10. Acute and Chronic Periodontal Conditions Flashcards
Etiology of periodontal abscess • Failure of \_\_\_\_ to drain • Changes in \_\_\_\_ environment • Introduction of \_\_\_\_ • Furcations • Poorly controlled \_\_\_\_
pocket
local
foreign body
diabetics
The periodontal abscess
• Gingival abscess-confined to the ____
We have a gingival or periodontal abscess. The differences is gingival abscess is ____ to the pdl and alveolar crest, and periodontal abscess is within.
gingiva
coronal
The periodontal abscess
• Periodontal abscess-an acute exacerbation of ____ process
inflammatory
Clinical features of an abscess • \_\_\_\_ pain • \_\_\_\_ soft tissue swelling • The tooth feels ”\_\_\_\_” • Possible \_\_\_\_ glands,facial swelling • Possible \_\_\_\_
throbbing localized elevated swollen fever
Treatment of periodontal abscess
- FIRST PHASE
- ____
- Occlusal adjustment
- ____ if necessary
- SECOND PHASE
- ____ planing
- ____ elimination
incision and drainage
antibiotics
scaling and root
pocket
Necrotizing ulcerative gingivitis CLINICAL FEATURES • Ulcerations of \_\_\_\_ • Pain and bleeding • Foul odor
It causes ulceration of ____. They are normally triangular and fill inter proximal space but a patient with this condition the papillae are cratered. The reason this disease is interesting is because invasion of spirochetes into tissue and it is closely correlated with ____. People with this condition are tense, it is prevalent among ____. It is usually the first oral sign of ____
papillae interdental papillae emotional stress smokers HIV
General description (NUG) • The disease is mostly seen in \_\_\_\_- income countries in the context of severe debilitation and malnutrition. In addition, poor oral hygiene, \_\_\_\_ infection, measles, local irritation from food impaction and \_\_\_\_ are associated factors.
low- and middle
HIV
smoking
Bacteria in ANUG
There is a frank invasion of ____ in the tissue
spirochetes
ANUG- ____ of the gingiva
You can see the scarring of the gingiva, there is ____ architecture of the gingiva which means there is a crater in the interdental papilla, it hurts
scarring
reverse
ANUG –Scarring of the Gingiva
Repeated episodes of ANUG causes ____ scarring of gingiva so you have this type of architecture. If a pt presents like this why is it not conducive to maintaining good oral health? This is called ____ tissue architecture, in normal architecture the interdental papilla should be coronal to the facial lingual margins, but here it is reverse so every time they eat there is a force of ____ impaction that accumulates and its difficult to keep the mouth clean
permanent
reverse
food
ANUG-ulceration
This is a micrograph schematic diagram of tissue so you have this epithelium with rete pegs and you have blood vessels and bacteria. The outer layer of the epithelium becomes ____ and the blood vessels are at the ____ and it bleeds easily, is very painful
ulcerated
surface
ANUG-etiology • Bacterial changes (invasion of \_\_\_\_) • Excessive \_\_\_\_ • Debilitating \_\_\_\_ • Emotional \_\_\_\_
spirochetes
smoking
diseases
stress
ANUG-TREATMENT
- INITIAL VISIT
- Gentle ____
- Oral ____ instructions
- Subsequent visits
- ____
- Continue OHI
- Possible surgical appointment to correct surgical deformities
Unlike an abscess, generally speaking ____ therapy is usually unnecessary. You do a gentle debridement or else there will be a lot of pain. If the tissue heals you will be able to clean more thoroughly so there can be several visits. Usually these patients are ____. Consult with smoking cessation.
Repeated episodes of NUG can cause NUG/periodontis so it can affect the ____ now. You will have to have surgery that involves bone manipulation.
debridement
hygiene
scaling
antibiotic
non-compliant
bone
Acute herpetic gingivostomatitis • \_\_\_\_ picture • Diffuse erythema and vesicular eruptions • \_\_\_\_ • Pain • Possible \_\_\_\_
This can mimic ANUG, as the term implies this is caused by ____ virus. Primarily in children but it can affect adults going through emotional stress
Unlike ANUG and abscess, you actually have a ____ and its exquisitely painful. Some patients are in such pain that they cannot eat and need ____ fluid. The way you recognize this disease is ____ eruptions that can be on the palate, on the lips
clinical
fever
dehydration
herpes
fever
IV
vesicular
AHGS-diffuse redness
You could see, you have to think herpetic gingivostomatitis. Do you remember the difference between diffuse and localized inflammation. The typical periodontal inflammation if it is caused by bacteria, the inflammation is confined to ____ nd interdental papilla.
