SYMPTOMS AND TREATMENT OF CONJUCTIVITIS.

What is conjuctivatis?

• Conjunctivitis: An inflammation of the mucous membrane lining the inner surface of the

eyelids and the cornea (conjunctiva).

Epidemiology

• Conjunctivitis is the most common eye disease worldwide

• The disease is highly contagious

• Conjunctivitis is caused by:

o Viruses such as herpes simplex, Molluscum contagiosum and measles virus

o Bacteria such as Neisseria gonorrhoeae, Streptococcus pneumoniae, Staphylococcus

aureus and Chlamydia trachomatis serotypes A-C.

o Fungal such as Candida albicans

o Parasites such as Ascaris lumbricoides, Schistosoma haematobium and Taenia solium

• Transmission is by:

o Contact with ocular discharge

o Contact with secretions from upper respiratory tract of infected person through

contaminated fingers, clothing and other articles

o Flies may transmit the disease from infected person to another (mechanical

transmission)

• The disease is common in children

• The predisposing factors include

o Poor personal hygiene

o Inadequate water supply

o Overcrowding

o Poor environmental hygiene • Foreign body sensation

• Scratching or burning sensation

• Sensation of fullness around the eye

• Itching

• Photophobia

Sign of conjuctivitis

• Oedema of eyelids

• The eyes are watery and feels ‘gritty’

• There is no actual pain or loss of vision

• If there is pain the cornea is probably also affected

• Normally both eyes are affected

Most Important Signs

• Hyperaemia

• Tearing

• Exudation (purulent drainage)

• Pseudoptosis (drooping of the upper lid)

• If trachoma is left untreated it can lead to blindness

• Note: Other conditions causing a red eye must be excluded particularly a foreign body to

the eye

Diagnostic Methods

• Do clinical examination to rule out other courses of red eyes.

• Take pus swab for microscopic examination (Gram stain or Giemsa) and culture if the

discharge is purulent

Treatment of Conjunctivitis

• Cleaning the infected eyes regularly by soap and water (do not put soap in the eyes).

• Hand washing is essential to avoid transmitting infection to unaffected eye or to others in

the household.

• Apply Chloramphenicol eyes ointment or 1% Tetracycline eye ointment for five days.

• Eye drops are more convenient for the patient but is short lived.

• If no response, eye specialist for further evaluation and management.

• If gram stain shows gram negative diplococci, add systemic antibiotic to cover

Gonorrhea.

• Most of Conjunctivitis cases are caused by virus from systemic viral infection such as

measles virus.

• They are only treated by frequent eye washing and antibiotics are not indicated, but if

there is secondary bacterial infection apply antibiotic (i.e. presence of purulent discharge

from eyes).

Prevention and Control of Conjunctivitis

• Personal hygiene-hand washing

• Care and treatment of infected eyes

• Proper refuse disposal to prevent fly breeding

• Health education at the community and schools on personal hygiene and danger of

improper refuse disposal

• Improve water supply

CAUSES, SYMPTOMS AND TREATMENT OF DENTAL ABCESS

What is dental abcess?

• Dental abscess: An lesion characterized by localization of pus in the structures that

surround the teeth, can be either acute or chronic.

• Sometimes the abscess develops some distance away from the teeth (like cervical region)

but if is of dental origin then still is called dental or odontogenic abscess.

• When dental caries is not treated by restoration will results into pulpitis.

• If pulpitis is not treated by root canal or extraction ends up with periapical abscess.

• The periapical abscess and its counterpart periodontal abscess (due to periodontal

diseases) when extend out of the tooth boundaries may extend through the bone and

muscles causing pus collection in soft tissues which is called abscess.

Aetiology of Dental Abscess

• Odontogenic (dental) infections are polymicrobial.

• On average 4-6 different bacteria species are involved.

• The normal flora bacteria are involved but the dominant isolates are anaerobes.

• Generally the Anaerobic Gram negative rods followed by Anaerobic Gram positive cocci

are of significant concern.

• The predominant species include; Bacteroides, Fusobacterium, Peptococcus,

Peptostreptococcus and Streptococcus viridians.

