Ch 16 Periodontal Emergencies Flashcards
What is included in the history?
- What is the chief complaint
- Location
- Onset
- Other symptoms
- Systemic factors
- Trauma
- Aggravating factors
- Alleviating factors
- Previous tx
What are the 3 basic type of abscesses
- ) Periodontal
- ) Gingival
- ) Periapical
Each type of abscess can be?
Acute or Chronic
This is a site of inflammation of microbial origin that is associated with accumulations of suppuration or purulence (pus) in the periodontal tissues
Periodontal
Pus is often referred to as what?
Exudate or purulent
Which type of abscess/infection have rapid onset and are usually characterized by pain, swelling and discomfort
Periodontal abscess
With the presence of which abscess doesn’t always mean that the tooth must be extracted
Periodontal
What is associated with pre-existing periodontal disease?
Acute periodontal abscess
What abscess may occur around any tooth in the mouth when periodontal pocket becomes occluded often as a result of a foreign object?
Acute periodontal abscesses
If the pocket can drain through a sulcus or a fistula (opening in the tissue), the infection can be stabilize and can be considered in the state?
Chronic State
What causes the pocket not to stabilizes?
If a object, such as a peanut skin, popcorn hull or blueberry seed remain in the pocket
What abscess appears as a shiny, red raised and rounded mass on the gingiva or mucosa
Acute periodontal
What is the most common symptom of acute perio abscess?
PAIN
What are some symptom of acute perio abscess?
- Swelling
- Deep red to blue discoloration of the affected tissue
- Tooth sensitivity to pressure
- Tooth mobility
- Tooth feels “high” to the pt
What does it mean when the tooth feels “high”
The tooth becomes slightly extruded as a results of swelling of the perio ligaments
How can x-ray images of acute perio abscess be helpful?
Can be used to locate an area of bone loss which may be the origin of the abscess
The opening of a fistula or sinus along the lateral aspect of the tooth in the adult dentition is usually what?
Indicative of a periodontal abscess
Tx of acute periodontal abscess consists mainly of what?
- Drainage after administering local anesthesia
- Use of antibiotics or antimicrobial agents
The teeth in the affected area are
scaled and root planed, and curettage is preformed to remove granulation tissue
Postoperative instructions after tx of acute perio abscess
rest
fluid intake
warm salt water rinses to reduce swelling
What are healthy gingival biota predominantly
Gram-positive and aerobic
Periodontal abscess are predominantly of what?
Gram-negative and anaerobic
The resemble acute perio abscesses, They may be indistinguishable
Chronic periodontal abscess
What abscess are usually painless, they drain into oral cavity, either through the opening of the pocket or a sinus tract
Chronic perio abscess
The tx for this is the tooth crown and root surface must be scaled and root-planed, curettage performed, local antimicrobial theraphy completed if needed, and the pt is scheduled for follow-up care to evaluate for any further periodontal tx is needed
Chronic perio abscess
This is a material such as fluid or cellular debris that has escaped from bld vessels and been deposited in or on tissue surfaces
Exudate
This abscess often occurs in disease-free areas and may be related to forceful inclusion of some forging object into the area?
Gingival abscess
This abscess are found on the marginal gingiva and are not associated with any abnormality of the deeper tissue
Gingival
Typically appears as a shiny, raised area of acute inflammation that may ne painful. The swelling is usually confined to the marginal gingiva.
Gingival abscess
With this abscess a suppurative lesion is usually evident on the gingival tissues
Gingival abscess
What is the tx for gingival abscess?
Drain and irrigate. Tx is usually performed by the dentist or periodontist
After the tx of gingival abscess what should be done the next day?
Scaled and root-planning
This abscess is difficult to distinguish from an acute periodontal abscess. The facial pain and tenderness to the tooth are similar in both
Periapical abscess
What type of abscess is result of infection through caries, traumatic fracture of the tooth, or trauma from a dental procedure
Periapical
In periapical abscess the pulpal infection to a tooth can spread to the pulp from an adjacent infected tooth through what?
lateral canals
Periapical abscess often appears on x-rays as what?
