chapter 9 Flashcards
Characteristics of acute periodontal diseases
sudden onset, rapid course of progression, accompanied by pain and discomfort, may be unrelated to preexisting gingivitis or periodontitis, lesion may be localized or more widespread in mouth, may present with systemic involvement
Abscesses of the periodontium
Circumscribed (abscess is localizd to specific site) fluctuant collection of pus localizedé within gingival wall of periodontal pocket. Pus (whitish, yellow, milky exudate consisting of dead and dying neutrophils, bacteria, cellular debris and fluid leaked from blood vessels. Precise bacterial etioly of abscess = unclear, most lesions contain microflora that are predominantly gram negative and anaerobic.
Implications of untreated abscesses
- Common dental emergency
- Can initiate rapid periodontal destruction and lead to premature tooth loss
- Possible link between abscesses of periodontium and systemic diseases
Characteristics of an abscess of the periodontium
- Acute abscess: constant, localized pain
- Chronic abscess: no pain or dull pain
- Circumscribed
- Possible increase in tooth mobility
- Radiographic loss of alveolar bone not involving tooth apex
- Tooth usually has vital pulp
- Fever may occur (serious) not common
- If delayed treatment, pus may drain through sinus tract
Causes of abscesses of the periodontium
- Blockage of orifice of pocket
- Accidentaly forcing foreign object into tissues
- incomplete calculus removal in periodontal pocket
Comparaison of periodontal abscesses and pulpal abscesses
- Vitalitity test results: PA(usually,vital pulp), PuA(usually, no vital pulp)
- Radiographic appearance: PA(bone loss present and an angular deflect and/or furcation radiolycency), PuA(bone loss at tooth root apex)
- Symptoms: PA(localized, constant pain), PuA(difficult to localize, intermittent pain
Classification of abscesses of the periodontium by course of the lesion
Acute abscess: rapid onset characterized by pain/discomfort, primarily caused by exacerbation of chronic inflammatory periodontal lesion
Chronic abscess: grows slowly and is not typically associated with pain, forms after spread of infection controlled by spontaneous drainage host response or therapy
Gingival abscess: primarily limited to gingival margin or interdental papilla without involvement of deeper structures of periodontium
Periodontal abscess: abscess of periodontium that affects deeper structures of periodontium as well as gingival tissues, usually occurs in site with preexisting periodontal disease invluding preexisting periodontal pockets, usually affects deeper structures of periodontium
Pericoronal abscess: involves tissues around crown of partially erupted tooth
Pericoronitis: soft tissue inflammation associated with abscess
Signs and symptoms of a pericoronal abscess
- Pain at site
- swelling of perculum
- Possible trismus
- Possible elevated body temperature
- Possible lymphadenopathy
Management of patients with abscesses of the periodontium
- Fundamental treatment steps: establishment of path of drainage for pus, thorough periodontal instrumentation of affected tooth surfaces in area of abscess, pain relief
Steps in treatment of a gingival or periodontal abscess
- Administer local anaesthesia
- Drain pus
- Perform thorough periodontal instrumentation
- Adjust occlusion, if needed
- Prescribe antibiotics, if needed
- Recommend warm saline rinses
- Prescribe pain meds if needed
- Establish follow-up appointments
Treatment of pericoronal abscess
Fundamental treatment steps: Establishment of path of drainage for pus, irrigation of undersurface of operculum, thorough periodontal instrumentation of tooth surfaces in area of abscess, relief of pain
Common steps in treatment of patient with pericoronal abscess
- Admisister local anesthesia
- drain pus
- Perform thorough periodontal instrumentation
- Irrigate under operculum
- prescribe antibiotics, if need
- Recommend warm saline rinses
- Prescribe pain medications if needed
- Evaluate for need for third molar extractions
- Establish follow-up appointments
- if pericoronal abscess reoccurs, reasses if surgical excision of operculum or extraction of offending tooth is warranted
Endodontic-Periodontal Lesions (EPL)
- Formerly known as combined periodontal-endodontic lesion
- Localized area of bacterial infection characterized by infection of pulp and periodontal tissues in same tooth
-Can originate from either dental pulp or periodontal tissues - Periodontlally derived lesion: Infection enters tooth via accessory canals and/or apical foremen of root, initialtes inflammatory changes in pulp-root canal complex
- Pulpally derived lesion: Infection escaped out of tooth of tooth, triggers secondary infection of periodontal tossues
Signs and symptoms of EPLs
- Deep pocketing that extends close to apex
- Negative or altered response to pulp sensitivity tests
- Bone resorption in apical or fungal regions of tooth
- Spontaneous pain
- Pain upon palpation or percussion
- Purulent suppuration
- Tooth mobility
- Presence of sinus tract
- gingival color alterations
Necrotizing periodontal disease (NPD)
Distinct characteristics: interdental tissue necrosis, intense gingival pain, spontaneous gingival bleeding
Secondary clinical characteristics: Fetid breath, pseudomembrane formation, systemic involvement
- Noncommunicable, destructive, inflammatory diseases
- Limited to interdental and marginal gingiva
- Historically called Vincent’s infection (no longer valid)
- Distinctive characteristic is tissue necrosis of gingiva
- Progression follows predictable course: interproximal gingival necrosis, causes punched out appearance, spreads to affect marginal gingiva
- Most often found in mandibular anterior region
