TMJ, ANUG, ODONTALGIA

 

DENTAL PAIN (Odontalgia, Toothache) = Is 2ry to caries. Pt c/o pain  on cold/hot/chewing/tapping. Gingival involvement may be noticed (gingivitis). This presents as erythema, pain and local edema. Both above entities are treated with pain meds, Pen VK and saline irrigation (decreases edema by osmosis).

 

ANUG = Acute Necrotizing Ulcerative Gingivitis, is an infection of  gingiva and the anchoring  unit, periodontium , by bacteria.  Although named "necrotozing", the gingiva infected is not necrotic. The exam reveals erythema, edema, possible constitutional  S&S. Treated as above and referred to dentist.

 

TMJ Dislocation - The TMJ dislocates anteriorly while laughing, yawning or trauma. Dislocation  may be unilateral (mandible is deviated to unaffected side) or bilateral (pt presents with open mouth).

After obtaining  x-ray  to r/o fx and confirm the dx, pt is seated on the chair with the back against the wall, given muscle relaxant (Midazolam) and with the gauze between the molars of the pt and the thumbs of the facing examiner, downward constant pressure is applied. Occasionally, slight  Left-to-Right rocking is performed if the downward pressure alone was not enough to reduce the dislocation. Pt is then dc with pain meds and puree diet.

 

MASTICATOR SPACE INFECTION & LUDWIG'S ANGINA

 

MASTICATOR SPACE
INFECTION

LUDWIG'S
ANGINA

1) Infection in space formed between
 pterygoid: and messeteric muscle.

1) Infection of bilateral submental, sublingual
and submandibular spaces

2)  Mixed oral flora

2) Mixed oral flora

3) Constitutional S&S, trismus, fluctuance,
 inability to open and evaluate the mouth

3) Constitutional S&S , indurated bucal floor
without fluctuance, elevationof tongue and
brown discoloration of chin.

4)  Ct may be needed to establish dx and the
extent of infection, to distinguish from parapharyngeal abscess.

4) Soft-tissue-neck X-Ray, laryngoscope or Ct
may be needed to evaluate the extent and to assess airway edema.

5) Admission for IV antbx (PCN and Metronidazole or Clinda).

5) Airway protection is a must.  Pt. is admitted
for immediate I&D and IV antbx (PCN, Clinda)

6) Can spread to media

  
 

 

 

 

 

 

 

 

 

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