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perio > emergencies > Flashcards

emergencies Flashcards

1
Q

symptoms that might lead pt to present

A 
PAIN
swelling
pus
bleeding
mobility
ulceration
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2
Q

abscesses types x4

A

periapical
gingival
periodontal
pericoronal

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3
Q

differential diagnoses - irreversible pulpitis

A

poorly localised
constant, dull throbbing
unlikely to see anything radiographically - pulp not necrosed, no bone destruction

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4
Q

differential diagnoses - reversible pulpitis

A

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

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5
Q

differential diagnoses - periapical periodontitis

A

TTP
no response to sensibility testing (if caused by pulp necrosis extension)
pain to biting
might see bone loss radiographically (takes 3m to show)

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6
Q

differential diagnoses - pericoronal abscess

A

PE tooth, usually L8s

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7
Q

Periodontal abscess

A

a localised accumulation of pus within the gingival wall of a PD pocket resulting from 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

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8
Q

PD abscess S + S

A

+ to sensibility testing
mobility
likely to see lat lesion on radiograph (but may not see anything)
pain and tenderness
swelling of gingiva
bleeding
deep pocket depth
may have suppuration

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9
Q

PD abscess - what to do if tooth is unrestorable

A

extract

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10
Q

SDCEP tx of a PD abscess

A
  • 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
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11
Q

PD abscesses in non-periodontitis pts - possible cause

A

impaction of foreign bodies
harmful habits- nail biting
alteration of root surface e.g. perforation, root fracture etc

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12
Q

what is ANUG now called?

A

necrotising gingivitis
necrotising periodontitis
- (chronically/severely compromised or temporarily/moderately compromised)
necrotising stomatitis

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13
Q

NG presentation

A

acute onset of severe pain
marginal gingival ulceration and craters
punched-out appearance
loss of ID papilla
slough
rapidly destructive
necrosis locally
may have local lymphadenopathy/systemically unwell
halitosis
bleeding

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14
Q

if NG not treated and controlled rapidly?

A

may leave significant gingival recession

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15
Q

NG microbiology

A

anaerobic bacteria with fusiform and spirochetes species in a compromised host

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16
Q

NG risk factors

A

neglected mouth - poor OH

smoking
stress
malnutrition
lack of sleep
prev NP
younger pts
immunosuppression/ immunocompromised
HIV infection

17
Q

NG tx SDCEP

A
  • debridement - LA, ultrasonic
  • MW until acute symptoms subside (0.2% CHX / 6% Hydrogen peroxide)
  • review within 3-5 days 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 or local measures are incomplete at initial presentation
    • metronidazole 400mg x3 daily for 3 days
18
Q

secondary herpes

A
  • 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
  • self-limiting - 10 days
  • analgesic , CHX MW
  • if doesn’t resolve/recurrent refer to oral med
19
Q

chemical trauma e.g. from etch/bleaching agent

A
  • acute onset, painful
  • manage conservatively and prevent infection and tissue loss if possible
  • irrigate lots
  • reassure should heal in 2 weeks
  • CHX MW and avoid brushing site until it heals
    • to prevent gingival recession
20
Q

primary herpetic gingivostomatitis spread and causative agent

A
  • highly infectious, spread through contaminated saliva
  • Herpes simplex virus HSV1
  • usually in kids 2-5 yo
21
Q

primary herpetic gingivostomatitis S + S

A

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

22
Q

primary herpetic gingivostomatitis tx

A
  • usually managed symptomatically as self-limiting over 5-7 days
  • attention to fluid intake
  • paracetamol
  • reassurance
  • consider aciclovir: shortens duration of symptoms, more rapid healing and helps to establish eating/drinking again earlier
23
Q

primary herpetic gingivostomatitis long term effect

A

may result in recurrent lesions at other sites, around 40% of individuals

24
Q

primary herpetic gingivostomatitis SDCEP tx

A

symptomatic relief: local measures
- avoid dehydration
- soft diet
- analgesics
- antimicrobial MW
if immunocompromised/severe infection
- aciclovir 200mg x5 daily for 5 days

25
Q

acute leukaemia

A

rare
presenting as severe hyperplastic gingivitis
hyperplastic tissue is full of leukaemic infiltrate
acute or slower onset over a few weeks
likely systemic S+S to aid diagnosis

  • bone pain
  • fever
  • freq infections
  • freq or severe nosebleeds
  • lymphadenopathy
  • pallor
  • SOB
    can also see ulceration of inner surface of lip due to acute neutropenic changes
    urgent referral via GMP/ oral med as soon as potential diagnosis is considered
26
Q

gingival abscess

A
  • a localised purulent infection that involves the marginal gingiva or ID papillae
  • peridontally healthy
27
Q

gingival abscess S + S

A

localised swelling
may have suppuration
usually painful and TTP

28
Q

what is a gingival abscess often due to?

A

subgingivally impacted foreign objects, tend to occur in a prev healthy gingiva
e.g. piece of nail due to a nail biting habit

29
Q

gingival abscess management

A

incise, drain and irrigate
may need mechanical debridement to mitigate aetiology
0.2% CHX MW/saline rinse
review

30
Q

SDCEP periodontitis associated with endo lesions - definition

A

clinical AL and also a tooth with necrotic/partially necrotic pulp

31
Q

perio endo lesions S+S

A

swelling
suppuration
TTP
may have generalised PDD with localised pain
deep pocketing to root apex with BOP
negative response to sensibility tests

32
Q

SDCEP perio endo lesion tx

A

endo tx of tooth (get drainage?)
recommend optimal analgesia
no ABs unless signs of spreading infection or systemic involvement
0.2% CHX MW until acute symptoms subside
review within 10 days and PD instrumentation, recall

33
Q

perio endo lesion

A
  • communication between PD lesion and pulp
  • deep pocket around a non-vital tooth

origin

  • the infection may arise primarily from pulpal inflammatory disease expressed through the PDL or the alveolar bone to the oral cavity,
  • or it may be initiated from a PD pocket communicating to the pulp apically or through accessory canals
34
Q

prognosis of primary endo lesions

A

often respond well to RCT alone

35
Q

prognosis of primary perio/truly combined lesions

A

often poor

36
Q

prognosis of endo perio lesions associated with trauma and iatrogenic factors e.g. perforation

A

usually poor as affect tooth structure

perio (8 decks)

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