Endo-periodontal lesions Flashcards
name the types of abscesses. (4)
gingival
periodontal
pericoronal
endo-perio
what is a gingival abscess?
Localised infection of the gum not associated with perio disease
what causes gingival abscesses? (3)
- Trauma
- Food impaction
- Stitch
what causes periodontal abscesses? (3)
- Pre-existing deep pockets
- Food packing into the pocket
- Gingival cuff tightens after HPT and there is less flow of fluid/debris out of the gingival crevice = infection
what is an perio-endodontic lesion?
Pathological communication between endodontic (pulp) and periodontal tissues
what are the signs and symptoms of a periodontal abscess? (8)
- Swelling
- Pain
- TTP in lateral instead of occlusal
- Associated deep and bleeding pocket
- Pus
- Systemic symptoms = Fever, Regional lymphadenopathy
- Tooth usually vital
- Patient will usually have pre-existing perio disease
how do we treat periodontal abscesses? (6)
- Don’t aggressively instrument – will inhibit repair of the pocket - careful, subgingival instrumentation short of the base of the pocket.
- Drain the pus by dilating the pocket – if no oose of pus then just make an incision
- Recommend analgesia
- Chlorhexidine mouthwash use until the acute symptoms subside
- Review when they’re not in pain and carry out more thorough instrumentation
Only give antibiotics if the abscess is persistent or the patient has systemic signs
when are antibiotics given for periodontal abscesses? (2)
- Only when there is persistent infection after local debridement
- Systemic involvement/symptoms
(Used in conjunction with mechanical therapy)
what antibiotics are given for periodontal abscesses?
250mg Penicillin V – encourage this as it causes less resistance
500mg Amoxicillin (allergy to pen)
400mg Metronidazole
(all used for 5 days)
what are the signs and symptoms of an perio-endo lesion? (9)
- Deep perio pockets reaching the apex
- Negative/altered response to vitality tests
- Bone resorption – horizontal, alveolar, apically, furcation
- Spontaneous pain
- Pain on palpation and percussion
- Purulent exudate
- Tooth mobility
- Sinus tract
- Crown, gingival colour changes – dark, red, brown, black
how do you distinguish whether its a periodontal abscess or a perio-endo abscess?
You must examine the tooth to decipher if its perio or perio-endo – is there an access cavity? (endo)
describe roots of communication between perio-endo lesions? (4)
a) Infection comes out of the apex and discharges up though the perio ligament infection can also discharge via lateral canals into the PDL = apical bone loss
b) Discharges via a furcal canal into the PDL – bone loss at the furcation as opposed to the apex.
c) Infection/pus moves up via the ligament for a prolonged period of time = leads to pocketing, plaque enters the pocket and then it calcifies on the root – Requires endo and perio treatment
d) Vital pulp with severe perio, perio has developed a pocket down to the apex and the microorganisms from the pocket can enter the pulp via the apex.
how do we treat endo-perio lesions if the tooth is non-vital? (6)
- endo treatment first!!
- Recommend analgesia and Prescribe a Chlorhexidine mouthwash until acute symptoms subside
- Only prescribe antibiotics if systemic or persistent
- Once endo initiated review the patient within 10 days and carry out instrumentation (perio treatment)
- If the tooth is primarily affected by endo = endo treatment is enough for resolution and this stage isn’t always required. - Surgical investigation on occasion if no resolution after perio and endo
Does endodontic disease affect periodontal health?
Pulp inflammation can cause an inflammatory response in the PDL = yes
Does perio disease affect endodontic health?
Not until the pocket is deep enough to involve the apex or affects lateral/accessory canals which are not protected by cementum = sometimes yes
