Acute Periodontal Lesions Flashcards
Acute periodontal lesions include: (3)
- periodontal abscesses
- necrotizing periodontal disease
- endo perio lesions
A dental emergency makes up ____% of all emergency patients and is the ____ most common reason for ER visits
7-14%; 3rd
(periodontal abscesses)
60% of dental emergency visits are due to:
untreated periodontitis
___% of patients in active periodontal treatment result in dental emergencies
13.5%
___% of patients in periodontal maintenance results in dental emergencies (due to periodontal abscess)
37%
(these patients are doing everything right and still end up with periodontal abscesses)
Etiology of periodontal abscesses include: (6)
- pulp necrosis
- periodontal infections
- pericoronitis
- trauma
- surgery
- foreign body impaction
Localized accumulation of pus located within the gingival wall of the periodontal pocket, with an expressed periodontal breakdown occurring during a limited period of time:
Periodontal abscess
Describe the clinical symptoms of periodontal abscess:
easily detectable
What are the sequence of events leading to abscess formation: (8)
- occlusion of existing periodontal pocket
- bacterial invasion of soft tissue wall
- leukocytic infiltration (neutrophils)
- vascular thrombosis
- edema & swelling
- tissue necrosis & liquefaction
- collagenolysis & bone resorption
- production of purulent exudate
The pain from a periodontal abscess is caused by:
pressure
The most common symptoms of acute periodontal disease (in order of decreasing frequency): (4)
- pain
- swelling & edema
- lymphadenopathy
- fever
Multiple periodontal abscess formation is often a manifestation of:
- diabetes (uncontrolled or undiagnosed)
- AIDS (compromised immune system)
- Depressed immune system (steroid therapy, chemotherapy)
What is the MOST common underlying cause for multiple periodontal abscess formation?
Diabetes (uncontrolled or undiagnosed)
What type of bacteria make up 65% of microbial flora found in periodontal abscesses?
Gram-negative and anaerobes
Bacteria that produce proteinases, such as_________ and _______are important in the pathogenesis of the periodontal abscess since they increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment
P. Gingivalis & P. Intermedia
Bacteria that produce ______, such as P. Gingivalis and P. Intermedia are important in the pathogenesis of the periodontal abscess since they increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment
Proteinases
Bacteria that produce proteinases, such as P. Gingivalis and P. Intermedia are important in the pathogenesis of the periodontal abscess since they:
increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment
List some of the bacteria found in periodontal abscesses: (7)
- Treponema (spirochetes)
- Fusobacterium nucleatum
- Prevotella intermedia
- Porphyromonas gingivalis
- Peptostreptococcus micros
- Tanerella Forsythia
- Candida albicans
What type of good can trigger abscess formation?
-popcorn
-almonds with skin (& anything with skin)
-chia seeds (and any small seeds)
Histopathology of periodontal abscess includes: (5)
- acute inflammatory infiltrate
- vascular hyperemia and thrombosis
- lysis of the collagen matrix in the lamina propria and the gingival fibers
- ulceration and apical proliferation of JE
- osteoclastic mediated bone resorption
Any time you have a perio abscess you need to rule out _______
How do you do this?
Endodontic origin; sensibility test
If the abscess is draining what might you do?
Trace it on a radiograph with gutta percha points
Periodontal abscess in a periodontitis patient could represent:
disease exacerbation
Periodontal abscesses in a periodontitis patient could represent disease exacerbation. What might this be due to? (5)
- presence of a tortuous pocket
- furcation involvement
- vertical defect
- composition of microflora
- decreased host defense
When do we commonly see acute exacerbation of periodontitis leading to an abscess?
- in untreated periodontitis
- patients that are non-responsive to periodontal therapy
- patients on supportive periodontal therapy
A periodontitis patient might develop a periodontal abscess following treatment. This could occur:
- post-scaling
- post-surgery
- due to post-medications (such as antimicrobials or nifedipine)
What post-treatment medications can lead to periodontal abscesses in a patient with periodontitis?
- Antimicrobials
- Nifedipine
List some causes for periodontal abscesses in non-periodontitis patients:
- impaction of foreign bodies
- harmful habits
- orthodontic factors
- gingival enlargement
- alteration of the root surface
Non-surgical periodontal treatment is:
scaling and root planing (SRP)
Periodontal abscesses in non-periodontitis patients can be due to alteration of root surfaces such as in:
- dens invaginatus
- cemental tears or enamel pearls
- iatrogenic conditions such as perforations
- severe root damage (VRF or cracked tooth syndrome)
- External root resportion
List the clinical signs of a periodontal abscess: (10)
- pain
- localized swelling & fluctuance
- purulent exudate
- deep periodontal pocket
- tooth exhibits VITAL pulp
- fistula presentation
- tooth mobility
- sensitivity to percussion
- low grade fever
- lymphadenopathy
List differential diagnosis for periodontal abscesses: (6)
- periapical abscess
- acute pulpitis
- tooth or root fracture
- pericoronitis
- lateral periodontal cyst
- gingival cyst
List three periodontal abscess complications:
- tooth loss
- bacteremia following abscess treatment
- chronic or episodic bacteremia from untreated periodontal disease
Tooth loss is a periodontal abscess complication. Up to ____% of teeth with periodontal abscesses in maintenance are extracted.
45%
Periodontal abscess treatment includes:
- non-surgical drainage & debridement with local anesthetic
- surgical drainage for large abscess
- surgical therapy with flap reflection, debridement with ultrasonic, sutures
- antibiotics if systemic infection indicated by fever or lymphadenopathy
- re-evaluation and any further needed therapy
When may antibiotics be indicated for treatment of a periodontal abscess?
