Acute periodontal disorders Flashcards
What are the different acute gingival disorders?
Non-specific Gingival abscess Traumatic - physical, chemical, thermal Bacterial and viral HIV associated Fungal - primary herpes Allergic
What are the different acute periodontal disorders?
Lateral periodontal abscess Acute generalised Traumatic periapical Acute necrotising HIV associated
What is plaque-related periodontitis?
1 week-10 days gingivitis
Goes away if remove plaque
What is acute herpetic gingivostomatitis caused by?
who does it affect?
Caused by herpes simplex virus 1
affects children and young adults
How is AHG spread?
Highly contagious, spread from lesions with 5-7 day incubation period
In many patients - infection sub-clinical
What are the symptoms of AHG?
more serious in adults
Sore, painful mouth
loss of appetite
Numerous vesicles which soon rupture
Ulcers (grey membrane surrounded by red mucosa)
Young children irritable and profuse salivation
Moderate or severe malaise, raised temperature
Lymphadenopathy, stomatitis, pharyngitis
How is acute herpetic gingivostomatitis treated?
Mainly supportive and symptomatic
Fluid intake/cold drinks/soft diet
Analgesics
Anti-pyretics
Topical anaesthetics 5% lignocaine mouthwash
Natually self limiting 10-12 days
Highly infectious - avoid contact with others
Antivirals e.g. acyclovir should be reserved for severe cases
What are complications of AHG?
Herpetic whitlow - if not wearing gloves
Herpetic lesion of eye in dentis if not wearing goggles
Herpeti satellite lesions e.g. caused if child sucks finger and scratches somewhere else
Herpetic encephalomeningitis
In relation to herpetic infection, who should the dentist not treat?
immunocompromised patients if have recurrent herpetic lesion
What is the reactivation of the virus HSV1
Primary illness leads to infection of the trigeminal ganglion
When may you get reactivation of herpes virus (HSV1)?
subsequent reactivation can occur
Presents as herpes labialis
Intra-oral re-activation may occur following trauma; surgery or infiltraton anaesthesia
Occasionally a complication of periodontal surgery
What is the appearance of HIV associated gingivitis
Marginal
when does acute fungal gingivitis occur?
Due to superinfection with candida albicans
Seen in patients who wear paritial dentures
Those who have recently finished a course of broad spec antibiotic therapy
Seen in debilitated patients
What are the 2 types of adverse reactions that can be seen via gingivitis?
Following systemic administration of drug or chemical
Following direct contact with mouth e.g. cosmetics, mouthwashes
What could the acute allergic gingivitis prevent from happening?
Prevents effective cleaning
What are the symptoms of acute allergic gingivitis?
Red, shiny gingiva
Oedema
Loss of stippling
What are traumatic periodontal disorders associated with
Root fracture
What are the associations with AUNG?
What is it caused by?
Ulcerarion Necrosis Pain Halitosis Due to the introduction of new biological flora and stress
What are the clincial features of AUNG?
Can be localised or whole mouth - often around the lower anteriors
Gingivae sore and bleeding
Ulceration and necrosis of gingival margin, particularly dental papilla
Ulcers covered in grey/yellow slough and painful to touch
Often no systemic symptoms but lymphadenopathy present
Metallic taste and hallitosis
Severe bone loss = periodontal detachment
Can be associated with HIV
What is the aetiology of ANUG?
Opportunistic infection by anearobes
Fuso-spirocehaetal complex
No evidence condition is transmissable
Lowered resistance predisposes
What is the Fuso-spirocehaetal complex that causes ANUG?
Treponema vinvetii
Fusobacterium nucleatum
What are the predisposing factors of ANUG?
Compromised immune system; HIV, leukemia, malnutrition Smoking Stress poor oral hygiene HIV associated = more destructive
What is the definition of a lateral periodontal abscess?
A collection of pus in the connective tissue wall of the pocket
What are the signs and symptoms of lateral periodontal abscess?
Pain - tissues surrounding the painful tooth are swollen, small localised enlargement to diffuse swelling
Tissues red or deep red-blue in colour
Lymphadenopathy
The affected tooth and the adjacent teeth are tender to bite on and TTP
Tooth is usually mobile and high in occlusion
Periodontal probing often shows as deep pocket
May be evidence of sinus tract draining the abscess
What is the aetiology of lateral periodontal abscess?
A deep periodontal pocket with active inflammation and micro-ulceration
Entry of micro-organisms through pocket lining into connective tissue produces abscesses
Get blockage
Trauma
Reduction in host response
How could you have a differential diagnosis of lateral periodontal abscess?
History Deep pocket Vital tooth Pus in the pocket Tooth may be extruded Radiograph confirms bone loss
If it was instead a periapical abscess what would you expect?
History Tooth non-vital - may be discoloured Tooth acute TTP Pus in the tissues Tooth may be extruded Radiograph show apical change Radiograph show cavity/restoration near pulp
What is the management: extract or retain influenced by?
Patient’s wishes
Patient’s medical condition
Prognosis for the tooth
Prognosis for the dentition as a whole
If retaining the tooth, how do you manage the lateral periodontal abscess?
Drain if fluctuant
RSD if nor fluctuant, aim for drainage through the pocket
Selective grinding to relieve occlusion if appropriate
Hot salt mouthwashes
Review
Antibiotics if systemic involvement
What are the prescriptions of antibiotics that can be made?
Amoxicillin 5 days with or without metronidazole
Azithromycin 3 days
What is the follow up treatment if tooth is retained?
Further assessment
Scaling
Plaque control
Periodontal surgery, if appropriate
