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Keeling Spring Textbook > 4. Endo - Perio Lesions > Flashcards

4. Endo - Perio Lesions Flashcards

1
Q

What are the signs and symptoms of acute periodontal conditions

A

Rapid onset and pain

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2
Q

What are the causes of acute periodontal conditions

A
  1. Abscess
  2. NUG
  3. NUP
  4. Pericorinitis
  5. Herpetic Gingivostomatitis
  6. Desquamative Ginigivits
  7. Apthous Stomatitis
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3
Q

Discuss gingival abscess

A
  1. Previously disease free site
  2. Confined to the marginal gingiva
  3. Localized painful and rapidly expanding
  4. Foreign Body
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4
Q

Periodontal Abscess

A

An acute destructive process, bacterial infection in pre existing pocket ( deeper and narrower increase risk), gram negative, anaerobic.
Attached gingiva

3rd most common cause of emergency dental visit

Pocket Present
Vital Pulp
Dull Pain
Lateral Radiolucency

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5
Q

What are the symptoms of a periodontal abscess

There are 8

A
  1. Pain
  2. Percussion
  3. Colour Change
  4. Mobility
  5. Extrusion
  6. Purulence
  7. Sinus Tract
  8. Fever
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6
Q

Periapical Abscess - Discuss

A 
Symptoms similar to perio abscess.
No Vitality
Deep Caries
Pain on palpation at root apex
Pain: Sharp, intermittent, severe
Swelling mucobuccal fold
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7
Q

Acute Pulpitis signs and symptoms

A

Diffuse and severe pain

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8
Q

Incomplete tooth fracture signs and symptoms

A

Pain on biting, reducing occlusion reduces pain, deep narrow pocket

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9
Q

Peri Corinitis

A

Build up exudate within flap. Tissue red and swollen

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10
Q

What is a periodontal cyst

A

Well defined radiolucency on lateral surface of root

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11
Q

Discuss osteomylitis

A 
Serious infection in bone
Rapid Onset
Pain on symptoms at start
Rapid and diffuse bone destruction
Radiographically: Loss of lamina dura, indistinct trabeculae
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12
Q

Issues with using systemic A/B

A

May cause super infection with opportunistic pathogens

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13
Q

What are the treatment goals in acute periodontal conditions

A

Reduce pain and resolve infection

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14
Q

What must you assess in acute periodontal conditions

A

Pulp vitality
Radiolucent lesions
percuss
Palpate

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15
Q

What is the repair potential for acute conditions

A

Good potential for repair, influenced by location and shape of the osseous defect. Best to treat during the acute phase

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16
Q

Describe the closed approach for acute perio conditions

A

Open pocket with sharp curette, root plane to remove plaque and calculus.
Irrigate with 0.1% povidone iodine and 3% H2O2
AB if pt systemically unwell

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17
Q

Describe the open flap approach for acute perio conditions

A

Maximize repair potential, treat the abscess in acute phase.

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18
Q

What AB to prescribe in acute conditions

A

Ideally based on pus sample

Pen V 500mg QDS for 7 Days

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19
Q

What are the post op follow up in acute conditions

A

RV in 1-2/7; and full perio exam in 2/52

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20
Q

What are the necrotising conditions

A

NUG/ NUP
Cancrum Oris
NOMA

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21
Q

Discuss NUG

A 
Inflamm dx that ulcerate and causes necrosis
Affects papillae and gingival margins
Sore
Bad smell
Bleeding and ulcerated papillae
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22
Q

What are the zones of infection in NUG

A
  1. Bacterial Zone.
  2. Neutrophil Zone.
  3. Necrosis Zone.
  4. Spirochete Zone.

Bad Ninjas Negotiate Secretively

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23
Q

Causes of NUG

A

Poor OH, Gingivitis, Stress, Smoking and reduced host resistance

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24
Q

“Average” NUG pt

A

20 year old student, 0.01% of population.

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25
Q

Treatment of NUG

A

Debride and scale, goal is to remove micro organisms, 3 hourly H2O2 rinse, nutrition and fluid. F/U in 1-2/7. Soft tissue craters that occur after healing may need surgery,

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26
Q

What is herpetic gingivostomatitis

Where is Herpes 1/2 seen

How contacted

How kids present

A

HSV-1 Above waist
HSV-2 Below Waist

Transmitted through contact, usually in children, 10-14 days incubation. Fever and lymphadenopathy.

27
Q

Where is HSV latent

A

Latent in the trigeminal ganglion

28
Q

What is Herpes Zoster

A

Reactivation of varicella, confined to 1 dermatome, very painful can cause post herpetic neuralgia

29
Q

What is pericorinitis

A

Inflammation of gingival tissue around the crown.
Frequently inflammed operculum
Sometimes extracting the opposing tooth can help

30
Q

What are the signs and symptoms of pericorinitis

A

Painful, foul taste, soreness, radiating pain, fever

Malaise, limited opening

31
Q

How do you manage pericorinitis

A

irrigate with warm water, AB if systemic signs and symptoms

32
Q

What is Aphtous Stomatitis

A

Recurrent mouth ulcers. Usually start in childhood and as part of their natural history usually resolve with age.

