Acute Periodontal Disorders Flashcards
APD can affect
Two diseases caused
Gingivae alone
Periodontium - mechanism holding teeth in places
Gingivitis and Periodontitis
Gingivitis
Features , example, causes
Non-specific Gingival abscess Traumatic - mechanical, chemical, physical, thermal Bacterial and viral Allergic HIV associated Fungal
Periodontitis
Example
Types
Can be associated with?
Periodontal abscess Acute generalised Traumatic PA Acute necrotising HIV associated
Types of gingivitis
Plaque related gingivitis
Physical trauma related gingivitis
Herpes related gingivitis
Gingival abscess
Involves?
ONLY the gingival tissue
Caused by infection within gingival tissue
Herpes causes - which herpes? Who does it affect? Spread? Relieving factors
Acute herpetic gingivostomatitis Common in children Contagious and spreads from lesions with 5-7 incubation period - subclinical in many Cold fluids are best reliever Refer on if symptoms are worse
Herpes symptoms
More in adults Sore mouth Loss of appetite Numerous vesicles which rupture Ulcers Salivation Moderate-severe malaise Lymphadenopathy, stomatitis, pharyngitis
Treatment of AHG
fluid intake soft diet analgesics anti-paretics topical antiseptic anaesthetics but naturally self limiting 10-12 days ANTIVIRALS e.g acyclovir
Herpetic complications
Herpetic WHITLOW without gloves
Herpetic lesion of eye in dentist if not wearing gloves
Satellite lesions - caused if child sucks finger and scratches elsewhere
Encephalomeningitis
Reactivation of virus
Primary illness
Reactivation
Primary leads to infection of trigeminal ganglion
Reactivation as herpes labialis
IO reactivation may occur following trauma e.g surgery or infiltration/periodontal surgery
HIV associated gingivitis
Distinct red line along gingival margin
Acute fungal gingivitis
Can occur due to?
Common in
Check with
Acute candidal gingivitis
Superinfection with superinfection with candid albicans
PD wearers, recently finished course of broad spectrum antibiotics, debilitated patients
Rub with cotton wool roll, white part will come off
Acute allergic gingivitis
Follows…2 types
Symptoms
Signs
What to do
Systemic administration of drug/chemical
Direct contact with mouth
Gingival tenderness may prevent effective cleaning
Red, shiny, gingivae, loss of stopping, oedema
Mild to anaphylactic shock
Stop and find cause
Traumatic periodontal disorder can be caused by?
Root fracture
ANUG
indicated by
Clinical features
Loss of interdental papilla
Halitosis
Localised or whole mouth
Gingivae sore and bleeding
Ulceration and necrosis of gingival margin
Ulcers covered in slough
No systemic symptoms but lymphadenopathy often present
If severe, bone and PD attachment can be lost
May be associated with HIV
Aetiology of (A)NUG
Pre-disposing factors
Opportunistic infection by anaerobes
Fuso-spirochaetal complex e.g treponema vincentii
No evidence of transmission
Lowered resistance
Compromised immune defence
Smoking
Stress
Poor oral hygiene
Lateral periodontal abscess
Collection of pus in connective tissue wall of a periodontal pocked
LPA presenting signs and symptoms
Pain
Tissue around teeth is painful, swollen, small localised enlargement
Tissues red or deep red blue
Lymphadenopathy and fever may be present
TTP on tooth and adjacent
Tooth usually mobile and high in occlusion
Deep pocket on charting
Sinus?
Aetiology of LPA
Deep perio pocket with active inflammation and micro ulceration
Entry of microbes through pocket lining into connective tissue –> abscess
Blockage, trauma and reduction of host response
Differential diagnosis of LPA
Things to consider
History Deep pocket Vital tooth Pus in pocket Tooth may be extruded Radiograph confirms bone loss
Differential diagnosis of PA abscess
History of pain, stopped pain Tooth non-vital Usually acute TTP Pus in tissues Tooth may be extruded Apical changes May show cavity/restorations
Management of an abscess
Consider
extract or remain
wishes of patient
medical condition
tooth prognosis
prognosis for dentition
Management - retaining tooth
and follow up
Retain the tooth (acute phase) Drain if fluctuant RSD for draining through pocket Selective grinding to relieve pain Salt water mouthwashes Antibiotics Amoxicillin 5 days Azithromycin 3 days
Further assessment
Scaling
Plaque control
Periodontal surgery
