Acute Perio Emergencies Flashcards
What is a gingival abscess? And its presentation
A swelling involving marginal gingiva/ interdental papilla
Rapidly expanding
Suppuration may be present
TTP
What causes gingival abscess?
Associated with subgingivally impacted foreign objects in healthy gingiva
What is the management of gingival abscesses?
Incise and drain
Irrigate with saline
Mitigate aetiology
Short term 0.2% chlorohexidine
What is a periodontal abscess?
Localised accumulation of pus within the gingival wall of a deep periodontal pocket, resulting in destruction of collagen fibre attachment and loss of alveolar bone
How does a periodontal abscess present?
Intra oral swelling and redness
TTP
BOP
Suppuration through the pocket
Increased mobility
How would a tooth with a periodontal abscess respond to vitality testing?
Positive
What is the management of a periodontal abscess?
Drainage via pocket or incision
Thorough debridement
Occlusal adjustment may provide temporary relief
Extraction
What is a perio endo lesion?
A communication between the periodontal pocket and pulp - abscess associated with a deep pocket surrounding a non-vital tooth (can be of perio or endo origin)
What are the symptoms of perio endo lesion?
TTP
Mobility
May have exudate
What is the management of a perio endo lesion?
Endo treatment first (drainage via extirpation)
Then thorough debridement
Consider if the tooth is restorable post endo.
What is necrotising periodontitis?
Most severe inflammatory lesion associated with the oral biofilm.
Most commonly affects the mandibular anterior teeth.
What are the signs of NP?
Necrosis and ulceration of free gingiva
Interdental papilla have ‘punched out’ appearance
Pseudo membrane may form over the necrotic area (slough)
Pain when eating and brushing
Bleeding
What is the difference between NG and NP?
In NP, inflammation has progressed into PDL and alveolar bone causing attachment loss
What type of bacteria cause NP?
Anaerobic gram -ve bacteria
What is the management of NP?
Debridement (PMPR) with ultrasonic (minimal pressure over soft tissues)
0.2% chlorohexidine 2x daily for acute symptoms
If systemic involvement - metronidazole 200mg 3x daily for 3 days.
Inform patient of risk factors - smoking, stress, malnutrition
Review in 10 days