• The abscess formation depends on loss of balance between the resistance of the host

tissues and virulence of bacteria.

• When there is high resistance of host tissues with normal or low virulence of microbes

inflammation is usually confined, and resolve, otherwise abscess develops.

• Common causes of entry of microbes and abscess formation include.

o Infected teeth e.g. deep caries, trauma involving the pulp.

o Periodontal infections.

o Pericoronitis is a common condition, and is an infection of the gingiva surrounding a

partially erupted third molar.

o Post-extraction infection – (especially in septic procedures).

o Introducing infection by a needle during administration of local anaesthesia especially

mandibular block.

o Mandibular and maxillary fractures.

Clinical Features of Dental Abscess

• Patient looks moderately ill sometimes severely ill and toxic.

• High body temperature.

• Painful swelling.

• The skin is tense, shiny, warm and red or purple unless the abscess is very deep.

• Muscle trismus (the patient is unable to open his/her mouth fully).

• Gingival fistulas (drainage of pus into the mouth).

• Cellulitis (inflammation of the soft tissues).

Extension of Dental Abscess

• The dental abscess usually extend to the following regions/spaces; buccal space,

sublingual, submental, submandibular and generally around the mandible and maxilla.

• Sometimes the infection can extend to distant areas like cervical, pharynx and

mediastenum on the inferior aspect, infraorbital, parotid and temporal superioly.

• Life threatening infections due to complications of dental abscess include:

o Ludwing’s angina(bilateral swelling of the submandibular and submental spaces

includind floor of the mouth causing rising of the tongue and airway obstruction).

o Mediastinitis; infection descending from orofacial region to cervical and eventually to

the chest.

o Carvenous sinus thrombosis:- infection ascends to the carvenous sinus and can cause

thrombosis with the sinus and and meningitis.

Treatment of Dental Abscess

Antibiotics

• Combination of broad spectrum antibiotics of penicillin family or its alternative with

metronidazole (highly active against anaerobic gram-negative bacilli).

Analgesics and Antipyretics

• Non-streroidal ant-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac are

useful to relieve pain and reduce fever.

Incision and Drainage and Removal of the Cause

• This is the ideal treatment of abscess once pus has been localized.

• The dental personnel around can be of help to the patient, if there is none patient shoud be

referred immediately after providing basic care like antibiotics and analgesics.

• Removal of the cause may mean extraction of an offendind tooth which is done during

incision and drainage where feasible if not then few day later. Note: Always Make Sure You Assess the Airway

• Some forms of dental abscess cause life threatening airway obstruction ( e.g. Ludwig’s

agina). • In such case endotracheal intubation or trachestomy may be required.

Ludwig’s Angina

• A bacterial infection of the floor of the mouth

• Swelling of the tissues occurs rapdily and may block the airway or prevent swallowing of

saliva.

• Symptoms include

o Breathing difficulty

o Confusion or other mental changes

o Fever

o Neck pain

o Neck swelling

o Redness of the neck

o Weakness, fatigue, excessive tiredness

o Drooling

o Earache

• Signs include

o An examination of the neck and head shows redness and swelling of the upper neck,

and under the chin.

o The swelling may reach to the floor of the mouth.

o The tongue may be swollen or out of place

Complications of Dental Abscess

• Osteomyelitis of the jaws

• Maxillary sinusitis

• Cavernous sinus thrombosis

• Necrotizing fasciitis

• Others:

o Mediastinitis

o Meningitis

o Brain abscess

General Pre-referral Care for Dental Patients

• Patient with pain due to pulpitis or any other cause are given analgesics

• Patient with acute infections are given antibiotics and analgesics

• Patient with acute infections are assessed for danger of airway obstruction and toxaemia

• Patients with traumatic dental injuries are given analgesics and antibiotics

• Patients with bleeding effort is made first to control bleeding by packing with a gauze

(preferably soaked with adrenaline) and if persist suturing is attempted. • If bleeding persists then pack the site, stabilize the patient with intravenous fluids (and

blood if patient has bled a lot) and refer

• Always insist on abiding to the referral plan