Acute Perio Disease

Question 1

What are the types of gingivits?

Answer 1

BAFTA HN

Bacterial/viral
Allergic
Fungal
Traumatic - physical/ chemical/ trauma
Abscess (gingival)
HIV associated
Non-specific

Question 2

Types of periodontitis?

Answer 2

HAT LA

HIV associated
Acute generalised
Traumatic periodontal 
Lateral periodontal abscess
Acute necrotising

Question 3

Give some examples/ reasons for gingivitis?

Answer 3

Plaque induced
Physical trauma - toothbrushing/ fingernails
Thermal trauma - food/drinks (ulceration

Question 4

What is a gingival abscess?

Answer 4

Doesn’t involve periodontal membrane - only gingival tissues

Question 5

What is acute herpetic gingivostomatitis?

Answer 5

Caused by herpes simplex virus (type 1)
Affect young children/ adults
Highly contagious and spread from lesions

Question 6

Incubation period for herpetic gingivostomatitis?

Answer 6

5-10 day

Question 7

Symptoms of acute herpetic gingivostomatisis?

Answer 7

Sore, painful mouth
Loss appetite
Numerous vesicles - rupture form sloughing ulcers
Young children - irritable/ professed salvation
May have flu-like symptoms

Question 8

What conditions can occur simultaneously?

Answer 8

ANUG and acute herpetic gingivostomatitsm

Question 9

Tx AHG

Answer 9

Supportive

1. Fluid intake/ soft diet
2. Analgesics/ antipyretics
3. Usually self limiting 10-12 days
4. Highly contagious - avoid contact w/ others

Symptomatic

1. Topical antiseptics 5% lidocaine mouthwash
2. Antivirals e.g acyclovir (reserved severe cases)

Question 10

Risks tx pt w/ AHG

Answer 10

Herpetic whitlow - hands/ eyes

Don’t tx immunocompromised pt if you have recurrent herpetic lesions

Question 11

What are children w/ AHG at risk of?

Answer 11

Satellite lesions - caused children sucking fingers/ scratching

Question 12

Mechanism of reactivation in AHG?

Answer 12

Primary illness = infection of trigeminal ganglion

Subsequent reactivation = most commonly present as herpes labialis

Question 13

How can dentists cause reactivation AHG?

Answer 13

Can be reactivated following trauma e.g surgery, periodontal tx, infiltration anaesthesia

Question 14

What is acute fungal gingivitis?

Answer 14

Acute candid gingivitis - superinfection w/ Candida albicans
Often seen in those w/ partial dentures or those who have finished course broad spectrum antibiotics

Question 15

What are the two types of allergic gingivitis?

Answer 15

1. Following systemic administration drug/ chemical

2. Following direct contact e.g mouthwash

Question 16

What are problems associated allergic gingivitis and how does it present?

Answer 16

Tenderness may prevent effective cleaning
See red, shiny gingiva, oedema and loss of stippling
Range of symptoms - mild to anaphylactic

Question 17

When might you see traumatic periodontitis?

Answer 17

Often associated w/ root fractures

Question 18

How does acute necrotising gingivitis appear?

Answer 18

Can be localised or whole mouth
Sore and bleeding gingiva - ulceration and necrosis of gingival margin esp dental papilla
Ulcers grey/ yellow slough - painful touch
Often no systemic symptom - lymphadenopathy present
Metallic taste w/ halitosis

Question 19

Where is localised NUG mostly seen?

Answer 19

Lower anteriors

Question 20

Is bone loss associated w/ NUG?

Answer 20

If severe - bone and periodontal attachment can be lost

Question 21

Aetiology of NUG?

Answer 21

Opportunistic infection by anaerobes - fuss-spirocheatal complex
No evidence transmissible

Question 22

Examples of fuso-spirocheatal complex in NUG

Answer 22

Treponema vincenti, fusobacterium nucleatum

Question 23

Predisposing factors NUG

Answer 23

Immunocompromised - HIV
Malnutrition
Smoking
Stress
Poor OH

Question 24

Definition lateral periodontal abscess?

Answer 24

A collection of pus in the connective tissue walls of periodontal pocket

Question 25

Presenting symptoms/ signs of lateral periodontal abscess?

Answer 25

Pain - tissues surrounding painful tooth usually swollen Small localised enlargement or diffused swelling Tissue - red or deep red-blue colour Affected teeth TTP - teeth usually mobile and high in occlusion Systemic features - lympahdenopathy/ fever Possible evidence sinus tract

Question 26

What does probing of tooth w/ lateral abscess reveal?

Answer 26

Deep pocket

Question 27

What is aetiology of lateral periodontal abscess?

Answer 27

Deep pocket w/ active inflammation and micro-ulceration Entry of microorganism via pocket lining into connective tissue = abscess Reduction host response

Question 28

What would you need to consider for differential diagnosis of lateral abscess?

Answer 28

Hx, pocket depth, if tooth vital, pus in pocket, radiographs

Question 29

Give example of differential diagnosis for lateral abscess and reasons why?

Answer 29

Periodontal abscess Tooth non-vital and TTP Pus in tissue Radiograph show periodical changes

Question 30

Mange periodontal abscess?

Answer 30

Retain tooth/ XLA Retain tooth 1. Drain if fluctuant w/ anaesthetic 2. RSD if not fluctuant 3. Selective grinding to relieve occlusion 4. Hot salt rinses and review 5. Antibiotic is systemic involvment

Question 31

What antibiotics would you give for periodontal abscess?

Answer 31

Amoxicillin +- metronidazole 5 days | Azithromycin 3 days