Rounded radiolucency at the apex of the tooth
To determine whether an abscess is periodontal or periapical, consider the following:
- 85% of the tooth pain is pulpal and 15% periodontal
- Periapically the teeth test nonvital
- Periapical pain is sharp, severe, intermittent and difficult to localize
- Periodontal pain is constant, localized and less severe
Tx of periapical abscesses requires what?
Endodontic therapy or the extraction of the tooth
Untreated periapical abscess can lead to what?
Abscess of the brain or swelling of the fascial planes
Extensions of infection into deeper tissues can be life threatening
Ludwigs angina
When an abscess spreads from the pulp to the periodontium or from the periodontal pocket to the pulp what is it considered?
Combination of periapical and periodontal abscess
What is the flap of tissue called that covers or partly covers a tooth
Operculum
What abscess is associated with a partially or fully erupted tooth that is covered completely or partly by a flap of tissue called operculum
Pericoronitits
Pericoronitis abscess commonly effect what tooth and age?
Mandibular third molar and in young adults
What are symptoms of acute pericoronitis
-Swelling of the operculum
-Gingiva redness and extreme pain
-Trismus (muscle spasm)
-Fever
Purulent exudate
Tx of Pericoronitis is:
- Initial therapy involves debridement of the infected area and flushing it with warm water or chlorhexidine
- Pt should rest, use warm salt water rinses and drink fluids
- Antibiotics of fever
- After acute condition has resolved, the operculum can be removed
This is an opportunistic infection of the gingiva that is associate with stress, lifestyle, and some chronic illnesses and conditions such as bld dyscrasias, human immunodeficiency virus infection and down syndrome
Necrotizing ulcerative gingivitis (NUG)
NUG is primarily observed in who?
Young adults who are under severe stress and individuals who are immunocompromised
Is NUG communicable
NO
Nug is a recurring disease with a complex bacteriologic structure that consists of a large proportion of what?
Spirochetes and gram-negative organism
When NUG reoccurs, the name for the disease
Necrotizing ulcerative periodontitis (NUP)
What are clinical characteristics that distinguish NUG from other forms of acute oral infections:
- Papillary gingiva becomes necrotic and appears cratered or “punched out”
- Surface of the gingiva has a pseudomembranous coating made up of necrotic bacteria and tissue
- Gingiva is red and painful
- Lesions (localized or generalized)
- Bad breath described as fetid (fetor oris)
Tx for NUG requires the following approaches
- ) Alleviation of acute inflammation and tx of chronic conditions
- ) Alleviation of systemic symptoms such as fever and malaise
- ) Correction of condition that contribute to the initation or progress of the disease
How many visits to tx NUG
Several
On the first visit of NUG what should be done?
- Limited amount of debridement, only what the pt can tolerate
- Use of ultrasonic and topical or local anesthetics may be helpful
- Don’t subgingival scaling or root planning bec increase the possibility of extending the infection into deeper tissue and causing bacteremia
- Dentist may prescribe systemic antibiotics if fever
What should be done in your second tx for NUG
- Should occur 1 or 2 days later
- Subgingival scaling if pts sensitivity permits
What should be done in the pts third visit for NUG?
Occurs 3-5 days after 1st visit
-Complete debridment
What is the pt instructed to do after the tx of NUG
- Rest
- Drink plenty of fluids
- Avoid spicy foods
- Rinse with warm salt water
- Refain from smoking
Oral manifestation of primary infection with the herpes virus, usually herpes simplex virus 1 (HSV1)
Acute herpetic gingivostomatitis
Acute herpetic gingivostomatitis is commonly found in
Young adults, possibly representing primary infection with genital herpes virus herpes simplex virus ll (HSVll)
Acute herpetic gingivostomaitis disease is?
- Highly infectious
- Dental and dental hygiene care should be postponed until the condition has subsided
Acute herpetic gingivostomatitis is commonly associated with symptoms such as
- Fever
- Malaise
- Headache
- Irritability
- Lymphadenopathy
What does the acute herpetic gingivostomatitis lesions begin out as:
Small yellow vesicles that coalesce to form larger round ulcers with gray centers and bright red borders.
Where are the acute herpetic lesions found at?
May be found on any of the oral mucous membranes. Pts may have serious, even extreme pain
After the primary infection has accrued the herpes virus travels through the nerves to reside in neuronal ganglia, there the virus can become what?
Active again and recur most commonly in the form of herpes labialis