33
Q

How are Aphtous ulcers classified

A

Minor, Major and herpetiform

34
Q

Discuss minor Aphtous ulcers

A

Non keratinized mucosa, red halo, less than 1 cm in diameter.
1-5 lesions and last 10 tp 14 days
Aetilogy local trauma and stress

35
Q

Treatment of Minor Aphtous ulcers

A

Topical steroids

36
Q

Discuss Major Aphtous ulcers

A

Larger than minor, take longer to heal.
Approx 10% of cases
Heal 6/52
Steroid as intralesional injection

37
Q

Discuss herpetiform ulcers

A

10% of cases, similar in presentation to minor
2 mm in size
10-100 lesions that coalesce
pain

38
Q

What systemic conditions in herpetiform ulcers

A

Crohns, Bechets and blood dyscrasia

39
Q

Discuss the diagnosis of perio- endo conditions

A

Pain - Endo is acute and severe, Perio chronic and ild
Swelling- dependent on muscle attachments
Probing
Test Vitality
Trace Sinus
Mobility - isolated with endo, generalized with perio

40
Q

Clinical Tests in perio endo lesions

A

Percuss Palpate, cold, electric, heat, test cavity

41
Q

Discuss inflamm root resorption

A

Avulsion, injury to PDL and pulp necrosis, must treat dentine when bone grafting, muss assess pulp status before perio

42
Q

Discuss lateral canals - frequency in furcation and where mostly found

A

28% in furcation

Mostly in last 3 mm of root apex

43
Q

Discuss the effects of perio dx on pulp

A

increase collagen in pulp with restorations causing coag necrosis

44
Q

Whats the microbiology of pulpal disease

A

Gram + strep, Gram - bacteroides, Fusobacterium, Spirochetes

45
Q

Discuss Primary endo lesions

A 
Necrotic pulp and possibly a sinus tract
negative vitality test
trace sinus
trt with RCT
Excellent prognosis
46
Q

Discuss primary endo / Secondary perio lesions

A 
1 endo with sinus colonized by plaque and calculus
Negative Vitality test
Probe sinus and feel calculus
Endo first then perio
Excellent prognosis
47
Q

Discuss Primary Perio Lesions

A 
Longer period of time
Multiple teeth involved
Pocket wider at the margin
No pain
Probe to apex
Tooth vital
Prognosis depends on perio status
48
Q

Discuss primary perio and secondary endo

A

Retroinfection of pulp
Generalized periodontal disease
Endo and perio
Perio status determines prognosis

49
Q

Differential diagnosis of combined lesions

A

Vertical root fracture

Perforation

50
Q

Discuss Combined perio endo lesions

A

Do Endo and perio treatment
Can be assoc with internal root resorption
must close root perforations asap
prognosis depend on perio treatment

51
Q

What is the success of endo

A

96% if no PARL
83% if PARL
quality of coronal seal key.

52
Q

When would you consider systemic disease in perio abscess patients

A

Multiple or repeated abscesses

53
Q

When do you do open or closed debridement of abscesses

A

Only do open if you cannot access with closed

54
Q

What is the necrotising Triad of NUG

A

Pain, bleeding or interproximal necrosis

55
Q

where is herpetic gingivo stomatitis seen

A

Attached mucosa

56
Q

What is the difference between minor and major apthous ulceration

A

size, minor below 1 cm and major above 1 cm.

57
Q

What is the difference between periodontal and gingival abscess

A

Perio - deep pocket

Gingival - marginal gingiva only

58
Q

World Workshop classified Endo-Perio lesions how

A

With or without root damage

59
Q

How is Endo- perio with root damage subclassified

A

Root fracture or cracking
Iatrogenic perforation
External Root resorption

Associated with pain

60
Q

How is Endo- perio without root damage subclassified

A

Endo perio lesion in perio pt

Endo perio lesion in non perio pt

61
Q

What are acute periodontal conditions

A

Rapid onset clinical conditions that involves periodontium or associated structures.
Pain or discomfort, tissue destruction and infection

62
Q

Perio abscess in non perio patient causes

A

Impaction of foreign body
Harmful habits
Alterations in root surface - external root resorption

63
Q

perio abscess in a perio pt causes

A

Exacerbation - untrt perio dx, non responsive site

After Tx - Post surgery, scaling or medication

64
Q

What is an endo perio lesion

A

Pathologic communication between pulp and periodontal tissue

Can be acute or chronic

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