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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
Treatment of NUG
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,
26
What is herpetic gingivostomatitis Where is Herpes 1/2 seen How contacted How kids present
HSV-1 Above waist HSV-2 Below Waist Transmitted through contact, usually in children, 10-14 days incubation. Fever and lymphadenopathy.
27
Where is HSV latent
Latent in the trigeminal ganglion
28
What is Herpes Zoster
Reactivation of varicella, confined to 1 dermatome, very painful can cause post herpetic neuralgia
29
What is pericorinitis
Inflammation of gingival tissue around the crown. Frequently inflammed operculum Sometimes extracting the opposing tooth can help
30
What are the signs and symptoms of pericorinitis
Painful, foul taste, soreness, radiating pain, fever | Malaise, limited opening
31
How do you manage pericorinitis
irrigate with warm water, AB if systemic signs and symptoms
32
What is Aphtous Stomatitis
Recurrent mouth ulcers. Usually start in childhood and as part of their natural history usually resolve with age.
33
How are Aphtous ulcers classified
Minor, Major and herpetiform
34
Discuss minor Aphtous ulcers
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
Treatment of Minor Aphtous ulcers
Topical steroids
36
Discuss Major Aphtous ulcers
Larger than minor, take longer to heal. Approx 10% of cases Heal 6/52 Steroid as intralesional injection
37
Discuss herpetiform ulcers
10% of cases, similar in presentation to minor 2 mm in size 10-100 lesions that coalesce pain
38
What systemic conditions in herpetiform ulcers
Crohns, Bechets and blood dyscrasia
39
Discuss the diagnosis of perio- endo conditions
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
Clinical Tests in perio endo lesions
Percuss Palpate, cold, electric, heat, test cavity
41
Discuss inflamm root resorption
Avulsion, injury to PDL and pulp necrosis, must treat dentine when bone grafting, muss assess pulp status before perio
42
Discuss lateral canals - frequency in furcation and where mostly found
28% in furcation | Mostly in last 3 mm of root apex
43
Discuss the effects of perio dx on pulp
increase collagen in pulp with restorations causing coag necrosis
44
Whats the microbiology of pulpal disease
Gram + strep, Gram - bacteroides, Fusobacterium, Spirochetes
45
Discuss Primary endo lesions
``` Necrotic pulp and possibly a sinus tract negative vitality test trace sinus trt with RCT Excellent prognosis ```
46
Discuss primary endo / Secondary perio lesions
``` 1 endo with sinus colonized by plaque and calculus Negative Vitality test Probe sinus and feel calculus Endo first then perio Excellent prognosis ```
47
Discuss Primary Perio Lesions
``` 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
Discuss primary perio and secondary endo
Retroinfection of pulp Generalized periodontal disease Endo and perio Perio status determines prognosis
49
Differential diagnosis of combined lesions
Vertical root fracture | Perforation
50
Discuss Combined perio endo lesions
Do Endo and perio treatment Can be assoc with internal root resorption must close root perforations asap prognosis depend on perio treatment
51
What is the success of endo
96% if no PARL 83% if PARL quality of coronal seal key.
52
When would you consider systemic disease in perio abscess patients
Multiple or repeated abscesses
53
When do you do open or closed debridement of abscesses
Only do open if you cannot access with closed
54
What is the necrotising Triad of NUG
Pain, bleeding or interproximal necrosis
55
where is herpetic gingivo stomatitis seen
Attached mucosa
56
What is the difference between minor and major apthous ulceration
size, minor below 1 cm and major above 1 cm.
57
What is the difference between periodontal and gingival abscess
Perio - deep pocket | Gingival - marginal gingiva only
58
World Workshop classified Endo-Perio lesions how
With or without root damage
59
How is Endo- perio with root damage subclassified
Root fracture or cracking Iatrogenic perforation External Root resorption Associated with pain
60
How is Endo- perio without root damage subclassified
Endo perio lesion in perio pt | Endo perio lesion in non perio pt
61
What are acute periodontal conditions
Rapid onset clinical conditions that involves periodontium or associated structures. Pain or discomfort, tissue destruction and infection
62
Perio abscess in non perio patient causes
Impaction of foreign body Harmful habits Alterations in root surface - external root resorption
63
perio abscess in a perio pt causes
Exacerbation - untrt perio dx, non responsive site After Tx - Post surgery, scaling or medication
64
What is an endo perio lesion
Pathologic communication between pulp and periodontal tissue Can be acute or chronic

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