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Perio > Acute Perio Conditions_19th Feb 1pm > Flashcards

Acute Perio Conditions_19th Feb 1pm Flashcards

1
Q

What are the different possible types of acute perio conditions?

A
  • Periodontal Abscess
  • Periocoronitits
  • Perio/endo lesions
  • NUG/NUP
  • Ulcerations/oral pathology on gingiva
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2
Q

What is a periodontal abscess?

A
  • Formation of deep tortuous pockets–>leads to bacterial build up in pocket forming abscess
  • Pressure exerted by bacterial/pus build up may cause spread to adjacent periodontal tissue
  • Changes in host defence, microflora, bacterial virulence may make it pocket lumen insufficient for draining suppuration
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3
Q

At what stages of periodontal disease can an abscess occur?

A
  • Acute exacerbation of untreated perio
  • Periodontal therapy (dislodgement of calculus deeper into pocket)
  • Refractory periodontitis
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4
Q

T/F Using systemic antibiotics to treat in pt with advanced perio without gingival debridement can cause perio abscess

A

T
Can develop multiple
Thought to be due to superinfection

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5
Q

Where are periodontal abscesses frequently found?

A

Furcations

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6
Q

What factors can predispose diabetic patients to periodontal abscess?

A
  • Lowered host resistance
  • Impaired cellular immunity
  • Decreased leukocyte chemotaxis, phagocytosis and bactericidal activity
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7
Q

What are some possible causes of periodontal abscess in the abscence of periodontitis?

A
  • Impaction of foreign bodies (e.g. toothpicks, popcorn kernals, getting lodged in gingiva)
  • Local root morphology (e.g. cervical enamel tears)
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8
Q

What can you notice clinically with periodontal abscess?

A
  • Ovoid elevation of gingiva along lateral aspect of root
  • Gingiva edematous and red, smooth shiny surface
  • Calculus normally present
  • Pus may be expressed with gentle digital pressure
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9
Q

What are the possible symptoms of periodontal abscess?

A
  • Think about location under abscess
  • Increased tooth mobility
  • Elevation of tooth in socket
  • Tenderness during mastication (and during percussion)
  • Slight discomfort to severe pain and swelling
  • Tightness in gums
  • Systemic symptoms sometimes present (fever, malaise_
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10
Q

What do you notice radiographically with periodontal abscess?

A
  • Bone loss

- May be widening of PDL or severe bone loss

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11
Q

What are the differential diagnosis of periodontal abscess?

A
  • Crack
  • Endodontic abscess drainaige
  • Root fracture
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12
Q

What is the treatment for peridontal abscess?

A
  • For pain relief: LA, handscale as best as possible, irrigate with saline
  • For full treatment: access surgery flap to fully debride
  • If systemic involvement: antibiotics
  • Metronidazole, 400mg, three times daily, 5-7days
  • If severe, add amoxicillin 500mg, 3x daily, 5-7days
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13
Q

What is pericorinitis?

A
  • Infection in tissue and mucosa surrounding partially erupted tooth
  • Usually occurs around wisdom teeth
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14
Q

What are the symptoms for mild pericoronitis?

A
  • Pain
  • Localised Swelling
  • Pus discharge
  • Foul odour + taste
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15
Q

What are the symptoms for severe pericoronitis?

A
  • Difficulty swallowing
  • Limited opening
  • Enlarged lymph nodes
  • Fever
  • Facial cellulitis
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16
Q

What is the treatment for pericoronitis?

A

Debride area under operculum as fully as possible + irrigate with chlorhex and saline

Place pt on chlorhex for a week and explain importance of keeping tissues clean

If major systemic sympotms, metronidazole + amoxicillin or penicillin V (phenoxymethylpenicillin) for 1 week

Then consider: Is it recurring + will tooth erupt into good position? Then decide:

  • Extract
  • Operculectomy
  • Wait and monitor
17
Q

What is NUG?

A
  • Rapidly destructive
  • non-communicable
  • gingival infection of complex aetiology
18
Q

What are the predisposing factors to NUG?

A

Local:

  • Oral hygiene
  • Plaque retentive factors (overhangs, crowded teeth, calculus)
  • Cigarette smoking

Systemic:

  • Stress
  • Nutrition
  • Hormonal imbalance
  • Immunosuppression
19
Q

What are the clinical features of NUG?

A
  • Necrosis of crest of marginal tissues
  • Spontaneous bleeding
  • Halitosis
  • Pain
  • Grey pseudomembrane
  • Punched out/cratered interdental papillae
20
Q

What are the symptoms of NUG?

A
  • Metallic taste
  • Pain
  • Halitosis
  • Systemic symptoms (lymphadenopathy, fever, malaise)
21
Q

What other diseases can be confused with NUG? (Study this later)

A
  • Acute herpetic gingivostomatitis
  • Desquamative gingivitis
  • HIV-related periodontitis
  • Streptococcal gingivostomatitis
  • Advanced marginal gingivitis
  • aphthous stomatitis
  • acute leukemia
  • dematoses
22
Q

What is the treatment for NUG?

A
  • Debridement under LA
  • Irrigate with betadine
  • Chlorhex mouthrinse bds (2x per day)
  • Investigate causative factors
23
Q

What is NUP?

A
  • Progression of NUG necrosis to affect PDL and alveolar bone as well as gingival tissues
  • Extremely severe pain
  • Commence at ID papilla, results in interproximal crater like defects
  • May cause denudation (exposure) of and sequestration (separation of bone piece from surrounding bone tissue) of bone
24
Q

What type of people is NUP most commonly found in?

A
  • HIV

- Severe malnutrition/immunosuppression

25
Q

What is the treatment for NUP?

A

-Refer to specialist

Involves debridement and cutterage of area with high dose antibiotics

26
Q

When does perio/endo lesions occur?

A
  • Perio first
  • Occurs when bone loss leads extends to root apex/apical foramina or more rarely large lateral or furcation canals to serve as entry ports for bacteria
27
Q

How is a perio/endo lesion treated? What is the prognosis?

A
  • Generally poor prognosis
  • Extirpate pulp before doing periodontal treatment
  • If only single root involved, can resect root
28
Q

How does endo/perio lesion occur?

A
  • Endodontic abscess drains out through sulcus

- Causes thin and localised pocket

29
Q

How is an endo/perio lesion treated? What is the prognosis?

A
  • Endodontic therapy–>localised pockets may heal with new bone formation to eliminate pocket
  • Is literally the only situation in perio where can get complete bone reformation/resolution naturally
  • thus differential diagnosis important

Perio (5 decks)

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