Acute periodontal disorders Flashcards
Acute gingivitis
Non-specific Gingival abscess Traumatic (physical, chemical, thermal) Bacterial and viral HIV associated Fungal(rare) Allergic
Acute periodontitis
Lateral periodontal abscess Acute generalised Traumatic periapical Acute necrotising HIV associated
Plaque related gingivitis
Gums bleed
Remove plaque
Within a fortnight it goes away
Traumatic gingivitis
Physical trauma e.g. toothbrush
Thermal trauma e.g. hot cheese on pizza
Chemical trauma e.g. aspirin on gums
Gingival abscess
Only involves gingival tissue i.e. does not involve periodontal membrane
Pocket-full of pus caused by pus within gingival tissue e.g. nail stuck in gingiva
Herpes
Primary herpes infection
Often in children but not always
Causes very red gingivae
Child is very upset, clingy, mouth hurts
Provide cold fluid e.g. ice cream helps sooth pain
Self-limiting so don’t need to prescribe anything else
Systemic complications - refer or prescribe acyclovir
Acute herpetic gingivostomatitis
Caused by herpes simplex virus (Type 1) Affects children and young adults Highly contagious and is spread from lesions with a 5-7 day incubation period In many patients the infection is subclinical
Symptoms of AHG
More serious in adults
Sore, painful mouth
Loss of appetite
Numerous vesicles which soon rupture
Ulcers (gray membrane surrounded by bright
red mucosa) may be discrete or confluent
In young children irritability and profuse
salivation
Moderate or severe malaise, raised
temperature: Flu-like symptoms
Lymphadenopathy, stomatitis, pharyngitis
Should be easy to distinguish from ANUG,
though these conditions have been known to
occur simultaneously
Treatment of AHG
Mainly supportive and symptomatic
Fluid intake/cold drinks/soft diet
Analgesics
Anti-pyretics
Topical antiseptics 5% lignocaine mouthwash
Naturally self-limiting 10 – 12 days
Highly infectious – avoid contact with others
Antivirals e.g. acyclovir should be reserved for
severe cases
Complications of AHG
Herpetic whitlow in dentist or DSA if not
wearing gloves
Herpetic lesion of eye in dentist or DSA if
not wearing goggles
Herpetic satellite lesions eg. caused if child
sucks finger and scratches elsewhere
Herpetic encephalomeningitis
You should not treat patients that are
immunocompromised if you have a
recurrent herpetic lesion
Reactivation of virus
Primary illness leads to infection of trigeminal
ganglion
Subsequent reactivation can occur
Most commonly presents as herpes labialis (cold
sore)
Intra-oral reactivation may occur following
trauma such as surgery or even infiltration
anaesthesia
Occasionally a complication of periodontal
surgery
HIV associated gingivitis
Two red lines all along the gum
Shouldn’t see it much anymore
Acute fungal gingivitis
Acute candidal gingivitis can occur due to
superinfection with candida albicans
Often seen in pts who wear partial
dentures
Seen in those that have recently finished a
course of broad spectrum antibiotic
therapy
Also seen in debilitated patients
-can rub candida off, would be left with red inflammation underneath
Acute allergic gingivitis
Adverse reactions - 2 types 1. Following systemic administration of drug or chemical 2. Following direct contact with mouth e.g. cosmetics, mouthwashes
Acute allergic gingivitis signs
Red, shiny gingiva
Oedema
Loss of stippling
Acute allergic gingivitis symptoms
Gingival tenderness may prevent effective
cleaning
Range of symptoms from mild to anaphylactic
shock
Acute allergic gingivitis treatment
Stop drug or cause if known
Traumatic acute periodontal disorders
Associated with root fracture UL1
Traumatic periapical
Swelling
Acute necrotising perio disorders
Could be due to stress
Changes in bacterial flora
Ulceration, pain, halitosis, necrosis
Clinical features of NUG
Localised or whole mouth (localised most often seen
around lower anteriors)
Gingivae sore and bleeding
Ulceration and necrosis of gingival margin, particularly
dental papilla (punched out)
Ulcers covered in grey/yellow slough and painful to
touch
Often no systemic symptoms but lymphadenopathy,
often present
Metallic taste, halitosis
If severe, bone and periodontal attachment can be lost
May be associated with HIV
Aetiology of NUG
Opportunistic infection by anaerobes Fuso-spirochaetal complex (eg. Treponema vincentii, Fusobacterium nucleatum No evidence condition is transmissable Lowered resistance
Predisposing factors to NUG
Compromised immune, defence system eg. HIV, leukemia, malnutrition Smoking Stress Poor oral hygiene
NUG or NUP
Dependent on if it affects/ involves periodontium or not
HIV associated periodontal disorder
Tends to be more destructive
Lateral periodontal abscess definition
A lateral periodontal abscess is a collection
of pus in the connective tissue wall of a
periodontal pocket
Presenting signs and symptoms of lateral periodontal abscess
Pain, most common presenting symptom
The tissues surrounding the painful tooth
or teeth are usually swollen, small
localised enlargement to diffuse swelling
The tissues often appear to be red or a
deep red-blue in colour
Lymphadenopathy and fever may be
present
The affected tooth, and often the adjacent
teeth, are usually tender to bite on and
TTP
The tooth is usually mobile and high in the
occlusion.
Periodontal probing usually reveals the
presence of a deep pocket
There may also be evidence of a sinus
tract draining the abscess
Lateral periodontal abscess aetiology
A deep periodontal pocket with active inflammation and micro-ulceration Entry of micro-organisms through pocket lining into connective tissue produces abscess Blockage Trauma Reduction of host response
Differential diagnosis of lateral periodontal abscess
History Deep pocket Vital tooth Pus in the pocket Tooth may be extruded Radiograph confirms bone loss
Differential diagnosis of periapical abscess
History Tooth non-vital (may be discoloured) Tooth usually acute TTP Pus in the tissues Tooth may be extruded Radiograph may show apical change Radiograph may show cavity/restoration near pulp
Management of lateral periodontal abscess
Extract or retain influenced by: Patient’s wishes Patient’s medical condition Prognosis for the tooth Prognosis for the dentition as a whole
Management of lateral periodontal abscess: retaining the tooth
Acute phase: Drain if fluctuant (topical or local anaesthetic) Root surface debridement if not fluctuant; aim for drainage through the pocket. Selective grinding to relieve occlusion if appropriate Hot salt mouthwashes Review Antibiotics, only if systemic involvement Amoxicillin 5days with or without Metronidazole, Azithromycin 3 days Follow up: Further assessment Scaling Plaque control Periodontal surgery , if appropriate
