19. Acute periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention. Flashcards
Periodontitis defintion
- Inflammatory process in periodontal space
- Affects alveolar bone, soft tissues and lymphatics
Two main parts of periodontium
- Periodontium periapicale(around root tip)
- Periodontium marginale(Around alveolar ridge)
Periodontitis can be classified according to:
- Aetiology
- Type of inflammation
- Location
- Clinical course
Periodontitis classifications according to aetiology
- Infectious
- Trauma
- Chronic
- Chemotaxic
- Allergic
Infectious organisms of Periodontitis
- Micro-organisms from infected root canals or periodontal pockets
- Aerobes
- Anaerobes
- Lactobacillus
- Fusobacterium
- Staphylococci
- Streptococci
- Actinomyces
- Clostridium
Causes of infectious periodontitis
- Untreated pulpitis
- Improper treatment
- Failure of root canal
- Gangrenous roots
- Periodontal defects
Types of trauma that cause periodontitis
- Acute
- Chronic
Acute trauma in periodontitis
- Fracture of crown->
- Disruption of vascular bundle
- Influx of MO=>
- Necrosis of pulp
Chronic trauma in periodontitis
- Poorly designed restorations overload periodontium
- Crowns
- Bridges
- Parafunction
Allergic causes of periodontitis
- Allergy to dental materials
- Hyperergic antigen antibody reactions
Chemotoxic causes of periodontitis
- Irritating toxic drugs
- Arsenic
- Phenolic derivatives
- Improper use of composite materials
Periodontitis classification according to location
- Periapical
- Total
Periodontitis classification according to type of inflammation
- Exudative
* Serous
* Purulent - Proliferative
* Granulomatous
Periodontitis classification according to Clinical course
- Sharp
- Chronic
- Excacerbated
Acute periodontitis classifications
- Periodontitis periapicalis acuta- serosa et purulenta
- Periodontitis marginalis acuta- Serosa et purulenta
- Periodontitis totalis acuta
The clinical course of periodontitis depends on:
- Aetiology
- Location and type of process
- Microbial contamination
- Virulence of microorganisms
- Local and general immune status
- Age
- Contomitant diseases
Important anamnestic data for diagnosis of periodontitis
- Presence of pain
- Socrates
- Site
- Onset
- Character
- Radiation
- Associated symtoms
- Time
- Exacerbating factors
- Severity
Important criteria assessed during periodontitis examination
- Adjacent teeth
- Mucous membranes
- Percussion of tooth-horiontal/vertical
- Pressure on tooth(V/H)
- Palpation(root tip/marginal gingiva)
Acute periapical periodontitis definition
Acute inflammation of periapical periodontium and adjacent bone
Acute serous periodontitis characteristics
Inflammation of pulp causing:
* Hyperemia, Edema
* Serous exudate->purulent
Acute serous periodontitis clinical presentation
- Pain similar to pulpitis
- Pain on percussion
- May or may not be able to localise
Treatment of Acute serous periodontitis
- Endodontic treatment
Phases of Acute Purulent periodontitis
- Periodontal
- Endosteal
- Subperiosteal
- Submucosal
Periodontal phase of Acute Purulent periodontitis characteristics
- Serous exudate-> Purulent
- Mixed virulent microflora, Complement activation
- Infiltration of neutrophils and macrophages
- Spreading bone resorption
- Strong constant pain intensifying on percussion
Periodontal phase of Acute Purulent periodontitis general symptoms
- Slightly enlarged and painful lymph nodes
- General malaise
Periodontal phase of Acute Purulent periodontitis paraclinical tests
- No radiological changes
- Tooth doesnt react to pulp testing
Differential diagnosis of Periodontal phase of Acute Purulent periodontitis
- Purulent pulpitis
- Pulp-periodontitis
- Localised ostemyelitis
Treatment of Periodontal phase of Acute Purulent periodontitis
- Endodontic treatment
- Extraction
- Antibiotics
Endosteal phase of Acute Purulent periodontitis characteristics
- Process continues expansion into bone
- Constant throbbing pain=>
- Unbearable on percussion
- Regional lymph nodes enlarged and painful
Endosteal phase of Acute Purulent periodontitis general condition
Flu like symptoms
Most are minor symtoms
Treatment of Endosteal phase of Acute Purulent periodontitis
- Endodontic treatment
- Extraction
- Medication
Medication: Anti-inflammatory, antibiotic(Clindamycin), analgesic, Antipyretic
Periosteal/subperiosteal phase of Acute Purulent periodontitis characteristics
- Increased invasion of bone and purulence
- Spontaneous very strong pain, mucosa hyperemic and edematous
- Mobility
MOST PAINFUL STAGE
Periosteal/subperiosteal phase of Acute Purulent periodontitis general condition
- Regional lymph nodes enlarged
Periosteal/subperiosteal phase of Acute Purulent periodontitis paraclinical tests
- X-ray same as endosteal phase
Periosteal/subperiosteal phase of Acute Purulent periodontitis treatment
- Draining of abcess
- Endo
- Medication- Analgin, Ibuprofen(400mg), Amoxicillin(1000mg x2), metranidazole
Periosteal/subperiosteal phase of Acute Purulent periodontitis differential diagnosis
- Different phases of periodontitis
- Osteomyelitis
- Exacerbated cysts
Submucosal abcess Acute Purulent periodontitis characteristics
- Purulent collection below periosteum forms abcess
- Decrease in pain
- Hyperemia and severe edema-spread
=> Abcesses and phlegmons
Edema spreads to: lips, cheeks, nasolabial folds, eyelids, sublingual, submental and submandibular space
Submucosal abcess Acute Purulent periodontitis general condition
Flu like symptoms
Submucosal abcess Acute Purulent periodontitis paraclinical studies
- Radiographic changes difficult to detect
- Leukocytosis
- Accelerated ESR
- C- reactive protein
