Acute Lesions

Question 1

What is stillman’s cleft

Answer 1

Soft tissue cleft due to trauma from flossing. Mucogingival triangular shaped defect predominantly seen on buccal surface

Question 2

How does trauma from flossing lead to marginal gingivitis

Answer 2

Create flossing cleft or stillmans cleft, increasing risk of bacteria permeating into tissues and cause cleft to expand laterally

Question 3

How to manage flossing cleft

Answer 3

If cleft is red and feels like soft tissue, likely to be reversible as only superficial layer affected. Patient stop parafunctional habit and use chx, review in 2 weeks

If cleft is white, can see bone underneath, completely coral pink —> entire width of tissue affected, has epithelialised. Irreversible, require surgical intervention

Question 4

Clinical feature of chemical trauma

Answer 4

Immediate erythema and oedema od oral mucosa. Subsequent formation of white slough pseudomembrane covering ulceration. Ulceration has irregular border and bleeds easily.

Question 5

Clinical feature of periodontal abscess

Answer 5

Localised purulent infection in periodontal tissues or lesion with expressed periodontal breakdown in limited period of time with easily detectable clinical symptoms

Herrera et al Perio 2000

Question 6

Gingival vs periodontal abscess

Answer 6

Gingival abscess at marginal and interdental gingival while periodontal abscess deeper, close to mucogingival line

Gingival abscess associated with subgingivally impacted foreign object while periodontal abscess associated with periodontal disease

Question 7

Acute periodontal abscess symptoms

Answer 7

Sudden onset of pain
Localised tenderness
Sensitive to palpation
Sappuration on gentle pressure
Tooth mobility due to periodontal breakdown of connective tissue
Elevation of tooth hence discomfort on biting down

Question 8

Chronic perio abscess symptoms

Answer 8

Asymptomatic
Sinus tract
Localised elevation due to granulation inflammatory tissue

Question 9

Do periodontal abscesses happen singly or multiply

Answer 9

Most patients get single lesions, associated with local factors eg a lot of calculus

Multiple lesions associated with eg uncontrollable diabetes mellitus, untreated periodontitis patient after systemic antibiotic therapy

Question 10

What is the most virulent microorganism in periodontal abscess

Answer 10

P gingivalis

Question 11

What is a pericoronal abscess

Answer 11

Localised inflammation of pus within overlying ginval glad surrounding crown of incompletely erupted tooth

Question 12

Diagnosis of anug

Answer 12

Punch out craters interdental, ulcers on interdental papilla

Rapid onset of pain

Pseudomembrane over necrotic area

Fever, discomfort

Marginal erythema

Question 13

Risk factors for nug

Answer 13

HIV positive 1-10% of HIV patients
Severe malnutrition 
Poor OH 
Stress
Lowered host immune response

Question 14

Histological features of necrotising ulcerative gingivitis (important)

Answer 14

4 zones

Innermost: spirochetes infiltration zone
Tissue components intact, filled with spirochetes

Necrotic zone
Disintegrated cells with spirochetes and fusiform bacteria

Neutrophil rich zone
High number of leukocytes and neutrophils, host immune zone

Bacterial zone
Superficial mesh degenerated epithelial cells. Leukocytes, spirochetes, fusiform present

SNNB

Question 15

Management of NUG

Answer 15

Acute phase (2-4 days)

• use ultrasonic to remove superficial plaque and calculus
• debridement daily for 2-4 days
• no toothbrushing for 1-2 days
• chx 0.12-2% mouth rinse twice a day

Clear existing perio

Corrective eg surgery to fix soft tissue craters

Maintenance