If patient shows sings of systemic infection such as fever or lymphadenopathy
Surgical therapy for periodontal abscess treatment involves:
flap reflection, debridement with ultrasonic, and sutures
What must be included for diagnosis of a periodontal a
bscess?
- health history and medications
- dental history
- current periodontal status
- current status of affected tooth
- periapical radiographs
- clinical exam
- determine etiology
When diagnosing a periodontal abscess, what should be noted in the patients health history and medications?
-diabetes
-systemic antibiotics
When diagnosing a periodontal abscess, what clinical tests should be done to determine the status of the affected tooth?
-cold & EPT tests vital
-pain on percussion
What type of radiographs should be taken when diagnosing a periodontal abscess?
periapical radiographs
When diagnosing a periodontal abscess, what should be noted on the clinical exam?
-redness
-swelling
-purulent discharge
-lymphadenopathy
When diagnosing a periodontal abscess, what etiologies of this abscess should be considered?
- calculus fragments from recent cleaning
- systemic antibiotic treatment without subgingival debridement
- acute exacerbation of untreated peridontitis
- foreign body impaction
- endodontic perforation
- cemental tear
How much keratinized gingiva do we need to be considered healthy?
2mm
Treatment for periodontal abscess can involve:
Closed approach or Open approach
Describe a “closed approach” treatment for periodontal abscess:
- incision and draining through the pocket
- root planning to depth of sulcus
Describe an “open approach” treatment for periodontal therapy:
- sulcular incisions and full thickness flap
- remove all visible soft and hard deposits from root and adjacent bone
- replace flap and suture closed
Regardless of whether a periodontal abscess is treated through an “open approach” or “closed approach”, they both are followed with:
- thorough irrigation
- consider systemic antibiotics (though usually not needed)
Post-operative therapy following treatment of a periodontal abscess includes:
- home care instructions
- prescribe analgesics
- re-evaluation
- frequently monitor radiographically and clinically
Acute periodontal diseases include: (5)
- acute periocoronitis
- acute periodontal abscess
- acute herpetic gingivostomatitis
- acute necrotizing ulcerative gingivitis
- endo-perio lesions
The role of keratinized gingiva has been ______ over many years
highly debated
All surfaces with less than _____ of keratinized gingiva exhibit clinical inflammation even in the absence of plaque
2.0 mm
When a narrow band of keratinized gingiva is present, sites with a thinner phenotype have a greater:
tendency to progress
All surfaces with less than 2.0 mm of keratinized gingiva exhibit:
inflammation even in abscess of plaque
What dimensions of keratinized gingiva is considered “enough” (minimum amount necessary for health):
2mm keratinized; 1mm attached
Mucogingival deformatities and conditions around teeth (2017) classification categories include:
- periodontal biotype
- gingival/sift tissue recession
- lack of keratinized gingiva
- decreased vestibular depth
- aberrant frenum/muscle position
- gingival excess
- changes in color
- tooth conditions
Mucogingival deformatities and conditions around teeth (2017) classification includes the category “Periodontal biotype”. List the different classes of “periodontal biotype”.
- thin scalloped
- thick scalloped
- thick flat
If someone is diagnosed with “thin scalloped gingiva” this would fall under the category of:
periodontal biotype
Mucogingival deformatities and conditions around teeth (2017) classification includes the category “Gingival/soft tissue recession”. List the different classes of “Gingival/soft tissue recession”.
- facial or lingual surfavecs
- interproximal (papillary)
- severity of recession
- gingival thickness
- gingival width
- presence of NCCL/cervical caries
- patient esthetic concern
- Hypersensitivity
Mucogingival deformatities and conditions around teeth (2017) classification includes the category “Gingival excess”. List the different classes of “Gingival excess”.
- pseudopocket
- inconsistent gingival margin
- excessive gingival display
- gingival enlargement
T/F: Pts with thin gingiva are more likely to present with recession (versus thick keratinized gingiva)
True
What are some questions to ask a patient regarding brushing?
- frequency of brushing
- type of toothbrush (hard or soft)
- type of toothpaste??
How of ten should a toothbrush/ toothbrush head be changed?
3 months or when the bristles become frayed
Label the periodontal phenoytpe seen in the following image:
thin scalloped
Label the periodontal phenoytpe seen in the following image:
thick scalloped
Label the periodontal phenoytpe seen in the following image:
thick flat
The periodontal phenotype is based on:
anatomic characteristics
The periodontal phenotype is based on anatomic characteristics. This includes:
A) Gingival phenotype
B) Bobe morphotype (BM)
C) Tooth position
What is the average keratinized tissue width for thick biotype?
5.72 mm
What is the average keratinized tissue width for thin biotype?
4.15 mm
Gingival thickness ranges from:
0.63 mm - 1.24 mm
What is the average bone morphotype value for thin biotype?
0.34 mm
What is the average bone morphotype value for thick/average biotype?
0.754 mm
Apical migration of the gingival margin with concomitant exposure of the root surface:
gingival recession
This condition affects a large population irrespective of oral hygiene:
gingival recession
T/F: gingival recession affects a large population irrespective of oral hygiene
True
What is the estimated prevalence of gingival recession in young adults?
54.5% of young adults
_____ % of middle-aged elderly adults suffer from gingival recessions with an average prevalence of _____
100%; 78.6%
Gingival excess includes:
- pseudopocket
- inconsistent gingival margin
- excessive gingival display
- gingival enlargement
NCCL:
Non-carious cervical lesions
Stop at slide: CEJ STEP Descriptors
