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Oral surgery > 19. Acute periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention. > Flashcards

19. Acute periodontitis. Etiology, classification, clinical features, diagnosis, differential diagnosis and surgical treatment. Complications and prevention. Flashcards

1
Q

Periodontitis defintion

A
  • Inflammatory process in periodontal space
  • Affects alveolar bone, soft tissues and lymphatics
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2
Q

Two main parts of periodontium

A
  • Periodontium periapicale(around root tip)
  • Periodontium marginale(Around alveolar ridge)
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3
Q

Periodontitis can be classified according to:

A
  • Aetiology
  • Type of inflammation
  • Location
  • Clinical course
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4
Q

Periodontitis classifications according to aetiology

A
  • Infectious
  • Trauma
  • Chronic
  • Chemotaxic
  • Allergic
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5
Q

Infectious organisms of Periodontitis

A
  • Micro-organisms from infected root canals or periodontal pockets
  • Aerobes
  • Anaerobes
  • Lactobacillus
  • Fusobacterium
  • Staphylococci
  • Streptococci
  • Actinomyces
  • Clostridium
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6
Q

Causes of infectious periodontitis

A
  • Untreated pulpitis
  • Improper treatment
  • Failure of root canal
  • Gangrenous roots
  • Periodontal defects
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7
Q

Types of trauma that cause periodontitis

A
  • Acute
  • Chronic
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8
Q

Acute trauma in periodontitis

A
  • Fracture of crown->
  • Disruption of vascular bundle
  • Influx of MO=>
  • Necrosis of pulp
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9
Q

Chronic trauma in periodontitis

A
  • Poorly designed restorations overload periodontium
  • Crowns
  • Bridges
  • Parafunction
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10
Q

Allergic causes of periodontitis

A
  • Allergy to dental materials
  • Hyperergic antigen antibody reactions
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11
Q

Chemotoxic causes of periodontitis

A
  • Irritating toxic drugs
  • Arsenic
  • Phenolic derivatives
  • Improper use of composite materials
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12
Q

Periodontitis classification according to location

A
  • Periapical
  • Total
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13
Q

Periodontitis classification according to type of inflammation

A
  1. Exudative
    * Serous
    * Purulent
  2. Proliferative
    * Granulomatous
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14
Q

Periodontitis classification according to Clinical course

A
  • Sharp
  • Chronic
  • Excacerbated
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15
Q

Acute periodontitis classifications

A
  • Periodontitis periapicalis acuta- serosa et purulenta
  • Periodontitis marginalis acuta- Serosa et purulenta
  • Periodontitis totalis acuta
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16
Q

The clinical course of periodontitis depends on:

A
  • Aetiology
  • Location and type of process
  • Microbial contamination
  • Virulence of microorganisms
  • Local and general immune status
  • Age
  • Contomitant diseases
17
Q

Important anamnestic data for diagnosis of periodontitis

A
  • Presence of pain
  • Socrates
  • Site
  • Onset
  • Character
  • Radiation
  • Associated symtoms
  • Time
  • Exacerbating factors
  • Severity
18
Q

Important criteria assessed during periodontitis examination

A
  • Adjacent teeth
  • Mucous membranes
  • Percussion of tooth-horiontal/vertical
  • Pressure on tooth(V/H)
  • Palpation(root tip/marginal gingiva)
19
Q

Acute periapical periodontitis definition

A

Acute inflammation of periapical periodontium and adjacent bone

20
Q

Acute serous periodontitis characteristics

A

Inflammation of pulp causing:
* Hyperemia, Edema
* Serous exudate->purulent

21
Q

Acute serous periodontitis clinical presentation

A
  • Pain similar to pulpitis
  • Pain on percussion
  • May or may not be able to localise
22
Q

Treatment of Acute serous periodontitis

A
  • Endodontic treatment
23
Q

Phases of Acute Purulent periodontitis

A
  • Periodontal
  • Endosteal
  • Subperiosteal
  • Submucosal
24
Q

Periodontal phase of Acute Purulent periodontitis characteristics

A
  • Serous exudate-> Purulent
  • Mixed virulent microflora, Complement activation
  • Infiltration of neutrophils and macrophages
  • Spreading bone resorption
  • Strong constant pain intensifying on percussion
25
Q

Periodontal phase of Acute Purulent periodontitis general symptoms

A
  • Slightly enlarged and painful lymph nodes
  • General malaise
26
Q

Periodontal phase of Acute Purulent periodontitis paraclinical tests

A
  • No radiological changes
  • Tooth doesnt react to pulp testing
27
Q

Differential diagnosis of Periodontal phase of Acute Purulent periodontitis

A
  • Purulent pulpitis
  • Pulp-periodontitis
  • Localised ostemyelitis
28
Q

Treatment of Periodontal phase of Acute Purulent periodontitis

A
  • Endodontic treatment
  • Extraction
  • Antibiotics
29
Q

Endosteal phase of Acute Purulent periodontitis characteristics

A
  • Process continues expansion into bone
  • Constant throbbing pain=>
  • Unbearable on percussion
  • Regional lymph nodes enlarged and painful
30
Q

Endosteal phase of Acute Purulent periodontitis general condition

A

Flu like symptoms

Most are minor symtoms

31
Q

Treatment of Endosteal phase of Acute Purulent periodontitis

A
  • Endodontic treatment
  • Extraction
  • Medication

Medication: Anti-inflammatory, antibiotic(Clindamycin), analgesic, Antipyretic

32
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis characteristics

A
  • Increased invasion of bone and purulence
  • Spontaneous very strong pain, mucosa hyperemic and edematous
  • Mobility

MOST PAINFUL STAGE

33
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis general condition

A
  • Regional lymph nodes enlarged
34
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis paraclinical tests

A
  • X-ray same as endosteal phase
35
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis treatment

A
  • Draining of abcess
  • Endo
  • Medication- Analgin, Ibuprofen(400mg), Amoxicillin(1000mg x2), metranidazole
36
Q

Periosteal/subperiosteal phase of Acute Purulent periodontitis differential diagnosis

A
  • Different phases of periodontitis
  • Osteomyelitis
  • Exacerbated cysts
37
Q

Submucosal abcess Acute Purulent periodontitis characteristics

A
  • 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

38
Q

Submucosal abcess Acute Purulent periodontitis general condition

A

Flu like symptoms

39
Q

Submucosal abcess Acute Purulent periodontitis paraclinical studies

A
  • Radiographic changes difficult to detect
  • Leukocytosis
  • Accelerated ESR
  • C- reactive protein

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