil in my mouth.” The complaint should be recorded in the patient’s own words. The next step- in taking of the history is determining how long the Infection has been present. First, the dentist should inquire as to time of. onset of the infection. How long ago did the patient first have symptoms of pain, swelling, or drainage, which indicated the beginning of’ the infection? The duration of the infection is then discussed. Have the symptoms of the infection been constant, have they waxed and waned, or has the patient

FIG. 15-2 Relationship of point of bone perforation to muscle attachment will determine fascial space involved. A, When tooth apex is lower than muscle attachment, vestibular abscess results. B, If apex is higher than muscle attachment, adjacent fascial space will be involved.

FIG. 15-2 Relationship of point of bone perforation to muscle attachment will determine fascial
space involved. A, When tooth apex is lower than muscle attachment, vestibular abscess results. B, If
apex is higher than muscle attachment, adjacent fascial space will be involved.

FIG. 15-3 Vestibuiar abscess arising from maxillary incisor. Overlyinq mucosa is thin because pus is near surface .•

FIG. 15-3 Vestibuiar abscess arising from maxillary incisor. Overlyinq mucosa is thin because
pus is near surface 

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steadily grown worse since the symptoms were first noted? Finally, the practitioner should determine the rapidity of progress of the infection. Has the infection process progressed rapidly over a few hours, or has it gradually increased in severity over several days to a week? The next step is eliciting the. patient’s symptoms. Infections are actually a severe Inftarnma:-x j response, and the typical signs of inflammation are clinically easily discernible. These signs and symptoms are dolor (i.c., pain), tumor (i.e., swelling), calor (i.e., warmth), rubor (i.e., erythema, or redness), and functio laesa (i.e., loss of function.) .The most common complaint is dolor. The patient . should-be asked where the pain actually started and how the pain has spread since it was first noted; the second dsign is tumor. Swelling is a physical finding that is sometimes subtle and not obvious to the  although it is to the patient. It is important that the dentist  sk the patient to describe any area of swelling, where it is, and how large it feels. “The third characteristic of intecnou is calor. The patient should be asked if the
area feels hot. Rubor of the overlying area is the next characteristic:
to be discussed. The patient should be asked’ if there has been or currently is any change in colorcially redness, over the area of the infection, Functio laesa should then be checked. When inquiring about this chactenstic, the dentist should ask about trismus and difficlifty in swallowing, breathing, Of chewing, Finally, the dentist should ask how the patient feels in general. Patients who feel fatigued, hot, sick, and generally out of sorts are said to have malaise. Malaise u_suaUy indicates a generalized reaction to a  moderate-to-severe infection (Fig, 15-5). – In the next step the dentist inquires about treatment.The dentist should ask about previous professional treatment a(‘jl self-treatment, Many patients will “doctor”
themselves with leftover antibiotics, hot soaks, and avariety of other home remedies, Occasionally, a dentistsees a patient who received treatment in an emergency room 2 or 3 days earlier and was referred to a dentist by
the emergency room physician, The patient may haveneglected to follow that advice _until the infection became rather severe. The patient’s medical history should be obtained in the usual manner by interview or by self-dministered questionnaire. Physical examination. The first step in the physical examination is to coUect the patient’s vital signs. Thisincludes temperature, blood pressure, pulse rate, and respiratory rate. The need for evaluation of temperature is obvious. Patients who have systemic involvement of infection Will have elevated temperatures. Patients withsevere infections will have temperatures elevated to 101Q
to 102 ° F (38.3° to 38.8° C). The’ patient’s pulse rate will-increase as the patient’s temperature increases. Pulse rates of up to 100 beats pel
minute are not uncommon in patients with infections. f pulse rates increase above 100 beats per minute, the patient may have a severe infection and-should be treated more aggressively. ‘The vital sign that varies the least with infection is the patient’s blood pressure. Only if the patient has significan  pain and anxiety ‘,,;ilI there be a mild elevation insystolic blood pressure Finally, the patient’s respiratory rate should be closelyobserved. One of the major considerations in odontogenic infections is the potential for upper airway obstruction as a result of extension of the infection into fascial spaces in the area of the pharynx. As respirations are monitored, the
dentist should carefully check to ensure that the upper airwayis clear and that breathing is without difficulty. The normal respiratory rate is 14 to 16 breaths per minute.Patients with mild-to-moderate infections have elevated  espiratory rates of up to 18 to 20 breaths per minute.
Patients Who have normal vital signs with only a mild emperature elevation usually have a mild infection that can be readily treated. Patients who-have abnormal vitalsigns with elevation of temperature, pulse rae, and espiratoryrate are more likely to have serious infection andrequire more elaborate therapy. Once vital signs have been taken, attention ‘should be
turned to physical examination of the patient. The initialportion of the physical examinationshouJd be inspectionof the patient’s general appearance. Patients who havemore than a minor, localized infection have an appear-

FIG. 15-5 Patient with severe infection and elevated temperature, pulse rate, and respiratory rate. The patient feels sick and tired; he _ has a "toxic appearance."

FIG. 15-5 Patient with severe infection and elevated temperature,
pulse rate, and respiratory rate. The patient feels sick and tired; he
_ has a “toxic appearance.”

ance of fatigue, feverishness, and malaise. This is a “toxic appearance” (see Fig. 15-5). •  he patient’s head and neck should be carefully examined
for signs of i nfection and the patient inspected for any evidence of swelling and overlying erythema. The patient should be asked to open the mouth widely, swallow, and take deep breaths so that the dentist can check I
for dvsfunction. Areas of swelling must be examined by palpation. The
dentist should gently touch the area of swelling to check for tenderness, amount of local warmth or heat, and the character of the swelling. The character of the swelling varies from feeling very soft and almost normal through a firmer swelling (described as having a dOl/ghy feeli/lg) to an even firmer or hard swelling (described as feeling induratedi. An indurated swelling has the same firmness as a tightened muscle .. Another characteristic swelling texture is [luctuant. Fluctuance is the feeling of a fluid-filled balloon. Fluctuant swelling almost always indicates an
accumulation of pus in the underlying tissues. The dentist then performs an’ intraoral examination to try to find the specific cause of the infection, There may be severely carious teeth, an obvious periodontal abscess,

 

 

 

 

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