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
Gingival recession
You will likely encounter the various types of gingival recession.
In healthy gingiva the gingival margin is ____m coronal to the cej. If at the ____ or below we now have gingival recession.
Not all gingival recession has been created equal. Some people people are ____ more prone, orthodontic tooth movement, excessive toothbrushing, poor hygiene.
In response to irritation thick tissue is more likely to result in ____ and thin tissue is more likely to end up with gingival ____.
1 to 2 CEJ genetically swelling gingival recession
Gingival recession- associated with Occlusal Trauma
One of the most important thing you have to look at is how far the gingival margin is from the mucogingival junction. Why is it important?
You need the ____ tissue, a tight gingiva. Why do you want to have a tight gingiva?
You examine the patient and see something like this, recession, the patient is not sensitive.
It is rare that someone has exposed bone during recession because as gum recedes ____ recedes
If I have a long sleeved shirt and I unbutton, my sleeve will move up and down as I move my arm. The point of a zone or keratinized attached gingiva is to ____ the muscles pull so every time you eat, speak, move your lip the gum doesn’t just ride up and down apical coronal pull
We believe that at least ____mm of keratinized attached gingival to dissipate muscle pull. When you eat when you bite there is tremendous apical pull on the gingiva and unless you have this sleeve or keratinized tissue the muscle pull will not be dissipated.
keratinized
bone
dissipated
1
Gingival Recession-self inflicted (biting ____)
Gingival Recession due to ____ abrasion
Gingival recession due to ____ surgery
nails
toothbrush
periodontal
Gingival Recession-____
When you have something like this, an inadequate zone of keratinized gingiva, this is a ____ problem. The gingiva will continue to recede. This doesn’t mean you always have to do gingival graft but you at least need to note it in your chart.
When you do complete Perio charting you have to worry about the zone of keratinized attached gingiva because when the gingival margin meets the mucogingival junction means there is zero keratinized gingiva and nothing to ____ muscle pull.
In which area of the mouth you don’t have to worry about it? The ____. It is all ____. We use the ____ to harvest tissue to reinsert it and increase the zone of keratinized tissue.
frenum pull mucogingival dissipate palate keratinized palate
____ to correct recession
free gingival graft
Altered Passive Eruption
Something you will definitely be seeing. Not every recession is to be treated but you need to note it in your chart and make sure it has follow up.
The opposite of recession is altered ____. In recession you have a dentogingival unit that is apical to the cej. In altered passive eruption you have the same healthy unit but it is ____ to where it should be. The clinical picture is most of the crown is covered by ____. Patients think they have ____ teeth but they have altered passive eruption.
passive eruption
coronal
tissue
small
Altered passive eruption
What is the etiology. Teeth erupt in two stages.
First when tooth bursts through the mucosa it carries the mucosa with it almost like putting hand under sheet in a bed and finally the sheet bursts and there is a hole and it starts receding. In altered passive eruption there is a failure for the gingival margin to ____ back to its normal level. This is the ____ stage of eruption which is not functioning well.
Besides being an aesthetic issue, it is not really a ____ issue but it is a problem when a patient needs a crown. Some dentists make a tiny crown that keeps falling off several times.
So either aesthetic treatment that needs to be addressed or considerations for retention for complete restorations like crowns or bridges. Some of the ____ needs to be taken away so good retention can be obtained.
recede
second
pathologic
gingiva
Fibromatosis - Cyclosporin Hyperplasia
Increased amount of ____ overgrowth. There are several different reasons for overgrowth. The most common was ____ hyperplasia that was from a drug used to treat epileptic seizures. The second reason that is more recent is from ____ a drug used to prevent rejection in organ transplant patients.
What type of drugs that cause excessive gingival swelling? ____ blockers for hypertension cause enlargement although that enlargement is a little different form cyclosporin and dilantin. Cyclosporin and dilantin create a ____ tissue and if patient stops taking the medication this would not ____.
If a patient taking calcium channel blockers and changes medication there is more spontaneous ____. The enlargement from calcium channel blockers the tissues are more ____ rather than hypertrophyed meaning there is more ____ there they are more likely to bleed. It is amazing that many cardiologists do not advise this side effect.
gingival overgrowth
dilantin
cyclosporine
calcium channel
fibrous
recede
healing
hyperplastic
fluid
Fibromatosis - Cyclosporine Hyperplasia
The treatment for dilantin and cyclosporin hyperplasia is ____. There is also idiopathic fibrzomatosis where patients through some ____ mutation they inherited they develop this for no reason. Sometimes ____ gingivectomies are necessary.
gingivectomy
genetic
repeated
Lichen planus
It is a mysterious condition that doesn’t usually cause discomfort unless it becomes ____. It has a ____ like spider web appearance.
Sometimes it appears somewhere else on the body and on the cheeks. Some controversy whether it is a precancerous lesion and you really have to pay attention because people mistake ____ cancer for lichen planus and it can be dangerous. The only way to make sure is to take a ____ and send it for analysis to make sure there is no malignant features.
erosive
lace
oral
biopsy