But more systemic factors, the inflammation is diffuse so it extends apical to the ____. You can see the inflammation extends to the entire area.
AHGS-Ulceration of the ____
gingival margin
mucogingival junction
lip
AHGS-TREATMENT
• ____
• Supportive fluids
• ____ ointment
The treatment is mostly palliative unless now there is ____ and other antiviral medications if necessary. You have to make sure the patient gets supportive fluid and rest.
The acute phase lasts a ____ and another week for treatment. Surprisingly, sometimes you have to treat with ____, of course they are ineffective against viruses but the multiple ulcerations can cause secondary infection by bacteria.
palliative
orabase
acyclovir
week
antibiotics
PERICORONITIS
• ____ PICTURE
• Acute
• Chronic
The last acute condition that I want to discuss that you are likely to see is pericoronitis. Inflammation around the ____.
This happens where there is excessive ____ surrounding the tooth and that excessive tissue that partially covers the crown can trap food and bacteria which are not cleanable and it becomes highly inflamed.
It happens not infrequently around the ____ because they are the last to erupt. There is nothing inherently different about third molars, it means there is not enough room in the oral cavity to erupt so over the years of our development we used to have a much longer face but over the years they have decreased anteriorly posteriorly but we have the same number of teeth. So the third molars are often ____ erupted. In some people who have had their third molar removed and now they are getting pericoronitis around their second molar because their mouth is small
clinical crown tissue third molars partially
Pericoronitis
Once again, the disease is caused by ____ in origin but flares up in acute stress.
bacteria
Periocoronitis
Clinical features:
- the partially erupted or impacted ____ is the most common site of periocoronitis
- the space between the ____ of the tooth & overlying ____ is an ideal area for the accumulation of food debris & bacterial growth
mandibular third molar
crown
gingival flap
Pericoronitis-etiology
• Infection due to retention of ____ and stagnation of food debris
• Trauma from the ____ tooth
How do you treat the acute phase. You may have to use ____. Sometimes we give patient a syringe with ____ to rinse and relieve the pain. Then you have to make a decision how to handle it permanently.
You can do a small ____ and restore the area to good health but sometimes the only way to permanently solve the area is to extract the tooth especially if it is misplaced and there is not enough room to erupt.
bacteria opposing antibiotics chlorohexidine gingivectomy
Pericoronitis-treatment • \_\_\_\_ • Drainage • \_\_\_\_-if necessary • Extract the tooth or remove the flap of tissue
cleanse
antibiotics
Chronic conditions affecting the ginigiva
• ____ lesions
• Gingival ____
• Gingival enlargements(____)
desquamative
recession
fibromatoses
Desquamative lesions
These lesions cause ____ of the epithelium and diffuse inflammation. There are a zillion of desquamative lesions but one of the underlying conditions is especially women during ____ or post menopause. There is a thinning of epithelium and sloughs off easily.
Pemphigus and Pemphigoid like lesions there is a fluid accumulation between connective tissue and epithelium that bursts and causes inflammation. They all result in diffuse ____.
Board question. A diffuse inflammation is not a classic manifestation of gingivitis, you have to look at underlying systemic causes. Diffuse means inflammation that extends apical to the ____. As you can see the gingiva is thin, lack of keratin and areas of bleeding
thinning
menopause
inflammation
APJ
Desquamative Gingivitis
Diffuse inflammation, this is definitely not the time to give them good ____ instruction because it would do very little to address it.
The treatment is to treat the underlying ____, work in conjunction with their physician.
Someone post menopause may need ____ replacement therapy. An allergic reaction needs a medical history, change in toothpaste, diet, acidic foods, do they have an acidic reflux.
These can all cause a thinning of gingiva. Do they have any other lesions anywhere int he body. ____, pemphigoid like disease, lichen planus, these are all conditions that have manifestations so work with the internist and ____.
There are local ____ to put in mouth rinses like prednisone that can alleviate the symptoms.
oral hygiene cause hormone pemphigus dermatologist steroids
