Answer :-
A patient presenting with swelling can have
multiple manifestations.
🌟 The swelling may be fluctuant or firm.
It can also be localized or diffuse, also referred to as cellulitis. Localized swellings are confined within the oral cavity, whereas cellulitis can
spread to adjacent soft tissues along fascial planes
(Natkin 1974; Sandor et al. 1998).
Incision and drainage are indicated when soft tissue swelling is
present and drainage through the canal system
cannot be achieved. I&D is most effective when the swelling is localized, soft and fluctuant (Franken al. 1983).
🌟 Movement of infection.
- Upper anterior and canine >> canine space
- Upper premolar and molar >> palatal or buccal space depending on Roots.
- Lower anterior >> sublingual space
- Lower premolar >> submental space
- Lower molars >> sublingual & mandibular space. Depending on mylohyoid Or buccal, masseteric pharyngeals
( All of them. Drainage in intraoral )
If pus in extra oral >> I&D ( Hospitalisation )..
🌟Patient with cellulitis
Treatment
[ antibiotics ampicillin + clavulinic 1g tabs ] 12h/5-7days
[ Metronidazole 500 gm tabs ] 8h/5-7days
[ Analgesic ] 8h/in pain ..
🌟 Patient with localized swelling ( periapical lesion )
- Gp test >> determine infection tooth source
- RCT or extraction
Without [ antibiotics ] except for medically compromised patients.
🌟 Patient with localized swelling in ( space )
Intraoral I/D but before that.
( Aspiration )
Blood ❌❌
Pus. ✔️✔️
🌟 Patient with diabetes mellitus.. be like:-
1. controlled diabetic patient
can be treated normally with some considerations
-) filed document for the last glucose test. (RGB: 180, fbg:90~130, A1c:>7%)
a)stress reduction protocol
b)treatment in the morning/daytime
c)consultation of the physician about the peak insulin level and the attended treatment modality.
d)postoperative meal or supplement.
e) analgesics such as aspirin and NSAIDs should be used with caution as they could synergize/increase the hypoglycemic effect of the antidiabetics.
2. uncontrolled diabetic patient who needs elective treatment:
(rbg:>200, fbg:>140, HbA1c:>6%)
a) should be postponed and referred to a physician.
b) could be treated with non-invasive modalities (fluoride, varnish ..etc)
2. uncontrolled diabetic patients who need emergency treatment
a) fasting glucose level shouldn't exceed 207mg/dl, random blood glucose level shouldn't exceed 234mg/dl
b) in addition to the considerations mentioned above, (stress reduction protocol. etc)
c) also referred to the physicians
