Acute Periodontal Conditions Flashcards
What are the 3 categories of endo-periodontal lesions with root damage?
- root fracture or cracking
- root canal or pulp chamber perforation
- external root resorption
What are the 3 grades of endo-periodontal lesions without lesions in periodontitis patients?
- grade 1
- narrow deep pocket in 1 tooth surface
- grade 2
- wide deep pocket in 1 tooth surface
- grade 3
- deep pockets in more than 1 tooth surface
What are the 3 grades of eddo-periodontal lesions without root damage in non-periodontitis patients?
- grade 1
- narrow deep pocket in 1 tooth surface
- grade 2
- wide deep pocket in 1 tooth surface
- grade 3
- deep pockets in more than 1 tooth surface
What symptoms may lead a patient to present with a periodontal emergency?
- swelling of the gum/abscess
- pain
- pus
What can be used to differentiate between a periodontal abscess and a periapical abscess?
- location of the abscess
- gingival margin is likely periodontal
- apex is likely periapical
- vitality testing
- periapical more likely to be non-vital
- periapical radiograph
- look for periapical radiolucency
- pocket depth
- identify calculus presence
Why is it important to differentiate between a periapical and periodontal abscess?
- treatment is different
- periapcial
- RCT
- XLA
- periodontal
- drainage through pocket or incision
- debridement of pocket
- periapcial
How does necrotising gingivitis/periodontitis present clinically?
- ulcerated necrotic papillae
- white/yellow slough
- punched out appearance of papillae
- marginal erythema
What are the symptoms of necrotising gingivitis/periodontitis?
- bleeding gingiva
- especially on bleeding and brushing
- pain
- extremely sore
- particularly painful on touching
- bad taste in mouth
- halitosis
- systemic symptoms
- not common
- fever
- malaise
- lymphadenopathy
- not common
What special tests can be carried out for necrotising gingivitis/periodontitis?
- diagnosis based on symptoms
- radiograph to determine attachment loss
- aim is initially to relieve symptoms
What are the causative agents of necrotising gingivitis/periodontitis?
- commensal organisms
- opportunistic infection
- spirochetes and fusiform bacteria
- anaerobes
What are the underlying risk factors for necrotising gingivitis/periodontitis?
- immunosuppressed/immunocompromised
- HIV/AIDS
- historical
- excellent diagnosis and treatment
- chemotherapy/transplant patients
- anti-rejection medication
- HIV/AIDS
- psychological stress
- insufficient sleep
- malnutrition
- especially developing countries
- inadequate oral hygiene
- pre-existing gingivitis
- smoking, alcohol and poor diet
- generally poor lifestyle choices
- push immune system to limits
What treatment can be carried out for necrotising gingivitis/periodontitis?
- superficial debridement
- remove soft and mineralised deposits
- ultrasonic scaler
- remove necrotic tissue and bacteria
- carried out under local anaesthetic
- remove soft and mineralised deposits
- mouthwashes
- 0.2% chlorhexidine mouthwash
- twice daily
- 3% hydrogen peroxide
- diluted 1:1 with warm water
- 0.2% chlorhexidine mouthwash
- if no improvement or systemic symptoms
- metronidazole
- 400mg 3x daily for 3 days
- good for anaerobes
- metronidazole
- review
- a couple of days after treatment
- enforce strict oral hygiene
- regular oral hygiene
- PMPR
- regular oral hygiene
- advice on general health
- smoking
- diet
- exercise
- treatment of gingival recession
- treated surgically
How does chemical injury to the gingival appear after contact with 37% phosphoric acid?
red erythematous border with white areas of necrotic tissue
What are the symptoms of a chemical burn?
- pain
- restricted to affected area
How can a chemical burn to the gingival be diagnosed?
- thorough history
- no special tests
What are the possible causative agents of chemical burns?
- medications
- dental matrerials
What does the treatment of a chemical burn to the gingival involve?
- analgesics
- removal of cause
- monitor wound healing
- treatment of gingival recession likely
How does primary herpetic gingival stomatitis present clinically?
- diffuse erythema of the gingival
- extends beyond gingival margin
- shiny, glazed appearance
- thinning of epithelium
What are the symptoms of primary herpetic gingival stomatitis?
- bleeding
- pain
- extreme
- vesicles burst throughout mouth
- mucosa, tongue, palate, etc.
- affects eating, talking, drinking
- halitosis
- systemic symptoms
- lymphadenopathy
- fever
What special tests could be used to diagnose primary herpetic gingival stomatitis?
- mouth rinse
- swab
What are the causative agents involved in primary herpetic gingival stomatitis?
- herpes virus
What are the treatment options for primary herpetic gingival stomatitis?
- not many treatment options
- bed rest
- soft diet
- hydration
- wait for healing
- systemic symptoms
- acyclovir
- no dental treatment carried out
- highly infectious
- avoid AGP procedures
How does recurrent herpetic gingival stomatitis present clinically?
- multiple round red lesions
- 1mm diameter each
- broken vesicles
What are the symptoms of recurrent herpetic gingival stomatitis?
- pain, tingling, burning
- reduced from primary episode
- affects one branch
- headache
- systemic symptoms
- fever
- lymphadenopathy
What special tests can be used to aid the diagnosis of recurrent herpetic gingival stomatitis?
swabs
What causative agents are involved in recurrent herpetic gingival stomatitis?
- herpes virus
- reduced immune system
What are the underlying risk factors for recurrent herpetic gingival stomatitis?
- immunosuppressed/immunocompromised
- primary herpetic gingival stomatitis
What treatment should be carried out for recurrent herpetic gingival stomatitis?
- bed rest
- hydration and soft diet
- chlorhexidine 0.2% mouthrinse
- acyclovir for immunocompromised children
How can leukaemia present clinically intra-orally?
- rolled erythematous gingival margin
- gingiva infiltrated with immune cells
What are the oral symptoms a patient with leukaemia might present with?
- tenderness
- not severe
- bleeding
- gingival oedema
- systemic symptoms
- fever
- lymphadenopathy
What special tests may be used to aid in a diagnosis of a patient presenting with oral symptoms of leukaemia?
- thorough history
- rule out other cause
- determine time scales
- blood tests
- tactile sensation of tissue
- very puffy and soft
- can be squashed with probe
What are the underlying risk factors for leukaemia?
- no local risk factors
- systemic disease
- genetic
What treatment should be carried out for patients presenting with oral symptoms of leukaemia?
urgent GP referral
How does desquamative gingivitis/periodontitis present?
peeling of the mucosa
How does drug induced hyperplasia occur and how does it feel clinically?
- associated with plaque accumulation
- drugs induce fibrocytes
- feels hard to probe
