Acute Perio Diseases

Question 1

What are types of Acute Perio Diseases?

Answer 1

1) Acute Pericoronitis
2) Acute Herpetic Gingivostomatitis
3) Acute Necrotizing Ulcerative Gingivitis
4) Acute Periodontal Abscess
5) Acute Gingival Abscess

Question 2

What are the most common symptoms in order of DECREASING frequency?

Answer 2

Pain–>Swelling & Edema–> Lymphadenopathy–>Fever

Question 3

What is the Tx for Acute Periocoronitis?

Answer 3

1) Control infection
2) Control inflammation
3) Control Pain
- Irrigation w/ H2O2 or CHX
- Systemic antibiotics
- EXT of MAX 3rd M
- Surgical removal of pericoronal tissue

Question 4

What is Acute Necrotizing Ulcerative Gingivitis (ANUG) also known as?

Answer 4

1) Vincent’s Stomatitis
2) Vincent’s Infection
3) Ulcerative Gingivitis
4) Gangrenous Stomatitis
5) Trench Mouth

Question 5

What are the Characteristics of ANUG?

Answer 5

1) Not contagious
2) Strong relationship between onset of disease & level of stress & anxiety
3) Age of onset is generally between 15 & 30 yrs
4) Smoking is commonly associated w/ disease
5) Can occur in clean mouth although disease is generally less severe
6) Disease exhibits an anterior to posterior gradient

Question 6

Patients with ANUG exhibit a localized defect in __________, ___________, and/or ______________ functions.

Answer 6

• Neutrophil chemotaxis
• Macrophage chemotaxis
• Phagocytic

Question 7

Patients with ANUG respond to what therapy?

Answer 7

1) Amoxicillin
2) Metronidazole (this is paired with amoxicillin)
3) Debridement

Question 8

What are the clinical Signs and Symptoms?

Answer 8

1) Pain
2) Sudden onset
3) Necrosis & cratering of gingival papillae
4) Pseudomembrane formation
5) Spontaneous gingival bleeding
6) Foul breath odor
7) Lymphadenopathy
8) Elevated temperature

Question 9

What are the microscopic zones in ANUG lesion from surface to lamina propria?

Answer 9

1) Bacterial zone
2) Neut rich zone
3) Zone of necrosis
4) Zone of spirochete infiltration

Question 10

What is the TX & Management of ANUG?

Answer 10

1) Smoking cessation, adequate nutrition & sleep
2) Stress control
3) Systemic ABX
4) Oral rinsing w/ CHX
5) Multiple sessions of debridement w/ ultrasonic or sonic scaler
6) Scaling & root planing or scaling & polishing
7) Surgery may be indicated if residual soft tissue deformities inhibit proper OH

Question 11

Which patients generally have acute periodontal abscess?

Answer 11

1) 10-15 % of ALL emergency patients
2) 60% of untreated periodontal patients
3) 14% of patient in active perio TX
4) 37% of patients in perio maintenance

Question 12

Multiple abscess formation is often a manifestation of?

Answer 12

1) Diabetes

2) AIDS

Question 13

What are the signs and symptoms of Acute Periodontal Abscesses?

Answer 13

1) Pain
2) Localized swelling & fluctuence
3) Purulent exudate
4) Deep periodontal pocket
5) Tooth exhibits vital pulp
6) May present a fistula
7) Tooth mobility
8) Sensitivity to percussion
9) Low grade fever
10) Lymphadenopathy

Question 14

What are the sequence of events leading to abscess formation?

Answer 14

1) Occlusion of existing perio pocket
2) Bacterial innovation of soft tissue wall
3) Leukocytic infiltration (Neuts)
4) Vascular thrombosis
5) Edema & swelling
6) Tissue necrosis & liquefaction
7) Collagenolysis & bone resorption
8) Production of purulent exudate

Question 15

65% of the microbial flora that cause Acute Periodontal Abscess are _____________ and ___________

Answer 15

• Gram-negative

- Anaerobic

Question 16

In Acute Periodontal Abscesses, bacteria that produce proteinases are _________ and ____________.
They are important in pathogeneses of the periodontal abscess since they ____________ the ____________ of nutrients, and ______________ the _________ of bacteria within the abscess environment.

Answer 16

• P. gingivalis and P. intermedia
• increase the availability
• Increase
• number

Question 17

What are all the microbes involved with Acute Periodontal Abscesses?

Answer 17

1) Treponema (spirochetes)
2) Fusobacterium nucleatum
3) Porphyromonas gingivalis
4) Prevotella intermedia
5) Parvimonas micra
6) Tannerella forsythia
7) Candida albicans

Question 18

What are the factors required of development of acute periodontal abscesses ?

Answer 18

1) Periodontal pocket
2) Blockage of perio pocket by (calculus, plaque, food debris, restoration, and fibrosis of marginal tissue)
3) Presence of sub gingival plaque
4) Presence of plaque microbes that exhibit multiple virulence factors ( endotoxins, collegians, tissue innovation, and organic acid production)

Question 19

What is the Histopathology of Acute Periodontal Abscess?

Answer 19

1) Acute inflammatory infiltrate
2) Vascular hyperemia and thrombosis
3) Lysis of the collagen matrix in the lamina propr. ad gingival fibers
4) Ulceration and apical proliferation of JE
5) Osteoclastic mediated bone resorption

Question 20

What is the Tx for Acute Periodontal Abscesses?

Answer 20

1) Establish drainage (Non surgical or surgical and debridement or surgical therapy w/ flap election with ultrasonic, sutures)
2) Systemic or local delivery antibiotics (if indicated by fever or lymphadenopathy)
3) scale and root planing
4) Surgery if indicated

Question 21

What are the signs and symptoms of an Acute Gingival Abscess?

Answer 21

1) Localized
2) Painful
3) Rapidly expanding
4) Limited to marginal gingiva or gingival papillae
5) Adjacent teeth may be painful to percussion
6) Etiology is generally impaction of a foreign body (popcorn hull, toothbrush bristle, shrimp husk,) associated bacteria carried into tissue

Question 22

What is the TX for Acute Gingival Abscess?

Answer 22

1) Establish drainage
2) Systemic or locally delivered ABX
3) Scaling & root planing
4) Surgery if indicated