acute perio inc lateral perio abscess Flashcards
How are acute perio disorders classified?
GINGIVITIS
Non specific
Gingival abscess
Trauma (physical/chemical/thermal)
Bacterial/viral
HIV
Fungal (rare)
Allergic
PERIODONTITIS
Periodontal abscess
Traumatic periapical abscess
Necrotising
HIV
How long does it take to manage plaque induced gingivitis?
After OHI, PMPR
7-10 days
What is a gingival abscess?
Only involves gingival tissues not perio membrane
Fluctuant swelling of pus
What is primary herpes?
Painful red gingiva
Self limiting
Fluids
Systemic fever- may prescribe acyclovir
ACUTE HERPETIC GINGIVOSTOMATITIS- by herpes simplex type 1
Highly contagious
5-7 day incubation period
Many sub clinical
What are symptoms of acute herpetic gingivostomatitis?
More serious in adults
Sore painful mouth
Loss of appetite
Numerous vesicles which will soon ruptured
Ulcers (gray membrane surrounded by red mucosa)- discrete/confluent
Irritability and profuse salivation (young children)
Malaise and pyrexia
Lymphadenopathy, stomatitis, pharyngitis
Should be easy to distinguish from necrotising (can occur together however)
What is tx of AHG?
Support and tx symptoms
Fluid intake/soft diet
Analgesics
Antipyretics
Antivirals if severe (acyclovir)
Topical antiseptics (5% lignocaine Diflam)
Self limiting 10-12 days
Highly infectious- avoid contact
What are complications of AHG?
Herpetic whitlow- finger of dentist no gloves
Herpetic lesion- eye of dentist no goggles
Herpetic satellite lesions- suck finger and scratch elsewhere
Herpetic encephalomeningitis
How does reactivation of herpes occur?
Primary illness leads to infection of trigeminal ganglion
Subsequent reactivation
Herpes labialis
IO reactivation may occur following trauma (surgery/infiltration)
Sometimes complication of perio surgery
What does HIV associated gingivitis look like?
Classic red banding along gum line
What is acute fungal gingivitis?
Superinfection w Candida albicans
Often w partial dentures
Those who’ve recently finished a course of broad spectrum antibiotic therapy
Also seen in debilitated pts
Can rub off white patch leaving red underneath
What is acute allergic gingivitis?
2 types of adverse reactions
1. Systemic administration of drug/chemical
2. Direct contact w mouth eg. Mouthwash (esp Corsodyl), cosmetic
Gingival tenderness
Mild-anaphylactic shock
Should stop cause
Red shiny gingival
Loss of stippling
Oedema
What is a traumatic periapical abscess?
Can be associated w root fracture and point pocketing
What are features of necrotising perio disease?
Characterised by lack of papilla and punched out appearance
Stress related
Localised or whole mouth
Sore, painful and bleeding gingiva
Ulceration and necrosis of margin
Gray/yellow slough
Distinct halitosis- metallic taste
Sometimes lymphadenopathy
Severe- bone loss
HIV ASSOCIATED- more destructive
What is the aetiology of necrotising perio?
Opportunistic infection by anaerobes
Fuso-spirochaetal complex (eg Treponema vincentii, Fusobacterijm nucleatum)
No evidence of transmission
Lowered resistance
What are predisposing factors of necrotising perio diseases?
Compromised immune system eg. HIV, leukaemia, malnutrition
Smoking
Stress
Poor oral hygiene
What is a periodontal abscess?
Collection of pus in the connective tissue wall of a periodontal pocket
Tooth is sound
Called lateral perio abscess as periapical is more at root apex
How common are periodontal/periapical abscesses?
1/3- periodontal
2/3- periapical
What are signs/symptoms of periodontal abscess?
Pain
Swollen, small localised enlargement to diffuse swelling
Red/deep red blue
Lymphadenopathy and fever
TTP and to bite on
Tooth mobile and high in occlusion
Deep pocket
Sinus tract draining abscess (to determine tooth, can introduce GP point and X-ray)
What is the aetiology of a periodontal abscess?
Deep perio pocket w active inflam and micro ulceration
Entry of microorganisms through pocket lining into c. tissue
Blockage- calculus pushed in
Trauma
Reduction of host response (immunocompromised)
What is the difference between periodontal and periapical abscess?
PERIODONTAL
History of perio disease
Deep pocket
Vital tooth
Pus in pocket
Extruded tooth
Bone loss
PERIAPICAL
History of large restoration
Tooth non vital
Acute TTP
Pus in tissues
Extruded teeth
Apical change
Caries/restoration near pulp
How can you manage a periodontal abscess?
Extract or retain
Depends on-
-pt wishes
-pts med history
-tooth prognosis
-dentition as whole prognosis
If retain-
- drain if fluctuant (topical/LA)
-PMPR if not fluctuant (drain through pocket)
-hot salt mouthwash
-antibiotics only if systemic (Amoxicillin w/o Metronidazole 5 days OR azithromycin 3 days)
- further assessment
-PMPR
-plaque control
-perio surgery if appropriate
- review
