Acute periodontal conditions

Question 1

List 4 examples of acute periodontal conditions

Answer 1

• Abscesses
• Endo-perio lesions
• Necrotising diseases
• Trauma

Question 2

What are acute periodontal diseases?

Answer 2

Clinical conditions of rapid onset that involve the periodontium and may be characterized by pain, discomfort or infection. They may or may not be related to gingivitis and periodontitis. May be localised or generalised, with possible systemic manifestations.

Question 3

Four types of absenses which involve the periodontium

Answer 3

• Gingival
• Periodontal
• Pericoronal
• Endodontic (periapical)

Question 4

Aetiology, Special tests, and tx of gingival abscess

Answer 4

• Caused by foreign body
• Radiographs and special tests
• Remove aetiological agent, debride and irrigate

Question 5

What would you include in a differential diagnosis of a periodontal abscess

Answer 5

• Gingival abscess
• Periodontal abscess
• Vertical root fracture

Question 6

Tx of periodontal abscess:

Answer 6

• Drainage and debridement
• Extraction (if prognosis is hopeless)
• If systemic involvement - antibiotics
• Ongoing periodontal management
• Biopsy if non resolving.

Question 7

In peri-coronal abscesses what acts are the reservoir for food and plaque

Answer 7

The operculum

Question 8

Presentation of peri-coronal abscess:

Answer 8

• Pain
• Swelling
• Trismus
• Purulent exudate
• Airway compromise

Question 9

Tx for peri-coronal abscess

Answer 9

• Drain and debridge
• Occlusal adjustment
• Systemic antibiotics if needed
• Maintain airways
• Operculectomy
• Exo of tooth/opposing tooth
• Will recur if the tooth position unchanged

Question 10

Presentation of a periapical abscess:

Answer 10

• Pain, TTP
• Non vital tooth
• Swelling, draining sinus

Question 11

Tx for periapical abscess

Answer 11

• Relief of pain
• Drainage
• RCT or Exo

Question 12

Which is more common:

A) Primary endo/secondary perio

B) Primary perio/secondary endo

C) True combined lesion

Answer 12

A) Primary endo/Secondary perio

B is rare anc C is very rare.

Question 13

In endo-perio lesions, what do you do first?

Answer 13

RCT first, then perio tx if required.

Question 14

Aetiology of necrotizing diseases:

Answer 14

• Psychological stress
• Smoking
• Malnutrition
• Inadequate oral hygiene
• HIV/AIDS/Immunosuppression

Question 15

Baterira involved in necrotising diseases

Answer 15

Fusoform and spirochetes

Question 16

Cliniceal features of necrotizing disease

Answer 16

• Confined to gingival tissue
• Punched out papillae
• Yellow-white slough
• Spontaneous bleeding/pain

Question 17

ANUG tx

Answer 17

First visit - manage predisposing factors, debride under LA, chlorhex, Hydrogen peroxide, metronidazole

Second visit - 2 days later reevaluate and debride

Third visit - 5-7 days debridge, tx for chronic conditions

Reevaluate a month later

Question 18

What is the difference between ANUG and ANUP

Answer 18

ANUP extends beyond the gingival margin with loss of attachment and crestal bone exposure. Increased pain and salivation and sub-mandibular lymphadenopathy.

Question 19

How does ANUP tx differ from ANUG tx

Answer 19

May need surgical reconditioning following acute phase debridement

Question 20

Describe ANUS

Answer 20

Large areas of osteitis/oral-antral fistulae, very painful. Uncommon. Found in people with severe systemic compromise and malnutrition.

Question 21

List 3 types of acute periodontal conditions of non-bacterial origin

Answer 21

• Viral - HSV, VZV, Coxsackie
• Fungal (candida)
• Hypersensitivity reaction
• Trauma

Question 22

Name three viruses which may present in the oral mucosa with vesicles

Answer 22

• HSV-1
• VZV
• Coxsackie

Question 24

IF systemic antibiotics are indicated for aggressive periodontitis, wohat would you precribe

Answer 24

Amoxicillin and Metronidazole combination therapy

Question 25

What antibiotic is prescribed for ANUG

Answer 25

MEtronidazole