Acute Periapical Lesions and Mucogingival Deformities and Conditions Flashcards
What are the types of acute periodontal lesions?
important!
- Periodontal Abscesses
- Necrotizing periodontal diseases
- Endo Perio lesions
Acute periodontal lesions are _______% of all emergency patients
7-14%
3rd most common dental emergency
____% of untreated
periodontal patients have acute periodontal lesions
60%
____% of patients in active periodontal treatment have acute periodontal lesions
13.5%
_____% of patients in periodontal maintenance have acute periodontal lesions
37%
What is the etiology of a periodontal abscess?
- Pulp necrosis,
- Periodontal infections
- Pericoronitis
- Trauma
- Surgery
- Foreign body impaction
What is a periodontal abscess?
important!
Localized accumulation of pus located within the gingival wall of the periodontal pocket, with an expressed periodontal breakdown occurring during a limited period of time, and with easily detectable clinical symptoms.
What is the sequence of events leading to abscess formation?
- Occlusion of existing periodontal pocket
- Bacterial invasion of soft tissue wall
- Leukocytic infiltration (neutrophils)
- Vascular thrombosis
- Edema and swelling
- Tissue necrosis & liquefaction
- Collagenolysis & bone resorption
- Production of purulent exudate
What is the #1 food to cause abscess?
popcorn kernels (the skin)
Most common symptoms of acute periodontal disease in order of decreasing frequency:
important!
- Pain
- Swelling and Edema
- Lymphadenopathy
- Fever
if patient does not have a fever they don’t get antibiotics
Multiple abscess formation is often a manifestation of:
important!
- Diabetes (Uncontrolled or undiagnosed): most of the cases have this as a cause.
- AIDS (compromised immune system)
- Depressed Immune System (steroid therapy, chemotherapy)
____% of the microbial flora is Gram-Negative and anaerobic
65%
Bacteria that produce proteinases, as P. gingivalis and P. intermedia are important in the pathogeneses of the periodontal abscess since they…
increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment
What is the microbiology of a abscess?
important!
- Treponema (spirochetes)
- Fusobacterium nucleatum
- P intermedia
- P gingivalis
- Peptostreptococcus micros
- Tannerella forysthia
- Candida albicans
exclusion question
What is the histopathology of an abscess?
- Acute inflammatory infiltrate
- Vascular hyperemia and thrombosis
- Lysis of the collagen matrix in the lamina propria and the gingival fibers
- Ulceration and apical proliferation of JE
- Osteoclastic mediated bone resorption
What is important to know about periodontal abscess in periodontitis patients?
- Periodontal abscess could represent a period of disease exacerbation (due to the presence of a tortuous pocket, furcation involvement, or vertical defect)
- Composition of microflora
- Decreased host defense
What are the types of periodontitis patients who experience acute exacerbation of periodontal abscess?
- In untreated periodontitis
- Non-responsive to periodontal therapy
- Patients on supportive periodontal therapy
What kinds of treatment can cause periodontal abscess in patients with periodontitis?
important!
- Post-Scaling
- Post-surgery
- Post-medication
— Antimicrobials
— Nifedepine
What are the causes of periodontal abscess in non periodontitis patients?
important!
- Impaction of foreign bodies
- Harmful habits
- Orthodontic factors
- Gingival enlargement
- Alteration of the root surface including
— Dens invaginatus
— cemental tears or enamel pearls
— Iatrogenic conditions such as perforations
— Severe root damage: Vertical root fracture or cracked tooth syndrome
— External root resorptio
What are the clinical signs of a periodontal abscess?
- pain
- localized swelling and fluctuence
- purulent exudate
- deep periodontal pocket
- tooth exhibits vital pulp
- may present with a fistula
- tooth mobility
- sensitivity to percussion
- low grade fever
- lymphadenopathy
What are the differential diagnosis for periodontal abscess?
- Periapical abscess
- Acute pulpitis
- Tooth or root fracture
- Pericoronitis
- Lateral periodontal cyst
- Gingival cyst
What complications can happen from an abscess?
- tooth loss
- bacteremia following abscess treatment
- chronic or episodic bacteremia form untreated periodontal disease
Up to ___% of teeth with periodontal abscesses in maintenance are extracted
45%
What are the treatment options for periodontal abscess treatment?
important!
- Non-surgical drainage and debridement with local anesthetic
- Surgical Drainage for large abscess
- Surgical Therapy with flap reflection, debridement with ultrasonic, sutures
- Antibiotics if systemic infection indicated by fever or lymphadenopathy
- Reevaluation and any further needed therapy
