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Tonsillitis - Causes and Treatment

 Tonsillitis


Inflammation of palatine tonsils is called tonsillitis. Each tonsil is a mass of lymphoid tissue at the back of your throat-one on each side.

What is the role of tonsils in our body?
It provides local immunity and surveillance to our body to fight against foreign intruders.

Tonsils are most active from 4 to 10 years of age. After puberty, gradual involution of the tonsils takes place..
Types:
1.Acute tonsillitis
2.Chronic tonsillitis




Etiology:
- Most common in school going children but may affect adult. Viruses are the most common offenders in tonsillitis.
1.Adenovirus
2.Influenza virus
3.Parainfluenza virus
4.Herpes simplex virus (HSV)

- Hemolytic streptococcus is a common bacteria causing tonsillitis. Other bacteria causing tonsillitis are:
1.Staphylococci
2.Pneumococci
3.Haemophilus Influenzae

What are the symptoms of Acute tonsillitis?
The most common symptoms of tonsillitis are:
1. Enlarged, red tonsils
2. Sore throat
3. Not able to swallow due to which drooling may occur
4. Fever
5. Ear pain
6. Abdominal pain in children
7. Headaches
8. General body aches 
9. Constipation

Diagnosis:
The doctor will do physical examination and look at your tonsils for signs of inflammation. A throat swab will be taken for culture. Growth of bacterial colony indicates bacterial tonsillitis. No growth will give a inference of viral disease.


Complications:
Complications will arise if the treatment is not provided or not adequate.
1.Collection of pus around tonsil (Peritonsillar abscess)
2. Infection may spread into surrounding tissues
3. Parapharyngeal abscess
4. Obstructive sleep apnea
5. Rheumatic fever if the causative agent is Group A beta-hemolytic streptococcus.
6. Glomerulonephritis


Treatment
1. Medical treatment
Antibiotics will be given if the culture shows growth of bacteria. Penicillin is the drug of choice. In patients with penicillin allergy, erythromycin can be given. If the cause is a virus then there is no role of antibiotics. With adequate bed rest and plenty of fluids body will recover on its own. Sometimes, your doctor may prescribe antibiotics in viral tonsillitis to prevent secondary bacterial infection. Paracetamol is given for fever and relief of pain. Prepare salt water solution at home and gargle the solution and spit it out.

2.Surgery
Removal of the tonsils (tonsillectomy) is required if there is recurrent tonsillitis. Recurrent tonsillitis is defined as;
- Seven or more episodes of tonsillitis in one year
- Five episodes per year for two consecutive year
- Three episodes per year for three consecutive year


A bony opening in the canine fossa is commonly used to:

 # A bony opening in the canine fossa is commonly used to:
A. Enter the maxillary sinus
B. Establish drainage of an alveolar abscess
C. Remove mandibular third molars
D. Uncover and marsupialize a cyst



The correct answer is A. Enter the maxillary sinus.

The wall of the sinus is very thin in this area. This area is used for following: (i) Diagnostic aspiration, and (ii) The site for Caldwell-Luc operation; that is, the antral exploration with or without an intraoral antrostomy.

Reference: Textbook of Oral and Maxillofacial Surgery, Third Edition, Neelima Anil Malik, Page no.  639


# Most frequent site for dry socket is:

 # Most frequent site for dry socket is:
A. Upper molar area
B. Upper incisor area
C. Lower molar area
D. Lower incisor area



The correct answer is C. Lower molar area.

'Dry socket' derives its name from the fact that after the clot is lost the socket has a dry appearance because of the exposed bone. This condition is more common in women and tobacco users, and is most frequently associated with difficult or traumatic extractions and thus most commonly follows removal of an impacted mandibular third molar. In a series of 138 ‘dry sockets’ among 6,403 teeth extracted in human patients, Krogh reported that 95% were in lower bicuspid and molar sockets, and this is confirmed by most other large series of cases.

Reference: Shafer’s Textbook of ORAL PATHOLOGY, 7th Edition, Page No:  601


Which one of the following is not a valid indication for apicoectomy?

 # Which one of the following is not a valid indication for apicoectomy?
A. Broken instrument in the apical third of the canal
B. Presence of a fistula
C. Perforation in apical third
D. Periapically involved teeth in patients with insufficient time for conventional endodontic treatment



The correct answer is D. Periapically involved teeth in patients with insufficient time for conventional endodontic treatment

Valid Indications for which apicoectomy can be considered are:
- Failure of nonsurgical endodontic treatment
- Failure of previous surgery
- Anatomical problems: non-negotiable or blocked canal, or severe root curvature
- Iatrogenic errors: ledging of canals, blockage from debris, separated instruments, overfilling of canals leading to foreign body reaction, and apical canal transportation
- Horizontal apical root fracture
- Exploratory surgery and biopsy: in teeth where a fracture is suspected or in teeth with vital pulp with a radicular radiolucency
- Periodontal considerations: Hemisection and radisection are planned in cases where the periodontal support of one of the roots goes beyond repair.

Reference: GROSSMAN’S ENDODONTIC PRACTICE 14TH EDITION, Page NO: 426

AIIMS November 2013 MDS Entrance exam MCQs


# Cavernous sinus thrombosis is due to infection of:
A. Pterygoid plexus
B. Submental space
C. Maxillary sinus
D. Submandibular space

# Tributaries of cavernous sinus include all except:
A. Superior petrosal sinus
B. Inferior petrosal sinus
C. Superior middle cerebral vein
D. Deep middle cerebral vein

AIIMS NOV 2012 MDS Past Entrance Exam MCQs - Dental MCQs


# Paralysis of cranial root of accessory nerve affects all except:
A. Cricopharyngeus
B. Salpingopharyngeus
C. Palatopharyngeus
D. Stylopharyngeus

# Direct and consensual light reflex is lost in which nerve palsy:
A. Trigeminal
B. Oculomotor
C. Optic
D. Trochlear

True regarding blood pressure is:

 # True regarding blood pressure is:
A. Diastolic BP is a more potent cardiovascular risk factor than is systolic BP until age 50
B. Systolic BP is a more potent cardiovascular risk factor   than is systolic BP until age 50
C.  Isolated Systolic hypertension most commonly is seen before age 50
D. Diastolic BP continues to rise throughout life



The correct answer is A. Diastolic BP is a more potent cardiovascular risk factor than is systolic BP until age 50.

The prevalence increases with aging, such that more than 65% of Americans aged 60 years and older have hypertension. If people live long enough, more than 90% will develop hypertension. Of note, systolic BP continues to rise throughout life, but diastolic BP rises until around age 50 years and then levels off or falls; as a result, after the age of 50, isolated systolic hypertension becomes the more prevalent pattern. In one study, isolated systolic hypertension was identified in 87% of inadequately controlled patients older than 60 years of age. Isolated diastolic hypertension most commonly is seen before age 50 years. Diastolic BP is a more potent cardiovascular risk factor than is systolic BP until age 50; thereafter, systolic BP is more important.

Reference: Little and Falace's Dental Management of the Medically Compromised Patient, 9th Edition, Page no. 39