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
What information do you need to make a diagnosis?
- Health history and medications
- Dental history
- Current periodontal status
- Current status of affected tooth
- Periapical radiographs
- Clinical exam
- Determine etiology
What is the closed treatment approach for abscesses?
- Incision and drainage through the pocket
- Root planning to depth of sulcus
What is the open treatment approach for abscesses?
- Sulcular incisions and full thickness flap
- Remove all visible soft and hard deposits from root and adjacent bone
- Replace flap and suture closed
What is the postoperative therapy after treatment for an abscess?
- Home care
- Prescribe analgesics
- Re-evaluation
- Frequently monitor radiographically and clinically at maintenance appointments for evidence of periodontal disease
If a patient has acute periodontal disease what should you think of?
- Acute Pericoronitis
- Acute Herpetic Gingivostomatitis
- (Acute) Periodontal Abscess
- (Acute) Necrotizing Ulcerative Gingivitis
- Endo- Perio lesions
What is the role of keratinized gingiva?
- Highly debated over many years
- Possible to maintain periodontal health in the absence of keratinized gingiva.
All surfaces with less then ____ mm of keratinized gingiva exhibit clinical inflammation even in the absence of plaque
2.0
When a narrow band of keratinized gingiva is present, sites with a __________ phenotype has a greater tendency to have disease progression
thinner
How much keratinized gingiva is enough?
important!
need 2 mm keratinized, 1mm attached
Mucogingival deformities and conditions around teeth- 2017 Classification include…
- Periodontal Biotype/phenotype
— Thin scalloped
— Thick scalloped
— Thick flat - Gingival/soft tissue recession
— Facial or lingual surfaces
— Interproximal (papillary)
— Severity of recession
— Gingival thickness
— Gingival width
— Presence of NCCL/cervical caries
— Patient esthetic concern
— Hypersensitivity - Lack of Keratinized gingiva
- Decreased Vestibular depth
- Aberrant frenum/muscle position
- Gingival excess
— Pseudopocket
— Inconsistent gingival margin
— Excessive Gingival display
— Gingival enlargement - Changes in color
- Tooth Conditions
What are the different periodontal phenotypes/biotypes?
- thin scalloped
- thick scalloped
- thick flat
What is the periodontal phenotype/biotypes based on?
A. Gingival Phenotype
- Keratinized tissue width - Avg 5.72 mm for thick biotype and 4.15 mm for thin phenotype
- Gingival Thickness- ranged from 0.63mm-1.24 mm
B. Bone Morphotype ( BM) – mean 0.34 mm for thin biotype and 0.754 for thick/Avg phenotype
C. Tooth Position
don’t memorize the numbers
Gingival recession by definition is the…
apical migration of the gingival margin with concomitant exposure of the root surface
Does gingival recession lead to tooth loss?
No
- but bone loss does and gingiva recession and bone loss can go hand in hand often
What is the prevelance of gingival recession in adults?
important!
half (50%)
Where does sensitivity come from during ginvial recession?
CEJ
What are the things to consider for gingival recession?
- esthtic concern
- hypersensitivity
- presence or no carious cervical lesions
- surfaces affected (lingual, facial, interproximal)
- severity
- gingival thickness
- gingival width
What types of mucogingival conditions does this show?
- decreased vestibular depth
- lack of keratinized gingiva
What type of mucogingival condition does this show?
aberrant frenum/muscle position
What are the conditions that contribute to gingival excess?
- Pseudo pocket
- Inconsistent gingival margin
- Excessive gingival display
- Gingival enlargement
What type of mucogingival condition does this show?
psuedopockets
What type of mucogingival condition does this show?
inconsistent gingival margin
What type of mucogingival condition does this show?
excessive gingival display (gummy smile)
What type of mucogingival condition does this show?
gingival enlargment
What are the abfraction (noncarious cervical lesions; NCCL) classes and steps when considering the CEJ?
What are the two most common mucogingival defects in daily practice?
important!
- Gingival Recessions
- Inadequate Zone of keratinized gingiva
What are the predisposing factors for gingival recession?
- Periodontal Phenotype and attached Gingiva
- The impact of tooth brushing
- The impact of cervical restorative margins
- The impact of orthodontics
- Other conditions
What is a recession type (RT) 1?
important!
Gingival Recession with No loss of interproximal attachment. Interproximal CEJ was not detected either on the mesial or distal aspect of the tooth
treatable
What is a recession type (RT) 2?
Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss was less or equal to the buccal attachment loss.
treatable
What is a recession type (RT) 3?
Gingival recession with the loss of interproximal attachment. Interproximal attachment loss is greater than the buccal attachment loss.
not as treatable
What are the classifications of recession?
- modern recesison classification (2011)
- type 1, 2, and 3
Cairo Classification for gingival recession treatement orientation includes…
- RT 1: 100% root coverage can be predicated
- Cairo RT 2: Mixed results
- Cairo RT 3: Full root coverage is not achievable
What occurs when if an existing recession is left untreated?
important!
- Untreated areas also showed a tendency to develop new recession
- make sure to watch/monitor it
