Acute Periodontal Disorders Flashcards
Gingivitis Types?
Non-specific Gingival abscess Trauma Bac and viral HIV associated Fungal Allergic
Peridontitis Types?
Lateral periodontal abscess Acute generalised Traumatic periapical Acute necrotising HIV associated
What does a gingival abscess involve?
Gingival tissue
What causes acute herpetic gingivostomatitis?
Herpes simplex virus (type 1)
Features of acute herpetic gingivostomatitis?
Affects children and young adults
Highly contagious and is spread from lesions with a 5-7 day incubation period
Many pts - infec is subclinical
Symptoms of acute herpetic gingivostomatitis (AHG)?
More serious in adults
Sore, painful mouth
Loss of appetite
Numerous vesicles which soon rupture
Ulcers (grey membrane surrounded by bright red mucosa) = discrete or confluent
In young children = irritability and profuse salivation
Moderate or severe malaise, fever (flu-like symptoms)
Lymphadenopathy, stomatitis, pharyngitis
Tx of AHG?
Supportive and symptomatic Fluid intake/cold drinks/soft diet Analgesics Anti-pyretics Topical antiseptics 5% lignociane M/W Naturally self limiting 10-12 days Highly infectious Antivirals - acyclovir for severe cases
Complications of AHG?
Herpetic whitlow in dentist or DST if not wearing gloves
Hereptic lesion in dentist eye if no goggles
Herpetic satellite lesions - if child sucks finger and scratches elsewhere
Herpetic encephalomeningitis
Not treat immunocompromised pts if you have a recurrent herpetic lesion
How does the herpes virus reactivate?
Primary illness = infec of trigeminal ganglion
Subsequent reactivation can occur
Most commonly presents as herpes labialis (cold sore)
Intra-oral reactivation may occur after trauma (surgery/infil LA)
Occasionally a complication of perio surgery
When does acute fungal gingivitis occur?
Acute candidal gingivitis due to superinfec with candida albicans
Often in pts with palatal dentures, pts recently finished a course of broad spectrum antibiotics therapy, debilitated pts
When does acute allergic gingivitis occur?
- Following systemic administration of drug or chemical
2. Following direct contract with mouth e.g. cosmetics, M/W
Appearance of HIV associated gingivitis?
2 red lines along the gingivae
Acute allergic gingivitis features?
Gingival tenderness may prevent effective cleaning
Mild symptoms to anaphylactic shock
Stop drug or cause if known
Appearance of acute allergic gingivitis?
Red, shiny gingiva
Oedema
Loss of stippling
Clinical features of NUG?
Localised or whole mouth (most common around lower incisors)
Gingivae sore and bleeding
Ulceration and necrosis of gingival margin, particularly dental papilla
Ulcers - grey/yellow slough and painful to touch
Often no systemic symptoms but lymphadenopathy common
Metallic taste, halitosis
Severe = bone and perio attachment loss
May be HIV associated
Aetiology of NUG?
Opportunistic infec by anaerobes
Fuso-spirochaetal complex
Lowered resistance
Predisposing factors of NUG?
Compromised immune, defence system e.g. HIV, leukaemia, malnutrition
Smoking
Stress
Poor OH
Define a lateral periodontal abscess?
A collection of pus in the CT wall of a periodontal pocket
Lateral periodontal abscess signs and symptoms?
Pain
Tissues around painful tooth = swollen, small localised enlargement to diffuse swelling
Tissue red or deep red-blue
Lymphadenopathy and fever
Affected tooth and adjacent = TTP
Tooth usually mobile and high in occlusion
Perio probing = deep pocket
Potential sinus tract draining the abscess
Aetiology of lateral periodontal abscesses?
Deep perio pocket with active inflam and micro-ulceration
Entry of micro-organisms through pocket lining into CT = abscess
Blockage
Trauma
Reduction of host response
How to make a differential diagnosis of lateral periodontal abscess?
History Deep pocket Vital tooth Pus in pocket Tooth may be extruded Radiograph confirms bone loss
How to make a differential diagnosis of periapical abscess?
History Non-vital tooth Tooth usually acute TTP Pus in tissues Tooth may be extruded Radiograph may show apical change, cavity/restoration near pulp
What influences the management of lateral periodontal abscesses?
Pt wishes
Pt medical condition
Prognosis for tooth
Prognosis for whole dentition
Management of retaining the tooth with a lateral periodontal abscess?
Drain if fluctuant (topical or LA) RSD if not fluctuant - aim for drainage through pocket Selective grinding = relieves occlusion Hot salt mouthwashes Review
Antibiotics (if systemic involvement)
Amoxicillin 5 days with or without metronidazole
Azithromycin 3 days
Follow up - further assessment, scaling, plaque control, periodontal surgery (if appropriate)
