Acute Periodontal Conditions Flashcards
What do all acute periodontal conditions have in common?
They cause pain and rapid periodontal destruction.
How are acute periodontal lesions distinct from other forms of periodontitis?
They are rapid onset
They cause rapid destruction of periodontal tissues
They cause pain or discomfort which prompts patients to seek urgent care
What is the definition of an abscess?
Localized accumulation of pus in the periodontal tissues (gingival wall of a periodontal sulcus/pocket) resulting in a significant tissue breakdown.
How are abscesses of the periodontium classified?
Location: Gingival and periodontal abscesses.
Course of the lesion: Acute and chronic
Number of abscesses: Single and multiple
How are gingival abscesses different from periodontal abscesses?
Gingival abscess - don’t have previous attachment loss (healthy or gingivits but not tissue destruction)
Previous periodontitis - then the patient has
periodontal abscess
What causes periodontal abscesses?
Impaction: Dental floss, orthodontic elastic, popcorn hulls.
Harmful habits: Wire or nail biting
Orthodontic factors: Orthodontic forces on a cross-bite.
How big of an issue is a periodontal abscess?
14% of all dental emergencies are periodontal abscesses.
It is the third most prevalent dental infection in the UK
37% of patients are under maintenance
Who are periodontal abscesses seen most often in?
Associated with probing depths deeper than 6mm and are more common in molar sites (furcations)
What adverse outcomes can periodontal abscesses lead to?
Can lead to tooth loss.
It is the main reason for tooth extraction in maintenance patients for questionable prognoses teeth.
Potential risk for bacteremia
What are potential etiologies of periodontal abscesses?
Acute exacerbation of untreated periodontitis
Acute exacerbation of maintenance patients
After periodontal debridement (incomplete or debris pushed)
After systemic antimicrobial intake
After surgical therapy (membrane or suture contamination)
Uncontrolled diabetic patient HbA1c 10+ (if they are periodontitis patients)
Impact of foreign bodies
How does a periodontal abscess develop?
Invasion of bacteria to soft tissue (pocket) -> Development of inflammatory process -> Inflammatory products lead to (PMN influx, production of pus, connective tissue destruction, encapsulation of bacterial infection) -> Rapid rate of destruction pending of bacterial growth, virulence and pH
Do periodontal abscesses have a distinct pathophysiology when compared to other periodontitis lesions?
Periodontal abscesses involve entry of bacterio or foreign body into the soft tissues surrounding the periodontal pocket which leads to PMNs and other immune cells. If the neutrophils fail to control the influx of bacteria or to clear the foreign body, degranulation, necrosis, and further neutrophil influx may occur. This leads to formation of pus and if the pus is not drained it forms into an abscess. This lesion resolves more rapidly because it creates a low pH environment within the abscess which leads to rapid enzymatic disruption of surrounding connective tissues and has a greater potential for resolution if quickly managed.
How does the microbiology of abscesses look?
It is polymicrobial Gram negative, rod predominant anaerobic bacteria
EXTRA INFO:
*4 complexes are possible with different bacterial content:
Red complex: Consist mostly of P gingivalis which is the most prevalent and T forshythia as well as treponema species.
Orange complex: Consists of P intermedia and F nucleatum
Yellow complex*
From Clinical and microbiological characterization of periodontal abscesses
How can a periodontal abscess be diagnosed?
Evaluation of symptoms: Discomfort, pain, tenderness, swelling, tooth mobility, tooth elevation, sensitivity to palpation.
Clinical findings:
Ovoid elevation lateral / labial to a tooth, or diffuse swelling or redness, BOP.
Suppuration, deep periodontal pocket and signs of periodontitis and mobility.
Radiographic examination: Normal appearance, some bone loss
Other: Fever, malaise, lymphadenopathy, elevated leukocyte number.
History of previous dental or antibiotic intake.
What are some differential diagnoses of periodontal abscesses?
Other abscesses of the mouth such as: Periapical abscess, Lateral periapical cyst, Vertical root fracture,
Post operative infection
Other serious dental conditions such as Osteomyelitis, ONJ, Squamous cell carcinoma, Metastatic carcinoma, Head and neck cancer, Eosinophilic granuloma, Pyogenic Granuloma
How can other periodontal abscesses ruled out?
Proper assessment: Caries or deep restorations, periodontal probing, pulp tests, abscess location, radiographic examination, general periodontal condition, and control the HbA1c
How can other serious dental conditions be ruled out?
Biopsy if not responding
How is a periodontal abscess treated?
Drainage through pocker or incision compression.
Meticulous periodontal debridement and removal of foreign body if that is the cause.
Extraction: Severe damage and/or hopeless prognosis.
Surgical procedures if needed.
Analgesics
Systemic antimicrobials adjunctive to treatment (especially if there is a fever and swollen lymph nodes)
Sole AB: if there is diffuse infection and inadequate draining.
How is an acute gingival abscess treated?
If it is very localized and there is no previous periodontitis:
Object should be eliminated, drained by incision, and scaling should be done through the sulcus and drained. Followed by warm saline risk and follow up 24 - 48 hours later.
Analgesics can be used but no ABs because it is very localized.
