emergencies Flashcards
symptoms that might lead pt to present
PAIN swelling pus bleeding mobility
abscesses
periapical
gingival
periodontal
pericoronal
differential diagnoses - irreversible pulpitis
poorly localised
constant, dull throbbing
unlikely to see anything radiographically - pulp not necrosed, no bone destruction
differential diagnoses - reversible pulpitis
pain triggered by stimulus - hot/cold, not constant - resolves
as it gets more established triggered by sweet
unlikely to see anything radiographically - pulp not necrosed, no bone destruction
heightened response to sensibility testing
differential diagnoses - periapical periodontitis
TTP
no response to sensibility testing (if caused by pulp necrosis extension)
pain to biting
might see bone loss radiographically (takes 3m to show)
differential diagnoses - pericoronal abscess
PE tooth, usually L8s
PD abscess
a localised accumulation of pus within the gingival wall of a PD pocket resulting in the destruction of the collagen fibre attachment and the loss of nearby alveolar bone
active period of PD breakdown which occurs whilst there is marginal closure of the deep PD pocket occluding drainage
non-draining infection of a PD pocket
PD abscess S + S
\+ to sensibility testing mobility likely to see lat lesion on radiograph (but may not see anything) pain and tenderness swelling of gingiva bleeding deep PD pocket may have suppuration
PD abscess - what to do if tooth is unrestorable
extract
SDCEP tx of a PD abscess
subgingival instrumentation short of base of pocket to avoid iatrogenic damage, LA?
if pus present - drain by incision or through the PD pocket
recommend optimal analgesia
don’t prescribe ABs unless signs of spreading infection or systemic involvement
0.2% CHX MW until acute symptoms subside
review within 10 days and carry out definitive PD instrumentation and recall interval
PD abscesses in non-periodontitis pts
impaction of foreign bodies
harmful habits
alteration of root surface e.g. perforation, root fracture etc
what is ANUG now called?
necrotising gingivitis
necrotising periodontitis
- (chronically/severely compromised or temporarily/moderately compromised)
necrotising stomatitis
NG presentation
acute onset of severe pain marginal gingival ulceration and craters loss of ID papilla slough rapidly destructive necrosis locally may have local lymphadenopathy/systemically unwell halitosis bleeding
if NG not treated and controlled rapidly?
may leave significant gingival recession
NG microbiology
anaerobic bacteria with fusiform and spirochetes in a compromised host
NG risk factors
neglected mouth - poor OH immunocompromised smoking stress malnutrition lack of sleep prev NP younger pts immunosuppression
NG tx SDCEP
debridement - LA, US
recommend use of 0.2% CHX MW until acute symptoms subside
review within 10days and do definitive instrumentation as required, recall interval
address risk factors - OH, smoking etc
if no resolution, review general health and consider referral to specialist
ABs if spreading infection/systemic involvement
- metronidazole 200/400mg x3 daily for 3 days
secondary herpes
often reactivated post-PD surgery esp palatally
often not painful
can be confused clinically with other bullous conditions and if uncertain refer to oral med
symptomatic tx, should resolve 10 days, CHX MW
if doesn’t resolve/recurrent refer to oral med
chemical trauma e.g. from etch/bleaching agent
acute onset, painful
manage conservatively and prevent infection and tissue loss if possible
irrigate lots
CHX MW and avoid brushing site until it heals
may leave residual gingival recession defect
primary herpetic gingivostomatitis spread
highly infectious, spread through contaminated saliva
caused by HSV-1, occ HSV-2 in adults
primary herpetic gingivostomatitis S + S
acute onset usually but not always children
+/- systemic (potentially serious if present) - dehydration/encephalitis
painful ulceration preceded by fragile vesicles which are only rarely visible
affects gingival tissue, tongue, lips, cheeks and roof of mouth
primary herpetic gingivostomatitis tx
usually managed symptomatically as self-limiting over 5-7 days, attention to fluid intake
consider acciclovir: shortens duration of symptoms, more rapid healing and helps to establish eating/drinking again earlier
primary herpetic gingivostomatitis long term effect
may result in recurrent lesions at other sites, around 40% of individuals
primary herpetic gingivostomatitis SDCEP tx
symptomatic relief: local measures - avoid dehydration - soft diet - analgesics - antimicrobial MW if immunocompromised/severe infection - acciclovir 200mg x5 daily for 5 days
