18. Acute Periodontal Lesions Flashcards
What are the characteristics of acute periodontal lesions?
- Sudden onset
- Associated with pain
- Short duration
- Rapid destruction of periodontal tissue
Traumatic lesions are a type of acute periodontal lesions. Describe 2 types of soft tissue clefts
- Stillman’s cleft: A mucogingival triangular shaped defect predominantly seen on the buccal surface of a root
- Flossing cleft: V-shaped or linear interdental marginal tissue deformities involving the CEJ that has minimal plaque deposits and inflammation. Chronic lesions
How do we manage soft tissue clefts?
It depends on their appearance.
If red cleft, the superficial layer is affected and the damage is reversible. Just stop flossing for 2 weeks and use chlorhexidine
If white cleft, the entire CT layer is involved so the damage is irreversible. Surgical intervention such as lateral position flaps have to be carried out
What are abscesses and how are they classified?
Abscesses are odontogenic infections that may be caused by pulp necrosis, periodontal infections, pericoronitis, trauma or surgery. They are classified according to the source of the infection:
- Periodontal abscess (includes gingival abscess)
- Periapical (dentoalveolar) abscess
- Pericoronal abscess (pericoronitis)
Note: Gingival abscess only affects the marginal and interdental gingiva while the periodontal abscess affects deeper periodontal structures like furcations and vertical osseous defects. Gingival abscesses present with PDs of 2-3mm while periodontal abscesses usually have 7mm or more
Periodontal abscesses are the 3rd most prevalent infection, consisting of 8-14% of dental emergencies in USA (#1 is dentoalveolar abscess, #2 is pericoronitis).
What determines the severity of a periodontal abscess
Bacterial load and virulence, and tissue resistance
What are the microbial changes that occur in a periodontal abscess?
- Gram negative > Gram positive
- Rods > Cocci
- Non-motile > Motile
- More strict anaerobes: 50-100% P.gingivalis
Note: Opportunistic bacteria such as Staphylococcus aureus can lead to superinfection
How do we treat a periodontal abscess?
To control the acute condition, we have the following options:
- Drain and debridement
- Periodontal flap surgery
- Tooth extraction
- Systemic or local antibiotics
Recall 24-48 hours after treatment to evaluate resolution of the abscess. Then schedule for follow-up therapy
What are some signs of necrotizing gingivitis?
- Necrosis and ulcers in the free gingiva
- Punched out appearance at interdental papilla
- Marginal erythema
- Most frequently found at lower anterior teeth
- Fever and discomfort, lymphadenopathy in severe cases
What are some signs of necrotizing periodontitis?
- Necrosis not only affects the gingiva but also the PDL and alveolar bone
- Clinical attachment loss
- Interdental papilla separates into buccal and lingual portions with a necrotic center
- Bony sequestrum may occur
What are contact allergies and what are their signs and symptoms?
A contact allergy is an ill-defined entity aka lichenoid reaction. It is not clinically distinguishable from a tooth-related irritation or trauma and it is normally associated with drugs (Eg. NSAIDs), metals (Eg. nickel, amalgam) and other dental materials (Eg. Acrylic resin, dental composites)
Signs and symptoms include:
• Burning
• Itching
• Stinging
• Erythematous and edematous gingival tissues with occasional ulcers and whitish areas
• Can be on lips, buccal or lingual mucosa
What are the main takeaways for acute periodontal lesions?
- Acute lesions are painful and occur suddenly in a short period of time. They are namely traumatic lesions, abscesses, viral infections and allergic reactions
- Traumatic lesions and allergic reactions: Remove causative agent
- Perio abscess: Drain, ScRP, review, treat underlying periodontitis
- Pericoronitis: Drain, ScRP, remove operculum or impacted tooth
- Usually self-limiting, use acyclovir for relief of symptoms
