Acute and chronic perio abscesses Flashcards
what is a periodontal abscess?
a localised purulent infection (accumulation of pus) within the tissues adjacent to the periodontal pocket.
May cause rapid damage to the periodontal ligament and alveolar bone
what is pus?
thick yellow fluid with a mix of white blood cells, necrotic tissue, bacteria, cell debris and any foreign substances
Multiple and recurrent periodontal abscesses may indicate what?
an underlying systemic disease such as if the patient is immunocompromised (body immune system is weak and struggles to fight of any disease) eg diabetes
what is the bacteria found in an acute or chronic perio abscess ?
gram -ive
AA - Aggregatibacter Actinonycetemcomitans
Porphryomonas Gingivalis
Prevotella Intermedia
Tannorella Forsythia
Fusobacterium Nucleatum
what are possible cardinal signs you would have/ experience with a perio abcess?
pain
Due to pressure within the tissues which can be acute or chronic
heat
redness
swelling
The temperature of the area increases due to the increased blood supply, causing erythema and swelling due to fluid and cellular exudate
loss of function
tender
increased mobility
unpleasant taste in mouth
what is an acute perio lesion?
an acute suppurating inflammatory lesion
what is the aetiology (cause) of acute perio lesion?
often arise in a pre existing pocket
Inadequate scaling / root planning
Pushing calculus fragments into tissues during scaling/leaving calculus at pocket base
foreign material – toothbrush bristle, tomato pip, fish bone
what is the clinical picture of an acute perio lesion?
Swelling and tenderness of gingiva
Periodontal pocket
Drainage of pus via pocket or sinus
Extra-oral swelling – uncommon
how would you diagnose an acute perio abscess from what symptoms and signs?
Sudden onset
Pain on biting
May be continuous pain
No special radiographic features, however, horizontal or vertical bone loss may be apparent at mesial / distal sites & furcation bone loss
what would you do on the 1st visit of an acute perio abcess how would you manage it?
encourage drainage from pocket
gentle subgingival scale to remove irritant
irrigate the pocket with chlolorhexidine mouthwash
pain relief such as paracetamol, ibuprofen
if drainage cannot be established you would get antibiotics prescribed such as metronidazole 200mg 3 x per day 5-7 days or penicillin 250 mg 4 per day 5-7 days- this is not common
what would you do on the 2nd visit with a pt that has an acute perio abcess?
review within 10 days after pocket drainage pt should return to have treatment carried out such as a gentle scale and OH until healing of the abscess site (aprox 2 months)
what would you expect to see if treatment was successful with an acute perio abcess?
should be a reduction in probing due to healing and no bleeding on probing
However…sometimes acute symptoms disappear but chronic draining lesion persists
what is a chronic perio abcess?
Usually found in patients with chronic periodontal disease
Found in those with deep pocketing
Usually incidental finding on BPE
what is the Inflammatory Reaction- for Chronic perio abscess?
Lymphocytes
Plasma cells
Monocytes
Macrophages
Also increased collagen production resulting in granulation tissue (develops in wound healing mix of fibroblasts, small blood vessels)
what is the clinical picture of a chronic perio abscess?
Usually symptomless or dull pain
Pus exudes from within the pocket through sulcus
Patient may notice bad taste/smell
May present as swelling
Radiographs may show angular defects
what would the treatment be for a chronic perio abscess?
may require extraction
Hygiene phase therapy- supra and sub-gingival PMPR right to the pocket base as unlikely to be viable tissue attachment
Irrigation if required
